Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [162], C).
2. 2.Show
   Wash hands or use an alcohol‐based handrub and put on apron.
   To reduce the risk of cross‐infection (NHS England and NHSI [148], C).

Procedure

1. 3.Show
   Wearing non‐sterile gloves and using thumb and forefinger, separate the eyelids.

   Method 1: keeping the eyelid stationary, place an index finger on the lower eyelid. Press the edge of the lower eyelid against the eyeball beneath the bottom of the contact lens. Lift the upper lid above the top of the lens and then push the lid down over the eyeball until the eyelid is shut – the lens should come out (Action figure 9.10).

   Method 2: placing the index finger at the outer corner of the eye, pull the eyelids tight by pulling out towards the ear. Get the patient to blink – the lens should come out.

   If neither method is successful, a suction device may be required to remove the lens.
   To remove the lens with minimal pain and trauma to the cornea (Lakhani [103], C; Shaw and Lee [213], E).
2. 4.Show
   Place the lens in the palm of the hand, apply some drops of cleaning solution to the lens and gently rub the lens with the little finger.
   To clean the lens of debris and contaminants (Lakhani [103], C).
3. 5.Show
   Apply 0.9% saline solution to the lens and rinse the lens by rubbing the lens gently between the index finger and thumb.
   To remove residues of cleaning solution and debris loosened during cleaning (Lakhani [103], C).
4. 6.Show
   Fill the clean storage case with new lens storage solution. Store the lenses in the contact lens storage case, in appropriate solution as recommended by the manufacturer, and ensure the lenses are placed in the correct storage pots (left and right).
   To prevent deterioration and contamination (Lakhani [103], C).
5. 7.Show
   Refer to the manufacturer's instructions for further storage information, particularly if the patient will not be using the lenses for a lengthy period of time.
   To prevent deterioration of the lenses and growth of organisms. E

Post‐procedure

1. 8.Show
   Remove and dispose of personal protective equipment, and decontaminate hands.
   To keep the environment clean and reduce the risk of cross‐infection (NHS England and NHSI [148], C).
2. 9.Show
   Document the intervention in the patient's notes.
   To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment (NMC [162], C; RCN [193], C).