Some patients are under the mistaken impression that two or more drops at a time of the same medication may be more effective than one. In fact, using more than the prescribed dose may cause a drug overdose with consequent side-effects. Despite the widespread use of eye drops, many patients do not know how to apply them correctly. Fortunately, there are several ways to do this effectively.

1. Lean your head back and look up toward your eyebrows while in front of a mirror or reclining in a chair or bed (Figure 1). The lower lid should be gently
pulled down to form a small pocket in which the drops are placed. This is most readily accomplished by gently pulling the skin down with one finger. Since more than one drop may be administered accidentally, a tissue should be kept handy to wipe the excess from the skin.

2. After applying the drop, the eyelids should be gently closed for about two minutes to allow time for the medication to be absorbed into the eye. Although you may feel like blinking, you should try to avoid this. Blinking may squeeze the drop out of the eye and into the tear duct which leads into the nose. Squeezing the lids closed also may cause the drop to spill over onto the cheek. By gently closing the lids, the medication will remain in contact with the eye so that it can be absorbed.

3. Block the tear ducts with your thumb or index finger for two minutes as the eyelids are gently closed, so the flow of the drop and the tears into the nose can be avoided (Figure 2).

Note: Be sure that your eyes are closed while you block the tear ducts. Since tears normally flow from the surface of the eye into the tear ducts, a drop which is placed on the eye and mixes with tears will do the same. This is particularly

Helpful Tips
1. Before applying drops, wash hands with soap and water.

2. Keep eye drop container clean. Avoid touching the dropper against the eye or
anything else.

3. After applying drops, replace the cap right away. Do not wipe or rinse off dropper.

important since the inside of the nose is like a sponge. It can readily absorb the drop into the blood, where it can then affect your heart, lungs and brain.

4. If you are using more than one eye drop, you should wait at least f ive minutes before applying the second eye drop. he lower lid pocket into which the drop is placed is small and cannot hold more than one drop at a time. Placing more than one drop at a time causes an overflow, and washes the eye drop from the eye. Bring your eye drops with you every time you have an appointment with your eye
doctor. Your eye doctor can help you learn to use your eye drops correctly.

Characteristics of Glaucoma Leading to Poor Compliance

Asymptomatic disease (no symptoms).

Chronic disease requiring long-term therapy may require use of several medications.

Expense of treatment.

Inconvenience of treatment.

Benefit of treatment not apparent.

Local side-effects of treatment (burning, stinging,etc.).

Systemic (body) side- effects of treatment.

What Is Compliance?
Compliance is the act of following the recommendations of your doctor. After all, an eye drop or any other drug will not work unless you use it correctly!

Failure to comply with your doctor's recommendations is not unique to glaucoma. In fact, it is widespread and occurs throughout medicine and with virtually all diseases. In fact, it is often the reason why medical treatment of a health-related problem is not successful. For several reasons, however, the glaucoma patient
is particularly likely to comply poorly with their doctor's recommendations (Table 1).

Glaucoma Is Largely Asymptomatic An individual is often unaware that they have glaucoma until late in the course of the disease. In the most common type of glaucoma, there is generally no change in vision until the optic nerve is significantly damaged. Hence, many patients cannot be persuaded to undergo treatment, and even may deny the need for it.

Glaucoma Is Chronic and Often Requires Lifelong Treatment
The most common types of glaucoma are chronic and require lifelong treatment. After being diagnosed with glaucoma, effective treatment may require the use of several medications. Use of these medications is often inconvenient and can be
costly.

The Benefit of Glaucoma Treatment Is Not Apparent
An important goal of glaucoma treatment is to prevent further vision loss. Most of the time, a treated glaucoma patient cannot tell whether or not they have been treated successfully. Even if treatment is effective, their vision is usually not improved.

Treatment with any drop will only lower eye pressure temporarily. Depending on the drop, the effective duration is between four and 24 hours. However, some patients only take eye drops before seeing their eye doctor. Others are only compliant using their eye drops immediately after seeing their eye doctor. Therefore, failure to use eye drops at the recommended regular intervals throughout the entire time between appointments is an important reason why glaucoma can continue to worsen in some patients.

Glaucoma Medications Have Side-Effects
Each of the medications used as an eye drop to treat glaucoma has a potential for having sideeffects. These side-effects may be serious, or they may be barely noticeable.

Some eye drops get absorbed into the blood, and can affect heart rate, blood pressure, breathing and even mental function. Either local sideeffects of the eye or general ones which affect other parts of the body can cause a patient to intentionally miss one or more doses of the eye drop. Patients may believe that
avoiding the use of eye drops as prescribed by their doctor will make them feel better.

What Can Be Done to Improve Compliance?
Education is perhaps the most important single means for improving compliance. A patient who is educated about the nature of glaucoma and its treatment is most likely to be a better patient, and correctly use the eye drops.

Support from Patient´s Relatives
Both you and your eye doctor should enlist the support and cooperation of friends and relatives. Educating them about the effects of glaucoma and its treatment, as
well as the importance of taking medications as directed, is often useful. For example, a spouse may assist you in using the eye drops so that they are properly placed and so that only one drop of a medication is given.Support from Patient´s Relatives Both you and your eye doctor should enlist the support and cooperation of friends and relatives. Educating them about the effects
of glaucoma and its treatment, as well as the importance of taking medications as directed, is often useful. For example, a spouse may assist you in using the eye
drops so that they are properly placed and so that only one drop of a medication is given.

Reducing Side-Effects
Reducing side-effects from eye drops is important for their safe use and can improve compliance. Depending on which eye drops are being used, this can be achieved in several different ways.

Correct Usage of Eye Drops
Perhaps most importantly, you should learn how to use your medications correctly. The method for taking eye drops correctly described earlier will
decrease the amount that is absorbed undesirably into the blood.

A Simple Schedule
A schedule of eye drop use may be simplified by relating the time of administration to routine daily events such as awakening in the morning and
going to sleep in the evening for once and twice daily use. For three times daily use, one may consider applying the eye drop at lunchtime as well. For
four times daily use, a simplified schedule may involve use at breakfast, lunch, dinner and bedtime.

Summary
Listening to and following your eye doctor's recommendations not only improves the likelihood of successful treatment, but allows the eye doctor to determine whether the eye drops are beneficial or additional ones are needed. You should ask your eye doctor about any possible side-effects from recommended treatment, and report them if they occur. You should also ask your eye doctor to observe you when applying an eye drop so that it can be determined if the eye
drop is being administered correctly. Don't be afraid to discuss these issues with your eye doctor, who is committed to providing you with the best possible chance for successful treatment of your glaucoma!