What is the proper way to place medication under the eyelid?

Proper Technique for Placing Medication Under the Eyelid

For eye drops, pull down the lower eyelid to create a pocket (the conjunctival sac) and instill the medication there; for ointment, apply approximately 1 cm directly into the lower conjunctival sac or along the lid margin depending on the condition being treated. 1, 2

Eye Drop Administration

• Pull down the lower eyelid to expose the conjunctival cul-de-sac (the pocket between the lower eyelid and eyeball) 3
• Instill the drop into this lower conjunctival sac, not directly onto the cornea 3
• For lubricants in acute conditions (such as Stevens-Johnson syndrome), apply every 2 hours using preservative-free formulations like hyaluronate or carmellose 3
• For routine dry eye management, preservative-free artificial tears are recommended if using more than 4 times daily 3

Eye Ointment Administration

The technique varies based on the condition:

For Conjunctival/Ocular Surface Infections

• Apply approximately 1 cm of ointment directly into the conjunctival sac (the space created by pulling down the lower lid) 1, 2
• For bacitracin: apply 1-3 times daily into the conjunctival sac 1
• For erythromycin: apply up to 6 times daily depending on infection severity 2
• Do not flush the ointment from the eye after instillation 2

For Blepharitis (Lid Margin Disease)

• First remove all scales and crusts from the lid margins 1
• Apply the ointment directly to the lid margins (the edge where eyelashes emerge), spreading it uniformly along the margin 3, 1
• Apply 1-3 times daily or at bedtime 3

Critical Sequencing

Always instill eye drops before applying eye ointment, as ointment will block absorption of subsequently applied drops 4

Key Safety Considerations

• Avoid contaminating the tube tip by not touching it to the eye, eyelid, or any surface 1
• For patients with poor manual dexterity or neurotrophic corneas, assess their ability to safely perform the technique and modify accordingly 3
• In high-risk situations (ventral positioning, head/neck surgery), combine lubricants with eyelid occlusion using adhesive strips 3
• For unconscious patients or those with corneal exposure risk, establish moisture chambers with polyethylene film rather than relying solely on ointment application 3

Common Pitfalls to Avoid

• Do not apply drops or ointment directly onto the corneal surface—always use the conjunctival sac 3
• Do not use oil-based ointments for high-risk surgical procedures 3
• Avoid preserved formulations when using artificial tears more than 4 times daily, as preservatives can damage the ocular surface 3
• Do not blindly sweep the fornices with cotton swabs, as this may cause corneal damage 3