EYE DISORDER

TREATMENT AND MODALITIES; PROCEDURES

GUIDELINES ON:

INSTILLATION OF MEDICATION; EYE IRRIGATION,

APPLICATION OF EYE PATCH, EYE SHIELD AND
PRESSURE DRESSING TO THE EYE; REMOVING
PARTICLE FROM THE EYE;

NCM 116 RLE

BATARIO, YSSA MARIELLE L.

JUNE 26, 2021 / GROUP 2
PROF. ZOLETA
 Instillation of Eye Medications
Nursing Action
Preparatory Phase
1. Inform the patient of the need and reason
for instilling drops or ointment.
2. Allow the patient to sit with head tilted
backward or to lie in a supine position.
3. Verify the patient’s identification.
4. Check written prescription and bottle, vial,
or tube for correct medication.
5. Check prescription, designating eye
requiring drops.
6. Wash hands before instilling medication.
Performance Phase
1. Remove cap from container and place on
clean surface.
2. If eyedropper is used, fill eyedropper with
medication by squeezing bulb.
3. Using forefinger, pull on skin below lower
lid
4. Instruct patient to look upward.
5. Drop medication amount prescribed into
center of lower lid (cul-de-sac) (see Figure
A).
Rationale
1. Allays fear and enlists cooperation.
2. Provides a position of comfort and safety
for the patient and accessibility for the
nurse.
3. Prevents error.
4. Avoids medication error.
5. Order may be written with abbreviation.
6. OD (oculus dexter)—right eye OS (oculus
sinister)—left eye OU (oculus uterque)—
both eyes
7. Prevents transfer of microorganisms to
patient.
1. Prevents contamination of lid.
2. Eye droppers are used less frequently than
dropper bottles.
3. Exposes inner surface of lid and cul-de-
sac.
4. Prevents medication from hitting sensitive
cornea and prevents blephorospasm.
5. Prevents medication from hitting sensitive
cornea.
 6. If ointment is to be instilled, squeeze out 8
– -inch ribbon of medication (size of grain
of rice) from the tube into the lower lid
without touching the eye with the end of
the tube (see Figure B).
7. Instruct patient to close eyes slowly but
not to squeeze or rub them. Open eye.
8. Clear any excess medication with gauze or
tissues.
9. If additional eye drops are ordered, wait
30 seconds between each drop.
Nursing Alert: Parietal occlusion (place finger over lacrimal duct for 1 minute) may be necessary
after instilling drops if systemic absorption is to be avoided, prolonged corneal contact is desired,
or taste or smell of medication is distressing.
Follow-up Phase
1. Wash hands after instilling medication.
2. Record time, type, strength, and amount of
medication and the eye into which
medication was instilled.
6. Prevents contamination of the tube.
Avoids dispensing excessive ointment;
clouds vision.
7. Squeezing or rubbing would express
medication from eye and increase lacrimal
drainage from the eye; closing allows
medication to be distributed evenly over
eye.
8. Prevents possible skin irritation.
9. Allows time for absorption of medication.
1. Prevents transfer of microorganisms to self
or other patients.
2. Provides documentation in the medication
record.
IRRIGATION OF THE EYE
Ocular irrigation is often necessary for the following:
1. To irrigate chemicals or foreign bodies from the eyes.
2. To remove secretions from the conjunctival sac.
3. To treat infections
4. To relieve itching.
5. To provide moisture on the surface of the eyes of an unconscious patient.
APPLICATION OF EYE PATCH, EYE SHIELD AND PRESSURE DRESSING TO THE
EYE
EQUIPMENT PICTURE
Eye covering to be used (shield,
oval patches)

Tape

Scissors

Tincture of benzoin or skin protect-

ant (optional)

PROCEDURE
NURSING ACTION RATIONALE
PREPARATORY PHASE
1. Wash hands. 1. Prevents contamination.
2. Explain procedure to patient. 2. Allays fear and ensures cooperation.
3. Verify patient and eye to be patched. 3. Prevents error.
4. Instill ointment, if directed, prior to 4. May be ordered to protect cornea from
patching. abrasion or prevent infection.
5. Shave the male face and apply tincture of 5. Enhances ability for tape to stick and
benzoin, as indicated. protect the skin from tape.
PERFORMANCE PHASE
1. For eye patch:
a. Instruct patient to close both eyes. a. It may be difficult to close only the
b. Place patch over affected eye. affected eye.
c. Secure the patch with two or more b. May need two or more patches, depending
strips of tape applied downward and on the depth of the eye compared with the
diagonally from midforehead to cheek. surrounding bones.
c. Although transparent tape is easy to
remove and adhesive tape is most secure,
hypoallergenic tape should be used if
patient has had reaction to tape in past.
2. For eye shield:
a. Apply over dressings or directly over a. Used primarily to protect the eye. Some
the undressed eye, fastening with two shields may be bent to rest over bony
or more strips of tape. prominences. Tape placed around edges
b. Be sure there are no rough edges of the shield will not obstruct vision
against the skin. through holes in the shield.
a. c. Secures dressing and applies b. Prevents abrasion. Use skin protectant, as
pressure. indicated.

