The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [314]
Care of contact lenses
Contact lenses are thin, curved discs made of hard or soft plastic or a combination of both. Hard contact lenses are made of a rigid plastic that does not absorb water or saline solutions and can be worn for a maximum of 12–14 hours continuously. Soft contact lenses are more pliable, retain more water and so can be worn for up to 30 days and cleaned once weekly. Ill-fitting lenses may reduce the tear film between lens and cornea, which may result in oxygen deprivation of the cornea, leading to corneal oedema and blurred vision. Further damage to the corneal epithelial cells may lead to corneal abrasion and pain. Gas-permeable lenses are a combination of both hard and soft plastic; these permit oxygen to reach the cornea, providing greater comfort, and can be left in for several days (Olver and Cassidy 2005).
Most people look after their own contact lenses. Cleaning and storage solutions depend on the type of lenses used; manufacturers provide specific instructions for the care of their products. They should be stored in a container with slots for right (R) and left (L) eye, so they can be worn in the correct eye. Seriously ill patients should have their lenses removed and stored correctly until they can reinsert them. Contact lenses are stored in a sterile solution when they are not in the eye; this helps to lubricate the lens and enable it to glide over the cornea, reducing the risk of injury.
Artificial eyes
These are made of glass or plastic; some are permanently implanted. Most people who have artificial eyes care for them themselves. If the patient is unable to do this, it is recommended that the eye is removed once daily for cleaning; the patient will be able to advise how they would like this done (Alexander et al. 2007). However, if they are unable to do so, advice should be sought from the local ophthalmology service or the nursing team in the ophthalmology unit.
Preprocedural considerations
Light source
A good light source such as a minor procedure light or bright lamp is necessary to enable careful assessment of the eyes and to avoid damage to the delicate structures.
Position of light source
The light source should be positioned above and behind the nurse. It should never be allowed to shine directly into the patient’s eyes, as this will be extremely uncomfortable for the patient (Shaw 2006).
Position of patient
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 usually a good position for patient comfort and compliance (Stollery et al. 2005).
Procedure guideline 9.2 Eye swabbing
Essential equipment
Sterile dressing pack
Sterile low-linting or lint-free swabs
Sterile water for irrigation
Light source
Optional equipment
Sterile/non-sterile powder-free gloves
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. Ask the patient to explain how their eyes feel, if they are able to. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C)
To have a baseline understanding of current problems or changes the patient is experiencing. (NMC 2008b, C).
2 Assist the patient into the correct position:
(a) Head well supported and tilted back
(b) Preferably the patient should be in bed or lying on a couch.
The patient needs to be discouraged from flinching or making unexpected movements and so should be in the most comfortable, pain-free position possible at the start of the procedure (Shaw 2006, R5).
To enable access and assessment of the eyes. E
To enable patient comfort. E
3 Ensure an adequate light source, taking care not to dazzle the patient. To enable maximum observation of the eyes without causing