COMMON

TRAUMATIC
CORNEAL INJURIES
Corneal Abrasion,
Foreign body/Penetrating Injury,
Ruptured Globe
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LAYERS OF THE CORNEA

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CORNEAL SCAR

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CORNEAL ABRASION

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SIGNS AND SYMPTOMS
Corneal abrasions may manifest as a:

 Red and painful eye,

 Foreign body sensation,

 Sometimes with blurry vision and/or

 Light sensitivity (Hersh, 2009) 75

FOREIGN BODY/PENETRATING INJURY

RUPTURED GLOBE
Foreign Body Penetrating Injury

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AETIOLOGY
Globe penetration or rupture can occur due to:
 Blunt injury
• Motor vehicle accidents or other trauma.
• BB and pellet guns present an extreme hazard to all age
groups.
• Paintball weapons
• Sports Balls

 Sharps objects or projectiles.

• Nails, Glass, Stones etc
• Knife, Pencil.
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PATHOPHYSIOLOGY
 Sharp objects at high speed perforate the globe
directly.

 Small foreign bodies may penetrate the eye and

remain within the globe (Intraocular foreign body).

 Once there is a full-thickness injury to

the cornea, sclera, or both it is
considered an open globe injury.
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PATHOPHYSIOLOGY
 Blunt object impacts the orbit, compressing the
globe along the anterior-posterior axis causing
an elevation in intraocular pressure to a point
that a tear results.

 Blunt or penetrating trauma can disrupted the

integrity of the outer membranes of the eye
causing a globe rupture (Accera, 2014)
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PATHOPHYSIOLOGY
The possibility of globe rupture should be
considered and ruled out during the evaluation of
all blunt and penetrating orbital traumas as well
as in all cases involving high-speed projectiles
with potential for ocular penetration. Ocular
penetration is an emergency.

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PREVENTION AND COMPLICATIONS
 Carefully trim your infant’s fingernails.

 Use appropriate protective eyewear at

work.

 For athletes, wear protective eyewear

that is appropriate for your sport.

 Clean your contact lenses thoroughly before you insert

them, as directed by your eye care professional (Acerra &
Dronen, 2014).
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PREVENTION AND COMPLICATIONS

 When nursing the unconscious client or a client
who cannot voluntarily close their eye, their
eyes should be taped close to prevent abrasions
and drying of the cornea (Verma, 2014).

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PREVENTATIVE /COMPLICATIONS
 Complications:
• Endopthalmitis - is an inflammatory condition of the
intraocular cavities usually caused by infection
(Egan & Peters, 2015).

• Evisceration of the eye - is a surgical technique by

which all intraocular contents are removed while
preserving the remaining scleral shell, extraocular
muscle attachments, and surrounding orbital adnexa
(Merritt et al, 2014).
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INVESTIGATIONS
 Investigations include:
• Visual Acuity
• Full Ocular Assessment

• Microscopic investigations are

done by the ophthalmologist
using a slip lamp.

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INVESTIGATIONS
 Fluorescein stain shining
green upon illumination with
cobalt blue light.

 Smears and culture.

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INVESTIGATIONS
• CT Scan to evaluate the orbit and identify
radiolucent foreign bodies should be
performed emergently.

• Bloods (FBC, U & E)

• Inquire about tetanus immune status and

update as indicated. (An open globe laceration
is considered a tetanus prone wound.)

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CT SCAN OF INTRAOCULAR
FOREIGN BODY

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MEDICAL TREATMENT

 Prophylactic antibiotics or ointment.

• Erythromicin, Fucithalmic, Polymixin/sulfacetamide
administered 2-3 hour a day for the drops and 4-6
hours for the ointments.

 Pressure patching over 24 hours.

 Polymixin/trimethoprim is more judicious to
cover fungi if foreign body is wood.

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MEDICAL MANAGEMENT
 After evaluation, a protective hard eye patch
should be placed to prevent further injury. (Al-
Thowaibi, Kumar & Al-Matani, 2011).

