Consuming a Whole Coconut for Better Health

The various parts of the coconut have a number of culinary uses. In this article, we will show you how to crack open a whole coconut to extract its:

• Coconut meat
• This is the main part you want to consume for better health
• A good way to consume coconut meat is adding it to your smoothies^[1]
• Coconut water

for your consumption.

How to Crack Open a Coconut

There are multiple ways of cracking open a coconut. You can see one of them here on Youtube. However, there is a better way of doing it if you have a good Chinese chef's knife as shown below.

Using the lower corner of the blade (i.e., highlighted circle), you can cut open the top part of the skull—which is the weaker part of it —as shown in the picture. As always, be cautious when you use the knife.

As we have said, the most nutritious part of coconut is its meat (i.e., the white, fleshy part). After cut open a hole on the top and pour out the coconut water, you can then use a table spoon to scoop out its meat from inside.

Health Benefits

As shown in [2,3,10], coconut—especially coconut oil—provide countless health benefits . In [4,6], we have also shown that the whole is greater than the sum of its parts. So, you should buy a whole coconut and consume it as described in this article.

Similar to the approach of a reductionist in nutrition, we have highlighted the individual nutrition constituent below^[5]

• Coconut meat
• Per 100 gram serving with 354 calories, raw coconut meat supplies a high amount of total fat (33 grams), especially saturated fat (89% of total fat) and carbohydrates (24 grams) (see below table). Micronutrients in significant content include the dietary minerals, manganese, iron, phosphorus and zinc (see below table).
• Coconut water
• Per 100 gram (100 ml) serving, coconut water contains 19 calories and no significant content of essential nutrients.
• Mature fruits have significantly less liquid than young, immature coconuts

Nutritional value of coconut meat per 100 g (3.5 oz)
Energy	354 kcal (1,480 kJ)
Carbohydrates	15.23 g
Sugars	6.23 g
Dietary fiber	9.0 g
Fat	33.49 g
Saturated	29.698 g
Monounsaturated	1.425 g
Polyunsaturated	0.366 g
Protein	3.33 g
Tryptophan	0.039 g
Threonine	0.121 g
Isoleucine	0.131 g
Leucine	0.247 g
Lysine	0.147 g
Methionine	0.062 g
Cystine	0.066 g
Phenylalanine	0.169 g
Tyrosine	0.103 g
Valine	0.202 g
Arginine	0.546 g
Histidine	0.077 g
Alanine	0.170 g
Aspartic acid	0.325 g
Glutamic acid	0.761 g
Glycine	0.158 g
Proline	0.138 g
Serine	0.172 g
Vitamins
Thiamine (B1)	(6%) 0.066 mg
Riboflavin (B2)	(2%) 0.020 mg
Niacin (B3)	(4%) 0.540 mg
Pantothenic acid (B5)	(6%) 0.300 mg
Vitamin B6	(4%) 0.054 mg
Folate (B9)	(7%) 26 μg
Vitamin C	(4%) 3.3 mg
Vitamin E	(2%) 0.24 mg
Vitamin K	(0%) 0.2 μg
Minerals
Calcium	(1%) 14 mg
Iron	(19%) 2.43 mg
Magnesium	(9%) 32 mg
Manganese	(71%) 1.500 mg
Phosphorus	(16%) 113 mg
Potassium	(8%) 356 mg
Sodium	(1%) 20 mg
Zinc	(12%) 1.10 mg
Other constituents
Water	46.99 g

Photo Credit

• World Traveller

References

1. Smoothie Recipes for Better Health
2. Countless Uses for Coconut Oil – The Simple, the Strange, and the Downright Odd
3. Oil Pulling for Your Oral Health—Why and How?
4. The Whole Is Greater Than the Sum of Its Parts (Travel and Health)
5. Coconut (Wikipedia)
6. THE SECRET INGREDIENT IN YOUR ORANGE JUICE
7. 5 Survival Foods to Consider for Your Emergency Supplies
• Coconuts with the thick husk intact can be stored for up to six months if kept cold; husked coconuts will keep up to 2 months. Once the hard shell of a coconut is cut open, coconut meat deteriorates rather quickly at room temperature, so needs to be consumed as quickly as possible.
8. Top 10 Ways Your Body Benefits From Coconut Water
9. Cocos nucifera (L.) (Arecaceae): A phytochemical and pharmacological review
• Coconut water seems to have protective effects, e.g., on the kidney and heart, and antioxidant activity, as well as a hypoglycemic effect.
10. Polyphenolics isolated from virgin coconut oil inhibits adjuvant induced arthritis in rats through antioxidant and anti-inflammatory action

