The administration of ophthalmic medication requires methodical care to ensure patient safety and therapeutic effectiveness. The eye’s natural defenses, such as the blink reflex and tear production, can rapidly wash away medication, making accurate delivery challenging. A standardized procedure maximizes the drug’s contact time with the ocular surface, allowing for optimal absorption and the desired local effect.
Pre-Administration Assessment and Preparation
Before administration, a thorough pre-check process must be completed to prevent errors. This involves verifying the medication order against the patient’s record, ensuring the “five rights” of administration are satisfied: the right patient, drug, dose, time, and route. Proper hand hygiene is performed, and non-sterile gloves are donned to maintain an aseptic environment and prevent cross-contamination. Necessary equipment, including the medication, a clean tissue, and potentially a cleansing solution like normal saline, must be gathered.
A focused assessment of the affected eye is necessary, checking for crusting, discharge, or inflammation that might interfere with absorption. If discharge is present, the eye should be gently cleansed using a sterile wipe or gauze, moving from the inner canthus (near the nose) to the outer canthus. The patient is then positioned either sitting upright with their head tilted slightly back or lying supine, which stabilizes the head and facilitates instillation. The patient’s ability to cooperate is assessed, as sudden movement or blinking compromises accurate drop placement.
Step-by-Step Procedure for Ophthalmic Drop Instillation
Once preparation is complete, the physical application of the eye drops begins. Instruct the patient to look upward and away from the dropper to minimize the blink reflex. Using the non-dominant hand, gently pull the lower eyelid down against the bony orbit to create the conjunctival sac, the correct target for the drop. The dropper is held one to two centimeters above the exposed sac, ensuring the tip does not touch the eyelid, eyelashes, or any other surface, which preserves sterility.
The prescribed number of drops is gently squeezed into the conjunctival sac, never directly onto the eyeball. After instillation, the patient is asked to close their eye softly, rather than squeezing it shut, which would prematurely expel the medication. This gentle closure allows the medication to spread evenly and begin absorption. Immediately following this, nasolacrimal occlusion is performed to maximize the drug’s local effect and minimize systemic absorption.
Nasolacrimal occlusion involves applying light pressure with a finger to the inner corner of the eyelid, over the lacrimal sac, for 30 seconds to one minute. This pressure temporarily blocks the tear drainage system, preventing the medication from traveling into the nasal mucosa, where it can be absorbed into the bloodstream and cause unwanted side effects. This step is important for medications like beta-blockers, which can have significant systemic effects. Any excess fluid is gently blotted away from the inner to the outer canthus with a clean tissue, taking care not to press directly on the eye itself.
Post-Procedure Care and Documentation
After the drops are instilled, attention shifts to patient comfort, education, and adherence to the prescribed regimen. If a patient requires multiple types of eye drops, a waiting period of at least five minutes must be observed between each distinct medication. This interval prevents the second drop from washing out the first, which would reduce the therapeutic concentration. When both a drop and an ophthalmic ointment are prescribed, the liquid drop should always be administered first, followed by the ointment after the five-minute waiting period.
Ophthalmic ointments are administered differently: a thin ribbon of 1 to 2 centimeters is applied along the lower conjunctival sac, moving from the inner canthus to the outer canthus. Because ointments are viscous, they cause temporary blurred vision, which is a normal, expected sensation patients should be informed about. Patients should also be advised on proper storage, such as refrigeration if indicated, and instructed to report any persistent burning, stinging, or signs of an allergic reaction.
The final step involves a complete entry into the medical record, detailing the medication name, dose administered, the route (e.g., O.D. for right eye, O.S. for left eye, or O.U. for both eyes), and the time and date of administration. Any immediate patient response, such as reports of stinging or difficulty cooperating, is also noted to ensure continuity of care. This documentation confirms adherence to the prescribed treatment plan and provides a record of the patient’s tolerance.