Eyedrop instillation

Definition

Eyedrop instillation is the dispensation of a sterile ophthalmic medication into a patient's eye.

Purpose

Eyedrops may be instilled to treat a number of eye disorders or to anesthetize an eye before treatment. An ophthalmic assistant, technician, nurse or physician instills eyedrops during a routine eye examination or during treatment for ocular disease. Anesthetic eyedrops are instilled before surgery on the eye. Sometimes ophthalmic professionals instill dyes to help diagnose ocular disease, either by traditional methods, or by intravenous administration, or by the use of strips.

Eyedrops or ophthalmic solutions are used to treat glaucoma , uveitis, allergic reactions and infections. Dilatory eyedrops may be instilled during an examination to achieve a better view of the retina.

Precautions

Health care professionals need to ensure that the proper drug is being instilled and that it has not passed its expiration date. Some ophthalmic solutions may be contraindicated or can cause allergic reactions. Eyedrop containers should be clearly labeled and checked before instillation.

The eyedrops should also be monitored for discoloration or sedimentation, which indicate that the ophthalmic solution is decomposing. In that case, a new dose of medicine should be obtained and the affected bottle discarded.

Moreover, the ophthalmic staff member dispensing the drops should double-check the patient's identification and chart to ensure the correct dose is being instilled into the correct eye. The dispensing ophthalmic professional should never touch the tip of the eyedropper to the patient's eye. Touching will contaminate the remaining medication. In case of direct eye contact, the medication should be thrown away.

Description

Sterilization is an important part of eyedrop instillation. Before eyedrops are instilled, the ophthalmic assistant, technician, nurse, optometrist, or ophthalmologist should wash his or her hands thoroughly. The ophthalmic staff member then should gather all necessary supplies. For some eyedrops, the dispenser may want to warm the drops to body temperature by holding the bottle in his or her hand for about two minutes.

Next, the dispenser should position the patient correctly. The patient should sit back in the examination chair with their head slightly hyperextended. Once the patient is correctly positioned, the dispenser should clean the eyelids from the inner canthus outward with a sterile saline solution to remove any eye secretions or previously instilled medications. The dispenser should wash their hands after these preparations are completed.

Immediately before instillation, the dispenser should depress the patient's lower lid with the finger of one hand and lightly pinch the patient's lower lid to make a pouch for the medication. The upper lid should also be held open to prevent blinking during instillation. The dispenser should tell the patient to look up. Using the other hand, the dispenser should instill the drop into the everted lower lid. The drops should not be instilled on the cornea. This precaution is necessary to avoid startling the patient, or causing unnecessary pain .

After the appropriate amount of medication is instilled, the ophthalmic professional should release the lid and remove any excess fluid. The patient should be told to gently close their eyes so as to not release any medication. If another medication is to be instilled, a delay of at least 30 seconds is required between instillations.

Preparation

Patients should have the procedure explained to them before instillation to ensure best results. If patients are treated for certain eye ailments such as conjunctivitis, they should be warned in advance not to wear contact lenses or eye makeup.

Before instillation, the ophthalmic staff should double-check the dosage and type of medication. They should also wash their hands thoroughly.

Aftercare

Patients who will be dispensing their own eyedrops after the initial treatment need careful instructions on proper instillation. Allied health professionals should guide patients step by step through the procedure to ensure maximum benefit from the medication.

If patients are treated for infections or conjunctivitis, they should be advised to wash their hands regularly; avoid touching their eyes; avoid wearing eye makeup or contact lenses; and to discard any eye drops or eye makeup used before treatment for the infection began. Follow-up appointments for further treatment may also be necessary.

Glaucoma patients using eyedrop medications should be monitored to determine if the drops are effective. Many times a combination of drops is necessary to treat glaucoma.

Complications

Eyedrops cause irritation in some patients that might result in eye redness or burning. Stronger medications can cause more extreme allergic symptoms, such as dizziness and disorientation. Some cycloplegic drops can cause such severe reactions as delirium, a rapid pulse, and difficulty swallowing. Patients should be monitored after instillation, and health care professionals should record any side effects.

Results

Properly instilled eyedrops should effectively treat a number of eye disorders. Dilatory drops facilitate eye refraction and retinal examination.

Health care team roles

Nursing and allied health professionals are usually responsible for eyedrop instillation. Ophthalmic assistants, technicians and nurses ensure that the proper dosage is administered to the correct patient, the medication is fresh, the medication and eyedropper are sterile and in good condition, and the patient is told step-by-step how the procedure is performed. The allied health professional may also need to repatch an affected eye, monitor patients for side effects, chart medications for each patient, and dispose of (used) equipment.

KEY TERMS

Canthus —Either of the angles formed by the meeting of an eye's upper and lower eyelids.

Conjunctivitis —Inflammation of the thin membrane covering the eye. It is caused by bacteria, virus, allergies, etc.

Cornea —The clear outer covering of the front of the eye.

Cycloplegic drops —Drops used to dilate the pupil and paralyze the eye's powers of accommodation.

Drops —A term for a liquid medicine taken in specific doses and usually applied by a dropper.

Glaucoma —An eye disease in which increased pressure within the eyeball can result in damage to the optic disk and a loss of vision.

Ophthalmic solutions —Sterile solutions for instillation in the eye.

Uveitis —Inflammation of the uvea. The uvea is a continuous layer of tissue that consists of the iris, the ciliary body, and the choroid. The uvea lies between the retina and sclera.

Resources

BOOKS

"General Management Modalities." In Brenner & Suddath's Textbook of Medical and Surgical Nursing. 7th ed. Philadelphia, PA: J.B. Lippincott Company, 1992.

Stedman's Medical Dictionary. 26th ed. Baltimore, MD: William & Wilkins, 1995.

ORGANIZATIONS

American Academy of Ophthalmology. PO Box 7424, San Francisco, CA 94120-7424. (415) 561-8500. <http://www.eyenet.org/>.

American Optometric Association. 2420 North Lindbergh Boulevard, St. Louis, MO 63141. (800) 365-2219. <http://www.aoanet.org/>.

Joint Commission on Allied Health Personnel in Ophthalmology. 2025 Woodlane Drive, St. Paul, MN 55125-2995. (888) 284-3937. <http://www.jcahpo.org/>.

OTHER

"Conjunctivitis." American University Online<http://www.american.edu/healthcenter/question_center/pink_eye.htm>.

"Eye Care Tip of the Month: Use Eyedrops Correctly." American Optometric Association Online. <http://www.aoanet.org/ectips-eyedrops.html>.

"Guidelines for Administration of Eyedrops and Eye Ointment." School of Nursing, The University of Texas at Austin Online. <http://www.nur.utexas.edu/n127/meds1.html>.

Mary Bekker