How to instill eye drops and avoid contamination
Correct procedure is critical for your patients’ best care
Eye drops and ointments are prescribed by doctors to treat acute or long-term ocular conditions. Drops and ointments are administered directly in the site of action and are therefore very effective in treating the diagnosed condition.
Proper instillation of drops or ointments is as critical as instructions for taking systemic medications. Ophthalmic staff and patients alike need to understand the proper technique for best delivery of the prescribed medication.
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Explain, then instill
First, be courteous and explain to the patient what you are doing and what she will experience.
Are you instilling the drop to anesthetize the eye or to dilate? Will she feel a burning or stinging sensation? Will her vision be blurry after the drop is instilled?
Hand patient a tissue to blot away any excess drops
Next, follow these steps to instill the drops.
• Position the patient in a sitting position with head tilted back.
• Remove the cap from the bottle, and hold the dropper over the eye.
• Ask the patient to look up while gently pulling down the lower lid.
• Squeeze the dropper to release one drop into the lower cul-de-sac. Avoid applying pressure to the globe.
• Release the eyelid, and ask the patient to close the eye gently for 30 seconds to contain the drop. This allows even distribution of the eye drop, and prevents rapid clearance of medication caused by blinking.
• Placing more than one drop is a waste of the solution; the total capacity of the cul-de-sac is one-sixth of a drop.
Avoid touching the dropper to touch the conjunctiva, eyeball, eyelid, or eyelashes. If contact is made, the bottle is considered contaminated and should be thrown away. Be sure to firmly screw the top of the bottle back in place immediately after use.
Anesthetic drops are an exception to the method in which the patient looks up.
When instilling anesthetic drops, ask the patient to look down and direct the drop to the 12 o’clock position of the sclera.
This method is used because drops placed into the conjunctival sac are used to dilate the eyes or instill a medication to be in contact with the eye for a period of time. When instilling drops on the 12 o’clock scleral position, the patient will blink, closing the eyelids so the cornea goes underneath the upper lid (called Bell’s phenomenon or palpebral oculogyric reflex). This provides maximum coverage of the cornea with anesthetic.
Instilling ocular ointments is similar to instilling drops. Instill them in the lower conjunctiva sac by gently pulling the patient’s lower lid away, then placing the ointment directly from the tube into conjunctival sac. Place about a quarter-inch ribbon of ointment into the sac.