Eye Injuries Lecture Notes

Eye Injuries

Types of Eye Injuries

• Eye injuries can result from various causes:
  • Foreign bodies: Dust particles, propellants, and eyelashes are common.
  • Burns: Chemical or thermal burns, which are considered medical emergencies.
  • Abrasions and lacerations: Usually superficial, caused by fingernails or clothing.
  • Penetrating wounds: The most serious, potentially causing permanent injury or blindness.

Foreign Bodies

• Most common cause of eye injuries.
• Examples include dust particles, propellants, and eyelashes.
• These can lodge anywhere in the congested mouth or cornea.
• Contact lens wearers are especially vulnerable in dusty environments.

Burns

• Considered a medical emergency.
• Classified as chemical or thermal.
• Can be superficial or deep, depending on the cause.
• Chemical irritants such as acid, alkaline, and metal flashes from signaling blow torches can cause significant pain.

Abrasions and Lacerations

• Usually superficial, caused by items like fingernails or clothing.
• Pain levels vary from mild to severe, depending on depth.

Penetrating Wounds

• Most serious type of corneal injury.
• Can cause permanent injury to eye structures and potentially blindness.
• Infection is a significant risk if the wound breaks through eye structures.

Clinical Manifestations

• Pain: Present when the eye moves, especially with foreign bodies.
• Excessive Tearing and Blinking: Common responses to irritation.
• Swelling: Indicates inflammation.
• Itching and Burning: Common sensations.
• Abrasions and Lacerations: Cause mild to severe pain; if deeper structures are involved, pain may be absent.

Medical Management

Foreign Bodies

• Flush with normal saline when the object is near the sclera and conjunctiva.
• Remove with a clean swab or tissue; avoid bare fingers.
• Eye doctor may prescribe antibiotic topical eye ointments.

Burns

• Flush with normal saline for at least 20 minutes immediately after exposure.
• This helps prevent scar formation and vision loss.
• Separate eyelids during flushing for maximum irrigation.
• Thermal or chemical burns require immediate medical treatment and transport to a hospital; call 911.

Abrasions and Lacerations

• Clean with normal saline solution by a healthcare professional.
• Antibiotic topical agents are usually prescribed.
• Seek medical assistance immediately for any injuries.

Penetrating Wounds

• Cover both eyes while transporting the patient to the hospital immediately.
• This prevents involuntary movement of the affected eye and reduces further injury impact; use shield being careful not to apply pressure.

Nursing Interventions

Foreign Bodies

• Assist with irrigation; do not perform irrigation as an LPN.

Abrasions and Lacerations

• Assist with cleaning.

Penetrating Wounds

• Note any irregularities in pupil size on the affected side.

General Interventions

• Effective and immediate therapy is crucial for any eye injury.
• Frequent complications include infection, vision disturbances, and blindness.
• Ensure the patient can apply ointments and dressings.
• Instruct on using warm or cool compresses.
• Emphasize hand hygiene.
• Advise wearing dark glasses, especially with mydriatic eye drops due to photosensitivity.
• Instruct the patient to avoid chemical or environmental hazards.
• Ensure follow-up appointments with the provider.

Enucleation

• Surgical removal of the eyeball, usually due to severe trauma or malignant tumors.
• An implant is inserted into the eye socket during enucleation to allow for a prosthetic eye fitting after healing.

Postoperative Nursing Interventions (Enucleation)

• Priorities for care include emotional support, open communication, and honest provision of information.
• Apply a pressure dressing over the eye socket to control hemorrhage.
• Observe the dressing every hour for the first 24 hours.
• A protective eye patch should be worn for days to weeks after surgery.
• Assess and report any pain on the affected side or headaches, which may indicate hemorrhage or infection.
• Avoid routine postoperative procedures like coughing and turning onto the affected side to prevent suture dislodgement or hemorrhage.
• The wound typically heals in approximately six weeks.
• Continue monitoring the socket to ensure proper fit of the prosthesis.
• Teach the patient how to care for and clean the prosthesis to prevent infection.