EYE CARE

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EYE CARE
Chapter 11

• Sara Raftery, Mary Clynes and Colleen ONeill

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Introduction

• This chapter explores the requisite standard of
  eye care within the healthcare setting and walks
  you through relevant, eye care related
  procedures.
• Part 1 Eye Care Overview
• Part 2 - Eye Cleansing Overview
• Part 3 Eye Irrigation Procedure
• Part 4 Eye Drops Procedure
• Part 5 Eye Ointment Procedure

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Eye Care

• Eye care is a fundamental aspect of nursing care.
  A lack of attention to the eye, or poor eye care,
  can lead to cross infection and may damage the
  eye, sometimes irreversibly.
• The aim of eye care is to
• Detect quickly any irritation, damage or disease
  of the eye and surrounding area.
• Prevent injury to the eye and surrounding area.
• Prevent eye infections.
• Treat eye infections.
• Prevent corneal damage in the unconscious
  patient.
• Relieve discomfort.
• Irrigate the eye to remove caustic substances
  from it.

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Patients

• Patients who may require eye care include
• Patients who are unable to attend to eye care
  themselves e.g.
• - Patients with a physical inability or weakness
• - Severely ill patients
• - Post operative patients
• - Unconscious patients (Joyce and Evans, 2006)
• Patients with eye infections or eye diseases who
  require the installation of eye drops or eye
  ointments.
• Patients who have suffered a spillage of caustic
  substances into the eye (e.g. domestic cleaning
  agents) and require eye irrigation.

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• PART 2 Eye Cleansing Overview

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General Equipment

• Trolley or tray holding
• - Sterile eye dressing pack
• - Gallipot
• - Non shedding gauze swabs
• Disposable waterproof towel
• Cleansing solution e.g. 0.9 Sodium Chloride (or
  other as advised)
• Receiver for soiled gauze swabs

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Preparing for Eye Cleansing

• Collect and prepare the required equipment in
  order to carry out the procedure without
  unnecessary stoppages.
• Ensure the patients privacy to promote dignity.
• Explain the procedure carefully to the patient to
  gain consent and co-operation and minimise
  patient anxiety.

• Position the patient in a reclined position,
  ideally lying in bed with the head resting on
  pillows to maintain comfort and to ensure ease of
  access to the eyes.
• Wash hands thoroughly using bactericidal handwash
  and dry hands to reduce the risk of cross
  infection.
• Open and prepare the required equipment.

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Procedure for Eye Cleansing

• Place disposable towel under the patients head
  and around the neck in case of spillages.
• Ask the patient to keep their eyes closed while
  the eyelids are cleansed, to reduce any risk of
  corneal abrasion.
• Moisten a non-shedding gauze swab with cleansing
  solution and clean the eyelid from the inner
  aspect to the outer aspect. Use each swab only
  once to reduce the risk of cross infection and
  repeat the procedure until all discharge has been
  eliminated.
• Ask the patient to look up, and swab the lower
  eyelid from inner aspect to outer aspect, using
  each swab once to reduce the risk of cross
  infection. Repeat the procedure until all
  discharge has been eliminated.

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• Take care that the swab does not touch the cornea
  of the eye, as this can cause damage to the eye.
• Dry the eyelid carefully to remove moisture.
• Ensure the patient is repositioned in the desired
  manner on completion of the procedure to promote
  comfort.
• Remove and dispose of equipment to ensure safety.
• Wash hands to reduce the risk of cross infection.
• Document the procedure in the nursing notes and
  report any findings to ensure a written record of
  nursing practice is maintained.

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• PART 3 Eye Irrigation Procedure

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Eye Irrigation

• Eye irrigation is required to remove corrosive
  substances that have spilled into the eye.
• It involves irrigating the surface of the eye
  with copious fluid to aid removal of the
  substance from the eye.

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Equipment Required for Eye Irrigation

• As per general equipment required for eye care
• Sterile 0.9 sodium chloride solution, or sterile
  water
• Towel
• Sterile receiver for irrigating fluid
• Warm water (in a bowl) to heat irrigating fluid
• Irrigating apparatus (irrigating flask or
  intravenous giving set)

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Preparing for Eye Irrigation

• Collect and prepare the required equipment in
  order to carry out the procedure without
  unnecessary stoppages.
• Ensure the patients privacy to promote dignity.
• Explain the procedure carefully to the patient to
  gain consent and co-operation and minimise
  patient anxiety.
• Warm the irrigation fluid to body temperature, to
  ensure the fluid is comfortable for the patient
  when poured over the eye.

