FAQs

The Morgan Lens provides continuous ocular irrigation and/or delivers medication to the cornea and conjunctiva. It may also be used for the removal of non-embedded foreign bodies, eliminating the need to use a cotton swab to sweep the fornices and cul-de-sac as all particulates are effectively flushed out. The Morgan Lens consists of a molded lens with directional fins, attached tubing, and a standard luer loc adapter. It may be attached to a bag of irrigating solution using the Morgan Lens Delivery Set or a standard I.V. set, or a syringe may be used for a more controlled flow.

It’s important to keep in mind that the Morgan Lens is not like a contact lens. Unlike a contact lens (or a bandage contact lens), the Morgan Lens does not rest on the surface of the eye, but instead it vaults the cornea, delivering a constant flow of fresh irrigating solution and creating a space between the lens and the cornea This continuous flow gently pushes the lens away from the surface of the eye, separating the injury from the sweeping action of the eyelids and washing out caustics or foreign bodies. Even when the eyelids are squeezed shut tightly, the irrigating solution is delivered to injured tissue unlike other methods which require the eyelids to be retracted for effective irrigation.

As can be seen in our Instructions For Use, the Instructional Video, or our PowerPoint presentation, the Morgan Lens is very easy to use and minimal training is required.

After attaching the Morgan Lens to the Morgan Lens Delivery Set or a standard IV set and a bag of irrigating solution of choice, and instilling a topical anesthetic, if one is available (it’s not essential, but it may help the patient relax), the lens is inserted in the following manner:

• Start a minimal flow of solution.
• Instruct the patient look down and slip the Morgan Lens under the upper eyelid.
• Have the patient look up, retract the lower lid, and drop the lens in place.

The flow can then be adjusted to the desired rate (see our Uses Chart for suggestions) and the outflow absorbed with the MorTan Medi-Duct (MT63), blue pads, or towels.

Removal of the Morgan Lens is equally easy. With the solution still flowing, instruct the patient to look up, retract the lower lid, and slip the lens out.

Although these steps are recommended whenever the Morgan Lens is used, it may still be used with patients that are unwilling or unable to comply (such as an unconscious individual or a child).

The Morgan Lens takes just 20 seconds to insert and, once in place, it works on its own. It is the only method of eye irrigation that does not require your constant attention or the assistance and cooperation of the patient. Unlike hand-held irrigation procedures, the Morgan Lens frees you to work on other injuries, treat other patients, or transport the patient without stopping the irrigation procedure.

Because patients may close their eyes while irrigation is underway, you are not fighting the natural reflex actions (blepharospasms) or the increased sensitivity to light (photophobia) which can make ocular irrigation so difficult. This is especially helpful when the patient is in an agitated state or if the patient is unable to understand the procedure, as is the case with young children. Irrigation with the Morgan Lens is relaxing for the patient, in turn making it more convenient for you.

• Irrigation can be underway in less than 20 seconds.
• Medical personnel are free to treat other injuries or patients.
• The procedure is more comfortable for patients as the eyes may be tightly closed.
• It reduces the need for staffing, helping with short-staffed departments or in mass casualty situations.
• All of the irrigating solution is delivered directly to the injured eye.
• Non-embedded particulates and foreign bodies may be removed without having to swab the fornices.
• The inner eyelids do not have folds and pockets that may trap particulates or chemicals (which may happen when the lids are held open or retracted).
• The patient may be transported from the accident site to the hospital, or throughout the hospital, without stopping irrigation.
• With the Morgan Lens Delivery Set, both eyes may be simultaneously irrigated with just one bag of irrigating solution.
• Irrigation may be continued for hours or even days.
• With children, the process is calming and children have been reported to quickly fall asleep.
• The Morgan Lens separates the injured cornea from the eyelids which otherwise scrape over the injury with every blink.

According to the 6th Edition of Goldfrank’s Toxicologic Emergencies, ocular irrigation following a caustic exposure should include “lid retraction and eversion” unless a Morgan Lens is used. Nothing else is as effective at clearing all regions of the eye and inner eyelids of caustics or particulates, and no other method of eye irrigation is “hands free”.

