Home' Australian Pharmacist : Australian Pharmacist February 2011 Contents Vol. 30 -- February #02
accredited pharmacists' special interest group
8--10 June 2011
Updating your knowledge
-- enhancing your skills
care planning may improve adherence
rates.2 Reminders and individualising
timing to suit lifestyle and 'fit' with
normal activities can become quite
creative and as more older people
now have mobile phones these can be
used as a reminder tool.
Number of drops
I still sometimes see '1--2 drops' on
the label instructions but as the eye
pouch will be full after a single drop
only one drop is needed. A second
drop is a waste and may increase the
possibility of systemic absorption and
side effects, or have greater overflow
around the eyes potentially increasing
the risk of contact allergy.3
More than one type of drop
It is important to separate the
instillation of two different types
of drops to prevent the second
drop washing out the first drop.
The evidence is sparse on exactly
how long to leave between instilling
different drops and different sources
of information suggest anything from
three to 15 minutes. The Glaucoma
Australia patient brochure advises
leaving at least 5--10 minutes between
each different drop.4 This is a useful
brochure to have in your HMR kit
to discuss with patients -- my only
criticism of this brochure is that it
would be helpful for the print to
be larger. As there are now more
combination drops available for
glaucoma it can be useful to check the
PBS to see if a combination product
could replace the individual drops.
Difficulty with administration
Eye drops are often easier to self
administer than eye ointments
but some patients have difficulty
administering drops due to a number
of reasons including tremor, arthritis
and hand weakness making it difficult
to squeeze the bottle.
If the patient is using preservative-
free artificial tears and having
difficulty with administering or
handling the drops, there is a soy
lecithin spray formulation that may
be worth trying if they meet the PBS
criteria for an authority prescription.
The spray is PBS listed for severe
dry eye syndrome in patients who
are sensitive to preservatives in
multi-dose eye drops. Soy lecithin is
thought to stabilise the lipid layer of
the tear film and can be sprayed onto
closed eyes 3--4 times a day.
If the patient has difficulty
administering other eye drops there
are aids available which may be of
assistance. Some of these are specific
for products and include:
• Xal-Ease -- this device can be
used for Xalatan and Xalacom
eye drops and is available at no
cost to the patient from Pfizer
Australia by calling their medical
line (1800 675 229). Xal-Ease has
been shown to reduce the need for
assistance with instilling drops (6.9%
vs 18.1%, respectively; p<0.001) and
decrease the tip of the dropper bottle
touching the eye (3.2% vs 35.6%,
• Eyot -- the blue 2.5 mL device is
specific for use with Travatan and
Duotrav drops and the green 5 mL
device is specific for Azopt and
Betoptic. These are available at no
charge to the patient by contacting
Alcon on 1800 025 032.
Alternatively, the above products are
available for patients at no charge if
they contact Glaucoma Australia on
1800 500 880.
• Opticare eye drop dispensers are
plastic devices that assist with
administering the correct dose of
eye drops by reducing the required
pressure to squeeze the dropper
bottle. They are available from some
independent living centres and
pharmacies or can be purchased
directly over the internet.
• Opticare arthro eye drop dispensers
feature long arms which squeeze
levers over the dropper bottle body.
An open basin at the top of the
device sits over the eye and reduces
the need for precision in placing eye
drops. These devices are available
in two sizes for different eye drop
• Auto-Squeeze -- this device is shaped
to bend and fit over eye drop bottles
to assist patients to squeeze the
bottle when dispensing drops.
No matter how eye drops are
administered, once it is in the eye the
patient should be advised to look down
and close the eye without blinking,
squeezing or rolling the eye around.
They should then press the tip of their
index finger gently against the inside
corner of the closed eye (over the tear
duct) for two to three minutes to reduce
drainage, increase the effectiveness
and reduce the amount of systemic
absorption and risk of side effects.
1. eMIMS. Prescribing information: Xalatan monograph.
In: 5.0 ed. Sydney: MediMedia Australia; 2010.
2. Gray TA, Orton LC, Henson D, et al. Interventions for
improving adherence to ocular hypotensive therapy.
Cochrane Database of Systematic Reviews 2009.
Issue 2 Art. No.:CD006132. DOI: 10.1002/14651858.
3. Steiner M. On the correct use of eye drops. Aust Prescr.
4. Glaucoma Australia. What you should know about
eye drops [online]. [Accessed 3 Dec 2010]. At: www.
5. Nordmann JP, Baudoin C, Bron A, et al. Xal-Ease:
impact of an ocular hypotensive delivery device on
ease of eyedrop administration, patient compliance,
and satisfaction. Eur J Ophthalmol. 2009 Nov-Dec;
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