Eye medication instillation in pediatrics is the process of administering prescribed eye drops or ointments into a child’s eye to treat infections, inflammation, allergies, or for diagnostic and preoperative purposes. It requires a gentle, sterile technique and age-appropriate communication to ensure safety and cooperation.
Indications for Eye Medication Instillation
| Purpose | Examples |
|---|---|
| Treat infections | Antibiotic drops for conjunctivitis |
| Reduce inflammation | Corticosteroid drops for uveitis or post-op care |
| Manage allergies | Antihistamine drops for allergic conjunctivitis |
| Dilate pupils | Mydriatic drops for eye exams or surgery |
| Anesthetize the eye | Local anesthetic drops before procedures |
| Lubricate dry eyes | Artificial tears for dry eye syndrome |
Preliminary Assessment
- Check label on medication against medication card.
- Review any special instructions.
- Recheck label and make sure that the medication is marked ophthalmic use only.
Also check the expiry date. - Check solution for color changes or sediment, this mean solution is decomposed. Do not use if it appears abnormal.
- Know which (eyes) gets the medication. (OD = right eye, OS = left eye, OU = both eyes).
Equipment Needed
A tray containing:
- Disposable gloves
- Prescribed medication
- Sterile saline-soaked cotton balls in a bowl
- Paper bag and kidney tray
- Sterile dressing pad (optional)
Preparation
- Explain the procedure to the parents and child (as appropriate)
- Provide comfortable position.
- Older children’s supine position with head should be slightly hyperextended.
- Infant-supine with mummy restraint or over the mother’s lap.
Procedure
- Wash hands and don the gloves.
- If child has discharge of crusting of the eye, make sure the eyelid and lashes are clean before administering the medication.
- Moisten a cotton ball or gauze with warm water.
- Place gauze on closed eye for a minute and gently wipe once from inner to outer canthus and discard after one wipe.
- Continue to moisten gauze and wipe eye until clean.
- Put your thumb directly below the center of the eye and gently pull down, making a pocket (conjunctival sac).
- The medication drops should be instilled on to the outer third of lower conjunctival sac.
- Take care not to touch the eye or eyelid with the dropper (1-2 cm above eye level).
In case of ointment:
- Squeeze a small ribbon (1/4-1/2 inch) of ointment from the inner canthus and move outward.
- With eye closed, gently massage eye with a tissue to distribute over the eyeball.
- Use a clean tissue to remove excess ointment.
- Wash hands.
- If applying two different kinds of ointments, wait at least 10 minutes between ointments.
- Document the procedure immediately.
Pediatric-Specific Tips
- For infants, swaddling or using a “mummy restraint” helps reduce movement.
- If the child won’t open their eyes, place the drop in the inner canthus and wait for them to blink.
- Use distraction techniques like toys, songs, or caregiver cuddles to ease anxiety.
Special Considerations
- Use separate bottles for each eye if both are infected.
- Wait 5–10 minutes between different medications.
- Avoid contaminating the dropper by touching lashes or skin.
- Monitor for allergic reactions or worsening symptoms.
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
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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