Using eye drops may seem simple enough, but a new study reports a majority of patients may not be self-administering them correctly, citing only 3% of its participants were able to properly follow all the recommended steps.

The observational study of 136 community pharmacies in Belgium included 6,758 subjects. Patients were approximately 69 years old and used drops for at least one month. Participants demonstrated their eye drop technique and completed a questionnaire. The study reported 98% of patients could get the drops in their eyes, but 14% had to make more than one attempt to do so.

The most common mistakes patients made were touching the bottle to their eye or eyelid (40.7%), failing to close the eye post-drop (67.8%) and not performing nasolacrimal occlusion for at least one minute after drop instillation (94.7%).

“Importantly, we found that 20% of ophthalmic suspensions were not shaken before use,” the researchers wrote.

Additionally, 40% of patients reported at least one problem with eye drop instillation.

Patients said their biggest issues were difficulties in getting a drop in their eye (18.3%), too many drops coming out of the bottle (14.6%) and difficulty squeezing the bottle (12.2%). Only about half of the sample recalled having any education in eye drop instillation technique.

The researchers suggested community pharmacists could take a proactive role in detecting and resolving these issues.