• Position the patient in a reclined position,
  ideally lying in bed with the head resting on
  pillows to maintain comfort and to ensure ease of
  access to the eyes.
• Incline head to the side which requires eye
  irrigation, to avoid the irrigation solution or
  corrosive substance running down the face or into
  the other eye.
• Wash hands thoroughly using bactericidal handwash
  and dry hands to reduce the risk of cross
  infection.
• Open and prepare the required equipment.

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Procedure for Eye Irrigation

• Place disposable waterproof towel under the
  patients head and around the neck in case of
  spillages.
• If there is any discharge from the eye, clean the
  area as per the procedure for eye cleansing.
• Position the receiver below the affected eye,
  against the patients cheek to collect the
  irrigation fluid as it drains.
• Inform the patient that the eye will be gently
  held open, as they will be unable to keep their
  eye open when the fluid is poured in.
• Prepare the patient for the procedure by telling
  them when the irrigation fluid is about to be
  poured into the eye.

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• Pour a little irrigation fluid onto the patients
  cheek initially, so that they are familiar with
  the temperature and are comfortable with it.
• Hold the irrigation apparatus above the eye,
  making sure it does not touch the eye, and direct
  the irrigation flow from the inner to the outer
  aspect of the eye to wash the corrosive substance
  away from the lacrimal apparatus and the other
  eye.
• While maintaining a constant flow of irrigation
  fluid, ask the patient to look upwards,
  downwards, right and left to ensure the entire
  eye surface is irrigated.
• Upon completion, remove the receiver and dry the
  eyelids using dry, sterile, non-shedding gauze.
  Dry the patients cheek and face using the towel
  to ensure patient comfort.
• Reposition the patient in the chosen position of
  comfort.
• Remove and dispose of equipment to ensure safety.
• Wash hands to reduce the risk of cross infection.
• Document the procedure in the nursing notes and
  report any findings to ensure a written record of
  nursing practice is maintained.

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• PART 4 Eye Drops Procedure

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Eye Drops

• Eye drops must be sterile. They are available in
  single use applicators and multiple application
  containers. When used in the home, multiple
  application containers should be discarded after
  four weeks even if the solution is unfinished.
  When used in hospital wards it is best practice
  to discard the bottle after one week (BNF, 2006).
  
• Each patient should have their own separate
  bottle, labelled with the patients name.
• If there are particular concerns regarding
  contamination, individual bottles should be used
  for each eye. When a patient has eye surgery, new
  bottles should be used post operatively.

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• Eye drops frequently contain preservatives. There
  is an increased risk of contaminating eye drops
  in preservative free solutions, and when the eye
  is accidentally touched by the applicator during
  the installation of eye drops. (Rahman et al
  2006).
• Eye drops must be stored according to
  manufacturers instructions. Many products
  require refrigeration.

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Rationale

• Eye drops are liquid drug preparations which are
  introduced to the eye. They may be prescribed for
  a patient for a variety of reasons.
• Local anaesthetic eye drops can be used to
  alleviate discomfort following an eye injury, or
  may be administered prior to procedures such as
• Eye irrigation
• Removal of a foreign body from the eye
• Minor eye surgery
• Tonometry (measures the pressure within the eye)

• Antibiotic eye drops may be prescribed to treat
  eye infections.
• Anti-inflammatory eye drops may be prescribed to
  treat inflammatory conditions of the eye.
• Eye muscle constrictors or dilators may be
  prescribed.
• Artificial tears may be prescribed to lubricate
  the eye when a patient has dry eyes.

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Equipment Required for the Installation of Eye
Drops

• As per general equipment required for eye care
• Prescribed eye drops

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Arranging for the Installation of Eye Drops

• Collect and prepare the required equipment in
  order to complete the procedure without
  unnecessary stoppages.
• Explain the procedure carefully to the patient to
  gain consent and co-operation and minimise
  patient anxiety.
• Check the eye drops against the prescription to
  ensure
• - The prescription is for the correct patient.
• - The prescription is fully completed and
  signed by a doctor.
• - The drug is correct.
• - The dose is correct.
• - The time the drug is to be administered is
  correct.
• - The drug has not expired.
• - The route for the drug administration is
  correct.
• - The eye to which the drug is to be instilled
  is correct.
• - The patient is not allergic to the drug.
• This will ensure that the medication is
  administered safely and accurately to the patient.

