The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [313]
A clean technique should be used for eye care procedures and an aseptic technique, if deemed necessary, for vulnerable exposed eyes or to reduce the risk of infection (Alexander et al. 2007).
The eye area must be treated gently and unnecessary pressure must be avoided, especially to the globe (Alexander et al. 2007). Low-linting swabs are generally used; lint from swabs can become detached and scratch the cornea so it is recommended where possible to use lint-free swabs (Woodrow 2006). The fluids most commonly used for eye care procedures are sterile 0.9% sodium chloride or sterile water for irrigation. Sterile 0.9% sodium chloride can irritate and sting the sensitive eye area so where possible it is recommended that sterile water is used (Woodrow 2006).
If able, and after appropriate instruction, patients should be encouraged to carry out eye care procedures themselves. However, in the case of postoperative, physically limited or unconscious patients, it is often the nurse who is responsible for eye care.
Consideration should always be given to patients’ sight aids, such as glasses and contact lenses (Holman et al. 2005). Assistance may be required to help clean these aids and advice regarding the most appropriate method should be sought, preferably from the patient.
For all procedures which involve removal or insertion of contact lenses or prosthetic eyes, the patient should be encouraged to do this themselves as they will have developed their own particular methods. However, the nurse must observe as the patient may still need education to improve upon their technique. Advice regarding the ideal method of removal and insertion should be sought from the local ophthalmology service or the nursing team in the ophthalmology unit.
Methods of eye assessment
Before beginning any eye care procedure, the eye and surrounding structures should be examined and assessed and then re-examined and reassessed after the intervention. Begin by examining the eye closed, looking carefully at the eyelids, noting any bruising, spasms, inflammation, discharge or crusting (Holman et al. 2005). Look for signs that the eyelids are closed properly, as an inability to close completely could indicate the presence of a cyst or lump that would require further investigation and reporting to the patient’s doctor.
Ask the patient to open their eyes and, using a pen torch, look for abnormalities in the conjunctiva such as inflammation, redness or the presence of a discharge; the eye should be clear of clouding and redness (Alexander et al. 2007). Ask the patient whether they are experiencing any pain or photophobia. Any abnormalities need to be reported to the patient’s doctor immediately, as eye complications can develop quickly. Any changes should also be documented (Alexander et al. 2007, Holman et al. 2005, NMC 2009).
Methods of eye swabbing
Eye swabbing is performed to clear the outer eye structures of foreign bodies, including discharges, which could be infected matter. The swab should be moistened with sterile water for irrigation and lightly wiped over the eyelid from the nose outward. This process should be repeated with clean gauze until the area is clean of discharge or encrustation.
Methods of eye irrigation
Eye irrigation is usually performed to remove foreign bodies or caustic substances from the eye, for example domestic cleaning agents or medications, particularly cytotoxic material; it should be performed as soon as possible to minimize damage (Stollery et al. 2005). The procedure is also used for preoperative preparation or to remove infected material.
Using the least volume of sterile water for irrigation necessary will reduce the likelihood of deeper corneal damage which can be a side-effect of the corrosive chemicals due to water’s hypotonic nature (Kuckelkorn et al. 2002). The volume required will vary depending on the degree of contamination; copious amounts