The human cornea contains 300 to 600 times more pain receptors than are found in the skin, meaning the eye is one of the most sensitive tissues in the body and making eye injuries especially painful. Following a chemical burn, the body’s natural reaction is to close the eyelids tightly, partly due to the reflex action called a blepharospasm but also because of an increased sensitivity to light (photophobia). Every blink drags the eyelids across the injured cornea. In addition, some chemical reactions generate heat, adding to the pain and anxiety.

The Morgan Lens addresses all these issues, making it the preferred method of eye irrigation by patients as well as healthcare providers. It is quickly inserted under the eyelids and immediately begins cooling and soothing the eye, relaxing the patient by allowing the eyes to be closed. It floats on irrigating solution, vaulting the cornea and protecting it from the painful sweeping action of the eyelids.

Any form of ocular irrigation may cause discomfort in some patients if Normal Saline is used, due to its low pH, and for this reason MorTan recommends the use of lactated Ringer’s solution. When using the Morgan Lens, the flow of irrigating solution should be started prior to insertion and continued through the entire process, not stopping until the lens has been removed. Reducing the rate of flow may also increase patient comfort, and some studies have shown that warmed fluid is preferred. One study (see our Papers and Abstracts page) found that irrigating with the Morgan Lens and lactated Ringer’s was preferred over other methods, while an unpublished study sponsored by MorTan found that the Morgan Lens was preferred unanimously over the manual irrigation method by both patients (for comfort) and medical workers (for ease of use).

The Morgan Lens is simple to use and the necessary training is minimal. On this website you will find the Morgan Lens Instructional Video, the Instructions for Use chart, and a PowerPoint presentation. MorTan offers a Training Tool, a molded model of an eye, which allows simulated insertion and removal of the lens. In addition, there is a Competency Exam that may be modified for your use as well as a sample protocol and links to ones currently in use by medical facilities and EMS organizations. Please visit our Training Materials page on this website for links to each of these.

Instead of touching the cornea, the Morgan Lens floats on the irrigating solution which means the solution should be flowing any time the lens is in the eye. It is recommended that the solution be started before insertion and continued until after the lens has been removed. Ensure that the irrigating solution is not allowed to run dry.

Some doctors and nurses are rightfully concerned about placing a “large piece of plastic” on an already injured eye. They’re concerned about further damage to the cornea–i.e. abrasions. The fact is that any significant corneal insult (acid, alkali, thermal or actinic burns) or infections (corneal ulcer, abscess, Stevens-Johnson, etc.) will cause a corneal abrasion, and millions of these have been successfully treated using the Morgan Lens.

Minor corneal abrasions, such as those induced by contact lenses, are often treated by patching the eye, preventing further irritation by the eyelids and eliminating photophobia. A more seriously abraded cornea caused by acid, alkali, dirt, or other foreign materials, can be made more comfortable simply by the presence of the Morgan Lens even if it were inserted without irrigation (NOT recommended) as it vaults the cornea, separating it from the sweeping action of the eyelids, preventing further damage. In addition, the patient is able to close the eyes, eliminating photophobia and creating a more relaxed situation.

The addition of the irrigating solution (MorTan recommends lactated Ringer’s) means the offending material and the damaged tissue is quickly removed from the cornea and other affected regions of the eye. The irritated tissues are cooled, oxygen is delivered to the cornea, and the eyelids are kept from causing additional damage while the caustics are diluted and washed away. With the solution flowing, the Morgan Lens “floats” above the eyeball with the layer of solution separating the lens from both the cornea and the inner lids. No pooling or “cesspool” condition exists.

Dr. Morgan performed numerous fluorescein studies and never saw a corneal abrasion caused by the Morgan Lens. This is due to the technique of starting the fluid before insertion, keeping the flow going the entire time the lens is in place, and removing the lens while the fluid is still running. The lens is, therefore, constantly floating on the cushion of fluid and not touching the cornea. Improper handling or insertion of the Morgan Lens could possibly lead to minor corneal changes, and prolonged irrigation with Normal Saline has been shown to cause corneal staining and discomfort.

