VISION PROTECTION & GENERAL EYECARE

An important means of preventing blindness and other less severe visual losses is through the following

Public Education

General eye care

Safety precautions

First aid for eye injury

Symptoms indicating possible eye problems

Persistent redness of the conjunctiva

Continuing pain or discomfort

Visual disturbances

Crossing of the eyes

Growth in the Eyes

Eye Discharges, Crusting or Tearing

Routine eye care is recommended… At birth At birth Between the ages of 2 to 5 years Between the ages of 2 to 5 years At age 10 and in early adolescence At age 10 and in early adolescence Every 5 years during young adulthood Every 5 years during young adulthood Every 2 years to 5 years after the age of 40. Every 2 years to 5 years after the age of 40. Whenever ocular symptoms develop Whenever ocular symptoms develop Annual IOP measurement for anyone who has a family history of glaucoma. Annual IOP measurement for anyone who has a family history of glaucoma.

Ways on how to protect your vision Regular Ocular Examination Regular Ocular Examination Keeping away hazardous materials Keeping away hazardous materials Early identification and treatment of strabismus in children Early identification and treatment of strabismus in children Immediate treatment when eye symptoms occur Immediate treatment when eye symptoms occur Instillation of appropriate eye drops in every newborn Instillation of appropriate eye drops in every newborn

Blood test during pregnancy to identify syphilis Blood test during pregnancy to identify syphilis Immunization against rubella Immunization against rubella Regulation of oxygen concentrations administered to premature infants. Regulation of oxygen concentrations administered to premature infants. Prevention of eye infection through proper treatment of eye injuries. Prevention of eye infection through proper treatment of eye injuries.

Maintaining healthy eyes… Do not habitually rub the eyes Do not habitually rub the eyes Teach the children about eye care and protection Teach the children about eye care and protection Have an adequate sleep to reduce eye strain Have an adequate sleep to reduce eye strain Wear protective goggles/ glasses as necessary Wear protective goggles/ glasses as necessary Keep glasses clean and protected from scratching or breakage. Keep glasses clean and protected from scratching or breakage. Do not use any eye medication or eye drops unless prescribed by a physician. Do not use any eye medication or eye drops unless prescribed by a physician. Do not use soiled wash cloth to clean the eyes. Do not use soiled wash cloth to clean the eyes. Take care when using aerosol sprays or any solvents to avoid splashing or spilling them into eyes Take care when using aerosol sprays or any solvents to avoid splashing or spilling them into eyes

Nursing Guidelines in General Eye care Wash hands thoroughly before and after touching the eyes Wash hands thoroughly before and after touching the eyes Be gentle when giving any eye care Be gentle when giving any eye care Keep solutions that are unsafe for the eyes away with the patient and from other eye medications Keep solutions that are unsafe for the eyes away with the patient and from other eye medications Use only sterile materials in the eye Use only sterile materials in the eye Have an adequate light when performing ocular procedures Have an adequate light when performing ocular procedures Provide safety measures to blind and partially sighted people Provide safety measures to blind and partially sighted people Clean eyelids from the inner to the outer canthus Clean eyelids from the inner to the outer canthus Try to prevent disorientation in people who are newly blinded and who have both eyes covered. Try to prevent disorientation in people who are newly blinded and who have both eyes covered. Teach basic principles on ocular first aid to others Teach basic principles on ocular first aid to others

NURSING INTERVENTION FOR THE EYE

Eversion of the Upper Eyelid Eversion of the eyelid is performed to inspect and assess and to remove foreign object from the palpebral conjunctival region.

PROCEDURE Ask the person to look down ( relaxes the levator muscle). Ask the person to gently close the eyelids ( not to squeeze them shut). Grasp the eyelashes of the upper lid between thumb and forefinger. Hold an applicator stick horizontally against the outer eyelid and push down and fold the eyelid on itself. As soon as the lid is everted, appose the fingers and hold the lashes up against he eyebrow.

Ocular Irrigation Cleaning and irrigating solutions are prescribed to flush the conjunctival sacs. Ocular irrigation is being done to remove secretions and harmful chemicals that splashed the eye Cleaning and irrigating solutions are prescribed to flush the conjunctival sacs. Ocular irrigation is being done to remove secretions and harmful chemicals that splashed the eye

Purpose: Remove chemicals (accidentally splashed in the eye). Remove secretions ( preoperatively or with inflammatory conditions. Irrigating Solution: Normal Saline Solution Lactated Ringers Solution Tap Water – for emergency situation All irrigation solution should be bland and at room temperature.