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SURGICAL MANAGEMENT
The primary aim is to maintain the anatomical
integrity of the eye ball as soon as possible.
 This is achieved by removing the intraocular
foreign body (IOFB)
• Vitrectomy Surgery
• Intraocular foreign body by a magnet or forceps

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SURGICAL MANAGEMENT

 Preoperative Treatment:
• Prophylactic antibiotics to prevent
endophthalmitis.
• Systemic and Topical
• Erythromicin, Fucithalmic,
Polymixin/sulfacetamide
administered 2-3 hour a day for the drops and 4-6
hours for the ointments.
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SURGICAL MANAGEMENT
• Prophylactically Tetanus booster for any foreign body
injury/ ruptured globe because of the risk of
endophthalmitis .
• Review investigation prior to surgery
• Patient informed of guarded prognoses of surgery
and complications.
• Surgical informed consent obtained.
• Referral to anaesthesiologist and informed consent
obtained.
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SURGICAL MANAGEMENT
 Intraoperatively
• Remove foreign body
• Restore normal anatomical relationships of
the globe (reclosing the eye).
• Obtain intravitreal specimen for culture
• Intravitreal antibiotics.
• Endophthalmitis prophylaxis, intravitreal
vancomycin (1.0 mg/0.1 ml) and ceftazidime (2.25
mg/0.1 ml)
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SURGICAL MANAGEMENT
Once there is no retained IOFB
 Primary repair of the eye
• Restore normal anatomical relationships of
the globe
• Suturing the laceration or tear
• Watertight closure is formed
• Reassess for further management
(Al-Thowaibi, Kumar & Al-Matani, 2011)
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SURGICAL MANAGEMENT
 Postoperative Treatment:
• Topical antibiotic eye drops
• Daily follow-up assessment
• Review of other surgical interventions and
referrals to relevant surgical speciality eg
corneal specialist.

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NURSING INTERVENTIONS
 The nurse is the first interaction with the
client on arrival to the clinical area.
 Obtain client’s history
• Onset of irritation
• Events prior to discomfort
• Symptoms experienced
• Other medical conditions

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NURSING INTERVENTIONS
 Client’s perceived cause of irritation (eg
chemical or foreign body went into the eye)
 Assess the client’s visual acuity (if possible
always assess the unaffected eye first)
 Maintain hygiene measures.
 Try to make the client as comfortable as
possible.

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NURSING INTERVENTIONS
 Inpatient Care.
• Prepare client for surgery (Routine pre-op care)
• Receive patient from surgery
• Administer care as prescribed.
• Conduct first post-op dressing.
• Administer hourly antibiotic eye drops as
prescribed with tapering.
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NURSING INTERVENTIONS
 Inpatient Care.
• Eye hygiene as needed
• Assess eye and report any changes
• Orient client to their clinical environment.
• Assist client and physician with ocular
assessment.
• Conduct patient teaching as for outpatient
care

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DISCHARGE PLANNING
 Discharge planning begins with your first
contact with the client.
 Client can be managed as an outpatient
 Admission may be warranted:
• with a severe case of infection/injury,
• is unable to administer care due to other
contributing factors.

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DISCHARGE PLANNING

 Client education is the main emphases in

your discharge planning.
• Focused on reducing further irritation,
• Exacerbation of the condition, and
• Infection of the eye.

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DISCHARGE PLANNING
Client Teaching-
 Eye hygiene:
• Hand washing before and after cleaning the eye,
• Using warm water in a designated clean bowl, and
• Using a clean cotton swabs for every wipe
• Not to rub the eye

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DISCHARGE PLANNING
 Treatment and importance of treatment.
 Instillation of drops and care of your dropper.
 Indicators for when to seek medical care.
 Importance of maintaining follow-up
appointments.

 Recognising signs and symptoms of infection.

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DISCHARGE PLANNING
Client is advised to:
 Wear sunglasses to help relieve pain from light
sensitivity.
 Not to wear contact lens or wear make-up until
the abrasion is fully healed and there are no
signs of infection.
 Not hesitate to call your doctor if there are any
concerns. (Nursing2013)

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