Eye Instillation and Irrigation

EYE
INSTILLATION/IRRIGATION
Modified by: DR. SAMMY B. TAGHOY, MAN, MN, RN
Anatomy of the eye
Anatomy of the eye
The eyeball
The eyeball
The eyeball
The eyeball
The eyeball
Anatomy of the eye
The eyeball
Anatomy of the eye
Anatomy of the eye
EYE INSTILLATION
Introduction
This is a clean procedure. When both eyes
require treatment, each eye must be
treated separately. If infection is present,
there should be two bottles of medicine
one for each eye to prevent cross
contamination. If only one container, the
least affected eye should be treated first to
minimize the likelihood of transfer of
infection from one eye to another.
If more than one medication being
inserted into the eye, care must be
taken to give time for the first
medication to be absorbed, before
applying further medication.
Equipment
• Prescribed eye drops / ointment
• Sterile gloves
• Sterile absorbent sponges soaked in sterile
normal saline (if required)
• Sterile eye dressing (pad) & tape (as needed)
• Dry sterile absorbent sponges
• Apron (if not packed)
• Record of administration of prescribed eye
treatment (a form will be
required for each prescribed medication)
• Care plan
Procedure and Rationale
1. Verbally check the identity of the patient
or confirm identity with family
(To confirm correct identity of the patient)
2. Explain procedure and obtain inform

consent
(To allow patient to make an informed
decision and gain cooperation)
3. Check history of allergies

(Reduce risk of allergic reactions)
4. Explain the benefits and potential side
effects of the medication to inform patient
that some eye medication may cause side
effects such as blurred vision and difficulty in
focussing
(Gain informed and understood consent and
reduce the risk of accidents / falls)
5. Collect and check all equipment

(To prevent delays and enable full
concentration on the procedure)
6. Check the prescribed medication chart for the
following:
√ The dose on the label matches the stated
dose of the prescription chart
√ The correct medication name and form on
the label issued by the supplying pharmacist
corresponds to the drug details on the prescription
chart
√ The date and time of administration on the
prescription chart
√ The route and method of administration
including which eye drops/ointment are prescribed
for
√ The frequency of administration
√ Validity of prescription must be
reviewed at least six months
√ Clearly written prescription,
unambiguous directions and signature of
prescriber is present
(To minimize the potential for drug errors.
Medication reviews needs to be undertaken
if the clinical needs of the patient changes
and prescription charts at least six months)
7. Check the expiry date
(Medication outside its expiry date is no
longer pharmacologically efficacious and
may be dangerous if administered)
8. Close doors / curtains where appropriate

(Maintain privacy and dignity)
9. If the eyelid needs to be cleansed prior

to administration of the drops, follow
Nursing Policy for cleansing of the eye
10. Patient to be encouraged to sit / lie with
head tilted backwards and well supported
(For ease and accuracy of administration)
11. Ensure light source is adequate

(For ease and accuracy of administration)
12. Decontaminate hands and apply gloves and

disposable apron
(Reduce the risk of transient organisms to
the healthcare worker’s hands transmitted
to the patient. To protect uniform from
contamination)
Eye Drops
13. Gently pull down the lower eyelid and

ask the patient to look upward
Instil the prescribed number of drops into
the lower fornix
(To ensure the lower fornix is exposed; to
allow for administration of the drop.
Administration in the lower fornix
minimizes the risk of corneal abrasion)
Eye Ointment
14. Hold the nozzle of the tube

approximately 2.5 cm above the eye
Apply a line of ointment to the inner
edge of the lower lid from the nasal
corner outwards
(Reduce the risk of cross infection,
contamination of the tube and trauma
to the eye)
15. Encourage patient to close eye immediately
after administration of medication
(To ensure adequate drug absorption)
16. Dab away excess medication with gauze

