Administering Ophthalmic Medications

Purposes:
• Instillation
- To provide an eye medication the client requires

• Irrigation
- To clear the eye of noxious or other foreign material or excessive secretion in the preparation for surgery

1. Review prescriber’s medication order.
2. Assess condition of client’s external eye structures.
3. Determine whether client has any known allergies to eye medications. Ask if client is allergic to latex.
4. Determine whether client has any symptoms of visual alterations.
5. Assess client’s level of consciousness and ability to follow directions.
6. Assess client’s knowledge regarding drug therapy and desire to self-administer medication.
7. Assess client’s ability to manipulate and hold eye dropper.
8. Explain procedure to client.
9. Wash hands.
10. Arrange supplies at client’s bedside.
11. Apply clean gloves.
12. Ask client to lie supine or to sit back in chair with head slightly hyperextended.
13. Wash away any crusts or drainage along client’s eyelid margins or inner canthus. Soak any crusts that are dried and difficult to remove by applying a damp washcloth or cotton ball over eye for a few minutes.
14. Hold cotton ball or clean tissue in nondominant hand on client’s cheekbone just below lower eyelid.
15. With tissue or cotton ball resting below lower lid, gently press downward with thumb or fore-finger against bony orbit.
16. Ask client to look at ceiling.
17. Instill eye drops while explaining steps to client:
A. With dominant had resting on client’s forehead, hold filled medication eye dropper or ophthalmic solution approximately 1 to 2 cm above conjunctival sac.
B. Drop prescribed number of medication drops into conjunctival sac.
C. If client blinks or closes eye or if drops land on out lid margins, repeat procedure.
D. For drugs that cause systemic effects, with a clean tissue apply gentle pressure with your finger and clean tissue on the client’s nasolacrimal duct for 30 to 60 seconds.
E. After instilling drops, ask client to close eye gently.
18. Instill eye ointment:

A. Ask client to look at ceiling.
B. Holding ointment applicator above lower lid margin, apply thin stream of ointment evenly along inner edge of lower eyelid on conjunc-tiva from inner canthus to outer canthus.
C. Have client close eye and rub lid gently in circular motion with cotton ball, if rubbing is not contraindicated.

19. Intraocular disk procedures:
A. Application:
(1) Wash hands.
(2) Put on gloves.
(3) Open package containing disk. Gently press fingertip against disk so it adheres to finger. Position convex side of disk on fingertip.
(4) With other hand, gently pull client’s lower eyelid away from the eye. Ask client to look up.
(5) Place disk in the conjunctival sac so that it floats on the sclera between the iris and lower eyelid.
(6) Pull client’s lower eyelid out and over disk.

B. Removal:
(1) Wash hands.
(2) Put on gloves.
(3) Explain procedure to client.
(4) Gently pull on client’s lower eyelid to expose disk.
(5) Using forefinger and thumb of opposite hand, pinch disk and lift it out of client’s eye.

20. If excess medication is on eyelid, gently wipe eyelid from inner to outer canthus.
21. If client had an eye patch, apply clean patch by placing it over affected eye so entire eye is covered. Tape securely without applying pressure to eye.
22. Remove gloves.
23. Dispose of soiled supplies in proper receptacle.
24. Wash hands.
25. Note client’s response to instillation. Ask if any discomfort was felt.
26. Observe client’s response to medication by assessing visual changes and noting any side effects.
27. Ask client to discuss drug’s purpose, action, side effect, and technique of administration.
28. Have client demonstrate self-administration of next dose.
29. Record drug administration and appearance of client’s eye.
30. Record and report and undesirable side effects.