NCLEX Review Guide: Eye Contusions

Definition and Pathophysiology

• Eye contusion is blunt trauma to the eye and surrounding structures causing bruising, swelling, and potential internal damage without penetrating the globe.
• Results from direct impact causing compression and decompression forces that can damage delicate ocular structures including the retina, lens, and anterior chamber.

Clinical Manifestations

• Periorbital ecchymosis (black eye) with progressive swelling that may prevent eye opening within 24-48 hours.
• Subconjunctival hemorrhage appearing as bright red blood covering the white sclera without defined borders.
• Visual disturbances including blurred vision, diplopia, or sudden vision loss requiring immediate intervention.
• Pain ranging from mild discomfort to severe throbbing, often worsening with eye movement or light exposure.

Nursing Assessment Priorities

1. Assess visual acuity immediately using Snellen chart or finger counting if chart unavailable.
2. Evaluate extraocular movements in all six directions to detect muscle entrapment or nerve damage.
3. Inspect for hyphema (blood in anterior chamber) by looking for fluid level when patient sits upright.
4. Check pupil size, shape, and reactivity comparing affected eye to unaffected eye.
5. Palpate orbital rim gently for step-offs or crepitus indicating possible fracture.

Immediate Nursing Interventions

• Apply cold compress for 15-20 minutes every hour during first 24-48 hours to reduce swelling and pain.
• Elevate head of bed 30-45 degrees to promote venous drainage and reduce periorbital edema.
• Administer prescribed analgesics avoiding aspirin or NSAIDs that increase bleeding risk.
• Provide eye shield protection if ordered, ensuring no pressure is applied to the globe.

Serious Complications Requiring Immediate Action

• Retinal detachment presenting with sudden vision loss, flashing lights, or curtain-like visual field defects.
• Hyphema with blood settling in anterior chamber requiring strict bed rest and head elevation to prevent rebleeding.
• Increased intraocular pressure causing severe pain, nausea, vomiting, and potential permanent vision loss.
• Orbital compartment syndrome with rapidly worsening proptosis, decreased vision, and afferent pupillary defect.

Home Care Instructions

• Continue cold compresses for 48 hours, then switch to warm compresses to promote healing and circulation.
• Sleep with head elevated on 2-3 pillows to minimize swelling and promote comfort.
• Avoid activities that increase intraocular pressure including heavy lifting, straining, or bending forward.
• Return immediately for worsening vision, severe pain, nausea, vomiting, or new onset of flashing lights.

• ☐ Can identify priority assessment findings in eye contusion
• ☐ Understands when to seek immediate medical attention
• ☐ Knows appropriate initial interventions for eye trauma
• ☐ Can differentiate normal healing from complications
• ☐ Remembers key patient education points