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Caring for patients eyes is an essential nursing skill. Nurses need to be able to carry out a baseline assessment of the eye and vision and deliver essential care including eye cleansing

Eyes should be assessed as part of a holistic patient assessment and eye care is an essential part of daily personal care. This article outlines the principles of eye assessment and the procedure for eye cleansing.

Citation: Gwenhure T, Shepherd E (2019) Principles and procedure for eye assessment and cleansing. Nursing Times [online]; 115: 12, 18-20.

Authors: Tendai Gwenhure is clinical educator, Moorfields Eye Hospital NHS Foundation Trust; Eileen Shepherd is clinical editor, Nursing Times.

The eyes have a vital role in helping us carry out our daily activities safely (Shaw, 2014). Light entering the eye is converted into nerve impulses that are transmitted to the occipital region of the brain, where they are converted into the images we see. Patients may present to hospital with pre-existing eye conditions or need help to care for their eyes during a period of illness. Nurses need to be able to:

The external structures of the eye (Fig 1) serve an important function in protecting the eye from injury. For example, the eyelashes provide a barrier to grit and debris and eyebrows prevent sweat from running into the eyes. Eyelids contain muscles that enable them to open and close (Dougherty and Lister, 2015) and the lacrimal apparatus is responsible for tear production and drainage. Tears provide:

Tears drain away from the eyes into the nasal cavity via the lacrimal puncta (singular punctum) (part of the lacrimal apparatus), which are found on the upper and lower eye lids (Fig 1).

Eyes should be assessed as part of a holistic patient assessment and as part of personal care. It is important to discuss any long-term eye problems the patient has and document how these are managed; for example, glaucoma requires regular eye drops, or blepharitis (inflammation of eye lid margin) may require a personalised plan of care.

Falls are linked to poor eyesight so eye assessment is an integral part of falls prevention. Older people with impaired vision fall 1.7 times more often, and sustain hip fractures 1.3-1.9 times more frequently than those with normal eyesight (College of Optometrists, 2014; College of Optometrists and British Geriatrics Society, 2011). In response to these concerns, the Royal College of Physicians (2017) has produced a bedside tool to help check older patients eyesight and reduce hospital falls risk.

Patients should be asked whether they have any new problems with their vision. These should be reported immediately, as acute eye problems such as acute glaucoma, orbital cellulitis or retinal detachment may result in serious eye complications if treatment is delayed.

It is important to record any sight aids the patient uses such as glasses, contact lenses and a prosthetic eye. If necessary, patients should be given support to use these aids, such as ensuringthat patients glasses are clean; nurses should seek expert help if they lack skills to meet a patients needs.

Eye cleansing is an essential aspect of daily hygiene and patients in hospital or residential/care home, or those who are dependent on care at home may need support to maintain this aspect of their care. Those with reduced vision or blindness may struggle to maintain independence in an unfamiliar environment, such as hospital, and may need help to manage their eye care (Dougherty and Lister, 2015).

Indications for eye cleansing are outlined in Box 1. The procedure aims to maintain healthy eyes and it is important that infection from one eye is not transferred into the other. General principles underpinning the procedure are outlined in Box 2.

Box 1. Indications for eye care

Sources: Dougherty and Lister (2015); Shaw (2014)

Box 2. The underpinning principles of eye cleansing

Nurses need to assess individual patients for risk of exposure to blood and body fluids (Royal College of Nursing, 2018) and be aware of local policies for glove use for this procedure. When gloves are required they must be single-use and should be disposed of according to local infection prevention and control policy (Loveday et al, 2014).

College of Optometrists (2014) Focus on Falls. London: College of Optometrists.

College of Optometrists, British Geriatrics Society (2011) The Importance of Vision in Preventing Falls.

Dougherty L, Lister S (2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell.

Loveday HP et al (2014) epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, 1-70.

McDermott AM (2013) Antimicrobial Compounds in Tears. Experimental Eye Research; 117: 53-61.

Ring L, Okoro M (2016) A Handbook of Ophthalmic Standards and Procedures. Oxford: M&K Publications.

Royal College of Nursing (2018) Tools of the Trade: Guidance for Health Care Staff on GloveUse and the Prevention of Contact Dermatitis.

Royal College of Physicians (2017) Look Out! Bedside Vision Check for Falls Prevention.

Shaw M (2014) How to administer eye drops and ointments. Nursing Times; 110: 40, 16-18.

World Health Organization (2009) WHO Guidelines for Hand Hygiene in Health Care.

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Principles and procedure for eye assessment and cleansing - Nursing Times

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