Compounded Eye and Ear Preparations: What Patients Should Know in Brampton

Eye drops and ear drops seem simple. A few drops, a quick blink or a tilt of the head, and you’re done. But eyes and ears are sensitive places, and medicines made for them have strict requirements. Eye preparations in particular need to be comfortable, the right acidity and concentration, and free from contamination. Ear preparations need to stay where they’re placed and be gentle on the delicate ear canal.

Most eye and ear medicines are commercially manufactured. Occasionally, though, an ophthalmologist, optometrist, family doctor, ear specialist or veterinarian needs a strength or formula that isn’t available. Pharmasave Kensington in Brampton lists ophthalmics and otics among the specialty areas on its compounded prescriptions page, describing them as eye-related and ear-related preparations that may be customised when a prescriber determines a specific strength, formulation or application is needed.

This article explains what these preparations involve and, most importantly, how to use them safely at home.

Why eye preparations are held to high standards

The surface of the eye is delicate and highly sensitive. Anything placed on it must be comfortable, compatible with the tear film, and, for most eye drops, sterile. A contaminated eye drop can cause a serious infection. That’s why preparing sterile eye drops requires specialised facilities, equipment and procedures beyond those used for creams or capsules.

Canadian compounding standards distinguish between non-sterile preparations, such as most creams and oral liquids, and sterile preparations, which include many eye drops. Pharmacies that prepare sterile products must meet additional requirements. If you’re prescribed a compounded eye preparation, it’s reasonable to ask the pharmacy how it’s prepared and, if it’s made elsewhere, where. Your prescriber and pharmacist can explain the arrangements.

When an eye preparation might be compounded

Prescribers may request a compounded eye preparation when:

• The required strength of a medicine isn’t commercially available.
• A product has been discontinued or is in short supply.
• A patient needs a preservative-free version because of sensitivity to preservatives found in commercial drops.
• A specific combination or vehicle is needed.

In veterinary care, compounded eye preparations are relatively common. Pharmasave Kensington’s veterinary compounds page lists several ophthalmic oil solutions, such as cyclosporine and tacrolimus in oil, which veterinarians may prescribe for certain eye conditions in dogs. These are prescribed and monitored by a veterinarian.

Using eye drops correctly

Technique makes a real difference to how well eye drops work and to avoiding contamination. Ask the pharmacist to show you, but in general:

1. Wash your hands thoroughly.
2. Check the label to make sure you have the right product and the right eye.
3. Tilt your head back and gently pull down the lower eyelid to form a small pocket.
4. Hold the bottle above the eye without letting the tip touch your eye, eyelashes, fingers or any surface.
5. Place one drop into the pocket. More than one drop usually just overflows.
6. Close your eye gently for a minute or two and press lightly on the inner corner near the nose. This helps keep the drop in the eye.
7. Wait at least five minutes between different eye drops, unless instructed otherwise, so the second doesn’t wash out the first.
8. Replace the cap immediately.

If you use contact lenses, ask whether you need to remove them before using drops and how long to wait before putting them back in.

Storing eye preparations

Compounded eye preparations, especially preservative-free ones, often have short beyond-use dates and may need refrigeration. Follow the label precisely. Note the date you open the bottle, and don’t use it beyond the date given, even if there’s liquid left. Never share eye drops with anyone else, even family members with similar symptoms, since this can spread infection.

If a drop changes colour, becomes cloudy or contains particles, stop using it and contact the pharmacy.

Keeping track when you use several eye drops

People with long-term eye conditions often use more than one eye drop, sometimes several times a day, and adding a compounded preparation to that routine can get confusing. Bottles can look alike, the schedule may differ between the left and right eye, and some drops need refrigeration while others don’t. Mix-ups are common, especially for older adults or anyone whose vision is already affected.

