By GARY ASANO, O.D, FAAO
And now the eyedrop rolled into my mouth! Now what do I do? It tastes terrible!
I’m sure you never had that experience, right? But most likely it streamed down your cheek! Did anyone ever tell you a better way?
First of all, make sure and look towards a specific area on the ceiling right above you. Your upper eyelid has one of the strongest muscles in the body, considering its length, so now it’s very much shortened in area. And this way, you’re not looking at the bottle nor the eyedrop “in slow motion.”
Make a small pouch of your lower eyelid with the thumb and index finger and put the drop into that cup-like area … voila, so much easier, right?
Then immediately after that, especially with prescription drops, put your index finger in the inner corner of the eye for at least 6-7 seconds so that the main tear duct is blocked off.
Isn’t two drops better than one? Almost no one has an eye that huge to hold the entire drop, much less two! But if the drops are too small, the opening may get clogged.
Do I always go by what the over the counter drops directions say in how many times per day? Ask your eye doctor, as they will have advice specific to you.
Now, when you receive a small sample bottle of a drop from your eye doctor and you go for more, make sure and take the bottle with you, or take a photo with your phone. Otherwise it’s bewildering to look at the rows of drops with similar names and even the color of the container.
Some drops will even have a three-part name to them, and who’s going to remember that mouthful? And as if to confuse us, it could be that the manufacturer has just changed the label color!
If you have a prescription eyedrop, look carefully to see if the label says to “shake well before using.” If so, instead of just tipping it upside down, do shake the bottle 4-5 times, otherwise the layers of the contents won’t be mixed together, and the lighter-weight part that doesn’t have the medication will come out instead.
What about preservatives? Is it necessary, or better, to buy the one without them, as in a separate unit dose container? Or one that has a “disappearing preservative,” meaning it breaks down as it exits the bottle, being exposed to air? If one is using a drop every day for a month, and more than twice per day, it makes sense.
The unit dose capsule certainly holds more than two drops, maybe up to five. So if you’re using it again in 3-4 hours, most of them with twist-off cap, can be recapped again by pushing it down. However, then make sure that it’s in a closed container, whether a plastic ziplock bag or a container with a screw on top.
A preservative is usually safe in small quantities, but that changes when we’re using it multiple times per day. It can start to increase in concentration in the eye and cause a negative reaction of its own, especially when three times more than it started.
It’s not always obvious in causing a red or irritated eye, at least not right away. The same goes for a contact lens solution, even if it says “for sensitive eyes.” People have a difference in tolerance and for that matter, who’s the “average person”?
There are prescription artificial tears. But these are very different than over-the-counter ones, even by the same company. They chemically change the eye’s tear producing system, and if we do not block the tear duct, it will cause changes in our bodies. So putting in more of them than prescribed could be harmful in the long run.
Now to turn to our tears themselves … much more complicated than they seem. There are three layers, the top one being an oily lipid one. Then the middle, aqueous or water-based layer is by far the thickest of all. At the base is a thin mucus layer. All of these layers have a small electrical charge to them, and the differences create a barrier to most bacteria.
So it stands to reason that very seldom is there a deficiency of the water-based layer. And guess why there are times when tears roll off the eye, but your doctor is actually telling you that “it’s a dry eye”? Whaat? It can very well be that the top layer is uneven or deficient, so there’s not enough protection from the environment.
How we see that is in the instrument with a bright light from the side while your chin in propped up in a rest. What your doctor will see is a lot of small bubbles in your eye. Normally we will not see those at all, but if there’s not enough of that top layer, its distribution is uneven. So use a specific artificial tear that helps that layer.
I have had many patients who told me, “But I’ve never found an artificial tear that works!” But upon asking how many times per day they used it, they looked at me as if I asked a silly question and said, “Just when my eye it bothers me.”
I then explained that was too late and not being preventive in nature. Rebuilding the tears needs a foundation of using the drops at least four times per day for at least a month. What will happen is that by providing that, it stimulates the multiple glands in our eyelids to start producing a normal type of tears. And once there’s improvement after a few months, then one can decrease that to three times per day, etc. Yes, it does work!
Now hopefully this created some interest, so stay tuned for more!
Gary Asano, OD has been a proactive leader and lectured to a wide swath of low vision rehabilitation for over four decades. Though honored with three national awards, his most rewarding moments are of seeing the innate interest of interns of the two Colleges of Optometry in Southern California. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.
Great article here, Mr. Asano. Very helpful.