I read an article recently that suggested that us eye care professionals are great at recommending drops but the level of uptake in patients is very much reduced because completely understandably, they have trouble getting them into their eye in the first place. We all have our own way of doing things but of course I think mine is much better than everybody else’s!
There are two techniques I am going to describe here. Firstly, how to get drops into your own eyes. Secondly, how to get drops into a child’s eyes – two rather different tasks. In both situations, it is very important that we don’t make things worse rather than better. Wash your hands carefully and then don’t touch anything else until you are finished. And don’t dry your hands on the towel beside the sink…how well did the person before you actually wash their hands?
For your own eyes, I reckon the aim of the game is to be working with your eye as far away from your line of sight (or your pupil if you like) as possible. This reduces the reflex to close your eye. To do this, it is good to have something to look at to keep your pupil in one place. Using a vertical mirror in the bathroom or the car is very useful so that you can see what you are doing and consequently keep your eyes still. Dropping your chin down towards your chest whilst still looking at your reflection in the mirror often gets your pupil even further away from your lower lid.
- Get the dropper in place and indeed get the drop so it is coming out of the dropper.
- Pull down your lower lid with one finger.
- Rest the hand you are holding the dropper with against your cheek.
- Simply touch the drop (rather than the dropper) against the little line of skin just inside the eyelashes of your lower lid. As soon as the drop makes contact, it goes straight in.
This method is non-traumatic for your eye meaning that you are definitely making things better rather than worse. It also enables you to see what you are doing which means that you can ensure that you are getting one good clear drop into your eye and indeed only one good clear drop. For medications dosage is important and with comfort drops, less is more as you don’t want to flush all the good stuff out of your tear film.
With children, the first thing to do is to be firm and confident. At least to begin with, it is a two person job. It is likely that the child will not be cooperative so you need one person to lie the child horizontally, tucking their head into the crook of their arm and holding the child’s arms firmly down by their sides. The second person has already prepared by washing hands, having a distraction ready for afterwards and getting the drop so that it is coming out of the dropper. They then firmly hold the eyelids open and touch the drop (but not the dropper) against any of the structures inside the eyelashes – the drop will go straight in. It is good to try to stay out of line of sight as much as possible so approach from the side and stay as far away from the pupil as possible. To make this possible, giving the child a direction to look in is helpful – but often not possible. What I do is to ask if they can see something that is quite tricky to see to create a challenge and once they have seen it, point out some sort of feature of it. Then get in there quick whilst they are distracted. For instance, ‘Can you see the clock up on the wall? Can you see the hands on the clock? What colour are the hands? Can you see a big hand and a little hand? Etc…’ If you are on your own, a good way to keep their hands out of the way, is to rap them up in a towel – that continues to completely fox a writhing 4 year old in our household!
Watch carefully to make sure the drop has gone in. The drops only sting in very rare circumstances so afterwards, distraction is then the key. I am not sure that I would be happy not really knowing how much of a drug I had got into an eye or indeed really whether we have got the drop in at all. I don’t think it’s accurate to put drops on the outside of the closed eye and then get the child to open their eyes. Equally, I don’t think I would be that happy with not knowing whether 2, 3 or 4 drops have gone in. Dosage is important and if a job is worth doing, it is worth doing right. Having said this, the world is not a perfect place and I reckon there are marks for effort on the parent’s part. In any case, it gets better and better with the 2nd 3rd and 4th instillation of drops.