Scott Webb (Host): Today, I have the pleasure of speaking with ophthalmologist, Dr. Alejandro Espaillat, from Prisma Health. We will talk about Eyedrops 101: What They Can—and Can't—Do For Your Eyes.

 ​This is Flourish, the podcast brought to you by Prisma Health. I'm Scott Webb. Doctor, it's nice to have you here today. As I mentioned in the intro there, we're talking eyedrops 101, you know, what they can do what they can't do for our eyes. So, let's start there. Do eyedrops help protect our vision?

Dr. Alejandro Espaillat: Well, eyedrops are one of the most commonly used medications in medicine. They can treat dryness, allergies, glaucoma, infections, and inflammation. But they're not magic. They work best when used correctly and for the right diagnosis, and sometimes they can even make things worse if misused.

Host: Interesting. Right. They're not magic. That's an important point to make today. And we don't want to misuse them. So then, let's talk about some of the eye problems. If they won't protect our vision per se, but what else can they help with? Is it outdoor allergies? Anything else?

Dr. Alejandro Espaillat: Well, they can help for many things. For example, artificial tears for dry eyes. They can relieve dryness. They can improve comfort. They can stabilize tear film, help blurry vision or dryness. But what they can't do is that they cannot cure dry eye disease. They cannot fix severe inflammation or replace medical treatment in advanced cases.

So, artificial tears are like moisturizers for your eyes. They're helpful, but not a cure if there's underlying disease. Allergy drops, they can reduce itching, calm redness from allergies and prevent symptoms if used early. What they can't do, they cannot treat any infections or fixed chronic redness from other causes. So if your main symptoms is itching, well, you have to think of allergy.

Host: Okay.

Dr. Alejandro Espaillat: Now, redness and relief drops to get the red out, they can temporarily reduce redness, but they can treat the cause or be used daily for long-term safety. They can cause rebound redness, dependency, or worsen the dryness.

Redness drops are cosmetic, not therapeutic and that's actually a very important thing that you need to really recognize. So, redness drops are cosmetic and not therapeutic. And we also have medications to control inflammation like steroid eyedrops. And they can treat inflammation, they can calm severe allergies, and they can help after surgery, but they cannot be used casually. They usually cannot be used for long-term without supervision, because they can increase the eye pressure and lead to other diseases like glaucoma or cataracts. We also have antibiotic eyedrops, and they can treat bacterial infections. What they cannot do is, they cannot treat any viral pink eye or speed up any viral conjunctivitis. So, most pink eyes are viral and antibiotic eyedrops don't kill viruses. We also use eyedrops for treatment of the disease called glaucoma. And the problem is that in this disease, the intraocular pressure tends to increase. So, these eyedrops, we use them to lower the eye pressure, to slow vision loss and to preserve sight, but they cannot restore the vision that has already been lost or cure glaucoma. So, glaucoma drops, they protect the vision you still have, but they don't bring back what's gone.

Host: Interesting. Yeah. Because I wanted to follow up and ask you like, are there actually any eyedrops that, you know, improve vision or maybe reduce the need for glasses?

Dr. Alejandro Espaillat: Well, they're very common misconceptions. And, like for example, "Can I use someone else's drops?" Well, no, drops are prescribed for a specific diagnosis. Using the wrong drops can delay treatment or even cause harm.

Also, people ask, "Are natural or herbal drops safer?" Well, no. Natural doesn't always mean safe. Anything you put in your eye needs to be sterile and appropriate for the condition. And the same question that you just asked, if eyedrops can improve vision, well, only if blur is from dryness, inflammation, or pressure. They cannot fix cataracts or macular degeneration and the need for glasses. So, eyedrops can improve vision when the problem is related to the surface of the eye. But they can't replace any surgery or glasses.

Host: Right. I've often wondered this, Doctor, is it okay to use eyedrops every day? I feel like I see people use them, you know, routinely, and I always wonder, "Is that okay? Is that right?"

Dr. Alejandro Espaillat: Well, it all depends on the diagnosis and the reason why. If you're using the eyebrows for lubrication due to dry eyes, yes, you can use those eyedrops every day up to four times a day without any problem whatsoever. If you're using the eyedrops for glaucoma, yes, you must use your eyedrops every day according to the prescription and the indications. So, it all depends for the reason why you're using the drops for.

Host: Gotcha. And, Doctor, how about over-the-counter eyedrops? You know, you go to the drugstore and you see all these different options and my head starts spinning a little bit. Just wondering from an expert, like, are they safe, the over-the-counter stuff?

Dr. Alejandro Espaillat: Yes, as long as they are from a reputable brand. There were some reports recently of some eyedrops that were contaminated, and that led to lots of issues. But those were from a brand that was not reputable and were not sterile. So, you have to ask your eyecare provider, which is the correct brand or brands that could benefit you for lubrication, and to treat the dry eyes mostly.

Host: Yeah. I was going to ask you if folks ever bring their eyedrops in and ask, they say, "Hey, I bought these, are these okay?" Like, is that something that folks should do? Is bring them with us when we go to the doctor?

Dr. Alejandro Espaillat: Yes. If you are a patient and you come to your eyecare provider, you must always bring your eyedrops, the ones that you're using at home regardless of the reason. That would be the best timing for you to ask, if you should continue using those drops or if you should change them or stop them.

