Hesperian Health Guides

Problems with the Eyes and Seeing: Medicines

How to use eye ointment or eye drops

Wash your hands before and after applying eye drops or eye ointment because many eye infections spread easily through touching a person’s face and then your own eye. Eye drop bottles come with a seal. Help the person break the seal and show them how to squeeze out 1 drop.

To be effective, eye drops and ointment must go inside—not outside—the eyelid. Ointment will last longer in the eye and work well overnight but will blur vision temporarily making drops more convenient during the day.

 how to put medicine in tube into lower eyelid and another image demonstrating how to put eye drops into eye
To avoid spreading germs, do not let the tube or the dropper touch the eye.

To use eye ointment, gently pull down the lower eyelid and squeeze a thin line of ointment along the length of the eye, starting at the inner corner.

To use eye drops, pull out the lower eyelid to make a small pouch and gently squeeze 1 to 2 drops into it while looking up. Gently close your eye but try not to blink. Most of the drop will spread around the eye surface.

Common types of eye drops

Eye drops with antibiotics are used to treat an infection by germs (bacteria). Eye antibiotics also come as ointments. Antibiotic eye drops and ointments will not help irritated or red eyes caused by a virus.

Eye drops with antihistamines relieve watery, red, and itching eyes caused by allergies. Cold compresses on the eyes can help calm itching eyes and cost nothing.

Eye drops for lubrication, called “artificial tears” or “natural tears,” are used for eyes that feel dry. They can be used up to 4 times a day and at night just before sleep. Resting with warm compresses over closed eyes 1 to 2 times a day for 5 to 10 minutes can help your eyes make more of their own moisture.

Eye drops with natamycin are sometimes used by health workers to prevent fungal infections when there is an ulcer on the cornea.

Eye drops with tetrahydrozoline or naphzoline shrink the tiny blood vessels so the eyes look less red. Because they do not cure the cause of a red eye, they are a waste of money.

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Eye drops with steroids (such as prednisolone or dexamethasone) reduce eye inflammation after surgery or from some other eye diseases. If used incorrectly, steroid eye drops can cause severe harm to the eye or may hide a problem that needs other treatment. Some drops mix antibiotics and steroids (often adding ‘Dex’ or ‘Pred’ to the name). Use eye drops with steroids only when specifically recommended by an experienced health worker.

Antibiotic eye treatments

Antibiotic eye treatments have the word “eye” or “ophthalmic” on the label to show they are safe for use in the eye. Do not use antibiotic skin ointments in the eyes.

Antibiotic eye ointment and antibiotic eye drops treat eye infections caused by bacteria and treat ulcers on the cornea. Erythromycin or tetracycline eye ointment is used at birth to protect a newborn baby’s eyes from infections that may pass at birth.

Common antibiotic eye treatments include:

  • 1% tetracycline eye ointment
  • 0.5% or 1% erythromycin eye ointment
  • 0.3% ciprofloxacin eye drops or ointment
  • 0.3% ofloxacin eye drops
  • 0.3% gentamycin eye drops
  • 10% sulfacetamide eye drops
  • 0.5% chloramphenicol eye drops
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For an eye drop or an eye ointment to work, it must be put inside—not outside—the eyelid. Show the person you are helping how to use them.

For conjunctivitis (pink eye) caused by bacteria

Use the antibiotic eye ointment or antibiotic eye drops 4 times a day for 7 days in both eyes. Even if the eye seems better, use the antibiotic treatment for all 7 days so that the infection does not come back. Sometimes it takes 2 days for the medicine to start working.

For an ulcer on the cornea

Apply antibiotic eye drops every hour and send the person for help. The drops are applied every hour for 24 hours and then, if improving, drops are applied 4 times a day for 7 days. More advanced help is needed if the eye does not improve in 2 days. For an ulcer on the cornea, never use drops or ointment that contain steroids.

For trachoma

If azithromycin pills are not available, tetracycline antibiotic eye ointment can be used. Use 1% tetracycline antibiotic eye ointment in both eyes, 2 times a day every day for 6 weeks.

