Cracking Open the Medicine Cabinet: A brief guide to eye drops for beginners and re-learners

If you’re a patient in a practice like ours, chances are you’ve been prescribed, or are currently using, an eye drop or two. At Cornea Associates of Texas, we perform a number of different surgical procedures (LASIK/PRK, cataract extractions, corneal transplants, among others), all of which require pre- and/or postoperative instillation of ophthalmic drops. It can get pretty confusing when you’ve got half a dozen different eye drops with varying doses and schedules. This article will outline some basic dos and don’ts, as well as discuss FAQs and provide a fool-proof method for instill eye drops in your own eye.

I can’t pronounce my medication’s name, how do I know which is which?

An easy way to keep track of your drops is by identifying them by cap-color or label-color as opposed to by name. We aren’t all pharmacists or English professors, some of these medication names can be nearly impossible to pronounce!

You mean the colors of the bottle caps aren’t arbitrary? They actually matter?

They absolutely matter! The American Academy of Ophthalmology recommends to the FDA and the pharmaceutical industry that a uniform color-coding system for the caps and labels of all topical ophthalmic medications be established. This practice pertains particularly to brand-name medications. The mostly widely recognized are pink for steroids, tan for antibiotics, grey for NSAIDs, and blue/purple/yellow/green for glaucoma. Unfortunately, this system is not an FDA-mandated requirement and doesn’t always extend to generic medications.

I’m using more than one kind of eye drop on the same schedule, which one should I use first?

In nearly every case, the order in which you instill your ophthalmic medications is inconsequential. It doesn’t matter which goes in first, as long as you allow sufficient time for the drop to be absorbed before instilling the next (5 minutes, bare minimum). If you're using a ophthalmic gel or ointment, this should be used last.  ocular surface is not capable of retaining large amounts of fluid, this is why tears spill over when we cry and why drops run down our face if we’re too heavy-handed with application. It is important to wait between drops so you don’t flush one out with the next.   

My drops sting or burn when I put them in!

This is not uncommon, especially with antibiotic drops. Chronic Dry Eye syndrome affects 15-20% of American adults, and the drier your eyes are, the more likely it is that medications will be uncomfortable on instillation. Our most frequently recommended method for application is the “Artificial Tear Sandwich.” When ready to instill your dose of medication, begin first with one drop of preservative-free artificial tears (these are available over the counter at pharmacies and drug stores) to prime the ocular surface. Wait 5 minutes, then instill your medication drop. Wait five, minutes, then finish with a second artificial tear drop. Many of our patients have found success in improving comfort with this method.

Is it normal that I get a weird taste in my mouth when I use my eye drops?

This is not uncommon and not dangerous. Fluid drains from the eye through the nasolacrimal duct. This duct, in turn, drains to the back of the throat. What little of your ophthalmic drops that your eye doesn’t immediately absorb can sometimes drain in this way, resulting in a strange (usually unpleasant) taste in the mouth. Your first instinct may be to drink water, but doing so is ill-advised. Water won’t immediately flush the drop remnants from your mouth, but suspend them and allow them to coat the back of your throat causing the unpleasant taste to linger longer. Instead, try eating some dry toast or crackers after instilling your drops. This will provide a more absorbent vehicle in which that taste can travel out of the mouth.

I know which drops to use and when, but I just can’t seem to get them in by myself without making a mess!

This is an incredibly common complaint among our patients. It can be very difficult to instill drops in your own eye. If you don’t have anyone present to help you, you can learn to do it yourself with these simple steps:

1. Lay down flat on your back, or tilt your chin up and head back as far as you can comfortably manage, so your face is towards the ceiling.

2. With your non-dominant hand, retract your lower eyelid by applying a small amount of pressure with one or two fingertips just below your lash line and tugging gently so your lower eyelid creates a “pocket.”

3. With your other hand, grasp the open bottle between your thumb and forefinger and upend it so the bottle opening is facing downwards, DO NOT SQUEEZE YET.

4. While holding the bottle upside down, rest the palm of your hand on the back of your non-dominant hand to keep it steady with the tip of the eye dropper directly above the eye. When looking up towards the ceiling, you should be able to see the tip of the eye dropper.

5.      Gently squeeze the bottle so one drop falls onto the ocular surface. Try to keep both eyes open and keep looking straight up. (Tip: refrigerate your drops prior to use, it will be easier to tell if you hit your target if the drops are cool.)

6.      Blink gently and completely a few times before lowering your head or sitting up.

7.      Dab the excess fluid with a clean tissue at the corners of your eyes or along the lash line. Do not press or rub.

Prescribed ophthalmic drops, like any medication, should only be used under the supervision of your doctor or eye care professional. Like, any prescription medication, ophthalmic drops carry risks with use and misuse. Never self-diagnose and use prescription drugs for any reason other than their intended use and according to your doctor’s instructions. Remember, a technician is always standing by to answer your questions if you’re at all uncertain about your ophthalmic medications, don’t hesitate to call!