Tuesday, 2 March 2010

CONTACT LENS CARE

Illness or emergency treatment may require that you insert or remove and store a patient's contact lenses. Proper handling and lens care techniques help prevent eye injury and infection as well as lens loss or damage. Appropriate lens-handling techniques depend in large part on what type of lenses the patient wears.
All contact lenses float on the corneal tear layer. Rigid lenses typically have a smaller diameter than the cornea; soft lens diameter typically exceeds that of the cornea. Because they're larger and more pliable, soft lenses tend to mold themselves more closely to the eye for a more stable fit than rigid lenses.
Modes of lens wear vary widely. Although most patients remove and clean their lenses daily, some wear lenses overnight or for several days (sometimes up to a month) without removing them for cleaning. Still other patients wear disposable lenses, which means that they replace old lenses with new ones at regular intervals (a few days to a few months), possibly without removing them for cleaning between replacements.
Keep in mind that handling contact lenses improperly can provide a direct source of contamination to the eye.
Equipment
Lens storage case or two small medicine cups and adhesive tape • gloves • patient's equipment for contact lens care, if available • sterile normal saline solution or soaking solution • flashlight, if needed • optional: suction cup.
Preparation of equipment
If a commercial lens storage case isn't available, place enough sterile normal saline solution into two small medicine cups to submerge a lens in each one. To avoid confusing the left and right lenses, which may have different prescriptions, mark one cup “L” and the other cup “R” and place the corresponding lens in each cup.
Implementation

Special considerations
  • If the patient's eyes appear dry or you have trouble moving the lens on the eye, instill several drops of sterile normal saline solution, and wait a few minutes before trying again to remove the lens to prevent corneal damage. If you still can't remove the lens easily, notify the physician. Avoid instilling eye medication while the patient is wearing lenses. The lenses could trap the medication, possibly causing eye irritation or lens damage.
  • Don't allow soft lenses, which are 40% to 60% water, to dry out. If they do, soak them in sterile normal saline solution and they may return to their natural shape.
  • If an unconscious patient is admitted to the emergency department, check for contact lenses by opening each eyelid and searching with a small flashlight. If you detect lenses, remove them immediately because tears can't circulate freely beneath the lenses with eyelids closed, possibly leading to corneal oxygen depletion or infection.
  • Advise contact lens wearers to carry appropriate identification to speed lens removal and ensure proper care in an emergency.
  • If a patient can't provide adequate care for his lenses during hospitalization, encourage him to send them home with a family member. If you aren't sure how to care for the lenses in the interim, store them in sterile normal saline solution until the family member can take them home.
Documentation
Record eye condition before and after removal of lenses; the time of lens insertion, removal, and cleaning; the location of stored lenses; and, if applicable, the removal of lenses from the facility by a family member.