What 'Eye' Did Not Know About Eyedrop Caps

I have been a pharmacist for almost 17 years, and before that, I worked in pharmacies since freshman year of college. You think you have seen everything in a community pharmacy, and then one day, you learn something that knocks your socks (sunglasses, in this case?) off.

Recently, I was surprised to learn that eyedrop cap colors coordinate with their therapeutic class. This practice has been around since 1983, but I asked several other seasoned pharmacists, and they also did not know.

Maybe it’s because we see the boxes, and not the actual eyedrops, that most of us don’t know about this incredibly smart practice. How many times a day does a patient say, 'I need my little white pill?' Yet, I have never once, in all my years, heard any patient say 'I need my blue eyedrops.' As soon as I heard this, I immediately ran upstairs to check my own eyedrops.

Recently, I had a corneal abrasion and, sure enough, my ciprofloxacin eyedrop cap was color-coded tan, and my ketorolac (NSAID) eyedrop cap was gray. It was so surprising to learn this, because we dispense eyedrops all day long, but no one (patients or doctors) mentions the color-coding.

Today, at work, I looked at the eyedrop boxes (not caps, as I did not open the boxes, of course). Sure enough, I noticed just a few examples of the strength, on the box, highlighted in the designated color:

• Timolol (beta blocker) highlighted in yellow
• Dorzolamde (carbonic anhydrase inhibitor) in orange
• Moxifloxacin, ciprofloxacin, ofloxacin, and gatifloxacin (anti-infectives) in tan
• Diclofenac in gray (non-steroidal anti-inflammatory)
• prednisolone (steroid) in pink
• Cyclopentolate (mydriatic/cycloplegic) in red

According to its website, the American Academy of Ophthalmology (AAO), 'endorses the uniform use of a color-coding system for the caps and labels of topical ocular medications.' This policy, first published in 1983, came about from reports to the Academy and to the National Registry of Drug-Induced Ocular Side Effects. There were serious adverse events occurring because patients had a difficult time telling their eye drops apart. The Academy’s Committee on Drugs, in combination with the FDA, developed a uniform color-coding system.

Specific Pantone colors were assigned to different classes of ocular drugs according to the nature of the disease, side-effect profile, and risk of serious events if a product is inadvertently switched with another. The AAO reports that voluntary cooperation between the pharmaceutical industry, the FDA, and the AAO has been very effective in achieving the goal of patient safety, when each drug class is assigned a specific Pantone color as described.

The American Glaucoma Society (AGS) strongly endorses this practice, stating that this color-coded system is essential for patients, their families/caregivers, and practitioners, to easily identify eyedrops. The system is essential for visually impaired patients to independently manage and administer their own eyedrops for chronic diseases of the eye, such as glaucoma. The system also enhances communication between the patient and provider when assessing patient adherence.

The AGS also states that this system is important for those patients with multiple topical eye medications, or with other eye diseases, and it is important for patients recovering from surgery, who need to rely on eyedrop color codes while their vision recovers. There are also many illiterate patients who can only maintain adherence with color-coded tops. Even when a patient cannot recall the name of the medication, he/she can usually recall the color. Physicians often provide patients with schedule aids that reference the color codes.

I think color-coding is brilliant! This is certainly both fascinating and informational for me, and I hope I have 'opened your eyes' to a practice that many pharmacists do not know about.

Do you have a fun fact? Share with me at karenmichelleberger@gmail.com