Mastering How to Instill Eye Drops in NCLEX?

According to studies, medication administration errors are a leading cause of patient harm in healthcare settings. For nursing students preparing for the National Council Licensure Examination (NCLEX), mastering the correct, safe, and sterile procedure for how to instill eye drops in NCLEX is a fundamental skill that requires precise technique and a strong understanding of pharmacological principles.

Quick Summary

A comprehensive guide on the NCLEX-compliant procedure for administering ophthalmic medications. It covers patient preparation, proper instillation technique, infection control, and preventing systemic absorption to ensure safe and effective patient care.

Key Points

• Infection Control is Key: Wash hands before and after and avoid touching the dropper tip to any surface, including the patient's eye.

• Conjunctival Sac is the Target: Always place the eye drops into the lower conjunctival sac, not directly onto the sensitive cornea.

• Nasolacrimal Occlusion Prevents Systemic Absorption: For medications with systemic effects (like beta-blockers), apply pressure to the inner canthus to block drainage into the bloodstream.

• Multiple Medications Require Waiting: Wait at least 5 minutes between different eye drop medications to ensure proper absorption and efficacy.

• Ointment Before Drops is Incorrect: If administering both drops and ointment, administer the drops first, wait 5-10 minutes, and then apply the ointment.

• Wipe Inner to Outer Canthus: When cleaning the eye before administration, always wipe from the inner corner outwards to prevent microorganisms from entering the lacrimal duct.

• Patient Education is a Priority: Teach the patient about the procedure, proper technique for self-administration, and the importance of adherence, especially for lifelong conditions.

Essential Preparation for Ophthalmic Medication

Before you even touch the medication bottle, a series of critical steps must be completed to ensure patient safety and procedure success. The NCLEX places a strong emphasis on foundational nursing skills, and ophthalmic administration is no exception.

• Verify the Prescription: This is the first and most important step. Adhere to the "Six Rights" of medication administration: right patient, right medication, right dose, right route, right time, and right documentation.
• Hand Hygiene: Perform thorough handwashing with soap and water before and after the procedure. This is a non-negotiable step for infection control.
• Gather Supplies: Ensure you have all necessary materials, including the medication, gloves, sterile gauze or tissue, and warm water or sterile saline if needed for cleansing.
• Assess the Eye: Before instillation, inspect the patient's eyes for redness, swelling, or drainage. If crusts or discharge are present, gently cleanse the area with a sterile, moistened gauze pad or tissue. Always wipe from the inner canthus (the corner near the nose) to the outer canthus, using a fresh wipe for each stroke to avoid spreading contaminants.
• Patient Positioning: Position the patient in a supine or sitting position with their head tilted slightly back, or hyperextended, if not contraindicated.
• Patient Education: Inform the patient about the procedure and the purpose of the medication. This builds rapport and encourages patient cooperation.

Step-by-Step Eye Drop Instillation

The correct technique is vital for delivering the medication to the intended site—the conjunctival sac—without causing discomfort or injury.

1. Apply Gloves: Don clean, non-sterile gloves to maintain infection control.
2. Position the Hand: Rest your dominant hand on the patient's forehead to stabilize it. Use the thumb or finger of your non-dominant hand to gently pull down the patient's lower eyelid, creating a small pocket, or conjunctival sac.
3. Instruct the Patient: Ask the patient to look up toward the ceiling, away from the dropper tip.
4. Instill the Drop: Hold the dropper bottle about 1 to 2 cm above the eye to prevent accidental contact and contamination. Instill the prescribed number of drops into the conjunctival sac, not directly onto the cornea, which is sensitive.
5. Address Missed Drops: If the patient blinks and the drop is missed, repeat the instillation.
6. Prevent Systemic Absorption: This is a critical NCLEX point, especially for medications that can have systemic effects, such as beta-blockers like Timolol. Instruct the patient to gently close their eye and apply gentle pressure with a clean finger or tissue to the nasolacrimal duct (inner canthus) for 30 to 60 seconds.
7. Manage Excess Medication: Use a clean tissue to blot any excess medication that runs down the cheek.
8. Post-Procedure: Advise the patient not to rub their eyes and to close them gently, not squeeze them shut, as this can force medication out.

