Eye drop or ointment placement. Ocular burn.contact lens.pptx

Eye dropp.

1. Eye drop or ointment placement technique, Ocular burn management, Eye irrigation Contact lens removal

2. Instilling Eye Drops Eye drops are instilled for their local effects: Pupil dilation ( Examples: Atropine, Cyclopentolate,Tropicamide , Phenylephrine) Pupil constriction ( Miotics : P ilocarpine) Infection treatment (Antibiotics, streoids , NSAIDs…) Controlling intraocular pressure (for patients with glaucoma). The type and amount of solution depend on the purpose of the instillation.

3. EQUIPMENT Gloves Medication Tissues

4. ASSESSMENT Assess the patient for any allergies. Check the expiration date before administering medication. Assess the appropriateness of the drug for the patient. Review assessment and laboratory data that may influence drug administration. Verify patient name, dose, route, and time of administration. Assess the affected eye for any drainage, erythema, or swelling. Assess the patient’s knowledge of the medication. If the medication may affect the patient’s vital signs, assess them before administration.

5. ACTION Ask patient about allergies. Explain the purpose and action of the medication to the patient Remove the cap from the medication bottle, being careful not to touch the inner side of the cap Have patient look up and focus on something on the ceiling Place thumb or two fingers near margin of lower eyelid immediately below eyelashes exert pressure downward over bony prominence of cheek. Lower conjunctival sac is exposed as lower lid is pulled down Hold dropper close to eye, but avoid touching eyelids or lashes. Squeeze container and allow prescribed number of drops to fall in lower conjunctival sac Release lower lid after eye drops are instilled. Ask patient to close eyes gently. Apply gentle pressure over inner canthus to prevent eye drops from flowing into tear duct Instruct patient not to rub affected eye. Remove gloves. Assist patient to a comfortable position .

6. Hold the ointment tube close to eye, avoid touching eyelids or lashes. Squeeze container and apply about 1 ⁄2 inch of ointment from the tube along the exposed sac. Apply the medication moving from the inner canthus to the outer canthus. Ask patient to close eyes gently. The warmth helps to liquefy the ointment. Instruct the patient to move the eye, because this helps to spread the ointment under the lids and over the surface of the eyeball. Assist the patient to a comfortable position. Explain that the ointment may temporarily blur vision; encourage the patient not to rub the eye. Remove gloves Administering Eye Ointment

7. Ocular Burn Management Ocular burns are true emergencies and represent a up to 10% of ocular trauma cases. Chemical burns and thermal burns account for the large majority of ocular burns. Most victims are young males Caustic agents are primarily responsible for the most severe chemical ocular burns . Most reports indicate that alkali burns are more frequent than acid burns. Noncaustic substances: shampoos, hair sprays, personal defense sprays do not cause significant or lasting damage

8. The damage produced to the eye by toxins depends on several factors : duration of contact; anion or cation concentration and amount , pH , and inherent toxicity of the chemical. Ocular Burn Management,

9. Alkalis generally produce the most damage. Alkalis release hydroxylions that combine with tissue fatty acids and proteins causing liquefaction necrosis. The resultant degradation of corneal tissue allows for easy passage of the chemical into the anterior chamber. This causes a rapid rise (e.g., within a few seconds to a few minutes of contact) in aqueous humor pH and consequent damage to the iris, lens, ciliary body, and other ocular structures. Damage to these structures and the cornea results in decreased visual acuity, secondary glaucoma, and cataracts. Ocular Burn Management,

10. Acids cause less damage than alkalis. Acids lead to coagulation necrosis and protein precipitation which usually prevents penetration beyond the cornea. Ocular burns caused by acids can progress if treatment is delayed. Ocular Burn Management,

11. The treatment of chemical exposures to the eye is the primary indication for ocular irrigation Irrigation has three principal objectives: Immediate dilution of the offending agent, Removal of the agent, Normalization of anterior chamber pH. Ocular Burn Management, Ocular irrigation must be employed rapidly. Delays in irrigation can limit its effectiveness and increase morbidity .

12. EQUIPMENT Topical ophthalmic anesthetic agent (0.5 % tetracaine ) Towels and a basin to collect fluid runoff Bags of crystalloid solution Intravenous tubing Gauze pads Cotton-tipped applicators Lid retractors, paper clip or Desmarres retractor Commercial irrigation device (e.g., a Morgan Lens) Protective eyewear, gloves, and gowns for healthcare personnel Ocular Burn Management, The Desmarres eyelid retractor. An eyelid retractor fashioned from a paper clip.