A few simple systems help. Write a chart listing each drop, which eye it goes in, how many drops, and the times of day, and tick off each dose. Put a coloured sticker or rubber band on each bottle to match the chart. Keep refrigerated drops together in one labelled container in the fridge, and room-temperature drops together in another spot. If a family member helps, make sure they use the same chart.

Bring all your eye drops, including over-the-counter lubricating drops, to the pharmacy for a medication review. The pharmacist can check the order and spacing, flag duplicate ingredients, and suggest ways to simplify the routine. If you have trouble squeezing bottles or aiming drops because of arthritis or a tremor, ask about eye drop aids, which are small devices that hold the bottle steady over the eye.

When a compounded drop is added, ask exactly how it fits into the existing schedule. Should it go before or after the others? Does it replace one of them? A clear answer at pickup prevents guesswork later.

Ear preparations and how they differ

Ear preparations, called otic preparations, are used for problems in the ear canal, such as infections, inflammation, itching or wax. The ear canal is skin-lined and less sensitive to contamination than the eye, so most ear preparations don’t need to be sterile. Prescribers may request compounded otic preparations for a particular combination of ingredients, strength or base.

An important safety point: some ear medicines should not be used if the eardrum is perforated or if you have ear tubes, because ingredients could reach the middle ear. Tell your prescriber if you’ve ever had a perforated eardrum or tubes.

Using ear drops well

General tips, to be adapted to your product’s instructions:

• Warm the bottle in your hands for a few minutes. Cold drops can cause dizziness.
• Lie on your side with the affected ear facing up.
• For adults, gently pull the outer ear up and back to straighten the canal. For young children, gently pull down and back.
• Place the prescribed number of drops without touching the dropper to the ear.
• Stay lying down for a few minutes, or as instructed, to let the drops reach the canal.
• Wipe away any excess on the outer ear.

If you’re using drops in a child’s ear, having a second adult to help hold and comfort the child can make it easier.

Avoid cleaning the ear canal with cotton swabs while using ear drops, as this can push debris deeper and irritate the skin. Ask whether you should keep the ear dry during treatment; some prescribers recommend a cotton ball lightly coated with petroleum jelly in the outer ear while showering, and avoiding swimming until the course is finished.

Ear and eye medicine for pets

Many dog and cat owners in Brampton manage ear and eye conditions in their pets. Pets often resist drops, and some veterinary preparations are compounded because the needed strength or vehicle isn’t available. Your vet will show you how to apply eye or ear medicine to your pet. Keep the pet’s medicine clearly labelled and stored separately from family medicines, and don’t use human eye or ear products on pets unless your vet specifically tells you to.

Warning signs to act on promptly

With eye problems, contact a healthcare provider urgently if you notice sudden vision changes, severe eye pain, sensitivity to light, a red eye with blurred vision, or an injury to the eye. With ear problems, seek prompt care for severe pain, sudden hearing loss, discharge with fever, swelling behind the ear, or dizziness.

If symptoms worsen after starting a new eye or ear preparation, or if you notice burning, swelling or redness that’s more than mild and brief, stop and contact the pharmacist or prescriber.

Questions to ask about an eye or ear compound

• Is this preparation sterile, and how should I avoid contaminating it?
• How should it be stored, and when does it expire after opening?
• How many drops, how often, and for how long?
• Should I space it from other drops I use?
• Can I wear contact lenses or swim while using it?
• What should I do if I miss a dose?
• What will it cost, and is it covered by my plan? Check with your insurer as well.

Ask Pharmasave Kensington about eye and ear prescriptions

If your prescriber or veterinarian has mentioned a compounded eye or ear preparation, the team can explain the process and show you how to use it correctly. Good technique and storage go a long way toward a safe, effective treatment.

Pharmasave Kensington is at 106-18 Kensington Road, Brampton, ON L6T 4S5. Call (905) 792-3100, visit the contact page for store information, or request a pharmacist consultation through the booking page.

General information only. Eye and ear symptoms can be serious; seek prompt medical care for pain, vision changes or hearing loss, and use prescribed preparations exactly as directed.