Using Eye Drops Correctly: Getting the Drop Where It Needs to Work

Eye drops only work if they land in the eye — and stay there. It sounds obvious, but it is not: a large share of drops miss, run down the cheek or pass through the tear duct into the body. With the right technique you can change that in a minute: pull down the lower lid, one drop, close the eye — and the underrated expert trick: press the tear duct closed for one to two minutes. This article shows step by step how it works, what applies when you use several preparations, and why the date of opening belongs on the bottle.

1. Why the technique decides whether the drops work

A surprising amount goes wrong when people put drops in: in studies of patients with glaucoma, many do not reliably hit the eye, touch it with the tip of the bottle or use several drops at once.^¹ The consequences are tangible:

• The drop lands beside the eye — and the dose is missing. Annoying with lubricating drops; with glaucoma drops it is a risk to the optic nerve, because the raised pressure inside the eye quietly carries on.
• The tip of the bottle touches the eye or the lashes — germs travel into the bottle and are dripped into the eye at every subsequent application.
• Too many drops — whatever the eye cannot hold runs off: down the cheek, or through the tear duct into the nose and throat, where the active substance enters the body.

To put it another way: with eye drops the technique is not a finishing touch but part of the dose. That applies above all to long-term treatment such as for glaucoma, where every single application over the years counts.

2. Step by step: the right technique for putting drops in

This is how to get a drop safely into the eye — in front of the mirror or lying down, whichever you find easier:

1. Wash your hands — thoroughly, with soap. Your hands are about to come close to your eye; this is the single most important protection against infection.
2. Prepare the bottle: check the expiry date and the date of opening; shake suspensions briefly (you can recognise them by the note "shake before use").
3. Tip your head back or lie down flat — looking towards the ceiling.
4. Gently pull the lower lid down with one finger until a small pocket forms between lid and eye — the conjunctival sac. That is exactly where the drop belongs.
5. Look upwards and hold the bottle above the pocket with your other hand — about one to two centimetres away. The tip must never touch the eye, the lashes or the skin.
6. Let one drop fall into the pocket. Tip: rest the hand holding the bottle on your forehead or the bridge of your nose — that stops it shaking.
7. Close the eye gently — do not screw it shut and do not blink, as that pumps the drop straight back out. Keep it closed for one to two minutes.
8. Press the tear duct closed: while the eye is closed, press a fingertip lightly on the inner corner of the eye (next to the bridge of the nose), likewise for one to two minutes. The next section explains why this matters so much.
9. Dab away any excess — with a clean tissue, from the inside outwards. Close the bottle again straight away.

3. One drop is enough — really

The conjunctival sac holds only a fraction of a standard drop — the eye simply cannot take up any more volume.^¹ So a second drop "to be on the safe side" does not increase the effect in the eye, only the amount that runs off: down the cheek or through the tear duct into the body. It also empties the bottle twice as fast — with long-term treatment, a real cost factor.

If you are unsure whether the drop hit its target: a drop that has clearly missed may be replaced — but deliberately, not by doubling up as a matter of routine. And when two drops are regularly prescribed, there should be a short pause with the eye closed between them.

4. The underrated expert trick: press the tear duct closed

The tear duct starts at the inner corner of the eye — the direct connection from the eye to the nose. Through the well-supplied lining of the nose the active substance reaches the bloodstream without any detour through the liver, almost as if it had been injected. That is exactly why some eye drops leave a bitter taste in the throat shortly after use — they are long since no longer only in the eye.

Pressing the tear duct closed for one to two minutes (the technical term is nasolacrimal occlusion) therefore has a double effect: more of the active substance stays in the eye, where it is meant to work — and less of it reaches the body, where it can cause side effects.^¹,²

5. Several preparations: 5 minutes apart, drops before ointments

If you need more than one eye medicine — in glaucoma, combinations of two or three are usual — you face a simple question of space: the eye can only ever hold one drop. A second drop straight after the first simply washes the first one out again.

• At least 5 minutes between two different eye drops — better 10, if you have the time.
• Order: drops first, then gels, ointments last. An ointment forms an oily film that later drops can no longer get through — which is why the thickest preparation always comes at the end.
• Use eye ointments in the evening where possible — they blur your vision for a while anyway.
• Write the fixed order down — with three preparations at different times of day, a written (or digital) plan helps more than the best memory.

6. Contact lenses and preservatives

Two topics that belong together: many eye drops in multi-dose bottles contain preservatives — most commonly benzalkonium chloride. It keeps the bottle low in germs, but it has two downsides:

• It builds up in soft contact lenses and can irritate the eye from there permanently. So the rule is: take your lenses out before using the drops and put them back in no earlier than 15 minutes afterwards — unless the package leaflet says otherwise.
• It can attack the tear film. If you use preserved lubricating drops several times a day for months because of dry eyes, you may be making the problem worse — the preservative irritates exactly the surface of the eye that is supposed to be soothed.

