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Eye drops/Ointment
Practice educator
●This article has been double-blind
Medicines management peer reviewed
The administration of topical eye medications must be given the same priority
and attention to safety as drugs administered by the systemic route
T
Nurses, patients and carers need a good drugs delivered
he eyes are a vital part of the cen- knowledge and understanding of the ther- by other routes
tral nervous system. They convert
light into electrical impulses that
are transmitted to the occipital
apeutic effects and potential side-effects
of the topical drugs they administer. They
must also be familiar with potential drug
4 Systemic
absorption
of eye drops and
region of the brain, where they are inter- interactions that can occur between dif- ointments occurs
preted into meaningful images. The eyes ferent types of eye drops and ointment, via the conjunctival
enable us to navigate our environment, see and also between these and drugs delivered blood vessels or
fine detail, interpret colour, and maintain by any other route (Andrews, 2006) – as an the nasal mucosa
our health and safety while performing
everyday activities. However, little atten-
tion tends to be paid to the eyes or their sur-
example, timolol eye drops may interact
with insulin. 5 Eye drop
dispensing
aids can help
rounding structures until something goes Administering drops and ointment patients to
wrong with them; Marsden and Shaw (2003) Eye drops and ointment should be admin- self-medicate
highlighted health professionals’ lack of istered:
understanding of eye conditions. » At the correct time;
» In the correct strength;
Administration principles » Via the correct route;
Eye drops and ointment are prescribed to » To the right person;
treat acute or long-term eye conditions » Into the correct eye.
and/or the structures surrounding eyes. Some eye drops have a long-acting effect
They are the mainstay of treatment for eye on the pupil so it is vital they are instilled
disease as they are administered directly to into the correct eye. For example, atropine
their site of action and are, therefore, more 1% makes the eye light sensitive as the pupil
effective than medications administered will not contract in bright light. Adminis-
orally. They are also used to prevent or treat tration procedures are stated in Boxes 1 and 2.
infection or inflammatory conditions and, It is vital to establish the patient is not
in some instances, are used to relieve dis- allergic to any of the eye drops or ointment
comfort or to prevent damage, such as ingredients. Before instilling these, the eye
with dry-eye treatment (Marsden, 2007). and eyelids should be examined for signs
Times.net
section at bit.ly/NTMedsManagement
of improvement or deterioration. In case of tion (www.glaucoma-association.com) has the same quantities. This may cause sensi-
the latter, medical help should be sought developed a compliance briefcase that tivity, resulting in sore eyes. If this occurs,
without delay. contains samples of most types of eye drop the proprietary item may be dispensed.
aids and provides these free of charge to It should be noted that generic bottles
Systemic absorption eye units in the UK. are not a uniform size and, as a result, the
Systemic absorption (SA) of eye drops and drop size itself may be larger. This can
ointments occurs via the conjunctival Generic eye drops result in the drug not lasting as long as the
blood vessels or the nasal mucosa. This is a Many eye drops are now off licence and a proprietary brand.
particular issue when drugs such as beta- generic product may be prescribed. Generic
blockers are prescribed (Marsden, 2007). preparations are generally cheaper than Safety considerations
For example, the beta-blocker timolol can proprietary products; they usually contain After administration of eye drops or oint-
cause bronchoconstriction, hypotension, the same ingredients but not necessarily in ments, patients must be advised against
bradycardia, nausea, diarrhoea, anxiety,
depression, hallucinations and fatigue.
Box 1. Procedure for instilling eye drops
These effects can be reduced through the
use of punctual occlusion (keeping the eye ● Position the patient comfortably, either sitting or lying down (semi-prone or
closed for a slow count of 60) after adminis- recumbent) with the head supported
tration. Alternatively, the patient can apply ● Wash hands before and after instilling eye drops to prevent cross infection and to
digital pressure to the tear drainage system remove drug residue from the hands
at the nasal corner of the closed eyelids (Fig ● Some local policies require that non-sterile gloves are used when instilling eye
2). These techniques minimise the amount drops or ointment and that an aseptic non-touch technique is used for first post-
of drug being taken into the nasolacrimal operative dressing and application of eye drops (Shaw et al, 2010)
system and into the systemic circulation. ● Cleaning the eye may be required, for example when there are crusty or purulent
In a theatre setting or when the eye is deposits on the eyelids. Clean the lids with non-woven or cotton wool swabs dipped
thought to have been lacerated or pene- in cooled boiled water or sterile saline solution (cotton wool is contraindicated when
trated, preservative-free eye drops must be there are sutures on the skin)
used to stop potentially sight-threatening ● Establish that you have the correct eye drops and that they have not expired
complications. The preservative will cause ● Gently agitate the bottle before use to make sure the drug is properly mixed
intraocular irritation and inflammation. ● Warn the patient the drops will sting transiently when administered (Andrews, 2006)
Eye ointment, if prescribed for the eye ● Instil the eye drop into the space (fornix) created by gently pulling down the lower
itself, should be applied into the lower lid (Fig 1)
fornix in a strip of approximately 5mm. If ● Ask the patient to look up – this helps to ensure the eye drop does not land directly
prescribed for treating the eyelids, care onto the sensitive cornea
should be taken to ensure the ointment is ● Once the eye drop is instilled, release the eyelid, using a tissue or swab to dab any
not be placed in the eye itself. excess from the cheek
● Avoid holding the tissue too close to the eye, to prevent the drug wicking away
Eye drop dispensing aids from the eye
Eye drop dispensing aids (Fig 3) can help ● Where multiple drops and/or ointment are prescribed for one or both eyes, the
patients to self-medicate and become inde- order of administration is important to ensure maximum therapeutic effect of each
pendent in managing their own condition, (Andrews, 2004) (see Table 1)
particularly when it is long term, such as ● Only one drop of each drug is required; more than this will create overflow onto the
open-angle glaucoma. The dispensing aid cheek. Ideally, five minutes should elapse between administration of a different eye
must match the patient’s needs and must drop to achieve maximum therapeutic effect (Andrews, 2006)
also fit the eye drop bottle. When patients Closed eye technique
are prescribed several different eye drops, Alster et al (2000) recommended a technique for patients who find it difficult to have
they will need an aid for each bottle. drops instilled directly into the eye, for example, children or older people:
Eye drop aids are available on prescrip- ● Ask the patient to lie flat or with their head tilted back
tion but some pharmaceutical companies ● Administer a drop of the medication onto the closed eyelid in the nasal corner
provide them free of charge for their prod- ● Ask the patient to open the eye and close it gently once the drug has entered it
ucts. The International Glaucoma Associa-