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Second Opinions > Ophthalmic preps

Ophthalmic preps

For our cataract preps we use 10% betadine. We're interested in finding out what FDA-approved solutions other centers are using for ophthalmic preps, particularly when the patient is allergic to betadine.

Started by: Sarah Hilligoss (Director, Surgical Services/Director of Nursing) at June 29, 2012 (11:13 am)

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We use the straight 10% as the 5% is very costly(30mL single use only) and we should not be mixing to create a 5%. We draw up 30cc BSS with Vanco from our 500cc bottle and use that to rinse the 10% out after a 3x swab and one drop inside the eye. It has worked very well for many years. And we still use Phisohex as an alternate to true iodine/Betadine allergies.

Lauren B. (OR Manager/Supervisor) at November 21, 2012 (4:23 pm)

We use the straight 10% as the 5% is very costly(30mL single use only) and we should not be mixing to create a 5%. We draw up 30cc BSS with Vanco from our 500cc bottle and use that to rinse the 10% out after a 3x swab and one drop inside the eye. It has worked very well for many years.

Lauren B. (OR Manager/Supervisor) at November 21, 2012 (4:22 pm)

We use commercially prepared Betadine solution. The patient is prepped in the OR around the lid and lashes then the solution is diluted with BSS to flush under the lids. Phisohex is still ok for true betadine allergies as long as you keep it off the cornea and rinse very well after the prep with BSS.
Gina Stancel, Administrator

Gina Stancel (Administrator/Director/Manager/Owner/Exec. Officer) at November 17, 2012 (6:50 pm)

Previously we made our own 5% ophthalmic betadine but after attending the annual Ohio Association of Ambulatory Surgery Centers meeting we changed our minds! One of the sessions was on OSHA compliance and the issue of compounding; making 10% betadine into a 5% solution is considered compounding! We have now added 5% ophthalmic betadine to our custom packs. The cost is not near what an OSHA fine would amount to!

Rebecca Milliron (Director, Surgical Services/Director of Nursing) at November 6, 2012 (12:38 pm)

We start off with Ocusoft Plus on the lid and lashes, followed by 5% commercially prepared ophthalmic betadine drops in the eye. We then use 2mL BSS to flush out betadine. This is followed by (3) 10% Betadine swabsticks. Betadine is wiped off with 3X3's which have been soaked in sterile water and wrung out.

Sharon G. (OR Manager/Supervisor) at September 11, 2012 (2:53 pm) [last edited on September 11, 2012 (2:55 pm)]

We use a 5% commercially prepared ophthalmic betadine drop in the eye & lashes,then prep around it with 10%. Just be aware that mixing your own solution (as simple as that is) can be considered "compounding" and the regulating bodies (CMS, AAAHC, etc.) often frown upon that. They may also question your ability to be certain your final product is truly 5% without carrying out true quality assurance indicators in the lab. Silly & extreme, but they have done so in the past.

For true betadine allergies (after a positive response to the skin test we do), we use a Dove eye/facial cleansing foaming towelette with an extra antibiotic drop.

L. Silva (Director, Surgical Services/Director of Nursing) at August 28, 2012 (12:49 pm) [last edited on August 28, 2012 (12:55 pm)]

We use a 5% ophthalmic betadine drop in the eye & lashes,then prep around it with 10%. Just be aware that mixing your own solution (as simple as that is) can be considered "compounding" and the regulating bodies (CMS, AAAHC, etc.) often frown upon that.
For true betadine allergies (after a positive response to the skin test we do), we use a Dove eye/facial cleansing foaming towelette with an extra antibiotic drop.

L. Silva (Director, Surgical Services/Director of Nursing) at August 28, 2012 (12:48 pm) [last edited on August 28, 2012 (12:49 pm)]

I agree with Jackie Dayton, but found an easier way to dilute the 10% betadine. Our scub places a 3cc syringe with a 1 1/2 cc BSS into our prep tray. We draw up 1 1/2 cc betadine 10% out of the tray to make a 5% soln. We irrigate the eye first, then proceed with the skin prep.

Julie S. (Director, Surgical Services/Director of Nursing) at July 11, 2012 (2:42 pm)

Sarah, 10% Betadine skin prep and a 5% Ophthalmic preparation topically. In cases of iodine sensitivity or allergy we typically use Phisohex and eliminate the topical 5%.

William Mulhall (Administrator/Director/Manager/Owner/Executive Officer) at July 11, 2012 (9:05 am)

I make our own betadine solution. I use a 15ml bottle of BSS, remove 7.5cc, and add 7.5cc of 10% betadine to it, thus making it a 5% solution. Much less irritation is seen at one day post op. For "true" betadine allergies, we do a Johnson's baby wash scrub and use an extra drop of antibiotic in pre-op. Many times patients confess to a sensitivity to iodine, but it isn't a true allergy. We use betadine anyway, but for a true allergy, we do the baby wash scrub.

Jackie Dayton (OR Manager / Supervisor) at July 11, 2012 (8:47 am)

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