How to Use Eyedrops Without Draining Your Wallet (Redux)
This month’s newsletter is a reprint of an earlier newsletter. Several times a week, patients call me, telling me they ran out of their eyedrops. When they try to refill them, the pharmacists say it is too early for a refill. Why are they running out so soon? Hopefully, this article will help answer that question.
I would like you to start thinking about eyedrops a little differently. When you buy a prescription that comes in a pill form, such as a blood pressure medicine, you are dispensed a certain number of pills for a given period of time. Let’s take for example a medicine such as the blood pressure pill lisinopril. Each pill contains a certain dose of medication that is consistent for each pill. If the instructions are to take one pill by mouth every morning, you are usually given 30 pills to last for one month. Then you can refill the pills after 30 days. There are no extra pills in the bottle just in case you drop a few down the sink. You cannot refill your pills a week early because you “ran out”. At least not and have the insurance company pay. There may be some wiggle room in special situations, but for the most part, you get 30 pills for 30 days if you take one a day. Period. That’s not too hard to do if the medication comes in a nice pill or capsule form.
But what about eyedrops? Instead of a nice formed pill, you’ve got a liquid that you are trying to squeeze out of a bottle into your eye. You might squeeze out anywhere from zero drops to half of the bottle trying to get a drop onto your eye, which might get in your eye or squirt all over your lids and run down your cheek. We all know that medicine is expensive and that we cannot afford to be wasting any. Pharmaceutical companies treat eyedrops the same as any other medicine. When you are dispensed an eyedrop, the amount of medication per drop is calculated and you are given an amount that should last for the period prescribed. Let’s take for example a glaucoma drop such as latanoprost. This is usually taken one drop in each eye at bedtime. So, for a one-month period, you should use a total of 60 drops (one drop in each eye for 30 days). Each bottle contains 2.5 ml. The other day, I took a 2.5 ml bottle of expired latanoprost and counted out 74 drops. That’s the whole 30-day supply plus a little more. Yet a few times a month, I get calls from patients saying they ran out of their eyedrops only after 2 weeks into a 30-day supply. Why? Was the bottle only half full? Is the bottle malfunctioning? Why am I getting more medicine on my face than on my eye?
Here is where I would like you to start thinking about eyedrops a little differently. Think of each drop the same way you think of a pill. When you take a pill, you don’t pour several in your hand, pop one in your mouth and throw the rest away. Those pills cost a lot of money. Why would you throw away good medicine? But that’s exactly what you do when you pour eye drops all over your lids and face. You’re wasting expensive medicine. The trick is to apply only one drop directly to where it belongs to provide its maximum therapeutic benefit.
That is what I would like to show you here. How to effectively, efficiently, and frugally use eye drops. First, you must understand that the conjunctival fornix (that’s the little pocket we will make with our lower eyelid) only holds ONE drop. Anymore, gets wasted and just runs down your cheek. Our goal is to apply one drop to the target every time. Anything else is your money being wasted.
To start. Let’s see what type of eyedrop bottle you have. Most are regular squeeze type bottles that have soft walls and are easily squeezed to dispense one drop. These types of bottles have a smooth round bottom (Figure 1.)
Some pharmaceutical companies have patented a different type of bottle technology called DROP-TAINER®. These can be identified by the small notch on the bottom (Blue Arrow Figure 2)
Rather than squeezing this type of bottle, the drop is dispensed by tapping on the bottom. Be careful. Squeezing this type of bottle can result in a lot of drops all at once.
Always start by shaking the bottle well. Some eye drops are suspensions rather than solutions and the medication tends to settle on the bottom. A good shake will take care of that.
Wash your hands well and take the cap off. Gently place the bottle upside down against your brow, looking right at the bottle tip. (Figure 3)
This way you won’t accidentally poke yourself in the eye and your target is aligned perfectly. Holding the bottle higher will result in showering your face with drops and only occasionally hitting the target. Next, tilt your head back slightly and gently pull down your lower eye lid to form a small pocket (Figure 4). This is where you put the drop, not directly on the cornea.
At this point, look up toward your forehead and gently squeeze to release just one drop or tap once on the bottom for a DROP-TAINER® bottle. Once you feel the drop, close your eyes and don’t blink. Blinking drives the drop off of your eye and down the back of your nose. Slow motion video shows that when you blink, the eyelids start to close on the outer corner first, pushing anything on the surface toward the inside corner. Here on the inside corner of the eyelids are small drains known as puncta. This passage leads to the back of the nose (Figure 5).
That is why you can sometimes taste drops after you put them in your eyes. Not blinking keeps the drop on the surface of your eye and allows it to perform its function. You can even use your fingers to press on the puncta to keep the drops from draining away (Figure 6). Just make sure you press over the drains and not on the side of your nose (Figure 7).
There are a few more important items I must mention. When prescribed more than one drop to be used at the same time, wait several minutes (3-5) between drops. You don’t want to put in one drop immediately followed by a different drop. The second drop may wash out the first one before it has a chance to get absorbed.
Unless instructed by your eye doctor, do not use prescription eye drops while wearing contact lenses. Wait at least 15 minutes before reinserting your contact lenses. This is very important.
If you are finding that you are running out of drops before you are eligible for a refill, follow these steps closely. Save yourself drops and money. I hope this helps. Thank you for reading.
This newsletter does not constitute medical advice. Make sure to contact your healthcare provider if you experience any of these conditions. Do not make any changes to your medications before consulting your physician.