Eye medications—drops, ointments, and disks—serve diagnostic and therapeutic purposes. During an eye examination, eyedrops can be used to anesthetize the eye, dilate the pupil to facilitate examination, and stain the cornea to identify corneal abrasions, scars, and other anomalies. Eye medications can also be used to lubricate the eye, treat certain eye conditions (such as glaucoma and infections), protect the vision of neonates, and lubricate the eye socket for insertion of a prosthetic eye.
Understanding the ocular effects of medications is important because certain drugs may cause eye disorders or have serious ocular effects. For example, anticholinergics, which are commonly used during eye examinations, can precipitate acute glaucoma in patients with a predisposition to the disorder.
Equipment
Prescribed eye medication • patient's medication record and chart • gloves • warm water or normal saline solution • sterile gauze pads • facial tissues • optional: ocular dressing.
Preparation of equipment
Make sure the medication is labeled for ophthalmic use. Then check the expiration date. Remember to date the container the first time you use the medication. After it's opened, an eye medication may be used for a maximum of 2 weeks to avoid contamination.
Inspect ocular solutions for cloudiness, discoloration, and precipitation, but remember that some eye medications are suspensions and normally appear cloudy. Don't use any solution that appears abnormal. If the tip of an eye ointment tube has crusted, turn the tip on a sterile gauze pad to remove the crust.
Implementation
Verify the order on the patient's medication record by checking it against the physician's order on his chart.
Wash your hands.
Check the medication label against the patient's medication record.
NURSING ALERT Make sure you know which eye to treat because different medications or doses may be ordered for each eye.
Confirm the patient's identity by asking his name and checking the name, room number, and bed number on his wristband.
If your facility utilizes a bar code scanning system, be sure to scan your ID badge, the patient's ID bracelet, and the medication's bar code.
Explain the procedure to the patient and provide privacy. Put on gloves.
If the patient is wearing an eye dressing, remove it by gently pulling it down and away from his forehead. Take care not to contaminate your hands.
Remove any discharge by cleaning around the eye with sterile gauze pads moistened with warm water or normal saline solution. With the patient's eye closed, clean from the inner to the outer canthus, using a fresh sterile gauze pad for each stroke.
To remove crusted secretions around the eye, moisten a gauze pad with warm water or normal saline solution. Ask the patient to close the eye, and then place the gauze pad over it for 1 or 2 minutes. Remove the pad, and then reapply moist sterile gauze pads, as necessary, until the secretions are soft enough to be removed without traumatizing the mucosa.
Have the patient sit or lie in the supine position. Instruct him to tilt his head back and toward the side of the affected eye so that excess medication can flow away from the tear duct, minimizing systemic absorption through the nasal mucosa.
Instilling eyedrops
Remove the dropper cap from the medication container, if necessary, and draw the medication into it. Be careful to avoid contaminating the dropper tip or bottle top.
Before instilling the eyedrops, instruct the patient to look up and away. This moves the cornea away from the lower lid and minimizes the risk of touching the cornea with the dropper if the patient blinks.
You can steady the hand holding the dropper by resting it against the patient's forehead. Then, with your other hand, gently pull down the lower lid of the affected eye and instill the drops in the conjunctival sac. Try to avoid placing the drops directly on the eyeball to prevent the patient from experiencing discomfort. (See Instilling eye medications.) If you're instilling more than one drop agent, you should wait 5 or more minutes between agents.
Applying eye ointment
Squeeze a small ribbon of medication on the edge of the conjunctival sac from the inner to the outer canthus. Cut off the ribbon by turning the tube. You can steady the hand holding the medication tube by bracing it against the patient's forehead or cheek. If you're applying more than one ribbon of medication, wait 10 minutes before applying the second medication.
Using a medication disk
A medication disk can release medication in the eye for up to 1 week before needing to be replaced. Pilocarpine, for example, can be administered this way to treat glaucoma. (See How to insert and remove an eye medication disk.)
After instilling eyedrops or eye ointment
Instruct the patient to close his eyes gently, without squeezing the lids shut. If you instilled drops, tell the patient to blink. If you applied ointment, tell him to roll his eyes behind closed lids to help distribute the medication over the surface of the eyeball.
Use a clean tissue to remove any excess solution or ointment leaking from the eye. Remember to use a fresh tissue for each eye to prevent cross-contamination.
Apply a new eye dressing if necessary. (See “Hot and cold eye compresses,†page 693.)
Return the medication to the storage area. Make sure you store it according to the label's instructions.
Wash your hands.
Special considerations
When administering an eye medication that may be absorbed systemically (such as atropine), gently press your thumb on the inner canthus for 1 to 2 minutes after instilling drops while the patient closes his eyes. This helps prevent medication from flowing into the tear duct.
To maintain the drug container's sterility, never touch the tip of the bottle or dropper to the patient's eyeball, lids, or lashes. Discard any solution remaining in the dropper before returning the dropper to the bottle. If the dropper or bottle tip has become contaminated, discard it and obtain another sterile dropper. To prevent cross-contamination, never use a container of eye medication for more than one patient.
Teach the patient to instill eye medications so that he can continue treatment at home, if necessary. Review the procedure and ask for a return demonstration.
If an ointment and drops have been ordered, the drops should be instilled first.
Complications
Instillation of some eye medications may cause transient burning, itching, and redness. Rarely, systemic effects may also occur.
Documentation
Record the medication instilled or applied, eye or eyes treated, and date, time, and dose. Note any adverse effects and the patient's response.