PROCEDURE FOR EYE IRRIGATION

FOR ADULTS AND CHILDREN

First Issue Purpose of Issue/Description of Change Planned Review

Issued Version Date
To promote safe and effective eye care in PCT 2012
April Two Walk In Centre’s
2007
Named Responsible Officer:- Approved by Date

Walk In Centre Nurse Manager Nursing Policy Group June 2009

Impact Assessment Screening Full Impact

Policy File:- Complete Assessment
Date: May 09 Required Y/N
Nursing Policy File No 17

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE
THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
 NURSING PROCEDURE FOR EYE IRRIGATION

This procedure should only be undertaken by Wirral PCT employed registered

nurses trained in the procedure working in Minor Injuries Units or Walk-in-Centres.

Note:
This procedure should NOT be used for eyes contaminated with C/S gas
( 2-Chlorobenzalmalononitrile )

Equipment Required

• Waterproof cape
• Towel
• Irrigation solution – Sodium chloride 0.9%
• Receiver
• Administration set (if required)
• Anaesthetic drops
• Gauze swabs
• Vinyl Gloves
• Apron
• Sterile dressing pack
• pH check strips (specific eye testing strips)
• Nursing records
• Relevant Patient Group Direction

Procedure Rationale
Verbally check the identity of the patient by To ensure positive identification of
asking for the patients full name and date of the patient
birth

Explain the procedure, including risks and
benefits
Establish patient has no known allergies
Remove contact lenses immediately if present
Check pH ( a measure of the hydrogen ion
concentration) of the eye prior to treatment
using specific eye testing strips for chemical
injury – pH testing should not delay
commencement of irrigation
When patient gives history of exposure to
agents containing alkali or acid immediate
irrigation should precede full examination
Instil anaesthetic drop (if required) as per
Patient Group Direction
So the patient understands the
procedure and to gain patient’s
informed consent and co-operation
To reduce risk of allergic reaction
To facilitate irrigation and prevent
corneal damage
To determine if an acidic or alkaline
corrosive substance is present
To reduce damage to anterior
segment ;the amount of damage is
related to the duration of the
exposure
To reduce discomfort and aid
assessment

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 Procedure
Prepare the saline, check that it is at room
temperature
Assist the patient into an appropriate position:
• Head comfortably supported with chin
almost horizontal
• Head inclined to the side of the eye to
be treated
Decontaminate hands and prepare equipment
Put on single use disposable apron
Remove any discharge from the eye by
cleansing
Ask the patient to hold the receiver against
the cheek, below the eye being treated
Apply towel and cape
If a Child: Two nurses required
One nurse to hold child, with parental /carer
consent and one nurse to hold the child’s
eyelids apart using the first and second finger
held against the orbital ridge. One nurse to
administer wash out.
Do not press on the eyeball
Inform the patient that irrigation is about to
start and pour a little of the fluid onto the
cheek
Direct the flow of irrigation fluid from the nasal
corner
Ask the patient to look up, down and to either
side whilst irrigating
Evert the eyelids when irrigating and ensure
there is a constant flow of irrigation fluid
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Rationale
To reduce discomfort
To reduce discomfort
To reduce the risk of transient
micro-organisms on the healthcare
workers hands
To protect uniform and prevent
contamination
To prevent discharge from running
across cheek
To collect fluid running from the eye
To protect the patient’s clothing
Patient will be unable to hold the
eyelids themselves once irrigation
commences
To avoid causing unnecessary
discomfort
To prepare the patient and to make
them aware of the sensation and
temperature of the irrigation fluid
To wash away any secretions
To ensure the whole eye is irrigated
To ensure complete removal of any
foreign body
 Procedure Rationale
Check pH ( a measure of the hydrogen ion A pH above 8.0 or below 7.5 may
concentration) of the eye prior to irrigation indicate that an acidic or corrosive
and after 20 minutes of irrigation using substance is still present in the eye
specific eye testing strips for chemical injury,
Irrigation should be continued until the
conjunctival sac pH is normal (7.5-8.0).
Retest after 20 minutes and use further
irrigation if necessary
identify chemical and discuss with
‘Toxbase’ a national poisons data base To assess level of chemical risk
0870 600 6266 www.spib.axl.co.uk hosts the
Toxbase web site

Patients with: To ensure emergency opthalmic

assessment of severe eye injury
• corneal damage
• patients whose symptoms do not
resolve rapidly and
• patients who have been exposed to
strong acids or alkalis
Should be referred for urgent ophthalmologic
assessment [same day]
Ask the patient to close the eye and dry lid To promote patient’s comfort
with a gauze swab
Remove receiver and dry patient’s cheek To promote patient’s comfort
Examine eye for corneal damage by To detect corneal damage
installation of Fluorescein as per Patient Group
Direction
Remove trolley and dispose of waste as per To prevent environmental
‘Disposal of Clinical Waste’ policy contamination
On completion of procedure remove and To comply with waste management
dispose of any personal protective equipment policy
Decontaminate hands To reduce the risk of transient
micro-organisms on the healthcare
workers hands
Document all actions and observations Ensure compliance with PCT Health
(including consent and patient perceptions) in Records Policy
nursing records

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REFERENCES AND BIBLIOGRAPHY

Dougherty, L. and Lister, S.E. (2004) The Royal Marsden Manual of Clinical
Nursing Procedures – Sixth Edition. Blackwell Publishing, Oxford.

St. Paul’s Primary Care Eye Centre – Guidelines for eye irrigation – Royal
Liverpool University Hospital
NPIS (2007) Chemicals splashed or sprayed into the eyes. TOXBASE. National
Poisons Information Service. www.spib.axl.co.uk [Accessed: 12/03/2009].

Clinical Knowledge Summaries- Corneal Superficial injury – Management

http://cks.library.nhs.uk [Accessed 12/03/2009]

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