1. OCULAR TRAUMA
Spring 14

2. Epidemiology 2.4 million eye injuries from: Pellet and air guns
Motor vehicle crashes
Violence
Falls
Sports injuries
Animal bites
Foreign bodies
Strikes to the eye

3. Mechanisms of Injury and Biomechanics
Chemical, thermal, and UV radiation
Foreign bodies
Types of injuries
Usual Concurrent Injuries
Head
Face

4. Pathophysiology Signs and Symptoms Signs of serious eye injury
Visual disturbances
Pain
Redness
Ecchymosis

5. Hyphema
Grade I: Blood in the lower 1/3 of the chamber Grade II: Blood in the lower 1/3 to 1/2 Grade III: Blood in more than half of the chamber Grade IV: Blood fills the entire chamber “eight ball”

6. Hyphema Signs and Symptoms Blood in the anterior chamber
Deep, aching pain
Mild to severely diminished visual acuity
Increased intraocular pressure
Somnolence (prolonged drowsiness)

7. Penetrating Ocular Trauma
Caused by:
Projectiles
Missiles
Foreign bodies
(may not be obvious)
Stab wounds
Impalement

8. Penetrating Trauma/ Ruptured Globe
Signs and Symptoms
Severe reduction in visual acuity or complete loss of vision (unilateral)
Severe pain
Obvious impalement or globe disruption
Boggy or asymmetrical globe
Extrusion of aqueous or vitreous humor

9. Penetrating Trauma/ Ruptured Globe
Signs and Symptoms (continued)
Extrusion of intraocular contents
Bulging of the eye
Grade IV hyphema (“eight ball”)
Hemorrhage
Decreased intraocular pressure
Globe may not have striking abnormalities

10. Chemical Burns Types Acids (most common) Alkalis (most serious)
Sulfuric
Hydrochloric
Alkalis (most serious)
Lye
Lime

11. Chemical Burns Prognosis depends on: Agent Concentration
Length of exposure
Adequacy of decontamination
Degree of corneal involvement
Presence of ischemia

12. Chemical Burns Signs and Symptoms Pain Corneal opacification
Co-existing chemical burn and swelling of the lids

13. Nursing Care - Assessment
History
Mechanism of injury?
Patient complaints?
History of eye problems?
Previous eye surgery?
Chronic conditions?
Glasses, contacts, or protective eye wear?

14. Nursing Care - Physical Assessment
Inspection
Inspect eye, tissues, and face
Observe for symmetry, edema, ecchymosis, ptosis, and lacerations
Inspect globe
Assess pupils
Assess for redness, tearing, and blinking

15. Nursing Care - Physical Assessment
Inspection (continued)
Foreign bodies
Impaled objects
Assess extraocular movements (unless globe injury)
Assess gaze defects
Assess for blurred or double vision
Perform visual acuity test

16. Nursing Care - Physical Assessment
Palpation
Do not palpate the globe
Tenderness
Edema
Stepoffs or depressions
Subcutaneous emphysema
Assess sensory function

17. Diagnostic Procedures
Radiographic Studies
Eye radiographs
Computerized tomography scan
Magnetic Resonance Imaging
Other
Fluorescein staining
Slit lamp exam
Tonometry

18. Nursing Diagnoses Altered visual (sensory/perception) Pain
Infection risk
Injury risk
Fear
Altered health maintenance risk

19. Planning and Implementation
Assess visual acuity test
Elevate the head of the bed
Instruct the patient not to bend or cough
Assist with removal of foreign bodies
Stabilize impaled objects
Apply cool packs

20. Planning and Implementation
Use a new bottle of medication
Instill topical anesthetic drops for pain
Instill normal saline drops or artificial tears for moisture
Drops for ciliary spasm or dilation
Topical NSAIDS can also be used

21. Planning and Implementation
Topical steroids (ophthalmologist orders)
Topical antibiotics
Systemic antibiotics used for penetrating eye trauma (preoperatively)
Tetanus prophylaxis

22. Planning and Implementation
Provide psychosocial support
Obtain ophthalmologic consult
Provide discharge instructions
Prepare for hospital admission, operative intervention, or transfer
Stabilize impaled objects

23. Nursing Interventions for a Chemical Burn
Use an eye shower
Use eye irrigation equipment
Irrigate for at least 30 minutes
Irrigate until conjunctival pH is normal (7.4)

24. Nursing Interventions for a Hyphema
Elevate the head of the bed
Shield the eye with a metal or plastic shield
No bilateral eye patching
Obtain ophthalmologic consult
Provide discharge instructions

25. Nursing Interventions for a Ruptured Globe
Elevate the head of the bed
Shield injured globe and patch the unaffected eye
Topical anesthetic agents and other medications are contraindicated in open globe injuries

26. Evaluation and Ongoing Assessment
Reassess visual acuity
Reassess pain
Monitor globe and pupillary responses