Factsheets Eye Drops for People with Learning Disabilities

Introduction

This factsheet will examine why people need to use eye drops.  It will look at how people can be helped to be comfortable having eye drops inserted and how to administer eye drops safely.

Reasons people need eye drops:

• hay fever
• eye infections
• to manage a sight-threatening condition such as glaucoma
• they may have them prescribed before or after an operation

Eye surgery

• Accepting drops is crucial to the success of some operations - such as corneal grafts for keratoconus.
• Medicated drops may be an essential part of the healing and after-care process, preventing infection and inflammation.
• It is important that preparatory work is done with people with learning disabilities before an operation.
• Ophthalmologists, optometrists or orthoptists may need to use eye drops during an eye examination to allow a more thorough view of the inside of an eye.  In most cases the drops will be inserted by the clinician and not by the staff member or carer - but ‘de-sensitisation’ may help.
• Staff often assume it will be impossible to insert drops into the eyes of reluctant people with learning disabilities - but it can be done, whether the person keeps his/her eyes open or not. 

Affects of eye drops

It is important that staff and family carers discover how most people are affected by eye drops and ensure that this is considered when working with a person. 

• Some eye drops may affect people’s vision, making the world seem blurred. 
  • The person may need additional help at this time - they may not be able to see near things clearly (such as their food or magazines).
  • They may not feel safe walking about by themselves. 
• Drops usually blur the vision for between 4 and 6 hours.  It is important to ask how long their vision may be affected.
• Some drops sting only when they are inserted, while others may cause discomfort for longer.  Some drops do not hurt but make the eyes water.
• Very rarely there can be side effects from the eye drops used during eye examination.  It is important to find out what to look for (painful, red eye) and what to do in the event of this being experienced.
• In certain circumstances drops will stain or colour the eye. 
• People with learning disabilities seldom have their allergies identified.  They may need to be watched carefully after being given any new medication in case they react adversely to it.

Preparing the person to have eye drops

• Eye drops are not normally part of people’s daily lives, so people may need careful introduction to them.
• The person needs to understand the importance of eye drops if possible.
• Role play may help in the process - perhaps with the person watching drops being inserted into the eyes of a carer or staff member.

Desensitizing the person to eye drops

It may be necessary to de-sensitise the individual to the experience of eye drops. Consider :

• Initially placing drops on the person’s hand so they can see what is happening. 
• The person  accepting drops being placed on the face - perhaps 2-3 cms below their eyes. 
• When they feel comfortable with this, drops can gently be placed higher up on their face, and eventually in their eye.

Before inserting drops

• Good hygiene is important.  Hands should be washed thoroughly.
• Be aware that if supporter is a smoker or has been handling spicy food this can sting the eyes.
• It is also important to ask person needing the eye drops to wash their hands too - especially if they are likely to rub their eyes.
• Some people may find it less threatening if they can learn to hold their eye open - or even cope with their own drops.
• People may react strongly if they are approached from behind and drops are inserted without warning!  They need a careful explanation of what is going to happen.

Ways of inserting drops

• The person sits down, holding his/her head back. 
• After explaining carefully about what is going to happen, the staff member stands behind the person and puts the drops into the eye from behind.
• When inserting the drops:
  • Rest the heel of your hand gently on the person's forehead.
  • Using the index finger, gently draw back the top lid and ask the person to look up.
  • Gently, using the thumb to draw down the lower lid, away from the eye, let the drops fall into the gap.
  • Close the eye for at least 30 seconds afterwards as this stops the drops draining away too fast.
• If the person shuts their eyes, it is possible to put the drops on to the eye-lid margin (where the eyelashes join the eye-lid) so when they open their eye, the drops should fall in. 
• It may be easier for all concerned if eye drops are inserted when the person is lying in bed, first thing in the morning or last thing at night.  This can be turned into a ‘ritual’.

Using eye drops before surgery

• It may be useful to practice using eye drops at home before planned surgery.
• Always try to discuss any plan to de-sensitise a person to eye drops with the surgeon or your GP so a simple preservative-free saline solution can be prescribed.

Safety

• Staff should always discuss plans to get a person familiar with eye drops with people who know the individual well and a medical advisor.
• Advice should always be sought from the person's surgeon or GP about the advisability of de-sensitising the person.  This is to minimise the risk of an adverse reaction. 
• Only a minority of people with learning disabilities have detailed medical histories and few have had their allergies identified.
• Do not de-sensitise people to eye drops by using:
  • contact lens solutions
  • ‘artificial tears’
  • solutions which are available over the counter at chemists as these contain preservatives
  • Saline solutions bought at chemists are also likely to contain preservatives 
• Preservatives may cause allergic reactions - such as blurring of vision, itchy eyes and so on. 
• Remember that the eye drops used before the operation may not sting but the more powerful medication prescribed for postoperative sore/infected eyes may hurt! 

Using saline solutions or prescribed drops

• Always read and follow the instructions on the bottle.
• Some drops need to be kept in a fridge. 
• Record the opening date of the drops on both the bottle and its box.
• Discover if the drops for de-sensitisation sting!  Using drops that cause discomfort might put people off.

Types of eye drop bottles

• Eye drops come in different types of bottles, with some being dispensed in bottles with droppers and vials.
• Some eye clinics can also provide a suitable gadget that makes it easier to insert eye drops.
• RNIB sells several different devices to help people manage their own eye drops - different devices are designed for different bottles. 

June 2009

Related Information:

Eye Lid Hygiene

Eye Surgery for People with Learning Disabilities

Planning the Operation

Preoperative Procedures

Day of the Operation

What to Expect at Hospital

Glaucoma