A nurse is caring for a client who sustained a blunt eye injury. Which nursing intervention should be the priority?

The priority is to apply a protective eye shield without pressure to prevent further injury to eye structures. Other interventions like warm compresses, antibiotic drops, or rubbing could worsen the condition.

Understanding the Priority in Blunt Eye Injury

The scenario describes a blunt eye injury from a baseball, which carries a risk of serious complications, including open-globe injury (OGI)—a full-thickness violation of the eye wall—and orbital compartment syndrome (OCS). In the initial emergency setting, the immediate priority is to protect the eye from further harm while avoiding any intervention that could worsen an undiagnosed rupture or increase intraocular pressure. ^[1][4]

Analysis of the Options

1. Apply warm compresses to reduce swelling: This is contraindicated. In the context of trauma, applying warmth can promote vasodilation and increase bleeding. More critically, any direct manipulation or pressure on the globe could cause extrusion of intraocular contents if an occult open-globe injury is present. ^[1][4]

2. Instill antibiotic eye drops immediately: While infection prophylaxis is a key component of ocular trauma management, it is not the first priority. Instilling any substance into an eye with a potential rupture is dangerous and should only be done after a thorough examination has ruled out an open-globe injury. ^[2][4]

3. Encourage the client to rub the eye gently to assess pain level: This is absolutely contraindicated. Rubbing the eye applies direct pressure to the globe, which can significantly worsen a corneal laceration, prolapse intraocular contents through a scleral rupture, or exacerbate a retrobulbar hemorrhage, potentially precipitating OCS. ^[1][4]

4. Apply a protective eye shield without applying pressure: This is the correct priority intervention. A rigid shield protects the injured eye from accidental contact, rubbing, or further blunt force while avoiding any pressure on the globe itself. Pressure could extrude intraocular contents through an undetected rupture. This action follows the core principle of stabilizing the injury and preventing iatrogenic harm before a definitive ophthalmologic evaluation. ^[1][2][4]

The Underlying Pathophysiology and Risks

A blunt injury from a baseball creates a sudden, dramatic increase in intraocular pressure, which can lead to a ruptured globe at the weakest points of the sclera. Simultaneously, trauma can cause a retrobulbar hemorrhage, where bleeding accumulates in the confined space behind the eye. This is a primary cause of orbital compartment syndrome (OCS), a vision-threatening emergency where rising pressure within the orbit compromises the optic nerve and retinal blood flow. OCS requires rapid identification and immediate treatment, such as a lateral canthotomy and inferior cantholysis, to preserve vision. ^[1] The initial nursing priority is to prevent any action that could tip a contained injury into a catastrophic one, which is why a non-pressure shield is the only safe and immediate intervention before a specialist examination. ^[1][2][4]