Diagnostic Evaluation
• Thorough inspection of the eye, including eversion of the upper lid to inspect for a foreign object
• Fundoscopic examination may detect abnormalities: dislodged lens, retinal hemorrhage, retinal detachment, or papilledema with increased IOP
• Staining with fluorescein dye will reveal lesions of the cornea, such as abrasions
• Assessment of eye function, including near and far acuity, extraoccular movements, and visual field testing
Medical Management
• Most childhood injuries are not severe and will resolve spontaneously with no adverse long-term consequences
• It is important to identify and obtain prompt treatment for significant injuries
Corneal Abrasion
• If the abrasion was caused by a contact lens or foreign body, removal of the offending body is indicated
• Patching of the affected eye, usually for 24 hours, will control pain
• Antibiotic eye drops or ointment prevent infection
Blunt Trauma
• Application of cold compress may help control pain and swelling
• The head should be elevated 30 degrees to avoid increased IOP
• Surgery maybe required because of damage to underlying bones or eye structures
Perforating Injury
• Surgery is usually necessary to remove the object and reconstruct damaged tissues
• Never remove a penetrating object from the eyes
• It should be stabilized and the eye should be shielded with no pressure applied
• The other eye should be patched and the client transported by stretcher
• The head should be elevated 30˚ to avoid increased IOP, and the child should be kept on NPO in preparation for surgery
Chemical Injuries
• Gentle flushing of the affected eye with water will help remove the offending chemical
• Done from the inner aspect of the eye to the outer to prevent from contaminated water from flowing into the other eye
• Antibiotics is prescribed to prevent infection
• Further management depends on the nature and extent of the injury
Complications
• Infection
• Extensive tissue damage may result in permanent visual impairment
• Disfigurement may result from severe or extensive tissue damage
Nursing Management
Nursing Diagnosis
• Pain, acute, related to inflammation, photophobia, or trauma to the eye tissue
• Risk for injury related to impaired vision and side effects of pain medications
• Self-care deficits related to impaired vision and side effects of pain medications
Nursing Interventions
Minimizing Pain
• Apply cold compress to the affected areas to help reduce swelling and discomfort
• Keep the child’s room as dark as possible to help reduce pain for photophobic client
• Administer or teach parents to administer analgesics as prescribed
Preventing Injury
• Enforce safety measure
- • Use side rails
- • Assistance with ambulation
- • Observe closely
Maintaining Activities of Daily Living
• Provide assistance with ADLs as needed
• Teach child location of self-care items and positioning of food on tray to promote independence
• Encourage child attempt self-care, and offer praise even if unsuccessful
Family Education and Health Maintenance
• Teach indications for reevaluation by health care provider
- • Increase in swelling, tenderness, discoloration, or pain
- • Worsening visual acuity
- • Development of additional symptoms: fever, alteration in sensorium, or other indications of neurologic injury
• Provide safety education