13. eye IRRIGATION Hang the bag of crystalloid solution at a height of 70 to 200 cm above the patient’s head in order to obtain an adequate flow rate. The traditional eye irrigation technique involves directing the flow of crystalloid solution over the globe at a wide-open rate Hold the end of the intravenous tubing 3 to 5 cm above the patient’s eye to avoid blunt injury to the ocular surface. Direct the flow of crystalloid solution at the entire surface of the globe including into the conjunctival sacs and down to the conjunctival fornices . Eyelid retractors (e.g., Desmarres retractors or a bent paper clip) must be employed The eye must be well anesthetized when using eyelid retractors and care must be taken to avoid further ocular injury . Standard ocular irrigation setup using intravenous tubing. An assistant retracts the eyelids using gauze pads or eyelid retractors.

14. Eye irrigation with the Morgan Lens The Morgan Lens. Placement of the lens under the upper eyelid. Placement of the lens under the lower eyelid. Removal of the lens. The Medi -Duct fluid collection system. It is a scleral contact lens-type device that is designed to fit over the anterior ocular surface

15. The EyeCap The unit is quick to set up by just screwing it onto a bottle of sterile saline The patient can open their eye “under water” to gently allow high-volume eye irrigation

16. IRRIGATION FLUID The choice of irrigation fluid is much less important than the speed with which irrigation is started. Tap water is perfectly acceptable Normal saline and Ringer’s lactate solution are both acceptable An optimal irrigant temperature is 32.2°C to 37.8°C Irrigation should not be delayed while an irrigant fluid is being warmed despite the potential value of warmed fluid. Use the irrigant fluid that is most readily available.

17. DURATION OF IRRIGATION Irrigation should be continued for 20 minutes in the home or workplace prior to patient transport . Emergency medical technicians should continue irrigation during ambulance transport until arrival at the Emergency Department No definite standard duration for ocular irrigation is available in the literature minimum : 1 to 2 L of crystalloid solution over 20 to 30 minutes Alkali burns are more likely to require prolonged irrigation than acid burns Several hours of irrigation may be required for severe alkali burns.

18. AFTERCARE Patients with mild exposures that result in corneal defects should be treated with topical antibiotics Analgesics or an eye patch may be offered if patient discomfort is significant Cycloplegics should be prescribed in order to decrease the pain resulting from ciliary spasm. Moderate to severe ocular burns: Medical treatment of secondary glaucoma may be required . Anterior chamber paracentesis and lavage may be needed early in the course of severe alkali burns to decrease the anterior chamber pH and intraocular pressure. The goals of longer-term therapy include the prevention of corneal ulceration Steroids, nonsteroidal anti-inflammatory agents, frequent lubrication,soft contact lenses More severe injuries require: surgical intervention due to the loss of stem cells at the limbus and thus the loss of potential corneal reepithelialization .

19. Contact Lens Removal The Emergency Physician must be familiar with the proper technique of removing soft and hard contact lenses from patients who are unable to do so on their own. Healthy individuals who wear contact lenses overnight experience a 4- to 15-fold increase in the risk of corneal injury compared with those who remove their contact lenses daily . The explanation for this increased risk of injury is based on the development of corneal hypoxia and an immune response to antigens present on the lens surface, both of which lead to an inflammatory response and susceptibility to infectious organisms

20. This tear layer provides oxygen and nutrients to the avascular cornea. The cornea receives nutrition from blood vessels at the limbus and the aqueous humor. Contact lenses increase tear evaporation and disrupt the three-layer tear film. This leads to the lack of corneal oxygenation and the symptoms of dry eye . Dry eye causes discomfort and corneal edema with resultant hazy vision. Contact Lens Removal Contact lenses rest on a three-layer tear film (i.e. outer lipid, middle aqueous, and inner mucin layer) that covers the corneal and conjunctival epithelium.

21. The normal resting position of the contact lens is over the cornea. It may occasionally drift from the center of the eye and relocate: over the sclera, in various parts of the eye socket under the upper eyelid. Inspect under the lower eyelid margin and eversion of the upper eyelid. Failure to adequately perform this examination can lead to the mistaken belief that a contact lens does not exist. A contact lens that remains in place acts as a foreign body and can lead to chronic irritation , inflammation, and development of a mass. Contact Lens Removal

22. INDICATIONS: Contact lenses must be removed from any patient who is unconscious or suffers an ocular injury . Give patients the opportunity to remove their own contact lenses if there are no contraindications (i.e ., immobilization or ocular trauma ). Remove the contact lenses if the patient is unable to remove them. Contact Lens Removal

23. CONTRAINDICATIONS: The only absolute contraindication to removing a contact lens would be in the case of a ruptured globe. Leave the contact lens in place for the Ophthalmologist to remove at the time of their examination and/or surgical repair . Contact Lens Removal

24. EQUIPMENT: Normal saline Two cups, labeled “left” and “right” Cotton-tipped applicators Fill the cups with enough saline to cover the contact lenses. Wear powderless gloves to prevent the powder from irritating the eye. Contact Lens Removal