Comparison of Eye Drops vs. Eye Ointments

NCLEX questions often test the differences in administration for various ophthalmic preparations. The following table provides a clear comparison of administering eye drops and ointments.

Feature	Eye Drops (Solutions)	Eye Ointments
Preparation	Shake the bottle gently if indicated.	Warm the tube to body temperature by holding it in your hand.
Consistency	Liquid solution.	Thick, viscous substance.
Administration	Instill drops into the lower conjunctival sac.	Squeeze a thin, even ribbon of ointment along the entire length of the lower conjunctival sac, from inner to outer canthus.
Post-Administration	Apply nasolacrimal pressure if necessary; advise against rubbing.	Advise the patient to close their eye and roll their eyeball to spread the medication; inform them of potential blurry vision.
Effect on Vision	Minimal, temporary blurring.	Can cause temporary blurred vision that lasts several minutes.
Multiple Medications	Wait at least 5 minutes before administering another eye drop.	Wait 10 minutes after an ointment before administering another eye drop.

Critical NCLEX Considerations and Patient Teaching

For the NCLEX, recall that patient safety, infection control, and clear communication are paramount. Beyond the mechanical steps, here are other crucial points to remember and to include in your patient education.

• Multiple Medications: Remember the timing rule for multiple ophthalmic medications. This prevents the second medication from washing out the first, reducing its therapeutic effect.
• Contact Lenses: Instruct patients to remove contact lenses before instilling eye drops unless instructed otherwise by the healthcare provider. Explain that lenses can absorb the medication and become damaged, or harbor bacteria.
• Contamination Prevention: Emphasize to the patient and staff that the dropper or ointment tip must never touch the eye, eyelid, or any other surface. If it does, discard the bottle to prevent cross-contamination.
• Lifelong Medication: For conditions like glaucoma, emphasize the importance of lifelong adherence to the medication regimen to prevent irreversible vision loss.

Conclusion

Mastery of the correct and safe procedure for instilling eye drops is a critical nursing competency, heavily tested on the NCLEX. By following the systematic steps of preparation, administration, and post-procedure care—including vital interventions like nasolacrimal occlusion and strict infection control—nursing students can demonstrate their readiness for safe practice. Understanding the nuances of different ophthalmic preparations and providing thorough patient education further solidify a nurse’s competence, leading to improved patient outcomes and success on the examination. To learn more about proper eye medication administration, review resources from authoritative organizations like the Glaucoma Research Foundation.

• Glaucoma Research Foundation: Eye Drop Techniques From Dr. Andrew Iwach

Frequently Asked Questions

Where should the nurse place the eye drop during instillation?

The nurse should place the eye drop into the lower conjunctival sac, the pocket created by pulling down the lower eyelid, not directly onto the cornea.

Why is it important to press on the inner canthus after instilling eye drops?

Applying gentle pressure to the inner canthus (nasolacrimal duct) helps to prevent the medication from draining into the systemic circulation, which can cause unwanted side effects, particularly with potent medications like beta-blockers.

What should the nurse do if the patient blinks and the eye drop is missed?

If a patient blinks and misses the drop, the nurse should repeat the instillation to ensure the full, prescribed dose of medication is administered.

How long should a nurse wait between administering two different eye drops?

The nurse should wait at least 5 minutes between administering two different ophthalmic solutions to prevent the second drop from washing out the first.

What is the correct order for administering both eye drops and eye ointment?

If both drops and ointment are prescribed, the nurse should administer the eye drops first, wait at least 10 minutes, and then apply the ointment.

How should a nurse instruct a patient to manage excess medication?

The nurse should provide the patient with a clean tissue to blot any excess medication that runs down their cheek. The patient should be advised not to rub their eyes.

What is the correct technique for cleaning the eye before instillation?

If the eye needs to be cleaned, the nurse should use a sterile gauze or cotton pad moistened with warm water or saline. The cleaning motion should be from the inner canthus outward to avoid pushing debris into the nasolacrimal duct.