Tai Chi Chuan Step-by-Step Instructions (3/8)

In simplified Yang-Style Tai Chi Chuan, it is composed of 24 forms. See below articles for the details:

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions 
3. Tai Chi Tips 

Clock-Facing Position

Whatever position you take at the start of the form (or whatever direction the center of your chest
and navel face) consider that starting position to be facing the 12 o'clock position.^[2] In this article, all our demonstrations use this viewing direction (or back view as you would follow a master in a lesson).

When the center of your chest and navel face the 12 o'clock position, your right side faces 3 o'clock, your back side faces 6 o'clock, and your left side faces 9 o'clock.

3 of 8

The best way to learn simplified 24 forms is to learn the whole session in 8 parts.  In the above diagram, we show you 3/8 which includes:

4. Left Grasp Sparrow's Tail (Zuo Lǎn Què Wěi, 左揽雀尾), Grasp the Bird's Tail
   • 9 o'clock
5. Right Grasp Sparrow's Tail (You Lǎn què wěi, 右揽雀尾)
• turn around and face 3 o'clock

Below you can find the matching video(s) of 3/8 taught by master 李德印 and demonstrated by 邱慧芳. in Chinese.

左揽雀尾 右揽雀尾

taichi 24 forms part 3 a

taichi 24 forms part 3 b

References

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions  (Travel and Health)
3. Tai Chi Tips (Travel and Health)

Tai Chi Chuan Step-by-Step Instructions (2/8)

In simplified Yang-Style Tai Chi Chuan, it is composed of 24 forms. See below articles for the details:

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions 
3. Tai Chi Tips 

Clock-Facing Position

Whatever position you take at the start of the form (or whatever direction the center of your chest
and navel face) consider that starting position to be facing the 12 o'clock position.^[2] In this article, all our demonstrations use this viewing direction (or back view as you would follow a master in a lesson).

When the center of your chest and navel face the 12 o'clock position, your right side faces 3 o'clock, your back side faces 6 o'clock, and your left side faces 9 o'clock.

2 of 8

The best way to learn simplified 24 forms is to learn the whole session in 8 parts.  In the above diagram, we show you 2/8 which includes:

4. Brush Knee Push Step (Zuoyou Lōuxī Àobù, 左右搂膝拗步), Brush Knee and Twist Step, LEFT and RIGHT
• 9 o'clock
5. Right Hand Strums Lute (Shǒuhūi Pípā, 手挥琵琶), Strum the Lute, Play Guitar
• 9 o'clock
6. Repulse Monkey (Zuoyou Dào juǎn gōng, 左右倒卷肱), Step Back and Drive Monkey Away, LEFT and RIGHT
• face 9 o'clock, but move backwards

Below you can find the matching video(s) of 2/8 taught by master 李德印 and demonstrated by 邱慧芳. in Chinese.

左右搂膝拗步 手挥琵琶 左右倒卷肱

taichi 24 forms part 2 a

taichi 24 forms part 2 b

References

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions  (Travel and Health)
3. Tai Chi Tips (Travel and Health)

Tai Chi Chuan Step-by-Step Instructions (1/8)

In simplified Yang-Style Tai Chi Chuan, it is composed of 24 forms. See below articles for the details:

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions 
3. Tai Chi Tips 

Clock-Facing Position

Whatever position you take at the start of the form (or whatever direction the center of your chest
and navel face) consider that starting position to be facing the 12 o'clock position.^[2] In this article, all our demonstrations use this viewing direction (or back view as you would follow a master in a lesson).