There is no set rule on the length of time for irrigation, as it varies depending on the type of injury being treated (including such factors as the chemical involved, the concentration, the amount of time before irrigation was started, the physical form of the caustic, etc.). However, the general guideline is to irrigate until the conjunctival pH has returned to approximately 7.5 to 8.0. It is necessary to ensure that the pH of the anterior chamber is corrected, especially with alkali burns, so the pH should be checked again after irrigation to make sure it hasn’t changed.

Goldfrank’s Toxicologic Emergencies recommends multiple checks of the lower fornix every 5 to 10 minutes following irrigation with at least two liters of solution per affected eye, continuing until the pH is between 7.5 and 8.

The article “Chemical Eye Injuries in the Workplace” by Pamela Lusk (AAOHN Journal, Vol. 47, No. 2) suggests irrigating with 2 liters of solution, removing the Morgan Lens and waiting 10 minutes, and checking the pH. The lens should be replaced and the cycle repeated until the pH is in the range of 7.5 to 8.

MorTan’s recommendations for irrigating times are shown on the chart found on the Instructions for Use page.

The Morgan Lens may be attached to any standard I.V. giving set, and towels, blue pads, or a basin may be used to collect the outflow. However, by using the accessories available from MorTan, the process can be made even faster, cheaper, and more convenient.

For the bilateral irrigation of eyes, MorTan recommends:

• Two Morgan Lenses.
• A topical ocular anesthetic (if available–not required).
• One Delivery Set for the Morgan Lens (part number MT202) (replaces the pair of I.V. giving sets, saving money and set-up time).
• Two Medi-Ducts (part number MT63) (replaces towels, blue pads, or other collection device; only one per eye is needed as they will not become saturated).
• One bag of irrigating solution–MorTan recommends lactated Ringer’s (Hartmann’s) solution (two bags are needed if the Delivery Set is not used).
• pH paper (litmus paper or a urine dipstick may be used).

Many hospitals develop an eye care kit or tray containing the above materials to ensure that all equipment is readily available when needed.

A guidance document released by the FDA in 2013 states that, because there are no tests that can demonstrate that a medical device is completely free of natural rubber latex proteins, products should not be referred to as “Latex Free”. Instead, following their recommendation, we can state that the Morgan Lens, the Delivery Set for the Morgan Lens, the Medi-Duct, and all of MorTan’s packaging materials are not manufactured with natural rubber latex.

The materials used in the Morgan Lens include LDPE (low-density polyethylene) for the “lens” portion, silicone for the tubing, and polypropylene for the luerloc. All of these materials are medical grade and, as stated above, are not manufactured with natural rubber latex.

Dr. Morgan used the lens on children as young as six months and reported that the children not only calmed down once irrigation was underway, it was not unusual for them to fall asleep. Many pediatricians have also told us this, stating that because infants and young children are not able to understand the irrigation process, they quickly relax once they are allowed to squeeze the eye shut and the irrigating fluid begins to soothe the injury. In addition, it’s possible when using the Morgan Lens for parents to hold the child in their lap, further helping to calm the child.

Human eyes do not grow much during our lifetime and a baby’s eyes are proportionally larger (explaining why they look so big). The length of the palpebral fissure (the horizontal opening between the eyelids) may be a little deceptive, however, as it does increase a fair amount, going from approximately 24 to 25 mm in an infant to 28 to 30 mm in an adult. The Morgan Lens, being about 23 mm long, can easily be slipped through the palpebral fissure into the larger region below the lids, even in a child. If necessary, the lens can be rotated slightly to help it slip into place more easily.

For more information, please refer to our White Paper on Pediatric Uses of the Morgan Lens found on our Technical Papers and Abstracts page.

The ideal eye irrigation solution is one that is readily available, has a pH close to that of the eye (approximately 7.1), acts as a buffer, and is inexpensive. Most experts agree that lactated Ringer’s (Hartmann’s Solution) comes the closest to meeting all of these. Irrigation with essentially any solution, however, is better than no irrigation at all, so while lactated Ringer’s is recommended, Normal Saline, water, or any safe solution should be used without delay if necessary.

The pH of lactated Ringer’s is 6.0 to 7.5, much closer to that of the healthy eye than Normal Saline (pH 4.5 to 7.0). In addition, lactated Ringer’s has a buffering capacity (approximately 0.00069) so that it is able to neutralize either acidic or basic solutions more quickly than NS, which has essentially no buffering capacity. Other commercially-available eye irrigating solutions may be used if available.

