11.4 Eye Injury, Removal of Foreign Body

Question 1

RTA

Answer 1

Road traffic accidents

Question 2

VA test

Answer 2

Visual acuity test

Question 3

Charts and documentation for VA
Normal VA

Answer 3

Snellen chart (20feet/6m)
Random E chart (10feet/3m)

CC= with glasses on
SC= without glasses
PH= use of pinhole

20/20
Testing Distance/ normal vision distance

Question 4

Fail reading chart;
CF
HM
LP
NLP

Answer 4

Count finger
Hand motions
Light perception
No light perception

Question 5

Retina and optic nerve assessment

Answer 5

Examine Red/ fundus reflex
By ophthalmoscope

Need pupil dilation to check retina
(Medication 15-30 min before, 4-6 hours to wear off)

Question 6

rAPD

Answer 6

Relative afferent pupillary defect
Eye dilate when exposed to light

Question 7

Fluorescein stain

Answer 7

Detect FB and any damage in cornea
Use fluorescein and blue light

After complete VA test/ fundus examination

Question 8

Seidel test and sign

Answer 8

Examine presence of corneal perforation/ wound leakage

By obverse flow of fluoresin (clean stream within green fluorescein = Seidel sign)

Question 9

IOP
Normal range

Answer 9

Intraocular pressure
By tonometry
Normal IOP: ~10-31mmHg

Avoid ruptured globe

Question 10

Open globe injury type

Answer 10

Open globe rupture
(Inside out mechanism)

Open globe laceration
(Outside in mechanism)

Question 11

Significant clinical manifestations of open globe injury

Answer 11

• Obvious corneal/ sclera laceration/ Seidel test positive (leakage of aqueous humor)
• Iris abnormalities
• traumatic hyphema
• marked decrease VA
• rAPD

Question 12

IOFBs injury
First-aid

Answer 12

Intraocular foreign body injury

No removal of object
No touching
No pressure
NPO
Place a plastic shield (not patch)

Question 13

Type of close globe injury

Answer 13

Contusion (no wound)
Lamellar laceration (partial thickness)
Chemical injury

Question 14

Chemical injury
Severity factor

Answer 14

1. Agent involved (acid+tissue->eschar, barrier of further penetration; alkaline+fatty acid-> disruption of cell membrane, deep penetration)
2. duration of exposure,
3. depth of penetration

Question 15

Blepharospasm

Answer 15

Involuntary muscle contractions of eyelid

Question 16

Management of chemical injury

Answer 16

• Copious irrigation
  Cooling running water to the floor, brush powder off with dry brush,
  Remove contaminated cloth
  (Until pH reach 7)
• Check IOP (alkaline immediate raise IOP)

Antibiotic
Surgery debridement

Question 17

S/S of FB

Answer 17

Discomfort, profuse tearing
Eye redness
Involuntary blinking, blepharospasm
Pain, photophobia

Question 18

Nursing care for eye FB

Answer 18

• Do not rub eye
• Wear sun glasses
• No contact lens untill totally recover
• No drive or operate mechinery if eye is patched
• instruct if l: increase pain, discharge, redness/swelling, worsen vision