25. PATIENT PREPARATION Explain to the patient the risks, benefits, and alternative procedures Place the patient sitting or supine position. Place several drops of a saline solution onto the eye Wait 5 to 10 minutes to allow the saline to penetrate the lenses All contact lenses should be centered over the cornea for ease of removal by gentle manipulation of the eyelids. Evert the upper eyelid (if a contact lens cannot be found elsewhere) Instill fluorescein into the eye if the patient still insists that it is present. Contact Lens Removal

26. SOFT CONTACT LENS REMOVAL TECHNIQUES Soft contact lenses can be identified by their larger sizes of > 12 mm They usually extend to, or just beyond, the corneal-scleral junction. There are numerous techniques to remove a soft contact lens. The easiest and simplest method is to remove it manually Retract the lower eyelid with the nondominant index finger The soft contact lens will slide partially onto the conjunctival surface of the lower sclera. Gently grasp the soft contact lens between the thumb and index finger of the dominant hand. Pinch the fingers together and remove the soft contact lens.

27. Gently place the index finger and thumb of the nondominant hand on the upper and lower eyelids, respectively. Retract the eyelids. Gently grasp the soft contact lens between the thumb and index finger of the dominant hand. Slide the soft contact lens inferiorly. Gently pinch the fingers together to pull the soft contact lens from the eye. SOFT CONTACT LENS REMOVAL TECHNIQUES

28. Place the thumb of the nondominant hand and dominant hand on the upper and lower eyelid, respectively. Retract the eyelids until the edges of the contact lens are fully visible. Close both eyelids against the superior and inferior edges of the soft contact lens. Continue to close the eyelids until the contact lens pops off the eye. Grasp and remove the soft contact lens with the dominant hand. SOFT CONTACT LENS REMOVAL TECHNIQUES

29. A commercially available rubber tweezer-like device can be used to remove soft contact lenses. Place the rubber tips of the device onto the center of the soft contact lenses Gently squeeze the tweezers closed using minimal pressure. Remove the soft contact lens from the eye . SOFT CONTACT LENS REMOVAL TECHNIQUES

30. HARD CONTACT LENS REMOVAL TECHNIQUES A hard contact lens can be identified by its small size of 6 to 10 mm Center the hard contact lens on the cornea. Place the index finger (or thumb) of one hand at the base of the eyelashes of the upper eyelid and the index finger (or thumb) of the opposite hand at the base of the eyelashes of the lower eyelid . Gently, but firmly, approximate the eyelids by moving them toward the center of the cornea until the margins of the eyelids touch the edges of the hard contact lens. Press slightly harder on the lower eyelid until the bottom edge of the hard contact lens lifts off the cornea using the edge of the lower eyelid as a fulcrum. Continue to push the eyelids together until the hard contact lens is lifted completely off the cornea and can be easily grasped

31. Pull the skin of the lateral margin of the eyelids laterally with an index finger Alternatively, place one finger on the lateral edge of the upper eyelid and one finger on the lateral edge of the lower eyelid and pull laterally Instruct the patient to look downward and inward toward their nose. The hard contact lens will pop off the cornea. Grasp and remove the contact lens. HARD CONTACT LENS REMOVAL TECHNIQUES

32. A commercially produced suction cup-like rubber device can be used to remove hard contact lenses if available Moisten the surface of the device with a drop of saline. Gently touch the suction cup to the center of the hard contact lens. Suction will form and result in the hard contact lens adhering to the device. Lift the device and the attached contact lens from the cornea. Slide the hard contact lens sideways to remove it from the suction cup. HARD CONTACT LENS REMOVAL TECHNIQUES

33. Use of a cotton-tipped applicator Moisten the cotton with saline. Place the cotton tipped applicator over the lower edge of the hard contact lens Carefully and gently slide the hard contact lens off the cornea and onto the sclera with the moistened cotton-tipped applicator. Gently press the cotton-tipped applicator into the sclera and under the edge of the hard contact lens Lift the hard contact lens from the sclera. Do not use the cotton-tipped applicator to elevate the hard contact lens from the cornea as this can result in a corneal abrasion HARD CONTACT LENS REMOVAL TECHNIQUES

34. AFTERCARE: Place removed contact lenses in the appropriately marked container. Ensure that the contact lenses are covered completely with saline solution. Perform an eye examination using fluorescein eye drops if the patient complains of eye pain after contact lens removal. The procedure may have resulted in a corneal abrasion. CONTACT LENS REMOVAL TECHNIQUES

35. COMPLICATIONS: Any attempt to remove contact lenses with fingernails or other solid objects not approved for the removal of contact lenses can cause corneal abrasions Do not patch corneal abrasions resulting from contact lens removal to prevent an infectious process Never remove a contact lens if there is concern for a potential globe perforation Failure to perform this simple procedure appropriately can result in serious ocular damage. CONTACT LENS REMOVAL TECHNIQUES

36. THANK YOU FOR ATTENTION!