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Author: Jones JB, Schoenleber DB, Gillen JP
Publication: Acad Emerg Med 1998 Dec; 5(12):1150-6
OBJECTIVE: To evaluate two solutions, lactated Ringer’s (LR) and a balanced salt solution (BSS Plus, Alcon Laboratories, Ft. Worth, TX), compared with normal saline solution (NSS), for ocular irrigation in healthy adult volunteers with and without the Morgan Lens. METHODS: This was a prospective, double-blind, randomized study of healthy volunteers who were at least 18 years of age. Exclusion criteria included the use of analgesics within four hours of the study. A complete ophthalmologic examination was performed at baseline and at the completion of the study. Following randomization and prior to any intervention, baseline discomfort scores were obtained by means of a verbally administered, horizontal, 100-mm, unnumbered analog discomfort scale. Both eyes of each volunteer were irrigated simultaneously for 15 minutes, with additional discomfort scores being recorded every 5 minutes using the same 100-mm, unnumbered analog discomfort scale. A global evaluation to assess the method of irrigation and the solutions used for irrigation was completed by both the physician blinded to the treatment groups and the volunteers. The volunteers were continuously monitored for any adverse effects resulting from the irrigation solutions or the Morgan Lens. RESULTS: Sixty-three volunteers were recruited into the study, with 61 entered in the final analysis. Age and gender were balanced within each group. There was no significant difference in discomfort scores between the two groups; however, all discomfort scores decreased over time (p = 0.008). A lens-solution interaction was identified, with LR being the most tolerated when administered with the Morgan Lens. A statistically higher ocular pH difference was seen between the pre- and postirrigation readings for the control eye in volunteers irrigated with the Morgan Lens (p = 0.046). Analysis of the global evaluations for each group revealed no difference in the distributions of physician and volunteer scores. No adverse event was reported in either group.
CONCLUSION: There does not appear to be any difference in discomfort scores between the ocular irrigation fluids when used without the Morgan Lens. Overall, the use of the Morgan Lens appears well tolerated by healthy, adult volunteers. However, there does appear to be a significant lens- solution effect on volunteers’ discomfort scores, with LR having significantly lower discomfort scores when used for ocular irrigation with the Morgan Lens. The authors conclude that the use of the Morgan Lens for ocular irrigation is well tolerated and recommend using LR as the irrigation solution for maximal patient comfort.
MorTan note: The authors of this article also concluded: “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.”
Thanks for the opportunity to sing the praises of the Morgan Lens! Those of us who have been in the field for a while wonder what we ever did without them! We find two general uses for the lenses. One is for contact irritation: most typically, splashes. After local anesthetic, for ease of insertion, the lenses fit comfortably on patients of all ages and provide gentle and thorough irrigation of irritant substances. We have many cases of this type. The second most common use is for patients show suffer multiple injuries due to automobile accidents, major trauma, burns, falls, etc. Not only does the lens thoroughly irrigate the eye, removing most or all of the debris that has accumulated, it more importantly frees up the nurse's hands so that she can perform other lifesaving functions. Quite frankly, eye irrigation was treated as "the bottom of the list" often because other patient's other injuries were more devastating with higher morbidity and mortality. Particularly in the burn patient, the soothing effect of the irrigation and potential to prevent infection or further injury, make it an easy to use, valuable asset for patient care.Registered Nurse (Montana)
The Morgan Lens is used in 90% of hospital emergency departments in the USA and can be inserted in less than 20 seconds. There simply is no other "hands-free" method of eye irrigation. Nothing else frees medical personnel to treat other injuries or to transport the patient while irrigation is underway. Nothing is more effective at treating ocular chemical, thermal, and actinic burns or removing non-embedded foreign bodies, even when the patient's eyes are closed tightly. Its design makes it simple and straightforward to use so minimal training is required.