Overview
Introduction: the Injury Where Doing Less Is Doing More
Most nursing emergencies reward decisive hands on intervention.
Most nursing emergencies reward decisive hands-on intervention. Open-globe injury rewards the opposite. Once you suspect that the wall of the eye has been breached, almost every instinctive action — pressing to stop bleeding, patching, instilling drops, checking the pressure, removing the object — becomes capable of causing irreversible harm. The globe is a closed, pressurized sphere. Its contents are held in place only by an intact wall. If that wall is open, any external pressure can extrude the intraocular contents — vitreous, uvea, retina — through the wound. That extrusion is not recoverable. A nurse who applies a pressure dressing to a bleeding eye with an occult rupture can convert a repairable injury into a blind eye in seconds. So the discipline of this lesson is restraint plus urgency. You protect the eye from any pressure, you stabilize the patient systemically, you prepare them for surgery, and you get ophthalmology involved immediately. What you deliberately do *not* do is as clinically important as what you do. The second theme is suspicion. Open-globe injury is not always obvious. A small self-sealing...