For many people, the arrival of summer is synonymous with holidays, hot weather and open-air activities. For patients with glaucoma, the season may bring a variety of challenges and lead to doubts that we hope to resolve in this post.

Glaucoma and sunlight

Ultraviolet light can cause damage to the eyes without the right protection. Light is reflected off surfaces like water or sand and can cause burns in the surface structures of the eye (the conjunctiva and the cornea). When there is exposure over a long period, damage to more internal structures, such as the crystalline lens or the retina, has been described.

The specific case of glaucoma also involves the sensitivity to light and the tendency to be dazzled that these patients usually experience. These symptoms may be considerably improved by wearing good-quality sunglasses and a double-brimmed or peaked hat.

Glaucoma and flying

Patients sometimes ask whether the changes in atmospheric pressure during a regular flight can affect glaucoma. In fact, changes in pressure inside the cabin are rigorously controlled these days and are made very gradually as the plane climbs and descends. As a result, the effect on eye pressure (intraocular pressure) is almost non-existent. However, these changes act on the volume of gas in the air, which could affect patients who have recently undergone retina surgery. Surgeons sometimes leave a gas bubble to keep the retina in its place. This may last for 6-8 weeks and can expand with altitude changes, increasing intraocular pressure suddenly.

In general, patients who have undergone retina surgery and who have received gas are advised that flying during these months is contraindicated. These gases are not used in glaucoma surgery and therefore such patients do not usually face restrictions when flying. In any event, it is best to ask the ophthalmologist before travelling, above all when surgery has taken place recently, in order to make sure.

In any case, the air inside the cabin is normally very dry. This means that it is recommendable to use artificial tears, especially in patients with glaucoma who take drops chronically and who show a greater tendency to suffer from dry eye. Likewise, we recommend that –just like any other medication- they always carry glaucoma drops in their hand luggage to avoid missing doses in the case of delays, longer flights or loss of luggage. The bottle should be closed to avoid spillages and kept in a cool place to avoid overheating.

Summer and glaucoma drops

Changes of locality can make adherence to the treatment more difficult and can lead to doubts about storing glaucoma drops. Most pharmaceutical companies recommend keeping the drops at 15-25ºC, so if we are travelling to warmer zones we should try to prevent the drops being exposed to direct sunlight and keep them in a cool place when we arrive at our destination. The instruction leaflet normally explains how a medicine should be kept. If you are still unsure, you can ask your chemist or find out on the website of the pharmaceutical company involved.

Picture: Lovely beach by Luke Ma.

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Drops are the most common treatment for reducing intraocular pressure (eye pressure) and are often the first therapeutic option when glaucoma is diagnosed. It is the ophthalmologist who will inform us which type of drop we need to apply and how often a day we should do so.

Despite being applied topically –directly into the eye– we should not forget that these drops are medicines and should therefore be used in a specific way (one or more times a day depending on the active ingredient). Nor should we forget that they may have side effects (especially eye irritation, dryness, red eye etc.).

As glaucoma is a chronic illness, drops must be applied for a long time, possibly years. It is most important to apply the treatment correctly as proper control of intraocular pressure is the only method that has been shown capable of halting glaucoma.

Here is a short set of recommendations that may help us with the treatment:

1. Follow the instructions of the ophthalmological specialist
It is the ophthalmologist who will inform us which type of drop we need to apply and how often we should do so. Some drops are more effective in the morning (e.g. timolol) and others at night (e.g. latanoprost). In addition, the more advanced the glaucoma the lower the eye pressure needs to be. This may mean that more than one medication needs to be taken.

2. Tricks to help us remember to take the treatment
Often the most difficult part of the treatment is remembering to apply the drops when required as this may be at a set time of day (morning, night etc.) If we get used to inserting the drops at the same time as we perform a daily activity (e.g. putting on cream in the morning, cleaning our teeth or leaving the drops on the bedside table by a book we read before going to sleep etc.), it is much easier to remember to carry out the treatment properly.

For technology fans, a good idea is to make use of our mobile phone alarms or smart apps that inform us when it is time for our drops (e.g. EyeDROPS)

*What to do if we forget?
If we forget to take drops and a short time has elapsed (e.g. one or two hours), we should administer the dose and continue normally with the treatment. If a longer time has passed (four or five hours), it is better to wait until the next dose. 

3. Adopt the right technique
Doing this right will ensure the drops enter properly and the intraocular pressure is better controlled.
• Wash your hands properly 
• Move your head backwards slightly whether you are seated, standing or lying down. Gently press your lower lid downwards with your index finger to form a small “pocket”.
• Look upwards. Press the bottle until a drop comes out and falls into pocket of the lower eyelid. Do not blink, do not rub your eye and do not allow the tip of the bottle to touch your eye.
• Close your eye as if you were asleep. Keep your eye closed for two or three minutes without blinking. Gently press the inner corner of your eye (the area of the lacrimal point) with your index finger and thumb for these two or three minutes (this will reduce the amount of drops that enter the throat and go on to the rest of your body).
• Remove any remaining product around your eyes with a gauze cloth.
• If you need to insert another drop, you must always wait at least five or ten minutes between the two. This will prevent the second drop from washing the first away and will ensure that the treatment is effective.

Fig.1 Drawing of the correct technique for inserting the drops (Source: Glaucoma Research Foundation: www.glaucoma.org)

4. Store the drops properly
It is important to keep the bottle for as long as the medicine lasts and throw it away when it is out of date or it has been open for 28-30 days (depending on the drug). After this time, the efficacy of the drops cannot be ensured. We should keep the bottle clean and take care to avoid direct contact with the eye and the face as it could become contaminated. The medicine should be rejected if it changes colour as it could be spoilt. It should not be directly exposed to sunlight nor to a high temperature (preferably at 20-25º). Most drops should be stored at room temperature in a cool place.

*Points of interest: 
• Some drops must be kept in the fridge in exceptional circumstances.
• Monodose drops are appearing increasingly on the market (i.e. instead of a bottle that lasts a month, these are in a box with thirty individual miniature bottles). This system is more hygienic as we open a bottle each day and then throw away the remains, minimising the risk of contamination. In addition, they can help us to remember to take the treatment as there is a miniature bottle for each day and it is more evident when we have forgotten a dose.

5. Look out for side effects
Drops are medicines and we should treat them as such. It is important to make sure that our ophthalmologist is aware of any disease we suffer from and of any other medications we are taking. Each type of medication has its possible side effects that need to be taken into account and discussed with the patient without forgetting that control of pressure is vital to maintain visual function.

Most glaucoma drops produce minor side effects such as eye irritation, dryness, slightly red eye etc. If new symptoms appear on starting new drops for eye pressure it is important to tell the ophthalmologist.

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