There are many types of eye medications. These medications are used to treat, diagnose, manage and prevent eye diseases. Many eye medications need a prescription but some do not. Artificial tears are often used to lubricate the eye and can be purchased over the counter. Ocular decongestants are used to decrease redness and irritation of the eye. These too are often available over the counter.
Blindness is a sad and difficult emotionally and economically. An examination of the graph below shows that many forms of blindness can be prevented. Some blindness is due to inappropriate treatments, particularly by non-professional practitioners
Graph A. Categories of Blindness by percentage
In this session we are going to learn about eye drops and eye ointments. Eye drops are the most frequently used route for medicating the eye. Other medications for the eye may be administered orally, IV, and by local injection.
Diagram A. Shows How to instil eye drops.
AIMS of Eye Medications.
Different types of medications are used to treat the eye.
- Medications for glaucoma. Example: Timoptic, Betagan, Betoptic.
- Medications for eye infections: Example: Gentamycin, Chloramphenicl eye drops
- Medications for allergies: Example: Livostin, chlorpheniramine (piriton) eye drops,
- Medications for diagnosis: Fluorescent purple, atropine eye drops
- Medications for anaesthetizing the eye: Lignocaine drops (Lidocaine). Needed for painful diagnostic tests and when removing foreign objects from the cornea, the clear protective outer coat.
The Procedure:
As usual explain the procedure to the patient and to obtain his/her consent. Gather all the items you need. Seat or lie the patient in a comfortable position. Check your medication for the five Rs.
- Wash your hands.
- Shake the container gently.
- Ask the patient to tilt his head back if he is sitting. If he is lying it should be alright.
- Gently pull the lower lid away from the eye to form a pouch. See diagrammatic representation above.
- Gently place one or two drops of the medication into the pouch. If you are applying and ointment the procedure is the same but make sure you place 1/4 to 1/2 inch of ointment in the pouch.
- Some doctors will advocate the closing of the tear duct for up to five minutes. This is done by gently closing the eye or by placing a finger against the inner corner of your eyelid and the side of your nose. You may need to explain this to the patient. This prevents the medication from entering the tear duct and draining away.
- For ointments, simply ask the patient to close his/her eye. Explain to the patient that the vision will blur for several minutes.
- Repeat with the other eye if needed.
- Replace the cap or dropper on the bottle or tube and place it in a safe place.
It takes five minutes for most of an eye drop to be absorbed into the eye. Wait at least five minutes before instilling a second drop or between applying other eye medications.
Some patient will have difficulty knowing if they properly instilled eye drops. To help the patient feel the drops as they contact the eye, try refrigerating them.
What to do if there are side effects.
Some eye medications may have side effects. The usual side effects are redness, stinging, blurred vision, sensitivity to light and constriction (narrowing) of the pupils. A class of anti-inflammatory drugs called corticosteroids (e.g., Pred Forte, Decadron) may cause cataracts, glaucoma and eye infections with prolonged use, in some patients. All medications must be used as per the written prescription of the ophthalmologist or the doctor. In some rare cases ocular decongestant drops (e.g., Visine, Murine Plus) can cause a type of acute (sudden) glaucoma. If this happens, the patient will have a red, painful eye after you have applied these drops. Call the treating doctor immediately.
Some anesthetic eye drops can cause severe damage to the cornea. Sometimes anesthetic eye drops are mistakenly prescribed after eye trauma, but they should never be used for this purpose except during the acute period.
Some eye drops can cause headaches and other systemic side effects, such as stomach cramps, diarrhea and sweating. Although most systemic side effects resulting from drops are mild, severe reactions have been known to occur. A nurse needs to be vigilant at all times.
The beta-blocker agents for glaucoma treatment (e.g., Timoptic, Betagan, Betoptic) may cause adverse reactions. These include slowing of the heart rate, asthma attacks, decrease in blood pressure, disorientation, loss of memory and loss of sex drive. Diabetics should use these drugs with caution because they may mask signs of low blood sugar.
Drops used to dilate the pupils during an eye exam may sting. A few of these drops may cause dryness of the skin and mouth, a rapid pulse or an increased heart rate or blood pressure in some people. They also may rarely cause more serious side effects such as heart attacks or strokes in persons with high blood pressure, heart disease, diabetes or hardening of the arteries. These complications are prevented by taking a medical, as well as ocular, history before an eye exam. If your patient has one of these conditions, please notify the treating physician.
Preventing Side Effects!
- It is important to take a careful history about all medications the patient is receiving, including eye drops.
- Many patients forget about their eye drops when a nurse or doctor makes these inquiries.
- Consequently, when eye drops are combined with other medications or with anesthesia, severe complications can occur. The treatment team must be informed of any allergies or other health problems.
- The chances for systemic side effects increase with the use of multiple drops of eye medications. The eye can hold only one sixth of the amount of eye drop that most commercial dropper bottles deliver. Excess medication either drips onto the cheek or flows into the nasolacrimal system.
- Excess eye drops travelling through the naso-lacrimal system go into the blood stream and can produce systemic side effects. This is why it is important to close the patient’s naso-lacrimal duct.
- Finally, remember to keep all medications out of the reach of children. Many eye drops can cause severe side effects and possibly death if accidentally swallowed, by children.
What is the state of research about eye medications?
Most medical practice models are moving to “best practice/evidence based” models. Scientists are always trying to find ways to reduce side effects of all medications/treatments and make them more effective and convenient to use. Many of the newer glaucoma drugs are available that reduce stinging, lessen the risk for systemic side effects and decrease the number of doses needed each day. Lesser doses needed translate into greater compliance.
These lecture notes are for nursing students only and should not be used for medical assessment, diagnosis, and treatment.