When the center of your chest and navel face the 12 o'clock position, your right side faces 3 o'clock, your back side faces 6 o'clock, and your left side faces 9 o'clock.

1 of 8

The best way to learn simplified 24 forms is to learn the whole session in 8 parts.  In the above diagram, we show you 1/8 which includes:

1. Opening (Qǐshì, 起势), Preparation, Beginning
• 12 o'clock
2. Part the Horse's Mane (Zuoyou Yémǎ Fēnzōng, 左右野马分鬃), LEFT and RIGHT
• 9 o'clock
3. Crane Spreads Wings (Báihè Lìangchì, 白鹤亮翅), Stork/Crane Cools Its Wings
• 9 o'clock

Below you can find the matching video(s) of 1/8 taught by master 李德印 and demonstrated by 邱慧芳. in Chinese.

起势 左右野马分鬃 白鹤亮翅

taichi 24 forms part 1 a

taichi 24 forms part 1 b

References

1. Yang-Style Tai Chi Chuan 24 Forms
2. Tai Chi Chuan—Directional Instructions  (Travel and Health)
3. Tai Chi Tips (Travel and Health)

Esophageal Cancer Risk and Alcohol Flush Reaction

In this article, we will discuss the link between esophageal cancer and alcohol flush reaction:

• Alcohol flush reaction
• is redness or flushing in the face or neck after consuming alcohol.
• Esophagus cancer^[17]
• Esophagus is the muscular tube that connects the throat and stomach.
• Cancer can form in the tissues that line the esophagus.

Higher Esophageal Cancer Risk If You Flush Easily

One Japanese study has found that: you're at higher esophageal cancer risk if you flush easily with drinking. The study found that about 1/3 of Japanese, Korean, and Chinese are "aldehyde dehydrogenase" deficient which make them flush easily with drinking and people who flush easily have 6-10 times higher risk of getting esophageal cancer than individuals who don't flush easily.

Alcohol Flush Reaction

Alcohol is metabolized by several enzymes. It is first broken down into acetaldehyde, a harmful substance that is then converted to harmless acetic acid (or vinegar). When high levels of acetaldehyde occur in the blood, the following “hangover” symptoms occur:

• Facial flushing
• Light headedness
• Palpitations
• Nausea

These symptoms are indicative of a disease known as the Alcohol flush reaction, also known as “Asian Flush” or “Oriental Flushing Syndrome”.^[16]

Enzyme and Gene

Aldehyde dehydrogenase (ALDH2) plays a crucial role in maintaining low blood levels of acetaldehyde during alcohol oxidation. Unfortunately, there is a mutant form of aldehyde dehydrogenase, termed ALDH2*2,

A gene is a locus (or region) of DNA that encodes a functional RNA or protein product, Genes can acquire mutations in their sequence, leading to different variants, known as alleles, in the population. These alleles encode slightly different versions of a protein, which cause different phenotype traits.

ALDH2 gene contains instructions for producing aldehyde dehydrogenase. A variant called ALDH2*2 in this gene results in an inactive enzyme. For individuals with the mutant allele:

• Homozygous individuals (with mutant alleles present on both homologous chromosomes)
• have almost no ALDH2 activity
• Heterozygous individuals
• have reduced activity.

Esophageal cancer

Esophageal cancer ^[6] is one of the common malignancies, with an increasing incidence and a high mortality in both developed and developing countries. Esophageal cancer exists in two main forms with distinct etiological and pathological characteristics:

• Esophageal squamous cell carcinoma (ESCC)
• Adenocarcinoma.

Whereas adenocarcinoma is more prevalent in the USA and some other Western countries, ESCC is the predominant type in the other parts of the world, especially in Asia, accounting for >90% of esophageal cancer worldwide.

