Introduction
Contact lens helps in correction of the refractive errors of the eye.
Definition
A contact lens is a thin, small, round, transparent, concave, and sometimes colored disk that fits directly over the cornea of the eye and stays in place due to the surface tension of the eye.
Purposes
- Corrects the refractive errors of the eye.
- Corrects the abnormalities of the cornea that distort the vision.
- Provides comfort compared to use of eyeglasses.
- Personal preference over eye glasses due to esthetic appearance.
Articles
| Articles | Purpose |
| Bath towels or waterproof pads | Protects the area. |
| Sterile saline solution | Moistens the eye. |
| Sterile lens care solution(s) | For cleaning, disinfecting, and rinsing. |
| Sterile wetting or conditioning solution (if required) | For cleaning, disinfecting. |
| Sterile enzyme solution (if required) | For cleaning, disinfecting, and rinsing. |
| Clean lens storage container | To store the lens. |
| Suction cup (optional) | To remove excess secretions. |
| Powder-free, clean gloves | Prevents contamination of the eye/lens and to protect the patient. |
| Lens (as recommended) | To optimize visual acuity. |
Procedure
| Nursing Action | Rationale | |
| Preparatory phase | ||
| 1. | Explain the procedure to the patient. | To gain the patient’s cooperation. |
| 2. | Verify date of expiry of all solutions. | To prevent allergic/toxic reactions. |
| 3. | Assemble equipment at bedside. | To carry out the procedure conveniently. |
| 4. | Be sure that the patient’s fingernails are short and smooth. | To prevent tear or damage to the lens. |
| 5. | Position the patient in supine or high-Fowler’s position in bed. | For ease of insertion/removal of lens. |
| 6. | Perform hand hygiene; wear clean gloves, and place towel just below the patient’s face. | Prevents contamination of the eye/lens and to protect the patient. |
| 7. | Removing lenses | |
| Removal of soft lens: | ||
| Follow steps 1-4 for each eye. | ||
| Add 2-3 drops of sterile saline solution to the patient’s eye. | Moistens the eye. | |
| Ask him/her to look up lens off cornea down onto lower sclera. | Avoiding placing fingernails prevents injury to cornea and damage to lens. | |
| Removal of hard lens: | ||
| Repeat steps 1-5 for each eye. | ||
| Inspect the eye. | To ensure that lens is positioned directly over the cornea. | |
| Place index finger on the outer corner of the eye and draw skin gently back toward the ear. | For easy access of the lens. | |
| Ask the patient to open eye wide. | For easy visualization of the lens. | |
| Ask to blink. Do not release pressure on eyelid until blink is completed. If lens does not dislodge, gently retract eyelid beyond the edge of lens. Press lower eyelid gently against lower edge of lens to dislodge lens. | Blinking/pressure over the eyelid aids in dislodging the lens from the eye. | |
| Allow both eyelids to close slightly, and grasp lens as it rises from the eye. Cup lens in hand. | To receive the lens. | |
| Inspect eye after removal of lens. | To identify redness, pain, swelling of eyelids or conjunctivae, discharge, or excess tearing. | |
| 8. | Cleaning and storage | |
| Apply 1 or 2 drops of cleaning solution to lens in palm of hand. Using index finger (soft lenses) or little finger (rigid lenses), rub lens gently but thoroughly on both sides for 20-30 seconds. | Friction by rubbing with solution aids in removal of deposits on lens. | |
| Hold lens over the emesis basin, rinse thoroughly with recommended rinsing solution. | Friction by rubbing with solution aids in removal of deposits on lens. | |
| Place lens in proper storage case compartment. “R” for right lens and “L” for left. Rigid lenses are placed inside up. | ||
| Fill the case with recommended disinfectant or storage solution. | Washes off the dislodged matter Keeps the lens moist and prevents shrinkage. | |
| Secure the lid and label the case with the patient’s name, identification number, and room number. | For ease in Identification for reuse. | |
| 9. | Inserting the lenses | |
| Wash hands thoroughly and wear clean gloves. | Prevents transmission of microbes. | |
| Place towel just below the patient’s face. | Protects the patient’s clothing. | |
| Inserting a soft lens: | ||
| Follow steps 1-5 for each eye. | ||
| Remove right lens from storage container, rinse with recommended solution; inspect lens for deposits or damage. | Ensures readiness for use. | |
| Place the lens on the tip of the index finger of the dominant hand with the concave side up. | Ensures readiness for use. | |
| Inspect the lens from the side at eye level to ensure that it is not inverted. | Aids in proper placement of lens on the eyeball. | |
| Using middle finger of the opposite hand, retract upper lid until iris is exposed. Using middle finger of the hand holding the lens, pull down lower lid. | Lens may get displaced if placed in the eye in an inverted position. | |
| Instruct the patient to look straight ahead and focus on an object in the distance. Gently place lens directly on cornea, and release lids slowly, starting with lower lid. | Exposes eyeball for easy insertion. | |
| Inserting a rigid lens: | ||
| Follow steps 1-6 for each eye. | ||
| Remove right lens from storage case; try to lift the lens straight up. | Aids in correct placement of lens. | |
| Hold lens on tip of index finger of dominant hand with concave side up. | Ensures readiness for use. | |
| Check the lens. | Aids in correct placement of lens. | |
| Pour a few drops of prescribed wetting solution over the lens. | Aids in proper placement of lens on the eyeball. | |
| Using middle finger of the hand holding the lens, pull down lower lid. | Aids in proper placement of lens on the eyeball. | |
| Instruct the patient to look straight ahead and focus on an object in the distance. Gently place lens directly on cornea, and release lids slowly, starting with lower lid. | Aids in proper placement of lens on the eyeball. | |
| Ask to close eyes briefly to avoid blinking. | To prevent escape of eye lens. | |
| Inspect eye to ensure lens is on cornea. | To ensure proper placement of lens. | |
| Ask the patient to cover the other eye with hand and report if vision is clear and lens comfortable. | To verify proper placement of lens. | |
| Repeat procedure. | To insert lens in other eye. | |
| 10. | Discard solution from storage case, and rinse thoroughly with sterile lens storage solution. | To ensure that it is moist, clean, clear, and free of chips or cracks. |
| 11. | Allow the case to air dry. | To wet the lens surface. |
| 12. | Dispose of towel, remove gloves, and perform hand hygiene. | |
| 13. | Ensure that the patient is comfortable after removal and reinsertion of lenses. | Promotes relaxation. |
| 14. | Check for any disturbances in vision. | Ensures proper placement of lens. |
| 15. | Document the date, time, and the procedure done (insertion/removal), type of lens, and lens care solutions used, condition of the eyes and lens, and any unexpected outcomes. | To plan further care. |
Special Considerations
- Educate patients on their specific replacement schedule and discourage overwear.
- Patients with keratoconus, post-surgical corneas, or severe dry eye may use scleral or hybrid lenses these require advanced care protocols.
- Always wash hands with non-moisturizing soap and dry with a lint-free towel before handling lenses.
- Teach patients to recognize redness, pain, discharge, or blurred vision these may indicate infection or corneal injury.
- Require close supervision and regular follow-up. Consider daily disposables to reduce infection risk.
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 Kluwers, 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
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