For newborn babies to prevent eye problems

Antibiotics are used to protect the newborn baby’s eyes from infection that can pass to the baby during birth. After gently wiping the eyelids with a cloth and water immediately after birth, use one of these antibiotic ointments with every newborn baby in both eyes within the first 2 hours:

1% tetracycline OR 0.5% to 1% erythromycin ointment Put a thin line of ointment in each eye, 1 time only, within 2 hours after the birth.

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Gently pull down the lower eyelid and squeeze a thin line of ointment along the eye moving from the inside corner outward. Do not let the tube touch the baby’s eye and do not wipe the ointment away.


If there is no ointment, use:
2.5% solution of povidone-iodine

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Put 1 drop in each eye, 1 time only, within 2 hours of birth.

Azithromycin

Azithromycin is an antibiotic that treats many infections including trachoma, for which just 1 dose by mouth is needed. Where health authorities have campaigns to eliminate trachoma, azithromycin may be offered to the whole community to cure current infections of trachoma and prevent new ones at the same time.

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For trachoma

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Children 6 months and older, up to 40 kg. To dose by weight: give at least 20 mg per kg by mouth in a single dose, but do not give more than 1000 mg (1 g).
For young children, liquid azithromycin is mixed to a strength of 200 mg/5 ml. For example, a child weighing 10 kg would take a single 5 ml dose (200 mg).
Give older children azithromycin by mouth. Pills usually come in 250 mg. It is safe to give a little more instead of dividing pills in half. For example, give 500 mg for children that weigh between 20 kg and 30 kg. Give 750 mg for children that weigh between 30 kg and 40 kg.
Programs distributing azithromycin often determine the dose based on the height of the child.
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Young people that weigh over 40 kg and adults (including pregnant women): give 1000 mg (1 g) by mouth in a single dose. Taking 4 pills that each have 250 mg is the same as 1 g.
When azithromycin is given to the whole community for prevention, doses may be given once every year for 3 years.
If azithromycin by mouth is not available, trachoma can be treated with antibiotic eye ointment. Use 1% tetracycline antibiotic eye ointment in both eyes, 2 times a day every day for 6 weeks.

Vitamin A, retinol

Vitamin A prevents night blindness and xerophthalmia.

To get enough vitamin A, people need to eat enough yellow fruits and vegetables, dark green leafy vegetables, and foods such as eggs, fish, and liver. In areas where night blindness and xerophthalmia are common and eating enough of these foods is not always possible, give children vitamin A every 6 months.

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Do not use more than the suggested amount. Too much vitamin A from capsules, tablets, or oil can be dangerous. Do not give the regular adult dose of 200,000 U to girls or women who could become pregnant, or women in the first 3 months of pregnancy because this can harm a developing baby. For pregnant women, vitamin A is given in smaller doses more often instead of a single large dose.

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Swallow pills or capsules. But for young children, crush tablets and mix them with a little breast milk. Or cut open capsules and squeeze the liquid into the child’s mouth.

To prevent vitamin a deficiency in children

As part of a prevention program:

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6 months to 1 year: give 100,000 U by mouth one time.
Over 1 year: give 200,000 U by mouth one time. Repeat every 6 months.


To treat night blindness

If someone already has difficulty seeing or has other signs of night blindness, 3 doses are given. The first dose is given right away, the second is given one day later and the third dose at least 2 weeks later.

For each of the 3 doses:

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Under 6 months: give 50,000 U by mouth in each dose.
6 months to 1 year: give 100,000 U by mouth in each dose.
Over 1 year: give 200,000 U by mouth in each dose.
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For pregnant women: give 25,000 U by mouth weekly in pregnancy for 12 weeks. If she has continued signs of night blindness or another severe eye problem from lack of vitamin A, an experienced health worker may give a pregnant woman a larger dose.

For children with measles

Vitamin A can help prevent pneumonia and blindness – two common complications of measles.

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Under 6 months: give 50,000 U by mouth 1 time a day for 2 days.
6 months to 1 year: give 100,000 U by mouth 1 time a day for 2 days.
Over 1 year: give 200,000 U by mouth 1 time a day for 2 days.

If the child has already received a dose of vitamin A in the last 6 months, give this treatment for one day only. If someone with measles is severely malnourished or already starting to lose her vision, give a third dose of vitamin A after 2 weeks.




This page was updated:10 Jan 2020