For long-term treatment and frequent use there are preservative-free alternatives: single-dose containers (small disposable pipettes) or special bottle systems that manage without preservatives. They often cost a little more, but for sensitive eyes, contact lens wearers and long-term use they are usually the better choice — raise it at the pharmacy or the eye clinic.

7. Shelf life after opening: the date belongs on the bottle

The printed expiry date applies only to the unopened bottle. Once opened, preserved eye drops can usually be used for 4 to 6 weeks, depending on the product — the exact period is in the package leaflet. After that, the risk rises that germs multiply in the bottle and go straight into the eye with every application.

• Note the date of opening: when you open the bottle, write the date on it or on the carton with a waterproof pen — the simplest and most effective measure in this whole article.
• Single doses are one-off doses: single-dose pipettes are as a rule preservative-free and, once opened, usable only for a short time — mostly up to 12 or 24 hours, depending on the package leaflet. Dispose of what is left.
• One bottle per person: eye drops are not shared — not even within the family. Otherwise germs travel from eye to eye.
• Cloudiness, flakes, discolouration: if the solution looks changed, it goes in the bin — regardless of the date.

8. Storage: fridge or room temperature?

There is no blanket answer — it is stated for each preparation in the package leaflet. Broadly: most eye drops are stored at room temperature, protected from heat and direct sunlight. Some — including certain glaucoma drops — have to be kept in the fridge before opening and may then stay at room temperature for the in-use period after opening. And some may be chilled voluntarily, which makes the drop easier to feel as it lands.

What never works: leaving the bottle in the car in summer, on the windowsill or in the bathroom above the radiator. How to store medicines properly in general — and why the bathroom is almost always the wrong place — is explained in the guide Storing medications correctly; a sensible basic stock is set out in the Home pharmacy checklist.

9. When your hands will not cooperate: drop aids and tricks

Aiming, squeezing, not blinking — all of that assumes steady, strong hands. With rheumatoid arthritis, a tremor, after a stroke or simply in advanced age, putting in drops quickly becomes a daily hurdle. There are good solutions:

• Drop aids (applicators): small attachments from the pharmacy that hold the bottle securely above the eye and keep the lid open. Some also increase the leverage, so that less finger strength is needed. There are different systems for different bottle types — it is best to try them out at the pharmacy with your own bottle.
• The lying-down technique: lie flat, place the drop on the inner corner of the eye with the eye closed, then open the eye and tilt your head slightly to the side — the drop runs in by itself. Ideal too if you are anxious about drops, and for children.
• Get help: if a relative or a nursing service puts the drops in, the same rules apply — wash hands, touch nothing, one drop, press the tear duct closed.

With older people who have several conditions in particular, it is worth being honest about this: glaucoma treatment that fails because of hand function does not lower the pressure in the eye. More on workable solutions in later life in Medications in old age.

10. Eye-whitening drops: beware the vicious circle

"Drops for red eyes" from the chemist or pharmacy work through vasoconstrictor substances (tetryzoline or naphazoline, for example): the vessels of the conjunctiva contract and the eye looks whiter within minutes. The problem: as the effect wears off, the vessels widen all the more — the eye becomes redder than before, and you reach for the bottle again. You may know this rebound principle from decongestant nasal spray — see Nasal spray dependence. In the eye, the vicious circle works in exactly the same way.

So the rule is: eye-whitening drops — if at all — only occasionally and for a few days, never as a permanent solution. And above all: a red eye is a symptom, not a diagnosis. Behind it may lie harmless irritation, but also dry eyes, conjunctivitis or — rarely, but seriously — an acute attack of glaucoma. A drop that whitens the symptom may, in case of doubt, delay dealing with the real cause.

11. When you should not be treating your own eyes with drops

Lubricating drops for occasionally dry, tired eyes are uncritical. In these situations, though, the eye belongs promptly in medical hands rather than in self-treatment:

• Severe eye pain, marked sensitivity to light or sudden deterioration in vision — including with headache and nausea (a possible attack of glaucoma: go to an eye clinic or the emergency department immediately).
• A red eye in a contact lens wearer — here an inflammation of the cornea may be behind it, and it needs treating quickly. Take the lenses out and have it assessed.
• Purulent discharge, stuck-together lids, marked swelling — signs of conjunctivitis that needs treating.
• A foreign body or chemicals in the eye — with chemicals, rinse immediately and copiously with water, then go to the emergency department; with chemical burns every minute counts, and if in doubt call 112 (emergency services in Germany).
• Redness or irritation lasting longer than a few days — even without pain.

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