5 Eye Care Misconceptions Series – Eyedrops
Part 3 of this series will cover common misconceptions on eyedrops. Drops usage, dosage, and application can understandably be very confusing. I see a lot of people waste their hard earned money by misusing drops. Below is the blueprint to curb the healthcare debt we are facing as a nation (oh, our health care costs are almost twice that of other developed countries? Nevermind):
1. “Okay, so you want me to place two drops of medicine X three times a day?” A very common misunderstanding is how many eyedrops to place of a certain medication at a time. I have seen people put 2-3 drops in per dose. Regardless of the medication I always have my patients place one drop at a time. In this case more is not better. To know why we have to do some simple math: each drop measures around 50 microliters in size, however our eye can only hold 10 microliters of liquid. So each drop contains 5x the amount our eye can hold. That means two things: a single drop is more then enough for every dosage and if a drop hits your upper eyelashes and finds it’s way in to your eye or hits your eye and falls onto your cheek that is likely sufficient.
2. I know I am hallucinating but I can taste my drops, is that possible?” You are actually tasting that drop. There is a connection from an opening in the inner corner of the eyelid (called the punctum) to the nose and back of the throat, and from there into your blood stream. This connection is also why when you have bad allergies or have been crying excessively your nose will start running. You can perform punctual closure, tilt your head back, and gently close your eyes to reduce the meds that get into your throat/blood stream.
This is a good technique for people that want to get the most out of their drops and have it bathe their eye before leaving either over your lower eyelid and on to your cheek, evaporating or through the aforementioned punctum.
3. “Doc are you trying to bankrupt me? That drop you prescribed is $300 after my insurance contribution.” When prescribing drops for my patients I have to take many things into consideration such as the effectiveness of medication, allergies, insurance, cost, longevity on treatment, etc. The cost is always one of the most difficult things to follow because there are numerous insurance plans with an ever-changing medication formula/tier. So to help counteract that complexity I tell my patients that I rarely need them to be on a specific drop. We have a lot of options in ophthalmology with name brand/generic options. We will prescribe an appropriate drop and have the patient do their homework and see how much it will be before picking it up. If its something they can’t afford I tell them to call us and we will give an alternative. Many times you can find the drop cheaper by not using your insurance (or in the case of the non-insured pt) by using the free app good RX and SingleCare. You search for the specific drop and it will show you all nearby pharmacies that have it in stock and the respective price. Then you can get a coupon card from your eye care provider and prescription and you are set.
4. Three days after prescribing a patient a bottle that should last one month, “I finished the bottle…I may have missed a few times.” I call this waterboarding in ophthalmology, people just squeeze 10 drops in the general vicinity of their eye and after one hits it’s target they move on with their day. Poor drop success occurs by sitting up, barely tilting your head and trying to open both eyelids to place the drop. This will usually result in drops hitting their forehead and/or cheek. To piggy back on the math done above 1000 microliters=1 ml. Each 1 ml contains around 20 drops. The common eyedrop bottle dosages are 5 and 10 ml, which have 100 and 200 drops total respectively. For a 5ml medication that costs $50 you are wasting 50 cents per missed drop (i.e. liquid gold). Put yourself in a position to succeed, lie on your back if your elderly or really tilt your head back so it’s almost parallel to the ground. Then look up towards your forehead and use your non-dominant hand to pull down your lower eyelid only. For those with tremors it is good technique to have the dominant hand come in contact with the non- dominant hand for stabilization. There is no need to touch your upper eyelid, a lot of people have deep set eyes and it’s difficult to get to/move their upper eyelid. I always have my patients close their eyes 3-5 min after drops and …(see next misconception)
5. “I place my different drops 1-12 hour apart so they don’t mix.” Drops mainly absorb through the cornea (window of the eye) within minutes of placing them. It is sufficient to space a round of different drops 3-5 min apart with your eyes closed in between them. If you place one medication immediately after another then they will wash each other out but at the same time you gain nothing for waiting hours apart. Another important point is the order of drops doesn’t matter except for ointments/gels. You want these thick medications last in a group of medications as it forms a barrier for drops to penetrate if done first.