What You Should Know About Eye Drops
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Eye drops, used in the treatment of glaucoma work by reducing the intraocular pressure (eye pressure) within the eyes. Increased intraocular pressure is a major risk factor for optic nerve damage. There are several classes of drops, which have different mechanisms of action. Prostaglandins, such as latanoprost, travoprost and bimatoprost reduce intraocular pressure by increasing drainage outflow from the eye. Other drop classes reduce the formation of fluid within the eye – such as beta blockers (eg timolol), alpha agonists (eg brimonidine, apraclonidine) and carbonic anhydrase inhibitors (eg dorzolamide, brinzolamide).
Eye drops are the most common form of treatment for glaucoma. Since glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take their medication/eye drops. Approximately one half of patients don’t take their glaucoma medication as prescribed, increasing the amount of visual loss caused by glaucoma. It is important that you follow your treatment plan and appointments, as recommended by your doctor. This is because glaucoma is a life-long, often progressive condition, and appropriate treatment can prevent vision loss.
It is important to instil eye drops correctly as a considerable amount may drain from the eye via the tear duct to the nose and the throat, eventually being absorbed into the bloodstream. Depending on the medication being used, this can result in side effects such as shortness of breath, anxiety, depression, heart palpitations or even an asthma attack.
To minimise the risk of side effects, after instilling eye drops, gently press your finger over the drainage canal openings (tear ducts) with your eyes closed for two minutes. This simple action will reduce the unwanted absorption of the eye drop into the blood by about two-thirds.
12 Steps to Correctly Instil Eye Drops
1. Wash your hands
2. You may be more comfortable instilling your eye drops sitting or lying down.
3. Carefully remove the cap of the eye drop container, ensuring the tip of the container doesn’t touch anything
4. Tilt your head back and look up
5. Gently pull the lower eyelid away from the eye to form a pocket or pouch
6. Position the tip of the container directly over this region. Hold the container as vertically as possible
7. Gently squeeze the container. Try to allow only one drop to fall onto the inside of the lower eyelid. If you are not sure the drop entered the eye, you may immediately instil another
8. Keeping your head tilted back, look down, then release the eyelid and close your eye without blinking or squeezing the eyelid or rolling the eye around
9. Press the tip of your finger against the inside corner of the closed eye, applying gentle pressure over the drainage canal opening. You can now lift your head back to a normal, relaxed position while continuing to put pressure over the drainage canal opening for at least two minutes. If you taste the drop you are not blocking your drainage canal opening properly.
10. Gently wipe off any excess medication that may have spilt onto your face with a clean disposable tissue or cotton make-up pad
11. Repeat steps 4 to 10 if you need to instil an eye drop in the opposite eye
12. If you have a number of different eye drops to administer, leave at least 5 minutes between each different drop.
Glaucoma Australia sells FRIO Eye Drop Travel Wallets. These will keep drops cool for up to 45 hours without refrigeration and are easy to use, light, compact and re-usable. The inner wallet is activated with water and does not require refrigeration. They come in three sizes:
Q. I was told to use my eye drops every day and to make sure I did it at the same time each day. Why is that important?
A. The eye drops only work when they are being used – if you stop using them the eye pressure will increase again. Hence it is important to use them every day, otherwise the IOP will fluctuate. There is some evidence to suggest that fluctuations in IOP may be as harmful to the optic nerve as high IOP.
Using the drops at the same time each day prevents day-to-day fluctuations in 24 hour IOP pattern, however is not as important as using the drops every day. Getting into a fixed daily routine generally helps patients to remember to use the drops each day. If, on the occasional day, you are a little late with using the drops, it is better to use the drops late than not at all.
Q. I don't think my drops are making my vision any better
A. At this point in time there is no cure for glaucoma. Fortunately though, for most people with glaucoma, taking the appropriate eye drop medication will preserve their vision and minimise the chance of further losses. This is why early detection, ensuring the medication is taken as prescribed and attending regular follow-up appointments is so important. At these follow-up appointments the effectiveness of treatment is assessed by taking a reading of the pressure in your eye, examining the health of the eye structures and measuring how well you see from the centre of your vision all the way to the edge of your sight. If you are experiencing problems taking your medication or with their side effects then this should be discussed with your eye-care practitioner as there may be a more suitable medication or treatment option for you. While new therapies to restore vision continue to be explored none have yet been proven to be effective. Glaucoma Australia and your care providers will continue to keep you updated on advances in treatments.
Q. The information says to discard my eye drop bottle 28 days after opening. I always have some left, why can’t I keep using it until it is empty?
A. On average, the preservatives in bottles of glaucoma medications are designed to safely prevent bacterial growth for 28 days. Hence using the bottle longer than is recommended by the manufacturer can potentially lead to solution degradation, less effective active ingredients and dangerous build-up of bacteria that can lead to infection of the surface of the eye.
Q. I use a product that comes in single use containers. Do I have to throw it out after one use if it holds more than I need for the day?
A. Single use containers generally have preservative free medication formulations within them. These are designed to be used once and then immediately discarded. If kept for a period after being opened, bacteria and other harmful micro-organisms could potentially grow in the solutions to dangerous levels. If reused after this period the micro-organisms in the solution could lead to a harmful infection of the surface of the eye.