PROCEDURE Client may be either sitting up with head tilted slightly or lying flat. Head should be tilted towards the side to be irrigated. While irrigating hold a handful of cotton balls or a clean towel against the clients cheek. Hold the clients eyelids apart with one hand and ask to look upward with both eyes.

Apply solutions by using: (a) an IV bag and tubing for copious irrigation (flushing for chemical burns (b) commercial sterile ophthalmic solution in plastic irrigation bottles (c) a soft rubber bulb syringe. Direct the flow of solution toward the inner canthus onto the conjunctiva. Do not direct the stream forcefully onto the cornea and do not contaminate the irrigating apparatus by touching the eye structure. Continue the procedure until chemicals and/or secretions are removed from the eye. Gently dry the area around the eye with cotton or gauze. Use individualized irrigating equipment and solution.

Cleaning Eyelids Clean a persons eyelids before: instilling ocular medication instilling ocular medication applying compresses applying compresses inserting artificial eyes inserting artificial eyes if the eyelids are crusted if the eyelids are crusted or have discharges or have discharges

Eye Drops Eye drops are saline- containing drops used as a vector to administer medication in the eye. Eye drops sometimes do not have medications in them and are only lubricating and tear- replacing solutions, and they can also contain anti-redness and similar chemicals. Eye drops are saline- containing drops used as a vector to administer medication in the eye. Eye drops sometimes do not have medications in them and are only lubricating and tear- replacing solutions, and they can also contain anti-redness and similar chemicals.

Eye Compress Using a compress will soothe the eye. To make a compress, use a cotton pad or very clean cloth and apply the compress for at least 10 minutes as often as needed. Using a compress will soothe the eye. To make a compress, use a cotton pad or very clean cloth and apply the compress for at least 10 minutes as often as needed.

Warm and Cold Compresses If compresses are to be sterile, or if eye has copious discharges, use a new compress each time one is changed. If compresses are to be sterile, or if eye has copious discharges, use a new compress each time one is changed. If both eyes are to have compresses applied, use separate sterile gauze or clean wash clothes for each eye. If both eyes are to have compresses applied, use separate sterile gauze or clean wash clothes for each eye. Warm Moist Compresses: May be applied to: Clean the eyes Clean the eyes Relieve pain Relieve pain Increase circulation Increase circulation Reduce ocular tension Reduce ocular tension Increase absorption in superficial infections and eyelid inflammation and deep seated disorders as iritis. Increase absorption in superficial infections and eyelid inflammation and deep seated disorders as iritis. Usually applied four (4) times a day. Usually applied four (4) times a day.

Procedure: If compresses are to be sterile, or if the eye has copiuos discharge, use a new compress each time one is changed. If both eyes are to have compresses applied, use separate sterile gauze squares or clean wash clothes for each eye.

Care for Artificial Eye Over time, the surface of the prosthesis collects protein and debris. Taking good care of your prosthesis helps to ensure a healthy socket and increase the life of your prosthesis. Some patients find that removing and cleaning their prosthesis every day is necessary, while others are able to wear it for a couple weeks or longer before cleaning.

Removing the Artificial Eye To remove the artificial eye, simply pull down the lower lid and look upward, which allows the prosthesis to slide out over the lower lid. Make sure you place the palm of your free hand on your cheek to catch the prosthesis as it slides out. There are also suction cups available to help with the removal of an ocular prosthesis if needed. To remove the artificial eye, simply pull down the lower lid and look upward, which allows the prosthesis to slide out over the lower lid. Make sure you place the palm of your free hand on your cheek to catch the prosthesis as it slides out. There are also suction cups available to help with the removal of an ocular prosthesis if needed.

Placing an Artificial Eye Attach suction cup to prosthesis, lift upper eyelid with finger to create an opening. Without suction cup, hold on to edges of prosthesis with fingers. Attach suction cup to prosthesis, lift upper eyelid with finger to create an opening. Without suction cup, hold on to edges of prosthesis with fingers. Gently slide top edge of artificial eye under upper lid into the socket. Gently slide top edge of artificial eye under upper lid into the socket. Release upper lid while holding artificial eye in place. Release upper lid while holding artificial eye in place. Gently pull down lower lid until eye drops into position behind the lids. Gently pull down lower lid until eye drops into position behind the lids. Remove suction cup and blink to moisten prosthesis. Check eye position and adjust if necessary. Remove suction cup and blink to moisten prosthesis. Check eye position and adjust if necessary.

