Factsheets Eye Poking and Touching in People with Learning Disabilities

Strategies for Supporting people who poke their eyes

This factsheet follows on from Eye Poking and Touching in People with Learning Disabilities

Introduction

Most people rub or touch their eyes from time to time and do so for many reasons.  Sighted and visually impaired adults with learning disabilities also poke or rub their eyes.  Some people with learning disabilities may do so more intensely and for reasons that might be difficult for other people respond to or understand.

Some people’s eye poking is dangerous, resulting in damage that could lead to blindness or their eye having to be removed.  It can be distressing for others to observe.  Even ‘gentle’ eye touching often causes eye infections.

Support Strategies: observing and recording

Many people with learning disabilities cannot explain why they frequently poke or harm their eyes.

It is not always clear when ‘mild’ eye poking becomes a major health risk to the person - so it is important to observe people who regularly poke, touch or rub their eyes.  Observing people will lead to a greater understanding of why people poke their eyes.

• Always record your observations and share them with others.
• Regularly look to see if the person’s eyes are healthy or are they blood shot, inflamed etc?
• Also check eyelids, eyelashes, for styes, cysts or skin problems. 
• Watch what the person is actually doing, how frequently and how intensely.
• Ask others if the person has done this in the past, or if it is a new behaviour.  Changes in behaviour indicate that their sight has deteriorated.  Even a small reduction in vision causes distress.
• Discover if a person suffers from allergies / hay fever.
• Establish if a person is more likely to touch their eyes at a particular time of day. 
• Watch if there are particular situations when people are more likely to poke or touch their eyes.  Are they bored, upset or lonely?
• Does the person use eye poking as a method of communication – does it attract the attention from others? 
• Is the person very upset and why?  What is their behaviour communicating?  Does the person need additional help urgently? 

Support Strategies: Considering eye care and general health needs

Minimise the risk of a person damaging their eyes:

• The person’s hands should be kept clean – consider using anti-bacterial hand wipes to the fingers and nails.  Fingernails need to be kept clean and short, with rounded ‘corners’ to reduce the risk of scratching eyes.
• Supporters need to ensure that their own hands are clean and should always apply universal precautions before supporting others.
• People with learning disabilities need regular eye tests and health checks.
• Ask about recent eye tests.  What did the optometrist find?  Were glasses prescribed?  When should they be worn and does the person wear them regularly?  Are glasses kept clean?  Has the person been referred to an ophthalmologist?

Have you or others acted on any recommendations – have you referred to the person’s GP any health concerns?

Support Strategies: interventions to consider

After observation and assessment it may be agreed that the person’s eye poking is likely to have a serious impact upon their eyes and vision.  If this is the case they will require skilled intervention to reduce the impact of their behaviour upon their eyes and sight. 

As well as contacting Eye Care specialist and the person’s GP you should consider seeking the advice from Communication specialists, behavioural support teams, specialist workers for the visually impaired and skilled support staff.

Some practical advice follows:

• If you believe that people eye poke to gain social attention and companionship – provide this on a regular basis – don’t wait for the person to eye poke before engaging with them.
• With the person’s consent consider holding or maintaining some gentle contact with the person’s hands whilst communicating with them.  This might provide distraction.
• If you believe that the person is bored increase activity and engagement – but be sensitive to not overloading a person’s day.
• Consider introducing activities that provide visual and sensory rewards – preferably those that occupy the person’s hands.
• Ensure people understand what is going on around them.
• Reassure people at times of stress or when settings might be confusing.
• Consider different ways to help people take more control and exhibit choices.
• Developing and extending people’s communication skills.
• Some people might be able to understand the impact their behaviour has on others – they may stop or reduce eye poking in social settings.  Some people may assert their right to poke their eyes.

Staff will need training to work successfully with blind and partially sighted people with learning disabilities – especially those supporting people whose behaviour may be hard to understand.

The use of splints

We have sometimes been asked if it is appropriate for the person to wear arm-splints to prevent damaging their eyes.  Splints are a form of restraint, used in the past but seldom recommended now.  Restraining a person with splints is almost certainly a violation of an individual’s human rights.  People wearing splints frequently learn other ways to touch their eye or self-injure.  These new behaviours may place the person at even greater risk.

June 2009

Related Information:

Diabetes and Eye Health

Cataracts and Eye Surgery 

Glaucoma

Keratoconus

The Need for an Eye Examination

Eye Conditions that Require Surgery

Eye Drops for People with Learning Disabilities

Eye Surgery for People with Learning Disabilities  

Low Vision Services for People with Learning Disabilities 

People with Downs Sydrome and Eye Conditions

Taking action on Eye Problems 

Recognising Eye Problems in People with Learning Disabilities

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