Eye Drops, Ear Drops and Nasal Sprays: How to Give Them Correctly (and Teach Patients to Do the Same)

Eye drops, ear drops and nasal sprays seem simple, so they often get less attention than injections or IV medicines. But poor technique means the medicine may not reach where it’s needed, can cause harm or spread infection. Many patients use these medicines at home for long periods, for example glaucoma drops, so teaching them well is just as important as giving them correctly in hospital.

General principles for all three

• Follow the rights of medication administration: right patient, medicine, dose, route, time, and documentation. Check which eye, ear or nostril (left, right or both).
• Check expiry dates. Many eye drops must be discarded a set time after opening (often 28 days). Write the opening date on the bottle.
• Use each container for one patient only to prevent cross-infection.
• Wash hands before and after. Wear gloves if there is discharge or per local policy.
• Explain the procedure and get consent.
• Don’t let the tip of the bottle touch the eye, ear or nose.

Eye drops

1. Ask the patient to sit or lie with the head tilted back, looking up.
2. Clean any discharge from the eyelids with sterile saline and gauze, wiping from the inner corner outward, using a new swab for each wipe.
3. Gently pull down the lower eyelid to form a small pocket.
4. Hold the bottle above the eye (about 1 to 2 cm away), resting your hand on the patient’s forehead for stability.
5. Instil the prescribed number of drops into the pocket, not directly onto the cornea.
6. Ask the patient to close the eye gently (not squeeze) for 1 to 2 minutes.
7. Apply gentle pressure to the inner corner of the eye (nasolacrimal occlusion) for about 1 to 2 minutes. This keeps the medicine in the eye and reduces absorption into the body, which matters for drops such as beta-blockers for glaucoma.
8. Wipe away any excess.
9. If more than one type of eye drop is prescribed, wait about 5 minutes between different drops so the first isn’t washed out.

Eye ointment

1. Pull down the lower lid as above.
2. Squeeze a thin line of ointment (about 1 cm, or as prescribed) along the inside of the lower lid, from the inner to the outer corner, without touching the eye.
3. Ask the patient to close the eye and move it gently to spread the ointment.
4. Warn the patient that vision will be blurred for a while.
5. If drops and ointment are both prescribed, give drops first.

Ear drops

1. Warm the bottle to body temperature by holding it in your hand for a few minutes. Cold drops can cause dizziness.
2. Ask the patient to lie on their side with the affected ear facing up, or tilt the head.
3. Clean any discharge from the outer ear with a clean swab (don’t insert into the canal).
4. Straighten the ear canal:
   • In adults and older children (over about 3 years): gently pull the outer ear (pinna) upward and backward.
   • In young children under about 3 years: gently pull the pinna downward and backward.
5. Instil the prescribed drops against the side of the canal, not directly onto the eardrum.
6. Gently press the tragus (the small flap in front of the ear) a few times to help drops move into the canal.
7. Ask the patient to stay in position for about 2 to 5 minutes.
8. A cotton wool plug may be placed loosely in the outer ear if advised, but not pushed in.

Check whether the eardrum is perforated before giving some ear drops; certain antibiotic and other drops may be harmful with a perforation. Ask the prescriber if unsure.

Nasal sprays

1. Ask the patient to blow their nose gently.
2. Shake the spray if instructed, and prime it if it’s new or hasn’t been used for a while.
3. Ask the patient to tilt the head slightly forward (not back).
4. Close one nostril by pressing gently on the side of the nose.
5. Insert the nozzle just inside the other nostril, pointing it slightly outward, away from the centre of the nose (the septum). A useful tip: use the right hand for the left nostril and the left hand for the right.
6. Spray while the patient breathes in gently through the nose.
7. Ask them not to sniff hard, which sends the medicine to the throat.
8. Repeat in the other nostril if prescribed. Wipe the nozzle and replace the cap.

Nasal drops

For nasal drops, the patient lies on their back with the head tilted back over the edge of the bed or a pillow, or kneels with the head down. Instil the drops and ask them to stay in position for 1 to 2 minutes.

Common errors

• Touching the tip to the eye, ear or nose, contaminating the bottle
• Giving drops in the wrong eye or ear
• Using expired or shared containers
• Not waiting between different eye drops
• Pulling the ear in the wrong direction for a child
• Tilting the head back for nasal sprays, sending medicine down the throat
• Overusing decongestant nasal sprays (more than about 5 to 7 days) causing rebound congestion

Teaching patients

Many patients struggle with self-administration, especially older people with arthritis, tremor or poor eyesight. Help them by:

• Demonstrating the technique, then watching them do it (teach-back)
• Suggesting aids, such as eye drop dispensers that help squeeze and aim
• Giving written instructions in their language, including timing and the opening date
• Explaining what side effects to watch for (for example, stinging, redness, blurred vision)
• Involving carers if needed

Correct technique means the medicine works as intended, fewer complications, and more confident patients.

References

• NHS: Glaucoma treatment and using eye drops
• WHO fact sheet: Blindness and vision impairment