Goals of ophthalmic drug delivery:
(1) Minimize tearing (which may dilute the preparation).
(2) Minimize loss of drug through the nasolacrimal duct.
(3) Minimize loss of drug onto adjacent skin.
Steps:
(1) The patient's head should be tilted back so that the cornea is pointing straight up (optical axis is vertical).
(2) Grasp the lower eyelid lightly between the thumb and index finger and pull outward, forming a small conjunctival pocket.
(3) Have the person look "upwards" (towards the forehead). This minimize corneal stimulation when the drug is introduced, which could result in excessive tearing.
(4) Dispense a single drop of the liquid into the small pocket, while keeping the lower eyelid grasped between the thumb and index finger. Unsteadiness in the hand holding the medication bottle can be reduced by resting it on the hand holding the lower eyelid.
(5) Once the drop is placed in the pocket instruct the patient to look down (towards the feet). At the same time bring the lower lid into contact with the upper eyelid.
(6) Release the lower eyelid and instruct the patient to keep the eyelids closed for at least 3 minutes. The patient should not blink, flutter or squeeze the eyelids during this period. Closure of the eyelids prevents ocular fluid from flowing into the nasolacrimal duct.
(7) During the period of eye closure blot any excess liquid that escapes at the inner canthus.
(8) Wait 5-10 minutes before application of a second ophthalmic preparation to the eye.
