Topical medication instillation techniques for glaucoma

Population: participants with glaucoma or ocular hypertension

Settings: ophthalmology clinics

Intervention: any intervention aimed to increase effectiveness or reduce adverse events when using topical medications (e.g. eyelid closure, nasolacrimal occlusion, removal of excess fluid after instillation)

Comparison: no intervention

Proportion of participants with IOP < 21 mmHg

at 1 year' follow‐up

‐

Mean IOP change from baseline

at 1 year' follow‐up

1 trial reported that reduction of IOP was similar in eyes when the eyelid was kept closed for up to 3 minutes after instillation of drops than fellow eyes that did not practice eyelid closure at 2 weeks (MD ‐0.33 mmHg, 95% CI ‐0.8 to 1.5; 51 participants); moderate‐certainty evidence.¹

Participant‐reported outcomes related to the ease, convenience, and comfort of instillation

at 1 year' follow‐up

‐

Physiologic measurements of systemic absorption

at 1 year' follow‐up

‐

Escalation of therapy

at 1 year' follow‐up

‐

Mean change in visual fields

at 1 year' follow‐up

‐

Adverse events

at 1 year' follow‐up

1 trial with up to 4 months' follow‐up reported that eyelashes were shorter among eyes when participants had wiped to remove excess fluid compared with fellow eyes that were not wiped (MD ‐1.70 mm, 95% CI ‐3.46 to 0.06; 10 participants) and fewer eyes had eyelash growth of > 1.5 mm when wiping compared with not wiping (RR 0.11, 95% CI 0.01 to 1.24); low‐certainty evidence.^1,2

This same trial also reported that fewer eyes showed skin hyperpigmentation in the eyelid region towards the nose when wiping compared with not wiping (RR 0.07, 95% CI 0.01 to 0.84); however, the difference was not certain when assessing skin hyperpigmentation in the eyelid region towards the temples (RR 0.44, 95% CI 0.07 to 2.66) or hair growth on the skin around the eye (RR 1.00, 95% CI 0.17 to 5.98); low‐certainty evidence.^1,2

*The basis for the assumed risk is the risk in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio.

GRADE Working Group grades of evidence
High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐certainty: We are very uncertain about the estimate.