14.1 Administering Eye Medications

Forms of Eye Instillations

Medications administered via the eye come prepared in a variety of forms, including drops, ointments, and medication disks. Generally, eye instillations should be used within thirty days of opening, unless otherwise indicated by the manufacturer. Expired eye instillations should never be used because they can become less effective or contaminated over time.

Eye Drops

Liquid solutions commonly used to treat conditions such as dry eyes, conjunctivitis (pink eye), glaucoma, red eyes, or itchiness are known as eye drops (Figure 14.2). They may be ordered as a prescription or found over the counter, depending on the symptoms and complexity of the condition. Examples of prescription eye drops include neomycin, bimatoprost, cyclosporine, and xalatan. Examples of over-the-counter eye drops include Refresh, Systane, Clear Eyes, and Visine. The medication bottle should always be assessed before use to ensure the medication is indicated for ophthalmic use.

Figure 14.2 Eye drop packaging must be carefully observed because it is similar in appearance to ear drop and super glue packaging. (credit: “Drops with MAR” by Thompson Rivers University, CC BY 4.0)

Eye Ointments

Greasy, semisolids that use body warmth to melt into tiny drops that rest between the eyeball and eyelid (Figure 14.3) are known as eye ointments. Typically, eye ointments are thicker than eye drops and will stay in the eye longer. Examples of eye ointments include bacitracin ophthalmic ointment (Ocu-Tracin), erythromycin ophthalmic ointment (Eyemycin), and over-the-counter lubricant eye ointments.

Figure 14.3 Eye ointment is typically packaged in flexible plastic or metal tubes. (credit: Stefani Resseguie)

Eye ointments are known to cause blurred vision. It is important to instruct the patient that blurred vision may occur and will go away within a few minutes. Patients should be educated that they might be unable to drive, operate machinery, or engage in tasks that require the use of their vision until the medication dissipates. Some providers may order eye ointments to be administered at bedtime because of the blurred vision. Eyelashes and eyelids may be sticky after ointments are applied because of the thickness of the ointment. A warm, wet compress or washcloth may be applied to the eye after administration to remove any excess ointment that is excreted from the eye.

Eye Medication Disks

Small, flexible disks that can release medication in the eye for up to one week are known as eye medication disks (Figure 14.4). The disk is placed in the conjunctival sac horizontally and will naturally adhere to the eye. Instruct the patient to blink several times after placing the disk in the conjunctival sac. If the disk is still visible after blinking, pull the lower eye lid out and over the disk again until it remains below the eye lid when blinking.

Figure 14.4 After performing hand hygiene and donning gloves, the provider inserts an eye medication disk in the conjunctival sac. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Medication disks should float between the eyelid and sclera. They may be repositioned by pressing a finger against a closed eye lid; however, the patient should be instructed not to rub the eye, which may cause the disk to move across the cornea. Medication disks can be used regardless of contact lenses, sleeping, or physical activities. To remove the disk, turn the lower eye lid outward and use your forefinger to slide the disk into the lid and out of the eye. Patients receiving medication via an eye medication disk may complain of feeling like there is something in their eye, mild tearing, redness, increased discharge, and itchiness. Typically, these symptoms resolve within the first several weeks of usage; however, patients should be instructed to report persistent or severe symptoms.

Purpose of Performing Eye Irrigation

Washing out the eye with a continuous flow of liquid or medication, known as eye irrigation, may be warranted to flush secretions, chemicals, and foreign bodies from the eye. It may also be used to administer medications to treat certain disorders affecting the cornea or conjunctiva. Chemical injuries to the eye are considered an emergency and must be treated by irrigation immediately to prevent long-term vision loss. The amount of solution and duration of the irrigation depends on the contaminant.

