My wife often claims that I run a torture chamber, not a medical eye care office. I always jokingly remind her that she is still to this day my worst patient. Once, it took me 10 minutes to get the drops in her eyes. In all fairness I was still an optometry student at the time and before they turn a young student doctor loose on the general public I had to give so many exams on family and friends. Instilling drops is commonplace in my practice but not everybody is OK with that.
Last week I had a pediatric patient who, upon hearing that we would place a drop of medicine in his eye, freaked out. Eye drops can be scary business, especially for the youngest of patients. This article will provide you with some tips from a practicing and licensed optometrist on how to get those drops in effectively.
So you’re child has been given a prescription for eye drops. Chances are that the drop will need to be put in multiple times per day over several days or even weeks. They may or may not be old enough to instill them on their own. They may be nervous or downright scared to have you do it. What do you do?
Depending on the reason for the eye drops and your own situation, you may want to take a bit of time to practice before placing the drops in your child’s eyes. If possible, practice on your own eyes first. Obviously don’t use a drop with medication for practice. Ask your eye doctor for a sample of artificial tears (which have no medication and provide only moisture) with which you can practice getting them into your own eyes. By practicing on your own (preferably away from your child) you will be more empathetic and be able to honestly explain what will happen when you try to place the drops in the child’s eyes. This will also help you feel comfortable handling the drop bottle without appearing nervous.
Make sure those eyelids are out of the way
It is natural and healthy for your child to blink or close their eyes when something threatening comes towards them. Most drops are improperly administered when the eyelid gets in the way. To prop the lids out of the way have the child look all the way down to their feet. With your forefinger you can put pressure on the upper lid and pull it up as far as you can. Try to hold that upper lid by the base of the lashes. Next, use the thumb of that same hand to pull the lower lid out of the way. If done properly this hold of both lids makes it nearly impossible for the child to blink.
Have a sitting child look all the way up to the ceiling or alternatively have the child lie down. If needed have another adult assist in holding the child’s head for support and to keep them still.
I know that this one is easier said than done. I think it is always fair that I explain what it is we are about to do when I place drops in my patients eye. I don’t like the “surprise” drop technique as it usually only works once. To help them overcome the mental aversion to drops try explaining that the drop will be just like swimming, where being splashed in the face isn’t the funnest thing, but it certainly doesn’t hurt. I often place a drop of the medication in the patients cupped hand to show them that it doesn’t hurt on the skin and that in the eye it isn’t much worse. If needed, the patient can then take that drop in their hand and rub their cheek or their eyelids with their hand to show them that the drop can get very close to their eyes and still not hurt. One of my opticians recommends warming the drop bottle to body temperature under hot water before instilling the drops. Consistently reassure the child and maybe even reward them.
Make it fun
Tell the child that as soon as the drops touch their eye they should cover their eye with a kleenex and count quickly to 10. Giving the patient a task helps them keep their mind off of what is happening.
Worst case scenario
Usually with patience and perhaps a bit of coaxing the drop will eventually get in. Below are a few tips if all else fails.
– Have the child close their eyes and place the drop on the closed lids. Before gravity pulls the drop off of the lid, have the child open and close their eyes 10 times really fast. Some drop will usually get in.
– Place several drops on a kleenex and have the patient rub their eyes with the kleenex. I don’t recommend using this often (or ever) because the dose of medication may be too high or too low depending on how much drop actually made it into the patients eye. Also you’ll burn through the bottle of drops too quickly if you need to do this one often.
– Your optometrist may have a small spray bottle that could be used to surprise the child. Again, I don’t like the surprise method as it usually only works once.
– Your optometrist can also instill the drops in office. Obviously it’s best to get them in at home on the proper time schedule, but I’d rather have the drop instilled in office a few hours early than to fail putting it in at the right time.
Stick with it
Hopefully you and your child can find a way to make it click. Proper administration of drops is crucial to the treatment of many eye conditions. Please always follow your doctors dosage recommendations.
In the coming weeks I hope to add articles relating to contact lenses, safe eclipse viewing, eye vitamins for macular degeneration, explanations as to why the doctor recommends putting in those dilation drops, and other common questions I receive as a doctor. Stay tuned.