Common Ocular Medications LOCAL ANESTHETICS MYDRIATICSMIOTICSANTI-MICROBIALSBETA-BLOCKERS CARBONIC ANHYDRASE INHIBITORS CORTICOSTEROIDS

Common Ocular Medications LOCAL ANESTHETICS MYDRIATICSMIOTICSANTI-MICROBIALSBETA-BLOCKERS CARBONIC ANHYDRASE INHIBITORS CORTICOSTEROIDS

Local Anesthetics Tetracaine Hcl – commonly used topical anesthetic. Anesthesia occurs 5-9 minutes Tetracaine Hcl – commonly used topical anesthetic. Anesthesia occurs 5-9 minutes Proparacaine Hcl – least irritating of the local anesthetics. Anesthesia occurs in 20 seconds Proparacaine Hcl – least irritating of the local anesthetics. Anesthesia occurs in 20 seconds

Mydriatics Causes the pupil to dilate Phenylephrine Hcl (Neo-Synephrine) – Most commonly used mydriatic. Phenylephrine Hcl (Neo-Synephrine) – Most commonly used mydriatic. Hydroxyamphetamine Hydrobromide Ophthalmic solution - useful in those with allergy to phenylephrine Hydroxyamphetamine Hydrobromide Ophthalmic solution - useful in those with allergy to phenylephrine Epinephrine Hcl – lowers IOP in angle glaucoma(increases outflow of aqueous humor) Epinephrine Hcl – lowers IOP in angle glaucoma(increases outflow of aqueous humor) Atropine Sulfate Atropine Sulfate Scopolamine Hydrobromide Scopolamine Hydrobromide Tropicamide (mydriacyl) Tropicamide (mydriacyl) Cyclopentolate Hcl (Cyclogyl) Cyclopentolate Hcl (Cyclogyl)

Miotics (Parasympathomimetics) causes the pupil of the eye to constrict. Carbachol Carbachol Physostygmine Salicylate Physostygmine Salicylate Acetylcholine Acetylcholine Pilocarpine Hcl – frequently used in glaucoma to decrease IOP Pilocarpine Hcl – frequently used in glaucoma to decrease IOP Echothiopate iodide (Phospholine Iodide) Echothiopate iodide (Phospholine Iodide)

Anti Microbials Gentamycin Gentamycin Neosporin Neosporin Bacitracin (ointment) – effective as penicillin substitute for local eye uses. Bacitracin (ointment) – effective as penicillin substitute for local eye uses. Erythromycin (ointment) Erythromycin (ointment) Chloroptic eye drop Chloroptic eye drop Sulfonamides Sulfonamides

Beta Blockers Lowers Intraocular Pressure Timolol Meleate (Timoptic) – most widely used medication to reduce IOP, reduces aqueous humor formation within 30 minutes Timolol Meleate (Timoptic) – most widely used medication to reduce IOP, reduces aqueous humor formation within 30 minutes Luvebunolol Hydrochloride (Betagan) Luvebunolol Hydrochloride (Betagan)

Carbonic Anhydrase Inhibitors Reduces Aqueous Humor Production Reduces Aqueous Humor Production Acetazolamide (Diamox) Acetazolamide (Diamox)

Corticosteroids Effective in treating inflammatory conditions and decreasing vascularization and scarring after burns trauma and severe inflammation Cortisone Acetate (ointment) Cortisone Acetate (ointment) Hydrocortisone (ointment) Hydrocortisone (ointment) Dexamthasone Dexamthasone Prednisone Prednisone

Care For Eye Surgery Orient the patient to the staff and environment before the surgery. Orient the patient to the staff and environment before the surgery. Call light should be placed within the patients reach if both eyes are covered. Call light should be placed within the patients reach if both eyes are covered. Children should practice having their eyes covered to decrease fear after the surgery. Children should practice having their eyes covered to decrease fear after the surgery.

Care For Eye Surgery General Postoperative Goal is to prevent the following : IOP IOP stress on suture line stress on suture line Hyphema Hyphema Infection Infection

Care For Eye Surgery Avoid coughing, vomiting, sneezing or sudden movements. Avoid coughing, vomiting, sneezing or sudden movements. Do not lie on the stomach or operated side Do not lie on the stomach or operated side Avoid straining when defecating, lifting the head or hips. Avoid straining when defecating, lifting the head or hips. Avoid bending forward to prevent stress on the suture lines. Avoid bending forward to prevent stress on the suture lines. Bedside table should be placed on the unaffected side to avoid excessive movement of the head. Bedside table should be placed on the unaffected side to avoid excessive movement of the head.

Care For Eye Surgery Supervision and assistance in ambulation should be given to avoid sustaining injury. Supervision and assistance in ambulation should be given to avoid sustaining injury. Patients who are to have visual limitation must be helped to learn to feed themselves Patients who are to have visual limitation must be helped to learn to feed themselves The patient should follow the surgeons instructions carefully and keep appointments as scheduled The patient should follow the surgeons instructions carefully and keep appointments as scheduled