Eye Care Management - Adult patients at the end of life |
| Publication: 25/05/2022 |
| Next review: 25/05/2025 |
| Clinical Guideline |
| CURRENT |
| ID: 7526 |
| Approved By: Trust Clinical Guidelines Group |
| Copyright© Leeds Teaching Hospitals NHS Trust 2022 |
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated. |
Eye Care Management (for adult patients at the end of life)
Aim
This guideline is intended to be specifically used to aid secondary care teams to manage the eyes of adult patients at the end of life.
Background
- At the end of life, patients can experience incomplete eye lid closure, dry or sticky eyes.
- Regular eye hygiene is vital to promote comfort and prevent complications.
- Consider an individual approach since regular eye interventions can cause distress for some patients.
Assess the patient
- Ask the patient (or close contact) if they have any concerns about their eyes or eye care.
- Find out what and when eye care is usually provided for the patient.
- Aim to assess the eyes every 4 hours, or during direct care.
- Record assessment and make an individual plan of care.
|
Assessment of eye condition |
Eye Score |
Recommended Action |
|
Blinking normally |
1 |
Clean with sterile water and reassess 4 hourly or during direct cares. |
|
Incomplete lid closure |
2 |
Apply prescribed ocular lubricant and reassess 4 hourly. Consider increasing frequency of ocular lubricant administration as prescribed if needed. |
|
Crusting |
3 |
Clean with sterile water and reassess 4 hourly. |
|
Corneal clouding/visibly dry eyes |
4 |
Inform medical staff if patient distressed. |
|
Redness, discharge, Inflammation |
5 |
Inform medical staff if appropriate. Use Individual prescribed treatments. |
Essential eye care management
| Action |
Rationale |
|
Wash hands, apply apron and gloves. |
Reduces the potential for infection. |
|
Explain procedure. |
Ensures patient understands and co-operates. |
|
Position patient with head tilted back if possible. |
Allows for comfort and ease of eye care. |
|
Always treat any unaffected eye first. |
Avoids cross infection. |
|
Moisten sterile gauze with sterile water, taking care not to saturate it. |
Excess water can possibly contaminate the other eye. Cotton wool must not be used as fibres can scratch the cornea. |
|
Wiping once from the nasal edge outwards clean the eyelid but avoid touching the cornea. |
Avoids swabbing discharge into the lachrymal duct or across the bridge of the nose into the other eye. Reduces risk of corneal abrasion. |
|
Repeat with new sterile gauze until lid is clean. |
Reduces risk of infection. |
|
With a new piece of sterile gauze remove excess water, dry eyes and ensure patient is comfortable. |
Leaves no discomfort for patient. |
|
Repeat the procedure with fresh gauze to the other eye. |
Prevents cross infection. |
|
If lid closure is incomplete apply prescribed ocular lubricant and reassess 4 hourly. |
Provides artificial lubrication. |
|
Evaluate, document and report any changes in eye condition. Take swabs as necessary. |
Monitors trends and effectiveness of treatment. |
Pharmacological management
All ocular lubricants are medication and must be prescribed on eMEDs.
|
|
1st line |
2nd line |
|
Day time use |
Carbomer 0.2% Gel (generic) - contains preservatives & multi-dose use. |
*Carmellose 0.5% preservative free drops; this can be increased to 1% if required. |
|
Gently pull down the lower eyelid to form a pocket and drop one drop into each eye QDS or p.r.n. |
||
|
Night time use (or if reduced application time preferred |
Xailin Night Lubricating Eye Ointment 5g (paraffin based) - preservative free & multi-dose use |
Hylo-night Ointment 5g (formerly VitA-POS) - preservative free & multi-dose use |
|
Gently pull on the lower eyelid. Apply one strip of eye ointment to the gap formed between eye and eyelid. Close the eye and ask the patient to gently blink if possible. It provides a lubricating shield that protects corneal tissue overnight. |
||
*Since carmellose is preservative free, it should be used preferentially first line if > 6 applications of any non-preservative lubricants are required; preservatives can cause toxicity (irritation to the front of the eye). 0.5% is less sticky compared to the 1%. Preservative free carmellose is available as either single dose container which should be discarded immediately after use or a multidose container which should be discarded after the “discard after” time stated on the label.
| |
Provenance
| Record: | 7526 |
| Objective: | |
| Clinical condition: | Eye care |
| Target patient group: | Adult patients at the end of life |
| Target professional group(s): | Registered Nurses Working in Critical Care Secondary Care Nurses |
| Adapted from: |
Evidence base
- British National Formulary. (2021.) BMJ Publishing Group Limited: London
- Demirel S, Cumurcu T Firat P et al (2014). Effective management of exposure keratopathy developed in intensive care units: the impact of an evidence based eye care education program. Intensive Care Nursing. 30.1 38-44
- Eye care for Adult Critical Care.The Leeds Teaching Hospital NHS trust guidelines.
- Johnson K, Rolls K (2014) Eye Care for Critically Ill Adults SHPN (ACI) 140005 NSW Agency for Clinical Innovation, Intensive Care Coordination and Monitoring Unit.
- The Royal College of Ophthalmologists. (2020). Ophthalmic Services Guidance: Eye Care in the Intensive Care Unit (ICU). Intensive Care Society. London.
Approved By
Trust Clinical Guidelines Group
Document history
LHP version 1.0
Related information
Not supplied
Equity and Diversity
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