A study performed independently of MorTan used healthy human volunteers to compare a number of irrigating solutions with and without the Morgan Lens. The study (the abstract of which may be viewed on our Technical Papers and Abstracts Page) concluded that the Morgan Lens used with lactated Ringer’s was more comfortable than irrigation with sterile saline solutions or manual irrigation techniques using either lactated Ringer’s solution, normal saline, or a balanced salt solution. The authors concluded that “the Morgan Lens was well tolerated as an irrigation tool in this group of volunteers. The acceptability of this device by patients would also allow for prolonged irrigation times following a chemical exposure.” Because it may be necessary to irrigate for at least 2 to 3 hours for an alkali burn (and often much longer), the importance of patient tolerability should not be ignored.

Other studies have shown that the prolonged use of saline can cause discomfort, especially when irrigating an injured eye. Minor morphological changes to the surface of the eye have also been noted. It’s possible it isn’t just related to the pH: one small study (you can read the abstract here) done on ocular burn patients compared different irrigating solutions. Of the eleven patients they treated in their ER, three “demanded discontinuance” when irrigation was done with normal saline and even pH-balanced saline (NS plus sodium bicarbonate) but, presumably, could tolerate the other solutions (LR and BSS Plus).

Current recommendations state that IRRIGATION SHOULD NOT BE DELAYED TO REMOVE CONTACT LENSES. Instead, irrigation should be started immediately and removal of the contact lenses done soon afterwards. Diluting and removal of the caustic is the number one priority, and time is of the essence so begin irrigation first. It is recommended that you ask if the patient wears contact lenses, and if they are still in place, and removal can be done once the patient can open the eye without difficulty.

The natural tendency to squeeze the eyelids shut in response to an injury (blepharospasm) can make it painful, traumatic, and difficult to remove contact lenses until irrigation has been underway for some time. In addition, the irrigation generally separates the lens from the cornea, making removal easier.

Although contacts certainly cannot be considered “protective devices”, some experts believe that in certain cases they may actually provide a degree of protection to the cornea. However, since they may absorb and retain chemicals, or block the irrigating solution, removal should be done as soon as possible and the contaminated lenses should be discarded.

The National Institute for Occupational Safety and Health has an informational bulletin that may be downloaded at http://www.cdc.gov/niosh/docs/2005-139/pdfs/2005-139.pdf and provides practical advice for setting up a program to address the use of contact lenses when working with chemicals. Scientific American published a short summary on contact lenses in the laboratory at http://www.scientificamerican.com/article/do-contact-lenses-protect/.

There are only a few situations where the use of the Morgan Lens is not recommended:

CONTRAINDICATIONS:

• Do not use when there is a protruding foreign body.
• Do not use with penetrating eye injuries.
• Do not use with suspected or actual rupture of the globe.
• Do not use anesthetic agents if there is a known allergy.

Yes–the Morgan Lens is recommended for use with biohazard exposures. Any exposure involving mucous membranes is considered “significant” and immediate irrigation is required. Experts recommend no less than 20 to 30 minutes of continual irrigation, starting as soon as possible after the exposure. Treatment should not be delayed to determine whether or not the patient has an infectious disease. Appropriate prophylactic regimens should be started promptly as well.

Unfortunately there is not a specific procedural code for irrigation with the Morgan Lens. Some possible ICD-10 codes include the following (click on the numbers to be taken to the CMS.gov website with the complete list):

Chemical burns to the eye:

• Burns to the eye (T26.00 to T26.42–click for the CMS.gov listings).
• Corrosion of the eye (T26.50 to T26.92).

Foreign body removal:

• Foreign bodies ON the external eye (T15.90-T15.92).
• Foreign bodies IN different parts of the eye (T15.00-T15.82).
• Superficial foreign body of eyelids and periocular area (S00.251 to S0025).

For the treatment of symblepharon, possible codes range from H11.231 to H11.239.

If the Morgan Lens is used as a corneal shield when treating lacerations or puncture wounds to the eyelids, possible codes include those from S01.101 to S01.149.

For treating corneal abrasions with the Morgan Lens (Injury of conjunctiva and corneal abrasion without foreign body), suggested codes include S05.00 to S05.02.

