Learn how to instill eye drops as a nurse and how to perform punctal occlusion for glaucoma medications.
It may seem like instilling eye drops into a patient’s eye is self-explanatory, but there are some very important steps you must follow to do this skill correctly.
It is important to keep in mind exactly where the eye drops will be instilled in the eye and if it is necessary to perform punctal occlusion (also called nasolacrimal blockage).
Video Demonstration on How to Give Eye Drops
Steps on How to Administer Eye Drops
1. Wash your hands and don gloves.
2. Inspect the eye and ensure it is clean before instilling the drops.
- Assess for excessive redness or drainage. If exudate is present around the eye, clean it with a warm washcloth. Do this by cleaning at the inner part of the eye to the outer.
3. Remove gloves, perform hand hygiene, and don a new pair of gloves.
4. Confirm patient’s medication administration rights: right drug, right dose, right patient, right time and right route. NOTE: It is especially important you note how many drops will be instilled in the eye and which eye (right or left). Many patients are taking multiple types of medications for the eyes, so be sure to pay attention.
5. Position the patient by having the patient look-up and tilt the head back. If they are unable to do this, have them lay back and extend the head with pillows.
6. Pull down the conjunctival sac with your non-dominant hand. NOTE: this is where you will instill the drops …not on the cornea or eye ball because this is a very sensitive area.
- Pull down the lower eye lid with the thumb or index finger at the cheek bone (keep the finger away from the eye…you don’t want to poke it). Also, it is a good idea to hold a piece of tissue paper in this hand to wipe away any excess that leaks from the eye.
7. Squeeze the prescribed amount of drops into eye with your dominant hand by holding the bottle between the index finger and thumb. NOTE: be very careful not to touch any parts of the eye with the tip of the eye drop container because it will become contaminated.
8. Have the patient close the eye and rotate it around to coat the eye with the medication. Tell the patient to refrain from blinking and to keep the eye closed for about 30 seconds to 1 minute.
Performing Punctal Occlusion
Why is punctal occlusion performed? Some glaucoma medications (beta-blocker, alpha-adrenergic agonist etc.) require you or the patient to perform punctal occlusion (also called nasolacrimal duct occlusion) AFTER instilling the eye drops for approximately 2-3 minutes. This prevents the medication from draining down into the nasal passages via the nasolacrimal duct and eventually to the bloodstream, which decreases the effectiveness of the drug in the eye and can cause systemic signs and symptoms in the body.
How to Perform Punctal Occlusion
*****Same steps as above but perform punctal occlusion immediately AFTER instill the eye drops for 2-3 minutes
1. Tell the patient to keep eye closed immediately after instilling the drops (it is very important they do NOT blink because with causes the medication to flow into the punctum (tear ducts)
2. Then take the index finger and place it at the side of the bridge of the nose at the inner corner of the eye, and place firm but gentle pressure to occlude the punctum for 2-3 minutes. This will prevent the medication from draining down.
You may be interested in more nursing skills.
- Facts About Glaucoma | National Eye Institute. Nei.nih.gov. Retrieved 23 March 2017, from https://nei.nih.gov/health/glaucoma/glaucoma_facts