# A nurse is assessing a 25-year-old male who sustained an eye contusion from a baseball injury 2 hours ago. He reports severe pain and blurred vision. Which assessment finding would be most concerning and require immediate intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541596  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 25-year-old male who sustained an eye contusion from a baseball injury 2 hours ago. He reports severe pain and blurred vision. Which assessment finding would be most concerning and require immediate intervention?

A 25-year-old male presents to the emergency department after being struck in the left eye by a baseball during a game. He reports severe pain and blurred vision.

## 보기

1. Mild periorbital swelling and bruising around the affected eye
2. Sudden onset of severe eye pain with nausea and vomiting **✔ 정답**
3. Slight decrease in visual acuity compared to the unaffected eye
4. Small subconjunctival hemorrhage visible on the sclera

**정답: 2**

## 해설

Sudden severe eye pain with nausea/vomiting indicates increased intraocular pressure requiring immediate intervention to prevent vision loss. Other findings like swelling or subconjunctival hemorrhage are less urgent.

## 심화 해설

Understanding the Clinical Scenario

The patient is a 25-year-old male who sustained a blunt eye injury from a baseball. He presents with severe pain and blurred vision. The critical task is to differentiate between expected post-traumatic findings and those signaling a sight-threatening emergency requiring immediate intervention. Blunt trauma can cause a spectrum of injuries, from superficial contusions to closed-globe injuries like traumatic glaucoma or open-globe rupture [1].

Analysis of the Correct Answer (Option 2)

The most concerning finding is sudden onset of severe eye pain with nausea and vomiting. This cluster of symptoms is a classic presentation of an acute and significant elevation in intraocular pressure (IOP). Blunt trauma can trigger a rapid IOP spike through several mechanisms, including intraocular hemorrhage (hyphema) or inflammation blocking the trabecular meshwork, which is the eye's drainage system [2]. The vagal response to this intense, rapid pressure increase stimulates the nausea and vomiting center in the brain. This condition, a form of traumatic glaucoma, is a true ophthalmic emergency. Without prompt intervention to lower the pressure, it can cause irreversible glaucomatous damage to the optic nerve and permanent vision loss [2]. This finding takes absolute priority over other less specific signs of trauma.

Analysis of Incorrect Options

Option 1: Mild periorbital swelling and bruising around the affected eye.

This is an expected and common finding after blunt trauma, often referred to as a "black eye." It results from soft tissue injury and capillary rupture. While it requires monitoring and symptomatic care like cold compresses, it is not an immediate threat to vision or a sign of a deeper ocular emergency [1].

Option 3: Slight decrease in visual acuity compared to the unaffected eye.

A slight decrease in visual acuity is a very common and anticipated consequence of a blunt eye contusion. It can be caused by mild corneal edema, traumatic iritis, or small amounts of debris in the tear film. While it necessitates a thorough ophthalmologic examination, a slight change does not carry the same emergent weight as symptoms indicating a dangerously high IOP [1].

Option 4: Small subconjunctival hemorrhage visible on the sclera.

A subconjunctival hemorrhage is a collection of blood between the conjunctiva and the sclera. Although it can look dramatic, it is generally a benign, self-limiting condition resulting from the rupture of small superficial blood vessels from the blunt force. It does not affect vision and resolves on its own without treatment, making it the least concerning finding in this clinical presentation [1].

Clinical Priority and Underlying Mechanism

The nurse's priority is to recognize the clinical triad of severe eye pain, blurred vision, and nausea/vomiting as a red flag for acute IOP elevation. The mechanism of injury—a high-velocity blunt impact from a baseball—provides sufficient force to cause internal damage such as a hyphema (blood in the anterior chamber) or lens dislocation, both of which can physically obstruct aqueous humor outflow [1][2]. The resulting pressure buildup directly compromises retinal and optic nerve perfusion. A case report on blunt trauma-induced hyphema highlights that active bleeding can elevate IOP, risking vision loss and requiring urgent, sometimes systemic, intervention to control . While a vitreous hemorrhage from blunt trauma can also cause visual disturbance, it typically does not present with the acute, severe pain and nausea characteristic of a rapid pressure spike . Therefore, the assessment finding in option 2 demands the most immediate reporting and intervention to prevent permanent visual impairment [2].References (research sources)

- [1]Blunt Eye TraumaResearch articleMohseni M, Gurnani B, Blair K. (2026)

- [2]Traumatic GlaucomaResearch articleNg JK, Kaur K. (2026)

## 임상 시나리오

Traumatic Glaucoma RecognitionPrioritizing the Sight-Threatening Emergency
The most critical assessment after blunt eye trauma is differentiating benign findings from a traumatic glaucoma emergency. The classic triad is sudden severe eye pain, blurred vision, and nausea/vomiting.

This symptom cluster indicates an acute spike in intraocular pressure (IOP), often above 40 mmHg. The nausea is a vagal response to the rapid pressure increase. Untreated, this can cause irreversible optic nerve damage in hours.

CautionDo not be distracted by obvious but benign findings like periorbital swelling or subconjunctival hemorrhage. A complaint of nausea with eye pain after trauma is a red flag for acute IOP elevation and requires immediate ophthalmology referral.

## 핵심 개념

- **Traumatic Hyphema** — Blood in the anterior chamber of the eye caused by blunt trauma tearing vessels of the iris or ciliary body, which can obstruct aqueous outflow and elevate IOP.
- **Intraocular Pressure (IOP)** — The fluid pressure inside the eye; acute elevation can damage the optic nerve and cause permanent vision loss if not promptly lowered.
- **Trabecular Meshwork** — The primary drainage system for aqueous humor located at the angle of the anterior chamber; blockage by blood cells leads to secondary glaucoma.
- **Oculocardiac Reflex** — A trigeminal-vagal reflex triggered by pressure on the globe or traction on extraocular muscles, resulting in bradycardia, nausea, and vomiting.
- **Corneal Blood Staining** — A complication of prolonged hyphema and high IOP where hemoglobin infiltrates the corneal stroma, causing permanent brownish opacification and vision loss.

## 같은 주제 문제

- [A nurse is assessing a patient who sustained a blunt trauma to the left eye 2 hours ago. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=541597)
- [A nurse is assessing a patient who sustained a blunt trauma to the left eye during a sport…](https://mymerci.kr/pages/nclex_q.php?qn_id=541598)
- [A nurse is caring for a client who sustained a blunt trauma to the eye resulting in an eye…](https://mymerci.kr/pages/nclex_q.php?qn_id=541599)
- [A nurse is caring for a client who sustained a blunt trauma to the left eye resulting in p…](https://mymerci.kr/pages/nclex_q.php?qn_id=541600)
- [A nurse is caring for a client who sustained a blunt trauma to the right eye resulting in …](https://mymerci.kr/pages/nclex_q.php?qn_id=541601)
- [A nurse is caring for a client who sustained a blunt eye injury. Which nursing interventio…](https://mymerci.kr/pages/nclex_q.php?qn_id=541602)
- [A nurse is caring for a client who sustained a blunt eye contusion. Which assessment findi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541603)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._