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Eye Care

Gail P. Mooney, MSc, PG Social Research Methods, RGN, lecturer, School of Health Science, University of Wales, Swansea.

Why is it done?


Why is it done?



Eye care is carried out for a number or reasons: to clean the eye of discharge and crusts; prior to eye drop installation; to soothe eye irritation; to prevent corneal damage/abrasion in the unconscious/sedated patient.



Equipment needed



• Clean trolley;


  • Sterile dressing pack – containing a gallipot, gauze swabs and disposable towel;
  • Sterile 0.9% sodium chloride;
  • Sterile gloves;
  • Appropriate eye ointment/drops (as prescribed);
  • Good light source;
  • Disposable bag for rubbish.




How is it done?



The patient should be sitting or lying with their head tilted backwards and chin pointing upwards. This allows for easy access to the eyes and is a good position for patient comfort (Mallett and Dougherty, 2000).






Explain to the patient what you are about to do – even if the patient is unconscious. Make sure the bed area is clear of any obstructions to enable you to move around the bed freely, and that you have all the equipment - ensuring you are prepared means you will not have to leave the patient unnecessarily during the procedure.



• Make sure that the patient is in a comfortable position and that there is a good light source.



• Ensure patient’s privacy.



• Make an assessment of the patient’s eyes.



• Wash hands, put on gloves and open sterile pack.



• Place disposable towel around the patient’s neck.



• Ask the patient to close their eyelids, to avoid damage to the cornea (Watts, 1998).



• With a gauze swab dampened in the saline 0.9% gently swab from the inner aspect (nasal corner) of the eye outwards. Use a new swab each time until all discharge has been removed (Mallett and Dougherty, 2000).



• Repeat the procedure for both eyes.



• Dry the patient’s eyelids gently to remove excess fluid.



• Dispose of equipment.



• Ensure that patient is comfortable.



• Wash hands thoroughly.



At this point, if required, eye ointment/ drops are instilled.



• The medicine prescription should be checked against the label on the eye ointment/ drops prior to cleaning patient’s eyes. The expiry date should also be checked on the medication.



• Check the patient’s prescription sheet for the date and time of administration.



• Make sure that you have the correct eye ointment/drop for each eye.



• Ensure the patient is in a comfortable position – head tilted back and supported.



• The patient should be warned if the medication is likely to cause side effects, such as blurred vision (Watts, 1998).



Instillation of eye drops



• Wash your hands thoroughly and put on gloves.



• Using a gauze swab under the lower lid gently pull down.



• Ask the patient to look up and instil the eye drop.



• Ask the patient to close the eye.



• Ensure the patient is comfortable.



• Dispose of any equipment.



• Wash hands thoroughly.



Instillation of eye ointment



• Wash your hands thoroughly and put on gloves.



• Using a gauze swab under the lower lid gently pull down.



• Ask the patient to look up.



• Hold the tube 2.5cm above the lower lid (Jamieson et al, 2002; Mallett and Dougherty, 2000).



• Gently squeeze the tube – applying the ointment from the inner corner of the eye outwards.



• Ask the patient to close the eye and wipe any excess ointment.



• Ensure the patient is comfortable after the procedure.



• Dispose of any equipment.



• Wash hands thoroughly.






• Remember to sign the patient’s prescription chart.



• Document that eye care has been carried out in the nursing records.



How often?



Assessing a patient’s eyes will give some indication of how often they should be cleaned. Patient comfort and the condition of the eyes should influence the frequency of eye care. The assessment will help to identify and plan nursing interventions.






To eliminate the risk of cross infection:



• The nurse should wash their hands thoroughly before applying gloves.



• The eye should be swabbed from the inner aspect (nasal corner) outwards.



• Always start the procedure with the cleanest eye and ensure a new swab is used for each eye.






Jamieson, E.M. et al (2002) Clinical Nursing Practice (4th ed). Edinburgh: Churchill Livingstone.



Mallett, J., Dougherty, L. (eds). (2000) The RoyalMarsdenHospital Manual of Clinical Nursing Procedures. (5th ed). Oxford: Blackwell Science.



Watts, A. (1998) Cleaning the eyelids. Nursing Times; 94: 38, supplement, 1-2.

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