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As this website has Eye Drops in its title!

On its launch in March 2015 this website was given the name Eye Drops Database and was envisaged to be centred around Dry Eye drops, however it has grown to be much more than that. Not withstanding its expansion, it seems appropriate for me to write an article on Dry Eye drops. This is my personal consideration of Dry Eye drops and will not necessarily be the same as your Eye Care/Health Care Professional (ECP/HCP).

Use of Dry Eye drops

The visual and physical symptoms associated with dry or excessively watery eyes (very often these are linked) seem to be increasing, due to multiple factors such as; increased use of concentrated near tasks with computers, mobile phones, tablets etc. In addition other factors, with or without the use of these tasks, such as warm, dry atmospheres, air currents (windy conditions, fan driven air) and/or Contact Lens wear add to the eye's challenge to maintain its normal hydration. As if all these external factors weren't enough to conspire against us, increasing Dry Eye problem are seen as we age (a study showed a third of people over 40 were predisposed to Dry Eye), general health conditions also contribute, as do many medications we take. Historically the only way of managing/treating Dry Eye was through eye drops, in fact they used to be called 'artificial tears', a term not used nowadays. As clinicians we knew, as patients told us, this was only partially helpful. Nowadays many modern specific eye drops are better than ever, however a weakness of all drops is the 'residence time' of the drop on the eye's surface, they get washed away quickly! Latest knowledge of the tear film has led to the development of specific formulations with properties that re-balance and and add to tear quality, stay on the eye surface longer than older products and either indirectly or directly protect the delicate cells that line the eye's surface. Your ECP can advise you on specific products. 

How do I know if I have a Dry Eye/Watery Eye or even an Allergic Eye reaction? Quite simply - talk to a registered Eye Care/Health Care Professional, I would always suggest you initially contact the Eye Care Practitioner you last attended. Typical symptoms you may be experiencing could be dryness (although often other symptoms are more noticeable), mild grittiness, burning, stinging, fluctuating vision (better  after blinking/use of drops). Do not try to self-diagnose. In the same way there isn't a drug/medication that doesn't have a side-effect (noticeable or otherwise), there isn't a Contact Lens that doesn't interfere with the eye's tear film (noticeable or otherwise), so using specific drops with Contact Lens wear is quite normal and to a certain extent recommended. Do seek specific advice from your Contact Lens Practitioner. 

Do Dry Eye drops have limitations?

Yes, we are still working on a single drop that can be applied before Today (BBCR4) and will still be effective when Newsnight (BBC2) comes on! As described, with one or two exceptions, drops don't hang around on the ocular surface very long, they don't generally treat the condition, but rather the symptoms. Newer forms of treatment, now accepted around the world, for specific Dry Eye conditions don't rely exclusively on Dry Eye drops alone - these have very high success rates. As it's always better to at least understand the condition (Dry Eye has a number of forms), than to simply mask the condition so I would always advocate Eye Care/Health Care Professional be made aware of the problem. An important limitation of older forms of drops is that they may contain preservatives, which in themselves can cause toxic reactions on the eye surface. Newer forms have self-eliminating or no preservatives. Many drops are not Contact Lens compatible so can cause eye injury if used with lenses, check with your Contact Lens Practitioner and read all product information thoroughly, this applies to the use of all drops for everyone. Don't do what I do with flat-pack furniture, decide to read the instructions half-way through assembly!

Where should I buy them from? 

It should be remembered that not all drops, and ocular surface products are equal, some are more equal than others! Obviously the practice that recommended specific products will stock them and prefer you buy from them. However, in the same way it is not always possible by your new toothbrush from your dentist, it is not always possible buy drops from your optical practice. Many drops are available from many different sources, however the range can be bewildering, it is tempting to assume all drops are the same, and pick them up with your groceries, they are not! It is probably better order on-line than switch away from the specific advised product. 

How should I use them?

Follow the advice given to you by your ECP/HCP, perhaps bearing in mind the following points. If you are commencing Contact Lens wear it is advisable to have a bottle of Contact Lens compatible drops available from day one. Sometimes Contact Lens Practitioners advise applying a drop to the lens before placing it on the eye. Contact Lens wearer or not, your ECP/HCP can show you how to safely and effectively best instill drops, not a skill that comes naturally! Starting point - always wash your and dry hands, more eye infections, and very sadly but very rarely, permanent vision loss comes from invisible hand contamination than anywhere else. Check the bottle expiry date from first opening. Don't touch the dropper to your eye or face. Look up while pulling the lower lid down to create a 'pocket' and place the drop in it. The eye can't normally hold more than one drop so multiple drops risk over-dosing the eye, wasting money or drops draining via the eye's drainage canal into your body, normally harmless, but with certain drops possible side-effects can occur. Your ECP/HCP can show you how to instil drops and how to ensure very little drains away via the eye's canal.

For an excellent video go to https://www.youtube.com/watch?v=_pa9H-ySSik&feature=youtu.be

Another very useful video related to administration of eye drops to babies and children can be found on the website of Mr Ross Ferguson, Pharmacy consultant to Eye Drops Database go to  https://pharmacyinpractice.scot/2017/05/20/educational-video-on-administering-eye-drops-to-babies-and-children/

Space drops out by at least 10 minutes, if you are using a gel or ointment instill that last. Alternatives to drops are sprays, again check with your ECP/HCP that they are appropriate for you and how best to use them. If this article has whetted your interest to know more it is always best to consult your current ECP initially, perhaps using the 'Find an Expert' resource if your practitioner is unable to help or refer you to someone else http://eyedropsdatabase.co.uk/patients/find-an-expert 

 

Andrew D Price FBDO(Hons)CL, COA(USA).

 

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