Glaucoma is often caused by a build-up of fluid in the eye called aqueous humour, or just aqueous. This causes pressure in the eye (called intraocular pressure or IOP) to increase, which damages the optic nerve and leads to vision loss. Eye drops are the most common treatment for glaucoma. They decrease the amount of fluid in the eye, either by increasing the drainage of fluid out of the eye, or by reducing the amount of fluid that is made.
The different drops fall into five main categories, which work in slightly different ways: Alpha agonist, Beta blockers, Carbonic anhydrase inhibitors, Cholinergic inhibitors and Prostaglandin analogues. These are explained in this document which is available to download here.
The names of medicines can be confusing. All eye drops have a generic name that links to the active medicine, and some have a trade name. Some drops are known by their brand name, which is chosen by the company that develops the drug.
When the patent on the drug expires, other companies can start making that drop – this is known as a generic eye drop. This is a bit like buying cheap ibuprofen tablets or buying the brand Nurofen. The active painkiller in each tablet – ibuprofen – is the same, but other ingredients may vary slightly.
Generic drops are usually cheaper than branded ones, so your GP or pharmacist may offer a generic in place of a branded drop. This may make no difference to you, but if you find your eye reacts differently to the generic drop, or that it’s harder to squeeze the bottle, do speak to your ophthalmologist, GP or pharmacist. They can change the drop to ensure that it works for you.
Get into a comfortable position. You may find it easiest to sit in front of a mirror, or you could lie down.
Pull down your lower lid with a finger of one hand, to create a ‘pocket’. With the other hand, squeeze or tap the bottle so one drop goes into your eye, into the pocket created by pulling down the lower lid.
If you’re lying down, you may find it easier to balance the bottle on the bridge of your nose. Look upwards and squeeze the bottle. The drop should fall into your eye. If it doesn’t, it will be in the corner by your nose. Turn your head slightly to the side and the drop should run into your eye.
The WOK technique is particularly helpful in holding the bottle steady or if you have long nails:
Immediately after putting your drop in, close your eye and press gently on the corner of the eye by your nose, for around one minute. This is called punctal occlusion. It blocks the tear duct, meaning the drop stays in the eye where it can do most good.
If you don’t do this, the drop can drain down the tear duct and into your throat, where it might cause an unpleasant taste or some side-effects.
If you miss your eye, or your eye is closed when the drop lands on it, put another drop in.
Remember: Try to put the drop in at the same time each day. If your drop needs to be put in twice a day, try to leave 12 hour gaps between drops.
If you have to use more than one eye drop, wait at least five minutes between them (or longer if advised by your ophthalmologist).
If you wear contact lenses, wait at least 15 minutes between putting in the drop and putting in the lenses, and never put eye drops in while wearing lenses
I missed a drop
If you forget to use your eye drop and remember a couple of hours later, put the drop in then, and get back to your normal routine as soon as possible. If you’re nearly at the time to put your next drop in, just wait until your normal time.
Don’t put extra drops in to “make up” for missing some – this won’t have any effect and the extra drop will just drain out of your eye
I keep forgetting…
Try leaving your eye drops somewhere obvious, to help you remember to put them in. Perhaps next to your toothbrush?
Set a daily reminder on your phone.
I need more help!
Download our drops chart, so you can tick off when you put your drop in.
Ask family members to help remind you to use your drops.
Frustratingly, many eye drops cause side effects. The possible side effects of the different eye drops are listed in this table – because each type of eye drop works in a different way, they have different side effects.
It is important that you keep using eye drops every day, but if side effects are stopping you from doing this, you should contact your ophthalmologist. You can phone the hospital at any time, you don’t have to wait until your next appointment.
Some people develop red or itchy eyes from using eye drops. This is often because of a preservative in the eye drop which irritates the surface of the eye. If you notice these effects, you may wish to ask your ophthalmologist for a preservative-free eye drop.
It’s possible that you may also have dry eye disease – around 50-60% of people with glaucoma also have dry eye. This is a disease where the tears don’t work properly and the eye gets irritated or inflamed. Click here for more information about dry eye.
It is important to put your eye drops in every single day, at the time of day that your doctor tells you. If you miss a drop, your IOP could increase and cause damage to the optic nerve. You might not notice any difference at first and your eye won’t feel any different. But if you miss drops often, the damage can build up and your sight could be permanently damaged.
Make sure you follow the storage instructions for your drop, e.g. keeping it in the fridge. If your drop needs to be kept cool and you’re going somewhere hot (lucky you!) you can purchase cool wallets.
There are other treatments available for glaucoma which may be recommended to you, for example, laser, trabeculectomy or MIGS. In some cases, the treatment can replace eye drops, but in other cases may be offered alongside eye drops. Do not stop using eye drops unless your ophthalmologist has told you to.
Many people find it difficult to squeeze the bottle the drop comes in. There are lots of aids that can help you with this. Some help to hold the bottle steady above your eye, while some help you squeeze the bottle.
This table states which compliance aid goes with each drops bottle. It can be complicated working out which aid is right for you but our helpline staff will be happy to help you, so feel free to call the team on 01233 64 81 70 or email firstname.lastname@example.org for advice.
Due to the COVID-19 lockdown, we are currently only providing a limited range of compliance aids, which can be ordered on our website or by calling our helpline on 01233 64 81 70. For further information on what other aids are available, please click here.
There are many different types of eye drops, and more are coming on to the market all the time. Unfortunately some bottles don’t fit into any of the aids available. If there isn’t an aid suitable for your eye drop, and you are having trouble putting the drop in, speak to your ophthalmologist. They may be able to prescribe you a different eye drop or form of treatment. But whatever you do, don’t stop using the eye drops!