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Eye CareAdults

Cleansing the eyelidsDemonstrated by Lynn Ring, Ophthalmic Nurse Specialist,

Epsom & St Helier University Hospitals NHS Trust

©2015 Clinical Skills Limited. All rights reserved

Ocular hygiene is a significant part of nursing care. It should be part of daily personal hygiene, when carrying out bed baths or assisting with washing, as well as when a patient complains of eye discomfort. It is important to clean both the upper and the lower eyelids to ensure that the patient gains maximum relief from symptoms. The frequency of care will depend on symptoms and patient preference. In patients who are sedated or unconscious, ensure that the eyelids are fully closed, to avoid exposure damage to the cornea.

Eyes that feel sore, itchy or gritty are a common complaint. Causes include: • Poor sleep.• Tear film dysfunction (dry eye). Patients may report sore eyes upon waking, with symptoms that worsen during the day. The symptoms may include pain, a burning sensation and a red eye (Shaw et al., 2010).• Blepharitis (a disorder of the eyelid margins). It usually affects both eyes and is chronic in nature. It occurs particularly in elderly people or young people with autoimmune disease (Pane & Simcock, 2005). It often causes crusting around the lash margins and stickiness when waking, as well as a red eye.• Conjunctivitis, which may be viral, allergic or bacterial. The symptoms may include a feeling of grittiness, itchiness, discharge and red eye.• Eye surgery, such as that to remove a cataract. Patients who have had eye surgery will have been given instructions about when and how to cleanse their eyelids; health professionals, patients and carers alike need to follow these instructions.

Regardless of the cause, eyes that feel irritable can be distressing, as the natural tendency to rub the affected eye(s) can cause further damage.

Equipment

Obtain an eye dressing pack or an ordinary dressing pack, and sterile normal saline. Cotton buds may be used to remove crusted debris (follow local policy). This procedure shows use of a clean technique to cleanse the eyelids.

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain his/her consent, in line with the policies of your employer or educational institution

Assess the eyelids. Check for inflammation, crusting and/or thick discharge. Does the eye itself look red? Take care not to touch the globe of the eye itself, particularly the cornea, to avoid accidental damage. As appropriate, you may need to carry out a full external examination of the eyes (see clinicalskills.net procedure on External examination of the eyes).

Explain the procedure to the patient and obtain informed consent. Ensure privacy. You will need a good light source, so that you will be able to see any minute particles. Avoid shining the light into the patient’s eyes; illuminate the eyes by directing the light to the side of the eye or just below the nose. Ask the patient to remove any spectacles or contact lenses.

Assess the patient Prepare your patient: obtain consent

STERILE R STERILE R

CONT: 50XECM FLN/WHT PAPER. 50X45CM DRESSING TOWELEYE DRESSING PACK REF: RML 101 - 514 REV B( 1715SHTO8L)

MEDIUM LATEX FREE EX/GLOVES.10. EX5CM 4FLY N/W/SWABS 1 GALLIPOT TRAV

= 912529 ===10/2009==10 2012 1 : YELLOW BAG

LOT : : :DO NOT USE IF PACK OPEN OR DAMAGED SINGLE USE ONLY 2 DO NOT USE IF PACK OPEN OR DAMAGED SINGLE USE ONLY 2

LOT : : :

25ml sterile topical irrigation solutioncontaining 0.9%wv Sodium Chloride Ph. Eur.

NOT FOR INJECTION

DISCARD ANY UNUSED SOLUTION

STORE BELOW 25ϒC IN ORIGINALCONTAINEROUT OF DIRECT SUNLIGHT

FOR THE TOPICAL IRRIGATION OF EYES,BURNS AND WOUNDS

INCOMPATIBLE CHEMICALLY WITHSILVER, LEAD AND MERCURY 0120

STERILESTERETSNormasol

Patient position

Make sure that you use each swab only once. Continue to talk to your patient, explaining what you are doing throughout the procedure, to reduce any anxiety and promote cooperation.

Ask your patient to open his or her eyes and look up. Repeat the procedure using a clean gauze swab or cotton bud, while you gently evert the lower lid away from the eye. Again, clean from the nasal edge outwards. Repeat as necessary.

Dispose of each swab after use Swab the lower lid Check that the eye is now clean

Swab away from the nose Ask the patient to look down

Eye Care

Adults

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Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain his/her consent, in line with the policies of your employer or educational institution

Cleansing the eyelids Page 2

Wash and dry your hands thoroughly. Put on gloves according to local policy. Keep talking to your patient as you open the dressing pack and pour the saline, to increase cooperation.

Make your patient comfortable with his or her head well supported. Protect the patient’s clothing with paper towels.

Dip a swab into the saline and squeeze off excess fluid. To prevent contamination, avoid touching the edge of the swab that you will use to clean the eyelids. Ask patient to close the eye to be cleaned.

Always clean the unaffected or least-affected eye first. Use one swab and gently wipe across the upper lid from the nasal edge towards the temporal edge. Dispose of the gauze swab. Repeat, using a clean, wet, gauze swab each time, until the eye looks clean.

Ask your patient to look down to protect the ocular structures while you clean along the lash margins, gently elevating the lid away from the eye. Use a new swab for each sweep across the lash margins.

Wash your hands Moisten a gauze swab with saline

Inspect the eye to ensure that no debris remains. Dispose of equipment and decontaminate your hands according to local policy. Document your intervention and the outcome in the patient’s records (NMC, 2009).