Download Ocular Medication Administration

patient to shake the bottle several times to get the maximum therapeutic
effect of the medication.
The most common ocular adverse reactions of long-term topical corticosteroid administration are glaucoma, cataracts, susceptibility to infection, impaired wound healing, mydriasis, and ptosis. High intraocular
pressure may develop, which is reversible after corticosteroid use is discontinued. To avoid corticosteroids’ adverse effects, NSAIDs are an alternative in controlling inflammatory eye conditions and postoperatively to
reduce inflammation. NSAID therapy in combination with topical and
oral preparations is an important adjunct therapy in managing uveitis.
__________________________________________________________
Source: Brunner and Suddarth’s Textbook o f Medical-Surgical Nursing,
11th ed., Lippincott Williams & Wilkins, 2007.
Take5 © 2007 Lippincott Williams & Wilkins. Available online at http://
www.nursing2007.com (click the “Educators” button).
Brought to you by Nursing2007
Ocular Medication Administration
The objective of ocular medication delivery is maximizing the amount
of medication that reaches the ocular site of action in sufficient concentration to produce a beneficial therapeutic effect. This is determined by
the dynamics of ocular pharmacokinetics: absorption, distribution, metabolism, and excretion.
Aqueous solutions are most commonly used for the eye. They’re
the least expensive medications and interfere least with vision. However, corneal contact time is brief because tears dilute the medication.
Ophthalmic ointments have extended retention time in the conjunctival
sac and a higher concentration than eye drops. The major disadvantage
of ointments is the blurred vision that results after application. In general, eyelids and eyelid margins are best treated with ointments. The
conjunctiva, limbus, cornea, and anterior chamber are treated most effectively with instilled solutions or suspensions. Contact lenses and
collagen shields soaked in antibiotics are alternative delivery methods
for treating corneal infections. Of all these delivery methods, the topical
route of administration—instilled eye drops and applied ointments—
remain the most common. Topical instillation, which is the least invasive method, permits self-administration of medication. It also produces
fewer adverse reactions.
Preservatives are commonly used in ocular medications. Benzal
konium chloride, for example, prevents the growth of organisms and
enhances the corneal permeability of most medications. However, some
patients are allergic to this preservative. This may be suspected even if
the patient had never experienced an allergic reaction to systemic use of
the medication in question. Pharmacists can prepare eye drops without
preservatives.
Instilling eye medication
Some commonly used ocular medications
Follow these general guidelines when instilling eye medications:
● Shake suspensions or “milky” solutions to get the desired medication
level.
● Wash your hands thoroughly before and after
the procedure.
● Ensure adequate lighting.
● Read the label of the
eye medication to make
sure it’s the correct medication.
● Assume a comfortable
position.
● Don’t touch the tip of
the medication container
to any part of the eye or face.
• Hold the lower lid down; don’t press on the eyeball. Apply gentle pressure to the cheekbone to anchor the finger holding the lid.
● Instill eye drops before applying
ointments.
● Apply a 1/2-inch ribbon of ointment
to the lower conjunctival sac.
● Keep the eyelids closed, and apply
gentle pressure on the inner canthus
(punctal occlusion) near the bridge of
the nose for 1 or 2 minutes immediately after instilling eyedrops.
● Using a clean tissue, gently pat
skin to absorb excess eyedrops that
run onto the cheeks.
● Wait 5 to 10 minutes before instilling another eye medication.
Topical anesthetics: Instill one or two drops before diagnostic procedures, such as tonometry and gonioscopy, and in minor ocular procedures, such as suture removal or conjunctival or corneal scrapings. Tell
patients not to rub their eyes because this may damage their corneas.
Never let patients take topical anesthetics home. Prolonged use can delay wound healing. An anesthetic is also used for severe eye pain so a
patient can open her eyes for examination or treatment, such as eye irrigation for chemical burns.
Mydriatics and cycloplegics: Cycloplegic medications are administered
to paralyze the iris sphincter. Instruct patients about the temporary effects of mydriasis on vision, such as glare and the inability to focus
properly. Patients may not be able to read and shouldn’t drive. The effects of the various mydriatics and cycloplegics can last 3 hours to several days. Advise patients to wear sunglasses (most eye clinics provide
protective sunglasses) and to have a responsible adult drive them home.
Mydriatic and cycloplegic agents affect the central nervous system.
Their effects are most prominent in children and elderly patients; assess
these patients closely for symptoms, such as rise in blood pressure,
tachycardia, dizziness, ataxia, confusion, disorientation, incoherent
speech, and hallucination. These medications are contraindicated in
patients with narrow angles or shallow anterior chambers and in patients taking monoamine oxidase inhibitors or tricyclic antidepressants.
Medications used to treat glaucoma: Therapeutic medications for glaucoma are used to lower intraocular pressure by decreasing aqueous production or increasing aqueous outflow. Because glaucoma calls for lifetime therapy, patients must be instructed regarding the medications’
ocular and systemic adverse effects.
Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs):
The topical preparations of corticosteroids are commonly used in inflammatory conditions of the eyelids, conjunctiva, cornea, anterior
chamber, lens, and uvea. In posterior segment diseases that involve the
posterior sclera, retina, and optic nerve, the topical agents are less effective, and pa-renteral and oral routes are preferred.
The topical eye drop preparation is prepared in suspension; tell the