Recapping Single Use Eye Drop Vials
Part 1 Ancient history
Before the invention of snap-top vials, all multi-dose OTC eye drops were required to contain a preservative to prevent bacterial contamination during use. Use in this case means for the duration that the bottle is open and someone is squeezing its contents into their eyes. Let’s face it, that could be months or years.
OTC eye drops may be labelled with “discard after” instructions such as “discard after 90 days.” This information is on the box, which no one keeps.
Do patients Mr. Sharpie their eye drop bottles with the date they were first opened? I don’t do that, and I’m a trained professional.
Do patients use an eye drop that has not only been open for years, but has expired? All the time.
My favorite moment of the clinic day is when a patient says, “Doc, I’ve been using this eye drop but it isn’t helping,” and then pulls a bottle out of their pocket and the label has been 90% rubbed off.
Part 2 Modern history
Modern eye drop history begins with the appearance of the snap-top vial for preservative free eye drops. Each vial is intended to be used one time and then discarded, although there is enough liquid in the vial for 2 more doses, or sometimes 3 if your aim is good.
Do you recap single use vials? Raise your hand. My hand is raised.
Disclaimer: Single use vials are not intended to be recapped. You know it. I know it. Re-using a vial that has been already used creates a risk that you are putting a drop with bacterial contamination onto the surface of your eye. This has the potential to cause a serious eye infection, which may lead to significant vision loss, total loss of vision, or loss of the eye.
If you have a serious ocular surface disease such as Stevens-Johnson syndrome, graft vs host disease, limbal stem cell deficiency or any other potentially blinding corneal condition, ask your doctor about safely re-capping vials according to the instructions below. If they say no, don’t do it.
Part 3 Be safely unsafe – Tips for re-capping eye drop vials
Once they are open, single use vials are usually not watertight. If you plan to re-cap them, they must be stored upright!
Tip #1 Put the cap back on sideways
Have you ever picked up a vial and tried to decide whether it was already open or not? If not, you don’t want to open it, you want to find the vial you already opened that you know is around somewhere.
If you consistently re-cap with the cap on sideways, then you always know when a vial has been opened.
Tip #2 Throw away all opened vials every night
Don’t use a vial that has been open for more than about 12 hours. Commit to finding and tossing all those opened vials before bedtime. If you are using Tip 1, there should only be one (of each product, if you use more than one type of drop each day).
When in doubt, throw it out.
Tip #3 For scleral lens filling, have a dedicated vial
Use a Mr. Sharpie to mark the vial that is for filling your scleral lenses only.
This vial should not come anywhere near your eyeballs.
Tip #4 Use an empty pill bottle for transport and clean storage
The right size prescription pill bottle makes a handy storage container for your re-capped open vial. You can use the pill bottle to carry a re-capped vial with you to work, and to store that re-capped vial safely on your desktop or countertop or wherever life takes you and your eye drops.
Tip #5 Places you should never store eye drops of any kind
In the car in the summertime (see video).
In the car in general. It’s just not very clean in there. Your cup holder is not clean enough.
For re-capped vials – in your purse, backpack or briefcase, unless you are using Tip 4.
Tip #6 Use a vial holder
I can think of various creative ways to make one for a single vial, or you can buy a holder from Amazon. If you buy one, I vote for the circular variety which keeps the vials further apart from each other and makes it easy to spot the “sideways cap” vial that is already open.
Funny Restasis story: I recently read the original approval package for Restasis and there was substantial concern about the volume of the eye drop in each “single use” vial, and whether patients would therefore be tempted to multi-use them. Allergan had a sufficiently soothing reply to the FDA.
Postscript to the funny Restasis story: When it was first released, Restasis drug reps would give doctors these groovy vial holders that said Restasis on them, to give to patients. Allergan knew perfectly well that this medication was going to be expensive, and patients were going to re-cap to save money. Allergan got a big smack-down from the FDA, which pointed out that the approval was for single use and the manufacturer should not be aiding and abetting multiple use.
Tip #7 Skip the snap-top re-capping hassle
Use a product with a multi-dose preservative free dropper.