Eye Irrigation Solutions and Procedure

Typically, normal saline is used to perform eye irrigation; however, water may be used in emergent situations, according to agency policy. The provider will order local anesthetic eye drops to be placed in the affected eye(s) before instilling the irrigation. The patient should be instructed to keep their eyes closed until the irrigation begins to retain the anesthetic in the eye. Assist the patient to lie down and place a towel over their neck and shoulders. Place a bowl or kidney dish against the patient’s cheek, on the affected side, with the head tilted sideways toward it. After performing hand hygiene and donning gloves, fill the syringe with the irrigant and test the temperature on your hand. To prevent discomfort for the patient, the irrigant should be room temperature. Open the eyelid and ask the patient to fix their gaze ahead. Inject the irrigant slowly and steadily, from no more than 2 in (5 cm) away, onto the front surface of the eye, inside the lower eyelid, and under the upper eyelid (Figure 14.5). Ask the patient to move their eye in all directions while the irrigation is being performed. The provider should ensure the syringe remains sterile at all times and does not touch the surface of the eye or eyelid or any other object. A minute or two of irrigation should be sufficient for foreign body removal, whereas at least fifteen to thirty minutes may be required for chemical burns. Assess and document the patient’s visual acuity and tolerance of the procedure when the procedure is complete.

Figure 14.5 After performing hand hygiene and donning gloves, the provider performs eye irrigation using aseptic technique. (credit: Heiko Philippin, Public Domain)

Clinical Safety and Procedures (QSEN)

QSEN Competency: Irrigating a Patient’s Eye

See the competency checklist for Irrigating a Patient’s Eye. You can find the checklists on the Student resources tab of your book page on openstax.org.

Eye Medication Administration

When administering eye medications, it is important to confirm the rights of medication administration, including the number of drops to be administered (right dose) and the eye in which the drops should be placed (right route). Abbreviations used for eye instillations include right eye (OD), left eye (OS), and both eyes (OU). Ensure the medication is labeled for ophthalmic use and check the expiration date.

Before administering eye medications, wash your hands and don gloves to prevent contamination. Assess the patient’s eyes, noting any new or unusual redness or drainage. If discharge, dirt, or debris is present, gently cleanse the eyelid by dampening a gauze or washcloth with warm water or normal saline. Wipe the eye from the inner canthus (corner of the eye nearest the nose where the upper and lower eyelids meet) of the eye to the outer canthus (corner of the eye nearest the ear where the upper and lower eyelids meet) to avoid introducing dirt and debris into the lacrimal ducts, which could cause infection. Use a new gauze or corner of the washcloth with each stroke. Remove dirty gloves, wash hands, and don new gloves before administering the eye medication.

Shake the bottle, if indicated on the medication label. If the medication has been refrigerated, warm the bottle between your hands until it comes to room temperature. Instruct the patient to tilt their head back, or lie down, and look upward. Remove the medication cap and place it on a clean surface, without contaminating the inside of the cap or the dropper tip. Using the thumb and/or index finger, gently pinch the eyelid and pull downward to form a pocket. Turn the medication container upside down and gently squeeze the eye medication into the pouch formed in the lower lid (i.e., conjunctival sac), not directly into the eye (Figure 14.6). If another drop of eye medication is needed in the same eye, wait at least five to ten minutes before administering the second drop so the first drop will not be washed out of the eye.

Figure 14.6 The provider gently pinches the patient’s eyelid and pulls downward to form a pocket in the lower lid (i.e., conjunctival sac) where the eye drop is placed. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

If an eye ointment is used, place a ¼ to ½ in (0.5 to 1 cm) line of ointment into the lower lid pouch, starting at the inner canthus and moving outward (Figure 14.7). Press one finger against the inner canthus of the eye for a few seconds, when appropriate, to keep the medication from going into the tear duct. A systemic reaction to the medication may result if the medication enters the tear duct. Instruct the patient to keep their eye closed for one minute, or as instructed by the provider, to allow the medication to be absorbed. If an eye drop and eye ointment are ordered for the same eye at the same time, administer the eye drop first, followed by the ointment. Perform hand hygiene and document administration of the medication as well as the patient’s tolerance of the medication and procedure.

Figure 14.7 Place a ¼ to ½ in (0.5 to 1 cm) line of ointment into the lower lid pouch (i.e., conjunctival sac), starting at the inner canthus and moving outward. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Incorrect use of eye drops is a common problem. When eye drops are not administered properly, the full benefit of the medication may not occur. For example, if the drop does not enter the eye, the medication will spill down the cheek and the medication will be wasted. If the patient wears contact lenses, the contacts should be removed before administering eye instillations, unless otherwise indicated by the provider. It is also important to ensure that the dropper or ointment tube does not touch the eye or your fingers, which may contaminate the medication. Always recap the medication container immediately after use. Do not wipe or rinse the tip of the container. Eye medications are for single-patient use only and should never be shared with other patients because of the risk of contamination.