Over-the-counter eye drops and ointments – a practical guide

The eye-drop shelf at the pharmacy can be confusing: dozens of small boxes, similar names and promises of quick relief. Most of what is on that shelf is safe and useful – artificial tears, lubricating ointments, rinsing solutions. But some of the problems that send people to the counter do not need a drop from the shelf; they need an examination. This page explains what you can buy yourself, what is available only on prescription and why, how to apply an ointment correctly, and when you should not treat your eye yourself.

What you can buy without a prescription

Artificial tears (lubricating drops)

These are the most common drops, and they suit a feeling of dryness, burning or “sand in the eyes” – after a day at screens, in air conditioning, in the wind or on a flight. You can use them as needed. If you use drops often – roughly more than six times a day – or your eyes are sensitive, it is better to choose preservative-free drops, sold in single-use vials or special bottles. Preservatives used frequently can irritate the surface of the eye. For the differences between the types, see lubricating eye drops.

Lubricating gels and ointments

A lubricating gel or ointment is thicker than drops and stays on the eye longer, but blurs vision for a while. That is why it is used mainly at bedtime – for example when you wake up with dry, painful eyes, or when the eyelids do not close fully at night. When dryness keeps returning, it is worth finding the cause – see dry eye.

When you search for an “eye ointment”, keep in mind that the same small tube may hold a simple lubricating ointment, sold without a prescription – or a medicine containing an antibiotic and sometimes also a steroid, available only on prescription. They look alike, but one cannot replace the other.

Allergy drops

When the main symptom is itching – usually in both eyes, sometimes with a runny nose and sneezing – the cause is most often allergy. There are antihistamine and mast-cell-stabilising drops; some are sold without a prescription and some only on prescription, depending on the product, and the pharmacist can guide you. What helps alongside them: not rubbing, a cold compress, and artificial tears that dilute the allergens on the surface of the eye. Allergy that returns every season, or itching that does not settle within a few days, warrants an examination – sometimes a different treatment is needed, and sometimes the cause is not allergy at all.

”Redness-relief” drops

Drops that constrict the blood vessels whiten the eye within minutes. The trouble starts when the effect wears off: the redness can come back stronger, and regular use creates a cycle of one drop after another. They are suitable only for occasional, short-term use – no more than a few days in a row – and must not be used by people with a narrow drainage angle in the eye, because they can trigger an acute glaucoma attack. More importantly, they hide the redness without treating its cause. For the common causes of redness, see red eyes.

Saline for rinsing

Sterile saline is suitable for rinsing dust, sand or an eyelash out of the eye. If a chemical gets into the eye, do not look for a special solution: rinse immediately with tap water, generously and for a long time, and then go to the emergency room.

What is available only on prescription – and why

Antibiotic drops and ointments. They treat a bacterial infection, but do not help with viral inflammation, allergy or dryness – and many red eyes belong to one of those groups. Unnecessary use masks the picture and contributes to bacterial resistance. For when they are really needed, see antibiotic eye drops.

Drops and ointments containing a steroid, including combined antibiotic-and-steroid ointments such as Maxitrol. A steroid calms inflammation effectively, and that is exactly why it is dangerous without an examination: it can worsen a viral (herpes) or fungal infection of the cornea, raise the eye pressure without any sensation, and with prolonged use contribute to cataract. This is why you should not use a tube left over from last time, or a family member’s ointment.

Anaesthetic (numbing) drops are never given for use at home. They make pain disappear for a short time, but repeated use damages the cornea’s ability to heal and can cause serious harm. Glaucoma drops, antiviral drops and anti-inflammatory drops are also prescription-only, according to the diagnosis.

How to put in drops and apply ointment correctly

Drops: tilt your head back, gently pull down the lower eyelid and place one drop into the small pocket that forms. One drop is enough – the eye cannot hold more, and the excess simply runs down the cheek. After the drop, close the eye gently for a minute and press lightly on its inner corner, next to the nose. This keeps more of the drop in the eye and lets less of it drain into the throat.

Ointment:

1. Wash your hands.
2. Tilt your head back slightly and gently pull the lower eyelid down to create a small “pocket”.
3. Squeeze a thin strip of ointment into the pocket, without letting the tip of the tube touch the eye, the lashes or your fingers.
4. Close your eyes gently for a moment so the ointment spreads, and wipe off any excess with a clean tissue.

Your vision will be blurred for a short time – so do not drive straight after applying it. If you use both drops and an ointment, the drops come first, and you wait about ten minutes before the ointment. Between two different drops, wait at least five minutes so the second does not wash out the first.

Safety rules for every drop and ointment

• Do not touch the tip of the bottle or tube, and do not share drops with others.
• Check the patient leaflet for how long the product may be used after opening – this varies from product to product. A single-use vial is discarded after use.
• Contact lens wearers: most drops are put in after the lenses are removed, and you wait about a quarter of an hour before putting them back – unless the product is explicitly intended for use with lenses. Do not apply ointment while wearing lenses.
• If burning or redness gets worse after a new drop, stop and seek advice.

When not to treat yourself

In some situations a drop from the shelf only delays the diagnosis. In the following cases you need to be examined by an ophthalmologist – and some of them require care the same day:

• Real pain in the eye – not just irritation – or marked sensitivity to light.
• Reduced vision, or blurring that does not clear with blinking.
• A contact lens wearer with a red, painful eye – see contact lens keratitis.
• An eye injury, an embedded foreign body or contact with a chemical.
• Thick discharge, eyelids stuck together in the morning, or a red eye in a baby.
• A red eye with headache, nausea or halos around lights.
• A history of eye surgery, herpes in the eye or glaucoma.
• Symptoms that have not clearly improved after two or three days of self-care, or that keep coming back.

When to have your eyes examined

When dryness, redness or itching keep returning, when you find yourself putting in drops every hour, or when one of the warning signs above appears – it is time to be examined. Prof. Michael Mimouni, Director of the Cornea Unit at Rambam, sees patients at his clinics in Herzliya Pituach and Haifa. A slit-lamp examination can identify what is really causing the symptoms and tailor the treatment – so that the drops you use at home work for you instead of hiding a problem. Contact us to book an examination.

The information on this page is general and is not a substitute for a personal examination and medical advice. Diagnosis and treatment decisions are made only after a full eye examination. In the case of a chemical injury, severe pain or a sudden drop in vision, go to the emergency room immediately.