How to Lower Your Risk

Most of esophageal cancer patients are over 60 and more common in men. If you're at higher risk, pay attention to the following advice:

1. Don't eat foods that are burning hot. Wait until it cools down a little bit.^[5]
2. Stop smoking.^{[4, 9]}
• Cigarette smoking and heavy drinking are the two major causes of esophageal cancer, especially when combined.
3. If you have Gastroesophageal reflux disease (GERD), treat it immediately. The acid burns the tissue and makes it rough and scarred, which is where the cancer begins to grow.^[12]
• Place a tall book (of the same thickness) underneath both posts of your bed frame on the side of your headboard. This will keep your bed at a slight angle so that the acid will go down instead of up into your esophagus.
• Avoid red sauces like tomato sauce, garlic, and things with caffeine like peppermint tea or chocolate.
• Do not wear control top underwear, because it is very tight and squeezes the acid up into your esophagus.
4. Avoid swallowing lye or other caustic substances.
5. Avoid dietary substance such as nitrosamine. High temperatures, as in frying, can enhance the formation ofnitrosamines.
6. Don't overweight.
• Obesity increases the risk of adenocarcinoma fourfold.
• When you gain weight, the stomach gets pulled down from the extra weight and the kink that is usually between the esophagus and the stomach gets pulled out. This results in that connective area getting very thick, which can lead to Esophageal Cancer.^[12]
7. Avoid alcohol^[19]
• There is strong evidence that alcohol causes cancer of the liver, colon, rectum, esophagus, larynx, pharynx and female breast.
8. If you have been infected with the Helicobacter pylori bacterim, treat it immediately.^[9]
9. Reducing radiation exposure to the chest.^[9]
10. Avoid red sauces like tomato sauce, garlic, and things with caffeine like peppermint tea or chocolate.
11. Take a vitamin E supplement
• High blood levels of alpha-tocopherol, a form of vitamin E, may lower the risk of developing cancer of the stomach and esophagus, according to new research from China.
12. NSAIDs
• Risk appears to be less in patients using aspirin or related drugs (NSAIDs).^{[2, 6]} 
• However, be warned that aspirin is a blood thinner and overdosing can cause excessive bleeding (see [10] for more side effects). 
13. Consuming more cruciferous foods
• According to the National Cancer Institute, diets high in cruciferous (cabbage, broccoli^[11], cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer^[2] 
14. Moderate coffee consumption
• Moderate coffee consumption is associated with a decreased risk too^{.[2, 7]} 
15. Zinc
• Zinc supplements can significantly inhibit the proliferation of esophageal cancer cells, according to a study co-authored by a University of Texas at Arlington researcher.^[21]
• Zinc can protect us against esophageal cancer.^{[3, 8]}

References

1. 日本研究发现：喝酒易脸红易罹食道癌
2. http://en.wikipedia.org/wiki/Esophageal_cancer
3. "Younger you" by Eric R. Braverman, M.D.
4. Factors associated with carcinoma of the oesophagus at Mulago Hospital, Uganda.
5. An Epidemiological Study of Precursor Lesions of Esophageal Cancer among Young Persons in a High-Risk Population in Huixian, China
6. Expression of macrophage migration inhibitory factor in esophageal squamous cell carcinoma and effects of bile acids and NSAIDs
7. Coffee and tea intake and risk of oral, pharyngeal and esophageal cancer
8. Zinc Deficiency Linked to Increased Risk of Less-Common Form of Esophageal Cancer
9. American Medical Association Complete Guide to Prevention and Wellness
10. Pros and Cons of Aspirin
11. Boosting Broccoli's Anti-Cancer Effect
12. Dr Oz: What Causes Heartburn?
13. ERCC1 Levels Strongly Associated with Survival in Esophageal Cancer
14. Digestive System
15. Red face after drinking suggests high blood pressure
16. Thomasson HR, Edenberg HJ, Crabb DW; et al. (April 1991). "Alcohol and aldehyde dehydrogenase genotypes and alcoholism in Chinese men". American Journal of Human Genetics 48 (4): 677–81.
17. The top 10 deadliest cancers -- and why there is no cure
• 1. Lung Cancer 2. Colon Cancer 3. Breast Cancer 4. Pancreatic Cancer 5. Prostate 6. Leukemia 7. Non-Hodgkin lymphoma 8. Liver Cancer 9. Ovarian Cancer 10. Esophageal cancer
18. Spitting up in babies: What's normal, what's not
• Normally, a muscle (lower esophageal sphincter) between the esophagus and the stomach keeps stomach contents where they belong. Until this muscle has time to mature, spitting up might be an issue — especially if your baby is relatively full.
19. Alcohol's cancer risks outweigh any health benefits, study shows
20. This is your brain on alcohol
• Even moderate drinking is associated w/ shrinkage in areas of the brain involved in cognition and learning
21. Zinc can halt the growth of cancer cells, study says
22. Alcohol, ‘Asian glow’ mutation may contribute to Alzheimer’s disease, study finds

