# Eye Irrigation

## Overview

This module describes how to irrigate the eye to treat superficial foreign bodies, or chemical or thermal eye injuries.

## Indications

1. Chemical or thermal injury to the eye

2. Superficial foreign body

## Contraindications

1. Suspected penetrating eye injury

2. Penetrating foreign body

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to rinse out your eye to remove what is irritating it.”

### What can my patient expect?

“I’ll give you an eye drop to reduce pain, and then I’ll rinse your eye with lots of water. It will be a little uncomfortable, but it’s important to prevent further injury to your eye. I’ll also lift up your eyelids so that the water washes away anything stuck there.”

### What is my patient’s role?

“Tell me if you have any allergies. Try not to squeeze your eye shut, stay relaxed and let me keep rinsing the eye, even if it’s uncomfortable. Afterwards, avoid touching the eye. I will give you sterile gauze packs to wipe around your eye if necessary. Always wash your hands beforehand and throw away the gauze immediately.”

## Preparation

###

### Documentation

1. Patient notes

2. If injury on duty, use appropriate documentation

### Equipment

1. Alcohol-based hand rub

2. Local anaesthetic:

   0.5% proparacaine eye drops
   0.5% proparacaine eye drops

   Kept in the fridge. Check the expiry date.

3. An IV giving set

4. Normal saline bags (several litres may be necessary for gross contamination of the eye)

5. A bowl and linen saver to catch water

6. Cotton-tipped applicators (earbuds)

7. If available,

   Morgan lenses
   Morgan lenses

   OR

8. Winged set (butterfly needle) to

   make
   make

   See Troubleshooting

   your own eye irrigator and plaster strips to attach irrigator to skin

9. Sterile eye pad

10. For chemical injuries,

    pH paper (litmus paper)
    pH paper (litmus paper)

    If not available, remove the pH square from a urine dipstick and use that.

    (at least two pieces)

11. For chemical injuries, use eye protection, gloves and an apron

## Site & Positioning

Position the patient with the affected eye closest to the ground to avoid contaminating the unaffected eye.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene. Don any PPE required.

2. For chemical injuries, touch the

   pH paper
   pH paper

   Normal pH is 7.0. Note the pH and rinse until the pH normalises.

   to the lower fornix of the eye.

3. Apply local anaesthetic:

   Apply
   Apply

   Ask the patient to look up and retract the lower eyelid with a thumb. Place the drop in the lower fornix of the eye. Ask the patient to keep their eye closed to improve the effectiveness of the anaesthetic.

   An alternative to proparacaine is adding 10 ml 1% lignocaine to each L of irrigation fluid

   a drop of proparacaine to the eye.

4. For particulate matter, sweep the ocular surface and upper and lower fornices with a moistened cotton-tipped applicator.

5. Position the linen saver and bowl under the eye.

6. Hang the normal saline well above the patient and attach the giving set.

7. Retract
   Retract

   If unable to retract the eyelids, see Troubleshooting.

   the eyelids and irrigate the eye with the giving set, directing the stream to flow over the contour of the eye, not directly onto the cornea. Irrigate the upper and lower fornices. Do not use force such as with a syringe.

8. If longer irrigation is desired, after using 1 L of saline, attach the

   Morgan lens
   Morgan lens

   If you do not have a Morgan lens, see Troubleshooting.

   to the giving set. Ask the patient to look down and insert under the upper lid, then perform the reverse for the lower lid. The lens should stay in place without support.

9. For chemical injuries, irrigate for at least 20 minutes, retest the pH and

   continue
   continue

   In some cases, such as significant alkaline exposure, irrigation may need to continue for several hours.

   irrigating until the pH has normalised (pH = 7).

10. Evert the upper eyelid. Place a cotton-tipped applicator on the upper eyelid and flip the lid upwards towards the forehead. Use the applicator to hold it in place.

11. Sweep the inside of the upper eyelid with a moistened second applicator for residual material.

12. Repeat the sweep of the upper and lower fornices.

13. Dispose of medical waste safely.

14. Examine
    Examine

    You might need fluorescein drops to provide better visualisation of an abrasion or ulcer. This is also kept in the fridge. Be sure to use the blue light on the ophthalmoscope and to reassure the patient that the orange discolouration is not permanent.

    the eye for signs of corneal abrasion or penetrating eye injury. Assess the visual acuity.

15. Patch the eye with a sterile eye pad.

16. Record visual acuity and completion of the procedure in patient notes.

17. Prescribe a topical antibiotic to be used for 3 days. Refer the patient if required for

    topical homatropine
    topical homatropine

    Only available on specialist prescription. Never send the patient home with local anaesthetic drops, but rather prescribe oral analgesia. If unsure, always discuss the patient with a specialist.

    drops to relieve ciliary spasm.

## Troubleshooting

I don’t have a Morgan lens.

Use the tubing of a winged set (butterfly needle). Cut off the needle and use it to poke holes in the tubing. Tie a knot at the end of the tubing. Attach the tubing to the IV giving set. To use, place a loop of the tubing under the eyelids, well into the upper and lower fornices, and secure the tubing to the face with tape. Open the IV giving set to irrigate.

I cannot open the eyelids.

Put topical anaesthetic drops in the eye. Use eyelid retractors or make your own retractors with paperclips to open the eyelids. Clean them with an alcohol swab before insertion.

## Risks

1. Corneal abrasion

2. Exacerbation of a penetrating eye injury

3. Never use buffer or neutralising solutions, which can cause additional chemical reactions

## References

1. Brady CJ. How to Irrigate the Eye and do Eyelid Eversion. 2020. MSD Manual.

2. Jansen van Rensburg J, Meyer D. Management of chemical ocular injuries - what every GP should know. CME. 2013 Apr;31(4):156-157. Available at: http://cmej.org.za/index.php/cmej/article/view/2664/2897.

3. Pons J. How to treat the eye. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 138-139.