Eye Drops Made Easy: Tips for Older Hands

A strong warning first

• Use only the drops prescribed or recommended for your parent's condition, in the dose and times given. Do not use someone else's drops, old leftovers or drops bought for "redness" without advice.
• Steroid drops can raise eye pressure, cause cataract and mask infection if used wrongly. Never use them without an eye doctor's supervision.
• No home remedies in the eye: kajal, surma, rose water, honey, breast milk, oils, herbal extracts and tap water can cause infection and injury.
• Do not stop glaucoma drops because the eyes feel fine. See glaucoma and macular degeneration: practical home support.
• A red eye with pain, reduced vision, light sensitivity or discharge needs a doctor, not drops from the shop; see most common causes of eye redness.
• Sudden vision loss, severe pain, halos with headache and vomiting, flashes or a curtain are emergencies. Go to an eye hospital at once, or call 112 if with weakness, speech difficulty or confusion.

Step by step: putting in a drop

1. Wash hands with soap and water and dry them. 2. Check the bottle: the right medicine and eye (left, right, both), the label and the expiry date. If the label says "shake well", shake it (this is for suspensions). 3. Sit or lie back with the head tilted back, or lie down. Many people find lying down easiest. 4. Look up at the ceiling or a spot. 5. Gently pull the lower eyelid down with a clean finger to form a small pocket. Rest the heel of the hand on the cheek or forehead to steady it. 6. Hold the bottle upside down above the eye, close but not touching the eye, lashes or lid. Keep the tip clean. 7. Squeeze one drop into the pocket. The eye can hold only about one drop; extra runs down the cheek. If you miss, try again with another single drop, or follow your doctor's guidance. 8. Close the eye gently (do not squeeze or blink hard) and press lightly on the inner corner, near the nose, for one to two minutes. This keeps the drop in the eye and reduces the amount that drains into the nose and the bloodstream, which matters for some drops. 9. Wipe away excess with a clean tissue, and wash hands again if you touched anything. 10. Replace the cap straight away, without touching the tip.

Two or more drops

• Wait at least five minutes between different drops in the same eye, so the first is not washed out. Your doctor may give a different interval.
• Follow the order the doctor or pharmacist gives. As a general idea, thinner (watery) drops are often given before thicker (gel or suspension) ones, and ointments are given last, but your own instructions decide.
• Put in drops for both eyes with a clean tissue between, and do not mix the bottles.
• Do not give extra drops to "make up" for a missed dose, unless told to.
• Use a chart with times and tick boxes, and set phone alarms. See medicine reminders for forgetful parents.

Eye ointments and gels

• Wash hands, tilt the head back and pull the lower lid down.
• Squeeze a thin line of ointment, about a centimetre or as instructed, along the inside of the lower lid without touching the tip to the eye.
• Close the eye and gently move it, and expect blurry vision for a few minutes. Wipe off excess.
• Ointments are often used at night, since they blur vision.
• Apply ointment after drops.

Helping hands: aids and tricks

• Drop guides and holders: plastic devices that fit over the bottle and guide the tip to the eye, helpful for tremor, arthritis and poor aim. Ask the pharmacist or eye clinic.
• Squeeze aids that make it easier to press the bottle.
• Bottle holders and grips for weak hands.
• Lying down for greater stability.
• Use the other hand to steady the wrist, or rest the elbow on a table.
• Look into a mirror with a magnifier, or ask someone to help.
• Large-print labels, colour codes and tactile markers so that the right bottle is picked even with poor eyesight; see low vision home safety: contrast, labels and layout.
• A helper: a family member can give drops, especially after surgery or for people with tremor, dementia or poor sight. Wash hands, use the same technique, and respect your parent's dignity.
• Single-dose vials (preservative-free) may be easier for some people and are used for dry eyes; ask the doctor. They are discarded after use.
• Ask the pharmacist about alternatives, such as a different bottle shape or a longer-acting drop that needs fewer doses; do not switch without advice.
• A light source from the magnifier or reading lamp helps people see the lid; see reading lamp and lighting and magnifier lamps: reading and hobbies with low vision.

Common mistakes

• Touching the bottle tip to the eye, lashes or fingers, which contaminates the bottle.
• Squeezing out many drops and wasting medicine.
• Not closing the eye or pressing the corner.
• Not waiting between drops.
• Using drops after the expiry date or for too long after opening.
• Not washing hands.
• Wearing contact lenses while using drops, unless the doctor allows.
• Missing doses, especially with glaucoma drops, or stopping early after surgery.
• Sharing bottles among family members.
• Mixing up bottles, especially similar-looking ones.
• Leaving the cap off.
• Using home remedies or drops advertised on social media.

Storage and expiry

• Read the label: some drops need to be kept in the fridge, others at room temperature, away from heat and sunlight. In hot Indian summers, avoid leaving drops in a hot car, a sunny window or a bag; ask the pharmacist if a cool storage place is needed.
• Keep the cap tight and the bottle upright, in a clean place away from children.
• Date the bottle when you open it. Many multi-dose drops with preservatives should be discarded about 28 days after opening, regardless of what is left, though some have different rules; follow the label and the pharmacist's advice. Preservative-free single-dose vials should be thrown away after use.
• Do not use cloudy, discoloured or contaminated drops, or ones that have been left open.
• Keep spares and order refills before the bottle runs out; glaucoma drops must not lapse.
• Carry the drops in a small case when travelling.

Side effects to watch

• Mild stinging or blurring just after use is common.
• Redness, itching, swelling of lids, rash may signal allergy; call the doctor.
• Some glaucoma drops can cause tiredness, a slow pulse, breathing difficulty (especially in people with asthma or heart problems), darkening of eyelid skin, changes in eyelashes or a deeper-set look. Tell the doctor about asthma, COPD, heart conditions and all medicines. Do not stop without advice.
• Dry mouth or bitter taste can follow.
• Severe pain, vision drop or increased redness need urgent review.

When it is hard for the person

If your parent cannot manage drops at all because of tremor, dementia or vision, tell the eye doctor. Options may include a caregiver giving them, different medicines or formulations with fewer doses, laser or surgery for glaucoma in selected people, or a home nurse. See dementia and medicines: managing safely and giving medicines safely at home. Respect fears: some people find drops frightening. Use a calm voice, a routine and encouragement.

When to ask a professional

Ask the eye doctor to review the need for each drop, and ask the pharmacist to show technique and suggest aids. Ask whether drops can be simplified. Ask about storage in hot weather and when to discard bottles. Call the eye doctor if drops are not being tolerated, if the eye becomes more painful, red or blurred, or if your parent cannot manage the schedule. Go urgently for sudden vision loss, severe pain, a curtain or flashes. Call 112 for stroke signs.