Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Ask the patient to explain how their eyes feel, if they are able to do so.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [162], C).

   To obtain a baseline prior to the procedure. E
2. 2.Show
   Assist the patient into the correct position:

   • head well supported and tilted back
   • preferably the patient should be in bed or lying on a couch.
   The patient needs to be discouraged from flinching or making unexpected movements and so should be in the most comfortable, pain‐free position possible at the start of the procedure (Shaw [210], E).

   To enable access to and assessment of the eyes. E

   To enable patient comfort. E
3. 3.Show
   Ensure an adequate light source, taking care not to dazzle the patient.
   To enable maximum observation of the eyes without causing the patient harm or discomfort (Shaw [210], E).
4. 4.Show
   Wash hands or use an alcohol‐based handrub and put on personal protective equipment.
   To reduce the risk of cross‐infection (NHS England and NHSI [148], C).

Procedure

1. 5.Show
   Always treat the uninfected or uninflamed eye first.
   To reduce the risk of cross‐infection (Tollefson and Hillman [227], C).
2. 6.Show
   Always bathe the lids with the eyes closed first.
   To reduce the risk of damaging the cornea and to remove any crusted discharge. E
3. 7.Show
   Ask the patient to look up. Using a slightly moistened swab, gently swab the lower lid from the inner canthus outwards. Use an aseptic technique for the damaged or post‐operative eye.
   If the swab is too wet, the solution will run down the patient's cheek. This increases the risk of cross‐infection and causes the patient discomfort. Swabbing from the nasal corner outwards avoids the risk of swabbing discharge into the lacrimal punctum or even across the bridge of the nose into the other eye. Aseptic technique reduces the risk of cross‐infection (Loveday et al. [114], R).
4. 8.Show
   Ensure that the edge of the swab is not above the lid margin.
   To avoid touching the sensitive cornea. E
5. 9.Show
   Using a new swab each time, repeat the procedure until all the discharge has been removed.
   To reduce the risk of cross‐infection (Shaw [209], E).
6. 10.Show
   Gently swab the upper lid by slightly everting the lid margin and asking the patient to look down. Swab from the nasal corner outwards and use a new swab each time until all discharge has been removed.
   To effectively remove any foreign material from the eye. E

   To reduce the risk of cross‐infection (Stevens [220], R).
7. 11.Show
   Once both eyelids have been cleaned and dried, make the patient comfortable.
   To ensure patient comfort. E
8. 12.Show
   Remove and dispose of equipment, and decontaminate hands.
   To keep the environment clean and reduce the risk of cross‐infection (NHS England and NHSI [148], C).

Post‐procedure

1. 13.Show
   Discuss with the patient any changes post‐procedure; report any adverse effects to the patient's doctor. Record the procedure in the appropriate documents.
   To monitor the effectiveness of the procedure as well as any trends and fluctuations (NMC [162], C).