Eye care may be necessary under the following circumstances:

These indications may present singularly or in combination.

Eye care includes patient education about the eye and surrounding structures as well as health promotion and safety advice to promote quality of life (Shaw and Lee [211]).

Examine and assess the eye and surrounding structures prior to and then again after any intervention. Begin by examining the eye closed, looking carefully at the eyelids and noting asymmetry as well as any bruising, spasms, inflammation, discharge or crusting (Marsden [119]). Look for signs that the eyelids are closed properly, as an inability to close completely could indicate (for instance) the presence of a cyst or lump that would require further investigation (Marsden [119]).

Ask the patient to open their eyes and, using a pen torch, look for abnormalities in the conjunctiva, such as inflammation, a foreign body, redness or the presence of a discharge; the eye should be clear of clouding and redness (Marsden [119]). Ask the patient whether they are experiencing any pain or photophobia. Any abnormalities need to be reported to the patient's doctor immediately, as eye complications can develop quickly. Any changes should also be documented (Marsden [119], NMC [162]).

Eye swabbing is performed to clear the outer eye structures of foreign bodies, which could be infected matter, as well as discharges. The swab should be moistened with sterile water for irrigation and lightly wiped over the eyelid from the nose outward. This process should be repeated with clean gauze until the area is clean of discharge and encrustation (Stevens [220]).

Eye irrigation is usually performed to remove foreign bodies or caustic substances from the eye, for example domestic cleaning agents or medications, particularly cytotoxic material; it should be performed as soon as possible to minimize damage (Marsden [120]). The procedure is also used for pre‐operative preparation and to remove infected material.

The volume required will vary depending on the degree of contamination; copious amounts (at least 1 L) are needed for corrosive chemicals. Irrigation should be carried out for 15–30 minutes until a pH of between 7–8 is obtained (College of Optometrists [39]).

Smaller volumes of irrigation fluid will be required for removal of eye secretions. The solution may be directed to the affected area by using an intravenous fluid‐giving set to ensure a controllable, direct flow of fluid (Marsden [120]). To avoid physical damage, the tubing should be held approximately 2.5 cm from the eye (Shaw and Lee [213]) and directed to the inner canthus. The Morgan lens (Figure 9.8) is an irrigating contact lens that is attached to a giving set to enable hands‐free irrigation.

Contact lenses are thin, curved discs made of hard or soft plastic or a combination of both. Hard contact lenses are made of a rigid plastic that does not absorb water or saline solutions and can be worn for a maximum of 12–14 hours continuously. Gas‐permeable lenses are a combination of both hard and soft plastic; these permit oxygen to reach the cornea, providing greater comfort (Olver et al. [170]). Soft contact lenses are more pliable as they retain more water. Soft lenses can be used daily and be disposed of after use; alternatively, some are reusable and can worn for up to 30 days but will require regular removal for cleaning and disinfecting. Ill‐fitting lenses may reduce the tear film between lens and cornea, which may result in oxygen deprivation of the cornea, leading to corneal oedema and blurred vision. Further damage to the corneal epithelial cells may lead to corneal abrasion and pain. Poor hygiene practices with either the contact lens or the contact lens case can lead to the build‐up of biofilms containing bacteria, such as Pseudomonades and Staphylococci, causing eye infections such as microbial keratitis, which can lead to corneal ulceration and can threaten vision (Tzu‐Ying et al. [232]).

Most people look after their own contact lenses. Cleaning and storage solutions depend on the type of lens used; manufacturers provide specific instructions for the care of their products. The lenses should be stored in an appropriate contact lens storage container with slots for the right (R) and left (L) eyes, so they can be worn in the correct eyes. Seriously ill patients should have their lenses removed and stored correctly until they can reinsert them. Contact lenses are stored in a sterile solution when they are not in the eye; this helps to lubricate the lens and enable it to glide over the cornea, reducing the risk of injury.

Care and attention should also be given to the cleanliness of the lens storage case, as this can harbour microbial sources of infection, such as Staphylococci, if not cleaned regularly (Tzu‐Ying et al. [232]). Lens storage solution should be emptied from the case daily, once lenses have been removed for use. The case should be rinsed with saline and left to air dry daily (Lakhani [103], [104], Tzu‐Ying et al. [232]). Contact lens cases and lenses should never be rinsed with tap water, as contaminants and micro‐organisms, such as Acanthamoebae, can reside in them (Carnt et al. [34]). Contamination of the lens or case by these micro‐organisms can lead to serious eye infections and potentially a degree of permanent vision loss (Moorfields Eye Hospital [137]). For this reason, contact lenses should not be worn while showering or bathing (Carnt et al. [34], Lakhani [103], [104]).

Artificial eyes are made of glass or plastic; some are permanently implanted. Most people who have artificial eyes care for them themselves. If the patient is unable to do this, it is recommended that the eye is removed once daily for cleaning; the patient will be able to advise how they would like this done (Stevens [219]). However, if they are unable to do so, advice should be sought from the local ophthalmology service or the nursing team in the ophthalmology unit.