Definition
Instilling eye drops is a fundamental nursing and self-care procedure used to treat conditions like infections, glaucoma, allergies, or dryness.
Purposes of Instilling eye drops
- To treat infection.
- To instill medication before examination or surgery of eyes.
- To lubricate eyes.
- To stain cornea for identifying abrasions and scars.
Articles for Instilling eye drops
- Sterile gloves.
- Sterile cotton balls soaked in sterile normal saline.
- Medication.
- Dry cotton balls.
- Dry sterile dressing pad and paper tapes.
- Kidney tray.
Procedure for Instilling eye drops
| Nursing action | Rationale | |
| 1. | Before procedure Identify patient and assess for: a. Allergy to medication. | Identifies contraindication for instillation of medication into eye. |
| b. Appearance of eye and surrounding structures. | ||
| c. Lesions, exudate, erythema or swelling. | ||
| d. Location and nature of any discharge. | ||
| e. Level of consciousness and willingness to cooperate. | ||
| f. Patient knowledge about medication. | ||
| g. Use of contact lens. | ||
| 2. | Check medication order: a. Check physician’s order for preparation, strength of medication, number of drops, frequency of instillation of medication, and eye to be treated. OD-Oculus dexter (right eye). OS-Oculus sinister (left eye). OU-Oculus uterque (both eyes). | Prevents medication error. |
| b. Check expiry date and medication label. | ||
| 3. | Prepare patient for treatment: a.Check patient’s identification and name. | Reduces anxiety and ensures cooperation. Reduces error. |
| b. Explain procedure. | ||
| C. Assist the patient to comfortable position – sitting or lying with head slightly hyperextended. | Prevents accidental injury during medication administration. | |
| d. Obtain assistance for immobilizing in case of young children. | ||
| e. Remove contact lenses if present. | ||
| 4. | During procedure Wash hands. | Reduces spread of microorganisms. |
| 5. | Clean eyelid and eyelashes: a. Don sterile gloves. | |
| b. Use sterile cotton swab immersed in sterile normal saline and wipe from inner canthus to outer canthus. | Cleaning the eye prevents secretions on eyelid and lashes being washed into the eye. Cleaning toward outer canthus prevents contaminants entering into the other eye and lacrimal duct. | |
| 6. | Administer new medication a. Check ophthalmic preparation for name, strength, expiry date and number of drops in case of liquids. | Checking medication prevents medication error. |
| b. Instruct the patient to look up to the ceiling. Give the patient a dry sterile absorbent cotton ball. | Person is not, such ask to blink if looking up and in this position the cornea is protected by upper lid. A cotton ball can be used to wipe off excess ointment /drug from eyelashes after instillation. | |
| c. Expose the lower conjunctival sac by placing thumb or fingers of non-dominant hand just below the eye on the zygomatic arch and gently draw down the skin on the cheek. If the tissues are edematous, handle the tissues carefully to avoid damaging them. | Placing finger on the bony prominence avoids pressure to the eyeball and prevents person from blinking or squinting. | |
| Liquid medication: a. Discard the first drop of medication. | The first drop is considered to be contaminated. | |
| b. Approach the eye from the side and instill the correct number of drops onto the outer third of lower conjunctiva, holding the dropper 1-2cm above the eye. | Patient is less, such asly to blink if a side approach is used. If drops fall directly on the cornea, it may cause injury. | |
| Eye ointment: a. Discard the first bead of ointment. | ||
| b. Hold the tube above conjunctival sac, squeeze 2 cm of ointment from tube into lower conjunctival sac from inner canthus outward. | ||
| 7. | Instruct patient to close eyelid. | Squeezing can injure eye and push out medication. |
| 8. | Instruct patient to press on nasolacrimal duct for at least 30 seconds after instilling liquid medication. | Pressure prevents medication running down the duct. |
| 9. | Clean the eyelid as needed by wiping from inner canthus to outer canthus. | Prevents spread of organisms into lacrimal duct. |
| 10 | Apply an eye pad if required and secure it with tape and instruct patient not to rub the eye. | Reduces risk of injury. |
| 11. | After procedure Assess patient response. | |
| 12. | Replace medication. | |
| 13. | Wash hands. | |
| 14. | Document administration: Medication administered, number of drops, and patient’s response, etc. |
Special Considerations
- If more than one eye drop (medication) is ordered, wait 5 minutes between each medication.
- Instruct patient on safety precautions, if drops are meant for dilation of pupils.
- If medication needs to be instilled imo both eyes, place in the unaffected eye first.
Paediatrics variation
Infants often clench the lids tightly closed so place the drops in the nasal corner, where the lids meet. The medication pools into this area and when the child opens lids, medication flows on to the conjunctiva.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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