Eye Health: How to Choose an OTC Drop

The understanding of dry eye disease has advanced recently through increasing recognition that the etiology of the condition involves both tear evaporation^[5] and insufficient tear production, and that tear film instability and inflammation play roles in the various stages of the disease.^[1]

In this article, we will review over-the-counter (OTC) drops used for dry-eye symptoms from two perspectives:

• What to consider
• What to avoid

What to Consider

Artificial tears are eyedrops used to lubricate dry eyes and help maintain moisture on the outer surface of your eyes. They are available without a prescription. When choosing an OTC artificial tear to manage dry-eye symptoms, you need to know the underlying cause of your dry eye first. Based on that finding, you then consider other factors such as:

1. Ingredients of the tear
• Common artificial tear ingredients include tonicity, buffering, viscosity, wetting, and lubricating agents; antioxidants; and preservatives^[7]
• Good products should mimic the biphasic nature of tears by providing a lipid and an aqueous component to the tear
• Consulting with your doctor to find if you have more of an aqueous deficiency, mixed disease or an evaporative form of dry eye, then make the decision
• Choose products with lower osmolarity
• May have a better effect on the ocular surface based on some studies
• Tonicity agents adjust the preparation’s osmolality
• Choose products with Osmoprotectants
• Osmoprotectants L-carnitine and erythritol, alone or in combination, protect against stress activation of corneal epithelial cells cultured in hyperosmolar media
• They are taken up by cells, and they blunt the response of the epithelial cells on the surface of the eye to high osmolarity in the tears.
2. Severity of symptoms
• Patients with mild dry eye
• May prefer a watery drop like Refresh Plus
• Problem with a watery drop
• Sometimes they really don’t last much longer than three to four minutes
• Patients with more severe dry eye
• May prefer a thicker drop that stays on the cornea longer.
• A thicker drop may decrease friction in the eye and lubricate the eye better
• “For more severe dry-eye patients and for patients who have many erosions on their corneal surface, I would prefer a thicker, more viscous drop, such as Refresh Celluvisc or Systane Ultra preservative-free,” Dr. Latkany says.^[2]
• Problems with a thicker drop
• It tends to blur the vision because they are gooey and sticky
• Some people use them at night, but you can even have blurred vision for an hour or so after you wake up in the morning
• It leaves more residual foreign particles in the eye
• It allows allergens and other chemicals to stick to the tear film
• High-risk individuals, postmenopausal females, patients requiring 4 or more drops of artificial tears per day, and patients with rheumatologic conditions
• Should strongly be considered candidates for anti-inflammatory therapy.^[6]

What to Avoid

“Self-selection of medications is not a good idea,” says Dr. Sheppard. “Invariably, when patients bring in their drops, they will be the Wal-Mart or Safeway brand of tears, which are by far the most inferior tears on the market.

Based on [2], here are the products to avoid:

1. Topical vasoconstrictor like Visine
• Which induces vascular fragility, rebound vasodilation and dependence upon the vasoconstrictor to maintain a quiet, white-looking eye.
2. Artificial tears using preservatives such as benzalkonium chloride (BAK)
• A recent study conducted at the University of Illinois at Chicago found that topical application of BAK to the eye causes:^[2,9,10]
• Corneal neurotoxicity^[10]
• Inflammation
• Reduced aqueous tear production

Finally, heed the following advice:

• After starting on an artificial tear, you needs frequent follow-up by eye doctors to determine whether the drop is relieving symptoms.
• Avoid using drops too frequent
• Patients were quoted to be using drops every 30 minutes or every hour, and this has a deleterious effect on their lifestyle and well-being.
• Be warned that artificial tears are helpful as adjunctive agents, but that they are not the answer for dry-eye patients.
• “None of these can come close to the complexity of our natural tears,” Dr. Latkany says.^[2,13]

References

1. Systane® lubricant eye drops in the management of ocular dryness
2. OTC Drops: Telling the Tears Apart
• Dr. Sheppard says. “The hydroxypropyl-guar in Systane provides an excellent matrix for the aqueous component of the tear. Refresh Optive Advance as well as Soothe from Bausch + Lomb provide a lipid substitute to better stabilize the tear film. Another valuable additive to over-the-counter tears is hyaluronic acid, which can be found in Blink tears from Abbott,” he explains.
3. Sarkar J, Chaudhary, Namavari A, et al. Corneal neurotoxicity due to topical benzalkonium chloride. Invest Ophthalmol Vis Sci 2012;53(4):1792-1802.
4. Corrales RM, Luo L, Chang EY, Pflugfelder SC. Effects of osmoprotectants on hyperosmolar stress in cultured human corneal epithelial cells. Cornea 2008;27:574-579.
5. Effect of systane and optive on aqueous tear evaporation in patients with dry eye disease.
6. DRY EYE SYNDROME
7. Power Graphics. Common ingredients in artificial tears. 1999;3(1):1–2.
8. I have dry eyes. What should I look for when selecting artificial tears? (Mayo Clinic)
9. Becquet F, Goldschild M, Moldovan MS, et al. Histopathological effects of topical ophthalmic preservatives on rat corneoconjunctival surface. Curr Eye Res. 1998;17:19-25;410–425.
10. Corneal Neurotoxicity Due to Topical Benzalkonium Chloride
11. Dry Eye: Proper Administration of Artificial Tears (Travel to Health)
12. Oxidative Preservatives and Dry Eye
• Blink® Tears with OcuPure™ preservative is preservative-free in the eye.
13. The Microscopic Structures of Dried Human Tears
• Both tears of grief and joy are psychic tears, triggered by extreme emotions, whether positive or negative. Would a tear of grief look any different than a tear of joy?

Dry Eye: Proper Administration of Artificial Tears

Dry eye is sometimes referred to as “a nuisance complaint — it’s not the sexiest of eye problems.” Nonetheless, said Dr. Rachel Bishop, chief consulting ophthalmologist at the National Eye Institute, “Dry eye disease deserves serious professional — and personal — attention. It can be very debilitating and seriously diminish a person’s quality of life.”^[12]

According to the the Dry Eye Workshop report, prevalence of dry eye ranges from 5–30% in people aged 50 years and older.^[1]

The management of dry eye involves various strategies and therapeutic approaches, which include:

• Find out the underlying cause of the dry eye^[10]
• Select a good and affordable OTC drop^[11]
• This turns out to be very important after some eyedrops made in India were found tainted with a drug-resistant superbug^[18,19]
• Get rid of day eye naturally^[13]

In addition, proper administration of dry eye medications remains vital to a successful treatment.

Preservative-Free Eye Drops

Artificial tear formulations are typically buffered solutions that contain electrolytes, surfactants, and one or more viscosity agents or lubricants, and may or may not also contain a preservative.^[1]

However, for long-term usage of eye drops, you may want to avoid artificial tears using preservatives such as benzalkonium chloride (BAK).  Why?  Based on a recent study conducted at the University of Illinois at Chicago, scientists have found that topical application of BAK to the eye may cause:^[5-7]

1. Corneal neurotoxicity^[7]
2. Inflammation 
3. Reduced aqueous tear production

Recommended Ways of Product Use

In the following discussions, we will focus on two areas:

1. Different forms of artificial tear preparations — liquids, gels, or ointments
2. Preservative or preservative-free drops

For optimizing benefit from ophthalmic medications, here are the recommended way of product usage:

