Glaucoma eye drops

Eye drops lower the pressure inside the eye, either by reducing the amount of fluid the eye makes or by helping it drain away.

They work well. The main reason they fail is that they never actually reach the eye. These are the questions that come up most often in clinic.

Do I have to use these for the rest of my life?

In most cases, yes, and this is usually the hardest part to accept.

Glaucoma is a long-term condition. The drops do not cure it; they hold the pressure down, and the benefit stops when they stop. That said, you are not locked into one particular drop forever, and for some people SLT laser can replace drops altogether.

What happens if I forget one?

Take it as soon as you remember, then carry on as normal. Do not double up to catch up.

Missing the occasional dose will not undo your treatment. Missing them regularly will. If you are finding it hard to remember, say so — that is a practical problem with practical solutions, not something to feel awkward about.

The drop runs down my cheek. Am I doing it wrong?

Almost everyone does this at first. Here is the method that works:

1. Wash your hands.
2. Tilt your head back, or lie down. Lying down is easier.
3. Pull your lower lid down gently to make a pocket.
4. Look up and away from the bottle. Watching the drop coming is what makes you blink.
5. Squeeze one drop into the pocket. Do not let the bottle touch your eye or lashes.
6. Close your eye gently. Do not screw it shut, as that squeezes the drop straight out.
7. Press on the inner corner of your eye, beside your nose, for a full minute.

That last step is the one nearly everyone skips, and it is the most useful on the list. It stops the drop draining down the tear duct into your bloodstream, so more of the medicine stays in your eye and you get fewer effects elsewhere in your body.

Is one drop really enough?

Yes. The surface of the eye cannot hold more than one, so a second drop simply runs down your face and empties the bottle faster.

If you genuinely miss your eye, take one more.

I use two different drops. Does the order matter?

Leave at least five minutes between them, or the second washes the first away.

If you also use lubricating drops, put those in last.

My hands shake and I can't aim it

Ask about a drop-aid device. Several are available, they clip onto the bottle, and they make a real difference.

If you still cannot manage, please say so rather than struggling on. Laser is a genuine alternative.

Why has one eye gone browner than the other?

That is the prostaglandin drops — latanoprost, travoprost, bimatoprost and similar. They are usually the first choice because they work best and only need to go in once at night.

They gradually darken the iris, which is permanent and most noticeable in hazel or mixed colour eyes. They also lengthen and darken the eyelashes, and over several years can cause a slight hollowing of the upper lid. If only one eye is being treated, the difference becomes more obvious.

None of this is harmful, but it is worth knowing in advance rather than discovering it in the mirror.

My eyes have been red and sore since starting

Worth mentioning, always. There are several possible reasons:

The preservative. Most drops contain benzalkonium chloride to keep the bottle sterile. With years of daily use it irritates the surface of the eye. Preservative-free versions exist and are worth asking about, particularly if you already have dry eye or use more than one drop.

An allergy. Brimonidine in particular can cause a red, itchy eye months after starting. People often mistake this for the glaucoma worsening.

The drop simply not suiting you. There are several different types. If one does not agree with you, we can change it.

Do these drops affect the rest of me?

They can, which is why the whole tablet and inhaler list matters.

The main one to know about is timolol, a beta-blocker. It is absorbed into the bloodstream and can affect the heart and lungs, so it is usually avoided if you have asthma, COPD, a slow heart rate or certain heart rhythm problems. Tell your GP and cardiologist that you use it.

Pressing on the inner corner after each drop, as above, reduces this considerably.

My pressure is fine now. Can I stop?

No, and this is the single most important thing on this page.

Your pressure is fine because of the drops. It returns to its old level within a few days of stopping. Glaucoma causes no symptoms until damage is advanced, so you would not notice anything going wrong until it was too late to undo.

Never stop on your own. If treatment is to be withdrawn, that is done deliberately, with your pressure monitored.

Do I still take them on the day of my appointment?

Yes, unless you have specifically been told otherwise. We want to see how well your treatment is working, which means seeing you on it.

Anything else that helps?

Bring your bottles with you, or photograph them. Drop names are genuinely confusing, especially combination drops, and "the white one with the blue lid" only gets us so far.

Order repeats early, before the last bottle runs out, and pack a spare in your hand luggage when travelling.

Ask about combination drops if you are on two or more. One bottle instead of two means fewer drops and better odds of actually taking them.

Next steps

Patients — contact the clinic to arrange an appointment.

GPs and optometrists — refer directly to Limerick or Ennis, including by Healthmail.