3. For pressure dressing:

a. Have the patient close both eyes a. Prevents eye from opening before
tightly. dressing is secured.
b. Fold patch in half (short end to short b. Provides pressure dressing bulk.
end) and place over closed eyelid a. c. Secures dressing and applies pressure.
(with fold line at eyebrow). Cover
with additional unfolded patches.
c. Apply strips of tape firmly from check
to forehead, overlapping each strip.

FOLLOW UP PHASE
1. Trim tape and monitor for security of patch 1. For patient’s safety and comfort.
or shield.

2. Advise patient that because depth 2. Prevent accidents or corneal abrasion if

perception will be impaired, he or she should eyelid opens and patch rubs against cornea.
perform activities carefully and report any
foreign body sensation.
Removing a Particle from the Eye and Fluorescein Staining:
EQUIPMENT

 Local Anesthesia
 Hand Lens
 Sterile Fluorescein strips and
illumination source

 Cotton Applicator
 Normal Saline
 Antibiotic Solution
Procedure:
Nursing Action Rationale

Preparatory phase:

NURSING ALERT It is important to take a

patient history to determine the nature of the
foreign body. If the particle is metal or
entered the eye with projectile force, trauma
to the eye could result. It may be necessary
for the ophthalmologist to remove the foreign
body immediately without attempting this
method to prevent further injury.
1. Perform hand hygiene 1. Prevents contamination
2. Explain procedure to patient. 2. Allays fear and ensures cooperation.
3. Instill anesthetic eye drops, as directed 3. Facilitates comfort

PERFORMANCE PHASE:
Removal of Particle:
As patient looks upward, place your finger
below the lower lid and pull downward to
expose the conjunctival sac. Inspect for
particles using a hand lens.
With small cotton applicator dipped in saline,
remove particle by gently wiping across
conjunctival surface
If offending particle is not found, proceed to
examine upper lid.
a. Have the patient look downward.
b. Encourage the patient to relax; move
slowly and reassure patient that
procedure will not be painful.
c. Place cotton applicator stick
horizontally on outer surface of upper
lid. Apply pressure about 1 cm above
lid margin (see Figure A)
d. Grasp upper eyelashes with forefinger
and thumb and pull the upper lid
outward and upward over cotton
Particles are often washed downward by the
upper lid
Prevents trauma. Saline promotes adherence
of a particle
a. Moves sensitive cornea down and
away from area of activity.
b. . Relaxation prevents squeezing the
lids shut, a maneuver that contracts the
orbicularis muscle, making eversion of
lid impossible.
. Because the upper tarsal plate extends
0.4−0.5 inch (10−12 mm) above the lid
margin, pressure must be applied at least
½ inch (1 cm) above the lid margin for
easy eversion of lid.
d. Because particles may be washed
under the lid, visual exposure assists
 applicator (see Figure B). Remove
particle if present.
e. Ask the patient to look up and blink.
Fluorescein Staining
1. Use fluorescein strip to detect corneal
abrasion.
2. Apply a drop of saline to the strip; pull the
lower eyelid down and gently touch the tip of
the strip to the inner aspect of the eyelid.
3. Ask the patient to blink several times to
distribute the dye.
4. Cornea is viewed through a slit lamp,
Wood’s lamp, or other blue filter light to best
illuminate area of abrasion and ulceration.
FOLLOW UP PHASE:
1. Apply antibiotic ointment, as directed.
2. Apply patch, if indicated
in detection. Eyelid will remain
everted by itself during inspection and
removal.
e. Returns eyelid to neutral position.
Green stain will indicate if abrasion is
present.
2. Moistening the strip enhances release of the
dye.
3. Dye will be dispersed over the conjunctive
and cornea
4. Breaks in the epithelium will cause
aqueous humor to color the fluorescein dye
green under blue light.
1. Prevents potential serious infection from
break in cornea.
2. Rest eye and protect cornea for healing.