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Preparing for the Installation of Eye Drops

• Position the patient with the head tipped back
  and supported to maintain comfort and to ensure
  ease of access to the eyes.
• Wash hands thoroughly using bactericidal handwash
  and dry hands to reduce the risk of cross
  infection.
• If there is any exudate in the eye, cleanse the
  eye as per the procedure for eye cleansing.
• Gently shake the eye drop container to ensure
  even distribution of the drug (Stollery et al,
  2005).

• Taking care not to touch the cornea, use a
  non-shedding gauze swab to gently pull the lower
  eye lid downwards. The swab will absorb excess
  eye drops.
• Ask the patient to look up, and evert the lower
  eyelid to ensure correct placement of the eye
  drops on the conjunctiva and not on the cornea,
  which would cause the patient to blink.
• Taking care not to touch the eye hold the dropper
  just above the eye and place one drop into the
  lower conjunctiva.

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Procedure for the Installation of Eye Drops

• Ask the patient to close the eye gently for
  approximately one minute, to ensure the drug is
  absorbed (Stollery et al, 2005).
• Wipe away any excess solution with the gauze to
  prevent discomfort and potential eye irritation.
• Reposition the patient in the chosen position of
  comfort.
• Remove and dispose of equipment to ensure safety.
• Wash hands to reduce the risk of cross infection.
• Complete the drug prescription document to ensure
  accurate records of drug administration are
  maintained.
• Continue to monitor the patient for effects and
  side effects of the prescribed drug.

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• PART 5 Eye Ointment Procedure

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Eye Ointment

• Eye ointments are drug preparations which are
  introduced to the eye. Eye ointments may be
  prescribed for a patient for a variety of
  reasons
• Where a prolonged drug action is desired, eye
  ointments can be preferable to eye drops.
• Antibiotic eye ointments may be prescribed to
  treat eye infections.
• Eye ointments can provide a protective layer for
  the cornea.
• Eye ointments can offer relief if the eye or
  eyelid is inflamed.

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Equipment Required for the Installation of Eye
Ointment

• As per general equipment required for eye care
• Prescribed eye ointment

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Arranging for the Installation of Eye Ointment

• Collect and prepare the required equipment in
  order to complete the procedure without
  unnecessary stoppages.
• Explain the procedure carefully to the patient to
  gain consent and co-operation and minimise
  patient anxiety.
• Check the eye drops against the prescription to
  ensure
• - The prescription is for the correct patient.
• - The prescription is fully completed and
  signed by a doctor.
• - The drug is correct.
• - The dose is correct.
• - The time the drug is to be administered is
  correct.
• - The drug has not expired.
• - The route for the drug administration is
  correct.
• - The eye to which the drug is to be instilled
  is correct.
• - The patient is not allergic to the drug.
• This will ensure that the medication is
  administered safely and accurately to the patient.

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Preparing for the Installation of Eye Ointment

• Position the patient with the head tipped back
  and supported, to maintain comfort and to ensure
  ease of access to the eyes.
• Wash hands thoroughly using bactericidal handwash
  and dry hands to reduce the risk of cross
  infection.
• If there is any residual ointment or exudate in
  the eye, cleanse the eye as per the procedure for
  eye cleansing.
• Taking care not to touch the cornea, use a
  non-shedding gauze swab to gently pull the lower
  eye lid downwards.

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Procedure for the Installation of Eye Ointment

• Ask the patient to look up, and evert the lower
  eyelid to ensure correct placement of the eye
  ointment.
• Taking care not to touch the eye, hold the
  applicator just above the eye and deliver a line
  of ointment along the lower conjunctiva, from the
  nasal corner in an outward direction.
• Ask the patient to gently close the eye to
  distribute the ointment across it.
• Wipe away any excess ointment with the gauze to
  avoid irritation to the peri-orbital skin.

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• Inform the patient that they may experience a
  slight blurring of vision for a short period, to
  minimise any anxiety.
• Reposition the patient in the chosen position of
  comfort.
• Remove and dispose of equipment to ensure safety.
• Wash hands to reduce the risk of cross infection.
• Complete the drug prescription document to ensure
  accurate records of drug administration are
  maintained.
• Continue to monitor the patient for effects and
  side effects of the prescribed drug.