An Evidence Base for Ophthalmic Nursing Practice

The first reference of its kind, An Evidence Base for Ophthalmic Nursing Practice alleviates the need for every ophthalmic practice area to develop diverse, often contradictory, guidelines. This book informs guidelines and protocols and provides up to date, evidence based information, covering: condition management (lice infestation, conjunctivitis, recurrent corneal erosion, removing foreign bodies, chalazion, pain management, acute glaucoma); techniques (padding, taking eye swabs, irrigation, administering eye drops, keratometry); and other topics, including papillary dilation, standards for driving, screening, topical anaesthesia and the eye, and prescribing.

Preface ix

Contributors x

Introduction: evidence and practice xi

Section 1

Lids and lacrimal

1 Basal cell carcinoma 3

2 Blepharitis 7

3 Cellulitis 9

4 Chalazion (meibomian cysts) 13

5 Dry eye syndrome 17

6 Ectropion 25

7 Entropion 29

8 Infestation of lashes: phthiriasis palbebrum 33

9 Lid eversion 35

10 Sac wash-out (irrigation of the lacrimal ducts) 39

11 Schirmer’s tear test 43

12 The Tear fi lm break-up time 47

Section 2

Conjunctiva

13 Conjunctivitis 51

14 Subconjunctival haemorrhage 55

Section 3

Cornea

15 Bacterial corneal ulcers 59

16 Bandage contact lenses 63

17 Contact lens care 65

18 Corneal scrape 73

19 Corneal topography 75

20 Herpes simplex keratitis/dendritic ulcers 79

21 Marginal ulcers and keratitis 83

22 Recurrent corneal erosion 85

Section 4

Angle and aqueous

23 Acute glaucoma 93

24 Angle assessment 97

25 Tonometry 103

Section 5

Lens

26 Biometry (IOL calculation) 109

Section 6

Vitreoretinal

27 Age-related macular degeneration 117

28 Fluorescein angiography 121

29 Indocyanine green angiography 125

30 Intravitreal injection procedures in the treatment of AMD 127

31 Photodynamic therapy 133

Section 7

Neuro-ophthalmology

32 Cranial nerve III palsy 137

33 Cranial nerve IV palsy 141

34 Cranial nerve VI palsy 143

35 Assessing pupil reactions 147

36 Electroretinogram and electro-oculogram 151

37 Visual evoked potential 155

Section 8

Pharmacology

38 Administration of eyedrops and ointment 161

39 Eyedrops that dilate the pupil (mydriatics and cycloplegics) 165

40 Eyedrops and health-care assistants 169

41 Prescribing and supplying drugs 171

42 Topical anaesthetics and the eye 177

Section 9

Trauma

43 Eye irrigation 183

44 Padding/patching the eye 187

45 Foreign body removal and treatment 191

46 Hyphaema 197

47 Ocular burns 201

48 Sprayed chemicals and the eye 207

49 Surface ocular trauma: treatment 211

50 Triage in the ophthalmic setting 217

Section 10

General topics

51 Cannulation 223

52 Differential diagnosis of the red eye 227

53 Focimetry 229

54 Heat treatment 233

55 Infection control in ophthalmology 235

56 Managing pain, nausea and vomiting 243

57 Visual acuity testing (in adults) 245

Section 11

Legal aspects of care and policy

58 Low vision registration 253

59 Recommendations for low vision services 257

60 Consent to treatment 265

61 Vision and driving 277

62 Standards for information for people with a visual disability 283

63 New pathways for common eye conditions 287

64 The Disability Discrimination Act 293

65 Visual health and Government priorities 297

Appendices 299

1 Orthoptic abbreviations 301

2 Glossary 305

3 Useful addresses 313

4 Useful references and documents 319

Index 321

Janet Marsden is former Chair of the Royal College of Nursing's Ophthalmic Nursing Forum, and a Postgraduate Programme Leader at Manchester Metropolitan University. Providing evidence-based care is a key skill for all healthcare professionals. This book considers the evidence base for ophthalmic nursing practice – looking at the ‘why’s’ of what we do and how we know what we know. The RCN Ophthalmic Nursing Forum Steering Committee recognise that best practice in ophthalmic care across the UK should be synthesised along with the evidence to support it, to enable practitioners to develop guidelines and to identify and use the best evidence possible in the care of patients with ophthalmic problems. This book addresses some of these issues. Where there is robust evidence, it is identified, practitioner experience is incorporated and when there is no obvious ‘scientific’ evidence, consensus, expert opinion is included.

An Evidence-base for Ophthalmic Nursing Practice explores condition management, including lice infestation, conjunctivitis, recurrent corneal erosion, echymosis, acute glaucoma etc. It considers the evidence for techniques such as padding, taking eye swabs, irrigation, and the use of heat. It also discusses topics such as visual acuity testing, visual standards for driving and other legal aspects of care and policy. This text will be an invaluable accessible reference tool for all nurses working in ophthalmic settings.