(Prevent excess medication irritating
surrounding skin)
17. Ensure patient / client is comfortable

following procedure
(Maintain privacy and dignity)
18. Remove gloves. Dispose gloves and other
waste as per Infection Control Policy
(To prevent contamination of items used. To
remove any accumulated transient skin flora
that may have built up under the gloves)
19. Document actions in nursing records
including the following:
• Consent
• Date
• Time
• Dose
• Administration site
• Expiry date
• Batch number
• Patient / client perceptions following care
(Ensure compliance with hospital policy
and local record keeping guidelines)
20. Print, sign, and note designation of staff
member for all entries made.
If medication NOT given – document and
explain the reason
EYE IRRIGATION
Purpose:
 Cleanse the eye and remove secretions

 Remove an irritating chemicals or
foreign body
 Treat an inflammatory process
 Relieve congestion and pain
 Lubricate the eye of the comatose
patient
Equipment:
 Sterile eye irrigation tray containing:

a. Bulb syringe or eyedropper
b. Solution container
c. Cotton balls in a medicine glass
 Sterile irrigating solution (type and amount as ordered by
the physician)
 Sterile normal saline (if not the solution ordered for
irrigating)
 Emesis or Kidney basin
 Sterile gloves
 Bed protector
 Waste receptacle
 Towel
Procedure and Rationale
 1. Assemble all equipment

 2. Verify the physician’s order
 3. Identify the patient
 4. Explain the procedure and its purpose to
the patient
CAUTION the patient not to touch
the eyes during any part of the
procedure
 5. Provide privacy
 6. Assist the patient to a supine position with
the neck slightly extended and the head tilted
slightly toward the affected eye so that the
solution will flow from inner canthus to outer
canthus
√ Gravity will aid flow of solution away
from the unaffected eye and help prevent
spread of material from eye to eye.
Solution directed toward outer canthus
aids in preventing spread of contamination
to lachrymal sac and duct and nose.
 7. Cover the surrounding area with a bed protector
 8.Wash hands
 9. Pour the sterile normal saline over the cotton balls
to moisten them, using aseptic technique
 10. Pour irrigation solution into solution container,
using aseptic technique
 11. Place emesis basin along the contour of the
patient’s face, supporting the basin with a towel if
necessary
√ Materials lodged on eyelids and lashes may be
washed into eyes if not removed
 12. Cleanse the eyelids with the moistened cotton
balls, starting with the inner canthus and
cleansing outward. Use a new cotton ball with
each stroke
 13. Fill the irrigation syringe or dropper with the
irrigating solution
 14. Separate the eyelids with your forefinger and
thumb, resting your fingers on the cheekbone
and brow
√ To avoid possible injury to the cornea,
solution is directed onto the lower
conjunctival sacs -- not onto the eyeballs
 15. Inform the patient that irrigation is about
to start and pour a little of the fluid onto the
eye
 16. Irrigate gently by directing the flow of
solution from the inner canthus along the
lower conjunctival sac
√ Length of irrigation depends on
cleansing effect desired
 17. Irrigate until the prescribed amount of
solution has been used
√ Excess moisture on eyelids and lashes is
uncomfortable for the patient
 18. Wipe the eyelids with a moistened
cotton ball after the irrigation has been
completed
 19. Position patient comfortably
 20. Discard waste and return it to the
appropriate area
 21. Wash your hands and document
procedure
Important:
 For children – 2 nurses required

1 nurse to hold the child (with parental
consent) and 1 nurse to hold the child’s eyelids
apart using the first and second finger held
against the orbital ridge and do the irrigation
or instillation.
 DO NOT PRESS ON THE EYEBALL -- TO

AVOID ANY UNNECESSARY DISCOMFORT
THANK YOU

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EYE

2. Explain procedure and obtain inform

3. Check history of allergies

5. Collect and check all equipment

8. Close doors / curtains where appropriate

9. If the eyelid needs to be cleansed prior

11. Ensure light source is adequate

12. Decontaminate hands and apply gloves and

13. Gently pull down the lower eyelid and

14. Hold the nozzle of the tube

16. Dab away excess medication with gauze

17. Ensure patient / client is comfortable

 Cleanse the eye and remove secretions

 Sterile eye irrigation tray containing:

 1. Assemble all equipment

 For children – 2 nurses required

 DO NOT PRESS ON THE EYEBALL -- TO

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