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NT skills update - EYE CARE

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VOL: 99, ISSUE: 08, PAGE NO: 29

- The eye consists of three layers:

The sclera and cornea - the white outer fibrous layer (sclera) provides shape and is attached to the extraocular muscles. The transparent epithelial cornea refracts light onto the retina;


The vascular layer or uveal tract - This layer contains the choroid, ciliary body and iris;


The retina - this is the inner, nervous tissue layer.


- Within the eye are the lens, aqueous fluid and vitreous body.


- Effective eye care is concerned with assessing, cleansing and irrigating the eye.


- Eye care may also include the delivery of prescribed medications and preparations.


- Where possible patients should be encouraged to meet their own eye care needs.


- When patient-administered eye care is not possible the nurse may be responsible. This may be the case in postoperative or sedated patients.


- To prevent and treat infection.


- To prevent damage to or drying of the cornea in patients who are unconscious or sedated.


- To relieve pain.


- To detect early stages of disease.


The most common types are:


- The applying of eye drops - usually applied just inside the lower eyelid (inferior fornix) where the conjunctiva is less sensitive. The nurse should be aware of exceptions to this technique: medication used for corneal lubrication and anaesthetic drops;


- Applying eye ointment - apply to the upper rim of the inferior fornix in a 2cm line starting from the nasal canthus. Avoid making any contact between the applicator and the cornea and eyelids;


- Irrigating the eye - usually done preoperatively or to remove contaminants from the eye and best carried out as close to contaminating source as possible to minimise eye damage. Sterile 0.9 per cent sodium chloride or sterile water is used, although tap water may also be used in an emergency. The amount of solution used depends on the degree and nature of contamination;


- Swabbing the eye - always treat an unaffected eye first and bathe the lids with the eyes closed. Using a lint-free swab, with the patient looking upwards, clean the lower lid from the nasal corner outwards. Repeat, with a new swab if necessary, until any discharge is removed. Repeat the procedure on the upper lid with the patient looking down;


- In each of these procedures the patient should be sitting or lying with the head tilted backwards and the chin upwards. Care should be taken not to shine light directly into the eye unnecessarily as this may cause discomfort to the patient;


- Aseptic technique is not usually required except in post-ophthalmic surgery or when the eye is damaged.


- If the eye is to be touched (to remove a foreign body), use a moistened cotton bud to prevent any further injury or abrasion.


- Always consult specialists if unsure of any procedure.


- Refer to local policies before carrying out any eye care.


British National Formulary (see 11.1 Administration of drugs to the eye):
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