The Morgan Lens is a small contact-lens-like doo-hickey that allows safe and efficient eye irrigation following chemical injury.
First of all always include the eye room in your checks at the beginning of each shift. Ensure that there are a couple of bags of Hartmans solution and some giving sets hanging ready to go.
When Joe Boggs (not his real name) presents with something icky in his eye prepare him for the procedure.
- if possible get a senior doctor to r/v this patient. Remember, when it comes to prioritization, ‘the eyes have it.’ (If the doctor is in the loo, do not delay ‘instigation of the irrigation’)
- Explain what you are about to do and reassure him that this will be a relatively painless procedure.
- Wash your hands. You can’t be sure that brown stuff under your fingernails is Betadine, in fact , better put some gloves on.
- Quickly inspect both eyes for any injury or foriegn bodies, asking the patient to look up, down, left and right. NEVER irrigate an eye that may have suffered penetrating trauma.
- Lie him down on the trolley in a supine position with the affected eye “lowest most”. I like to rest the patients head in a bowl, and drape him with towels al-a barbers shop fashion. We are about to unleash 1 or 2 liters of fluid, so lets try to prevent an eye irrigation evolving into a near drowning.
- Test his eye pH with a pH testing strip. Alternatively you can use a sterile urine dipstick. (Using a pair of sterile scissors….cut of a urinalysis stick at the pH patch). Holding down his lower lid and avoiding impaling him with the test stick, gently touch the conjunctiva.
- Instil 2 drops of Oxybuprocaine. Tell him this will sting like buggery for a few seconds before it settles down.
- Now is a good time to prime the giving set and attach the Morgan Lens..giving the local ample time to percolate.
- Note: MorTan, Inc. the manufacturers of the Morgan Lens, recommend the use of Lactated Ringers Solution for irrigation due to pH: Tears pH: approximately 7.1; Normal Saline pH: 4.5-7.0; Lactated Ringers pH: 6.0-7.5. (In Australia Ringers Lactate is known as Hartmans) And warmed fluid will be tolerated better than cold.
- Start the Hartmans at a very slooow rate before you begin, to lubricate the lens during insertion. The lens is designed to float above the cornea on a cushion of fluid. It is also designed to vault the cornea so that only touches the less-sensitive sclera (white) of the eye if the flow of solution runs dry.
- Now ask the patient to look down. With your left hand, lift the upper lid, and with the right, slide the lens up under it. (swap hands if you are left-handed or hanging from the ceiling). Now, reach around with your left hand, ask the patient to look up, and retract the lower lid.
- The lens should pop down under the lower lid with a satisfying flop; however this is a tricky and fiddly business. Once mastered will make you the envy of your family and friends.
- Turn the drip up as high as the patient can tolerate, and irrigate for 30 minutes.
- Wait a further 5 min. and repeat the pH test.
The normal eye pH is 7.4.
- You may cease the irrigation if the pH is < 8 for alkaline burns or >7 for acid burns.
- if his pH has not normalized instil another 2 drops of local and repeat the procedure.
- Keep him warm and comfortable throughout. If you are going to leave the room make sure he has a call-bell handy.
- To remove the lens just reverse the insertion steps.
If his eyeball pops out as you remove the lens you have incorrectly performed this procedure. Hide it under the slit-lamp and sneak off to clean the tea-room before anyone notices.