Host: Yeah. And, Doctor, I'm sure a lot of us have experienced this where we have red eyes or, you know, eyes are being irritated. And we make an appointment and we come in. And then, while we're there, even though they were super red the day before, they're not red anymore. Any sense of why that happens?

Dr. Alejandro Espaillat: It could be, again, for many reasons. It could be from simple dry eyes, to allergies, to inflammation, to trauma. So, It is very important to also ask about other symptoms like pain or light sensitivity or irritation or drainage. So, those are the things that you will discuss with your eyecare provider in order to find the right and correct diagnosis.

Scott Webb: Sure. And, Doctor, how about the sun? A lot of us spend time in the sun. I've been wearing sunglasses most of my life, whether it was, you know, to protect my eyes or because they look cool or to keep the sun out of my eyes. But is the sun bad for our eyes? And if so, would eyedrops make any difference?

Dr. Alejandro Espaillat: Well, the sun radiates ultraviolet light A, B, and C. Ultraviolet light A and B can actually harm the eyes, not only causing dry eyes, but also affecting the retina. And in some patients, leading to something called macular degeneration, as well as the formation of cataract. So, you have to have some protection with polarized sunglasses that would deviate the sun ray, in a way that would not be harmful to your eyes. So, yes, I deeply believe that you have to use sun protection.

Host: Sure. How about eyedrops and contact lenses? Do those things go together? And if so, how do they work together?

Dr. Alejandro Espaillat: A contact lens, it is a very important part of the tools that we have in order to provide good vision for patients. But they are, in reality, a foreign body that you are applying and putting in contact with your eyes. So, they need to be properly fitted as well as you have to clean them properly to prevent any infections, which are very common in patients with contact lens use, as well as severe dryness and irritation and inflammation.

If you wear contact lenses, you have to use them according to the manufacturing prescriptions, as well as the way they were instructed to be used by your eye care provider, and you have to keep them clean. Plus, you need to use regular lubricating eyedrops in order to facilitate and prevent any foreign body sensation in your eye.

Host: Yeah. I am sure, Doctor, there are folks out there that use multiple kinds of drops, types of drops every day, maybe allergy, prescription, whatever it might be. And provided that's okay, do they need to space them out? And if so, how should they be spaced out?

Dr. Alejandro Espaillat: Well, it is important to remember that as we grow older, we tend to produce less tears. The quality of our tears is not the same. And we tend to also use medication for other reasons. And all of those things can lead to severe dryness. Especially patients who are with medication for high blood pressure or medications for glaucoma, they can induce some toxicity to the eye.

So, dry eyes is a severe condition that would affect lots of people, especially here in South Carolina, during the winter and the spring months. And so, using lubrication accordingly, it is extremely important, but you have to also use the right lubricating drops. Because the tears are formed of a layer of water, mucus, and oil. That's the composition, the normal composition of the tears. So if you're missing one of those elements, then the dryness would be due to that particular element being missed. So, you have to use the artificial tears that would provide that missing element and not just any drop.

Host: Right. So, we can use different types of drops in the same-day. Is there any recommendation for spacing them out? Should we do them one right after the other, or do we need to allow a little bit of time in between?

Dr. Alejandro Espaillat: You can use different drops every day. For example, patients with glaucoma, they use glaucoma drops and, at the same time, they use artificial tears for lubrication, usually you have to space the drops about three to five minutes in between. Because otherwise, if you do it much closer, then one will wash the other one. So, you have to space them at least three minutes in between. Sometimes you have to shake the bottle well and follow your instructions accordingly.

Host: Yeah. And in terms of the instructions, Doctor, I feel like I've never been particularly good at using eyedrops. I always feel like I get more in one eye than the other eye, or I miss one eye entirely. Is there a correct way, if you will, to apply eyedrops to ensure maximum effectiveness?

Dr. Alejandro Espaillat: Absolutely. The best and the proper drop technique usually starts with washing your hands. Then, you tilt your head back. You pull your lower lid down. And then, you instill one drop only. Then, you close your eye gently, wait 10 seconds. And most of the time, if you're using medication, you can press the inner corner for one minute. That would guarantee that the eyedrop will stay there for the time that it needs.

Host: Right.

Dr. Alejandro Espaillat: One drop is enough. You do not need to instill more than one drop at the same time. The eye can't hold more than that. So, one drop is enough. So, you don't need to be instilling like two, three drops at the same time thinking that more is better, no.

Host: Yeah. And I'm sure we've all been there thinking, you know, whether it was dry eye or whatever it was, more is better. But as you say, your eye can only hold so much. So more isn't better. It's been great to have you here, Doctor. Great to have your expertise. Just final thoughts, takeaways when we think about using eyedrops, when, how, why, all that good stuff.

Dr. Alejandro Espaillat: When to see the doctor, well, the red flags are usually pain, light insensitivity, sudden vision loss, trauma or symptoms lasting more than one week or thick discharge. If it hurts or affects your vision significantly, don't self-treat. You have to get evaluated by an eye care provider.

So, eyedrops are powerful tools when used correctly. The key is matching the right drop to the right diagnosis. When in doubt, don't guess. Your eyes are too important.

Host: Right, way too important, as you've said here today. Eyedrops are generally safe and effective, but they're not magic. When in doubt, speak with our provider. Maybe bring them with, say, "Hey, Doc, are these okay?" So I appreciate everything today. Thank you so much.

Dr. Alejandro Espaillat: Thank you very much, Scott. Have a great day.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.