Expert view: Top tips for glaucoma patients

Julia Phillips has been an Advanced Glaucoma Practitioner at the Dudley Groups of hospitals for the past 12 Years. She works with patients to ensure they manage their glaucoma drop treatment and while choosing the right glaucoma treatment for each patient is a priority to protect the optic discs and maintain good lifelong vision, it is equally important to understand how to instil the drops in the eyes for treatment to be consistently effective and to maintain as far as possible a good tear film for eye comfort.

How to maintain a good tear film and comfortable eyes when using glaucoma drop treatment

1. Choose preservative-free eye drops
If possible, preservative-free glaucoma drops are a good starting point, as the preservatives in eye drops tend to cause more discomfort and disruption to the tear film with prolonged use.

2. Adopt an eyelid cleansing routine
A daily cleaning and massage routine to the eyelids and lashes will help maintain a healthy tear film, keeping the oil glands working well and will remove drop residue, skin and debris from the eyelashes for comfortable eyes.

3. Massage the meibomian glands
Tired, itchy eyes and sore eyes are signs that the tear film could be improved. Warmth is the starting point, followed by massage. Heated eye masks can be bought which have been designed to provide the needed amount of heat that lasts long enough to be effective.

Once you have washed your hands and the eyelids have been warmed, start from the eyebrows and with a gentle circular massage, move down the eye lids towards the lashes. This is to move the oil in the meibomian glands towards the pore openings which are on the eye lids margin where the eye lashes grow. Repeat this action from the eye lid socket (the lower eyelids) up towards the lashes. Then gently rub through the eye lashes to clean. This should be done daily and is good eye hygiene even for those not on drops!

How to apply drops for a consistent, effective lowering of the eye pressure.

If you have difficulty putting the drops in then, you are not alone. Poor technique and poor absorption of the drop treatment may lead to additional treatment, so let’s see if we can keep this to a minimum.

1. Stick to the recommended dose
The glaucoma drop lowers the eye pressure once it has been absorbed through the cornea (the front of the eye) and acts over a period which is dependent on the drug. If the glaucoma drop is a daily drop, then it will work for 24 hours, a twice daily drop works for 12 hours, and this is why it must be used more often.

2. Try not to skip a dose
Glaucoma treatment does not work if the dose is missed and permanent damage to the optic discs and, in time, vision may still occur if drops are frequently missed. If the drop does not absorb in the eye, then the treatment will not work.

3. Choose your position wisely
The best positions for putting the drops in are always sitting or lying down to utilise that strong force of gravity in your favour and to keep the drop sitting on the front of the eyeball for a minute or two for absorption.
Standing can make getting the drop in the eye difficult and dangerous if you lose your balance. Leaning forward to look in a mirror will make it more difficult to put the drop in as well as risking poor absorbency of the drop treatment.

4. Take your time
An extra few seconds may make all the difference to the outcome of the treatment and the stability of your eye pressure.

5. Gently squeeze the bottle
You don’t need to watch the end of the drop container, just try to position it directly over the centre of the eye then look up to open your eye and gently pull the lower lid down to provide a bigger surface area to aim the drop onto. This position along with the drop container being held completely upside down, will also help the drop come out of the bottle with ease, a gentle squeeze is all that is required.
Do the same in the other eye if the drop treatment is required for both eyes. Stay looking up at the ceiling for a minute or so, with gentle normal blinking that will just wash the drop over the front of the eyeball.

6. Avoid using tissues
Only use a tissue to wipe if you have completely missed the eye, or after a couple of minutes when the drop has already been absorbed. Tissues suck drops out of the eyes.
Using gravity in your favour negates the need to press on the punctum (drainage holes into the nose) which can be difficult to do and get right.

Frequently asked questions

Q. Can I put another drop in my eye if I think it didn’t go in?

A. Yes, as the eye will only hold a drop and the excess will spill out. Of course, try to aim for one drop only.

Q. Do I have to put my drop in at the same time every night?

A. For many reasons it may not always be ideal to put the drop in at bedtime, for example reliance on others to help, and lifestyle. A daily drop should be put in once a day around the same time. Discuss with your health care professional if you have concerns as alternative arrangements or treatments can be considered if you have difficulties.