1. General instructions
• If using two different types of eye drops, instill the first, wait 5 minutes, then instill the second.
• If using drops and ointment, instill the drop first, wait 5 minutes, then apply ointment.
• When using products in single-use vials, agitate the container so that the color and/or opaqueness of its contents are uniform. 
2. Preventing contamination
• For patients who need to instill artificial tears several times daily, larger containers of medication are desirable
• British researchers observed that patients who frequently apply eye drops may need to carry multiple single-dose containers, which are cumbersome.^[2] They also recognized that purchasing single-dose containers can be more than 1,000 percent as expensive. 
• If you want to save remaining medication for use beyond the first day, then consider:
• Dry eye medications have been tested and scientists have found that they remained uncontaminated when exposed to room air for as long as 28 days
• However, to reduce the risk of infection to a level with which we are relatively comfortable.  Here are what Dr. Perry and Dr. Donnefeld have advise their patients:^[3]
• Preservative-free artificial tears are free of contamination the day they are opened, are probably not contaminated on the second day, but are likely contaminated on the third day and must be discarded
• Wash hands before opening container
• Prevent container tip from touching the eye
• When finished, tighten container cap
• Single-use vials should be used immediately after opening and discarded after use
3. Eye Drops
• Instilling instructions
• Lean head back. 
• Instill eye drops by gently sliding skin below eyelid over prominent point of cheekbone to form pocket. 
• Put one drop into pocket. 
• Close eye and refrain from blinking for about 1 minute. 
• Press tightly (but not tightly enough to cause injury) with one finger on inside corner of eye for about 30 seconds after instilling drop. 
• Use only 1 drop at a time.
• The eye’s conjunctival fornix can accommodate only 1 drop at a time. Any fluid beyond 1 drop will overflow. 
4. Ointment
• Application instructions
• Start at inside corner of eye
• Squeeze thin line (about 0.5 cm) of medication along inside of lower lid
• Blink
• Artificial tear ointments may offer longer lasting relief but may cause blurred vision and, as such, may work best just before bedtime.

References

1. An Overview on Dry Eye Treatment: Approaches for Cyclosporin A Delivery
2. Eye Health: How to Choose an OTC Drop (Travel to Health)
3. Oldham GB, Andrews V. Control of microbial contamination in unpreserved eyedrops. Br J Ophthalmol. 1996;80:588–591.
4. Issues in the UseOf Preservative-Free Topicals
5. OTC Drops: Telling the Tears Apart
6. Becquet F, Goldschild M, Moldovan MS, et al. Histopathological effects of topical ophthalmic preservatives on rat corneoconjunctival surface. Curr Eye Res. 1998;17:19-25;410–425.
7. Corneal Neurotoxicity Due to Topical Benzalkonium Chloride
8. "Help Improve Your Vision with Simple Exercises" (Dr. Mercola)
9. How to Get Rid of Dry Eyes Naturally
10. How do I soothe dry eye symptoms?
11. Eye Health: How to Choose an OTC Drop (Travel to Health)
12. Dry Eyes Deserve Attention
13. How to Get Rid of Dry Eyes Naturally
14. Five Dry Eye Treatments Unheard of by Most People
15. Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?
• “Optometrists can handle nearly all the medical aspects of ophthalmology. But they do not perform surgery,” Dr. Wagenberg explains.
16. Sjogren's Syndrome (Dr. Weil)
• The most common symptoms are dry eyes or dry mouth.
17. Systemic omega-6 essential fatty acid treatment and pge1 tear content in Sjögren's syndrome patients
• Omega-6 administration increases the PGE1 levels in tears of patients with SS and improves ocular surface signs and symptoms of ocular discomfort.
18. How Eyedrops Contaminated With a Superbug Blinded and Killed Americans (Bloomberg)
• Superbug were found in the over-the-counter eyedrops which were made in India.
• What made the outbreak possible is a gaping hole in the FDA’s supervision of these kinds of medicines.
• Over-the-counter drugs are essentially produced and sold on the honor system.
19. No Testing, No Inspections: Contaminated Eyedrops Blinded and Killed Americans (Bloomberg; 07/17/2023)
• The eyedrops from EzriCare LLC and Delsam Pharma LLC were recalled after the pseudomonas contributed to four deaths, 18 cases of vision loss and scores of infections.