Should eye drops be used before or after meals?

“Good morning Dokita,” Mama Bose greeted me as usual. “Good morning young lady,” I replied teasing. At 69, she looked more like 49. I asked if all was well and she was using her medications. “Certainly, I use my medicines regularly,” was her enthusiastic response.

A few minutes later, my tests, confirmed she wasn’t really using her medications. She certainly hadn’t used them that morning. “Mama  Bose, why aren’t you telling me the truth? You certainly haven’t used your medicines today?”

I avoided telling her she was lying. In Yoruba culture, it is rude to tell an older person or a stranger she is lying to her face. It is not proper! But you can say what it is in a roundabout way that what she is saying is not exactly correct! Pure semantics!

“It is because I haven’t eaten,” she replied. It was about 10am. The only reason I had given her an appointment for that day was to see if the new medicine I had prescribed for her was working adequately or not. If it was effective, I could leave her on the medication. If on the other hand, it wasn’t, I would have to change to another type. Now, what would I do? Obviously, she would have to repeat the visit on another day!

A few minutes after this encounter, Chief Daruba, another patient came in. He had been on treatment for glaucoma for a number of years. Chief had not been good at using his medications. I had scolded him many times but it didn’t appear to have made any impact on him. He was seeing very well and for him that was all that mattered. He couldn’t understand what all the fuss was about.

From experience, I knew that Chief would soon become apprehensive. He had lost a considerable portion of his visual fields and even though he could still see very well, he was actually sitting on the edge of a cliff! He could suddenly lose the remaining nerve fibres in his right eye and go blind if he continued with his lackadaisical attitude. I checked his intraocular pressure. My fears were confirmed. It was exactly the same value as at the last visit before I introduced the new eye drops.

“My dear Chief,” I said affectionately, looking at him straight in the eye, “you have not used your medications. Why?” He smiled wryly. His answer hit me like a bomb! I was dumbfounded.  I thought my ears were misbehaving. I repeated the question in another way. He held on to his statement, “Doctor, I haven’t eaten, how could I put drops in my eyes? I usually use the tablets after my breakfast and then follow with the drops.” Must you eat before you instil eye drops in your eyes?”, I asked.

As ridiculous as it sounded, I was later to discover that he was not alone. Some patients chose to use their eye drops after eating. How this idea came about I wouldn’t know.  Some said that the bitter taste of the medicine passing into their throat made their food unpalatable. Others claimed eye drops often provoked them to vomit if used before food.

I decided to find out a bit more on how patients used their eye medications. The result was fascinating.  Peter told me that he would only use his eye drops if he didn’t have any important engagement within three hours of using them. They make his vision blurry. He wasn’t alone!

I discovered that limitation of activity was a major impediment to the use of eye drops. This shouldn’t come as a surprise. The eye is for seeing and if for any reason a medicine that is supposed to promote healthy eyes makes it impossible for the patient to see well, it is unlikely to find favour with him.

Many patients found it inconvenient to use eye drops more than twice a day except they were in severe pain or discomfort. At the best, they would use it in the morning and night even if told they should use it three or more times daily.

Is there really any scientific basis for taking medicines after meals? Are there medicines that should be taken on an empty stomach? Which medicine should be taken after meals? Should you use eye drops before or after meals? What has eye drops got to do with vomiting? Watch out for the answers to these questions and more next week.