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.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

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.

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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.

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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.
Apply prescribed ocular lubricant. Reassess 4 hourly.

Redness, discharge, Inflammation

5

Inform medical staff if appropriate. Use Individual prescribed treatments.

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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.

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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

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.