Please note that these are not the only ICD-10 codes available and this listing is not meant to be complete. Please use your own judgment when determining the correct code to use.

Other recommended codes include the CPT Code 65205 (Removal of foreign body (external) from eye but non-surgical).

To bill for the Morgan Lens itself we suggest that you use a miscellaneous supply code such as 99070 or the HCPCS code V2797.

Please contact MorTan (or, if outside the United States, the distributor in your area) for pricing information, ordering quantities, and to see if you are eligible for certain discounts.

The Morgan Lens is very cost effective. It is the only method of eye irrigation that allows medical personnel to treat other injuries or patients rather than having to devote their time to the injured eye. If bilateral irrigation is needed, or when irrigating the eyes of infants or children, the Morgan Lens may even replace two medical providers. When irrigation is performed properly and continued for the necessary amount of time (something that may be very difficult if the lens isn’t available), follow-up care may be reduced. Further cost saving may be realized with the use of MorTan’s accessories: the Delivery Set for the Morgan Lens (which replaces the two I.V. setups and two bags of irrigating solution otherwise needed) and the Medi-Duct (which may be used instead of towels or blue pads).

In 2010, the Bureau of Labor Statistics listed the cost of a Registered Nurse at $33.13 per hour. Using this as a guide, it is readily apparently that it is more cost effective to allow that nurse to treat other injuries or patients rather than being tied up for two to three hours of continual irrigation, as is needed for a severe alkali burn. Many doctors have reported that it often takes far longer for the pH to return to neutral; irrigating for 24 to 48 hours without the use of the Morgan Lens not only would be nearly impossible for the patient to tolerate, but the cost would be extreme.

A 1995 study of the literature looked at the results of 101 patients (131 eyes) who suffered severe ocular burns, comparing those who received prompt irrigation with ones where irrigation was delayed or not performed. Although there were considerable variations in the results, the average length of follow-up treatment decreased from 6.0 months to 4.2 while the number of operations went from 10.4 to 6.5; visual acuity improved with prompt irrigation from 55% to 76%. Prompt and proper treatment through the use of the Morgan Lens not only saves manpower, but may also reduce the need for later treatments.

Accelerated aging studies on packaged Morgan Lenses show that the shelf life is at least five years with no change in properties or loss of sterility (provided the package is undamaged and stored under suitable conditions).

MorTan’s lot numbers consist of two parts. The first seven digits represent the month and year of release of the lens following sterilization, with the next three being a batch number (for example, 0114200 shows that the product was released in January, 2014 and is the 200th batch). Next is the ISO “hourglass” symbol representing the expiration date, followed by the year and month the device will expire. For example, 2019-01 would show that the device will expire in January, 2019.

Yes. Although today it is widely used for treating chemical, thermal, and actinic burns, or for the removal of non-embedded foreign bodies, the Morgan Lens was originally developed to treat corneal ulcers, corneal perforations, and severe ocular infections, and it works equally well for all of these. In addition, the Morgan Lens provides an excellent shield to protect the eye during eyelid surgery or when performing other procedures where damage to the cornea may occur. Not only is the surface of the eye protected, but by blocking the patient’s vision during the procedure, it reduces stress.

Experimental investigations have been performed by the Departments of Ophthalmology and Microbiology at the University of Toronto which corroborates the clinical experiences of the Morgan Lens. These experiments include:

• Continuous flow delivery of gentamicin to the cornea. Rapid penetration into the aqueous humor was obtained.
• Pseudomonas was injected into corneas, and the subsequent treatment was performed with the Morgan Lens. While pseudomonas generally perforates in a few hours, the infections healed without perforation by continuous perfusion of gentamicin with the Morgan Lens.
• Superficial keraectomy with removal of epithelium, basement membrane, and anterior stroma was performed. With the Morgan Lens, epidermal growth factor was perfused and substantial healing occurred in eight hours.

No corneal damage occurred (i.e. perforation, corneal ulceration) while treating with the Morgan Lens.

Many other experimental investigations have been performed showing the applications and advantages of the Morgan Lens, either on behalf of MorTan or independently. Please contact us for additional information or with specific questions.