Advice re corneal ulcer

[greatshakes]

Hello ER Staff

I work as a school nurse (RN) and one of my pupils came in to have eye ointment applied. I administered the ointment and placed a new eyepad on as per Drs directions. The advice I had been given by my superior Nurse was just to discontinue any drops formerly prescribed and apply the ointment and renew the patch. This was in line with the Drs order. The pupil came back later as his boarding master was concerned about him. I stayed behind and again applied the cream and provided another patch and administered some pain killers plus more in an envelope to be handed to the boarding master and rang him to advise what I had done plus documenting it. The boy had seen the Dr earlier and is to be reviewed tomorrow. I feel now I should have provided an eyewash prior to inserting the ointment. Was there anything else I could have done to provide more comfort. I am concerned as the pupil has an ulcer on the cornea. I really think that he should be seeing an opthamologist. Have many of you experience in the eye department and can you advise any other actipons i could have taken. Eyes, like head injuries are so chancy.

[classicdame, MSN, EdD]

An ophthalmologist would be the ideal person to make a definite evaluation and possibly save his vision. The eye surgeons I used to work for did not recommend irrigation for every circumstance, due to the possibility of trauma to the cornea.

[Wave]

I agree with the previous post about not flushing. If the pt has been seen by a MD (any), hopefully the situation has been correctly assessed. What caused the ulcer in the first place? Do you know how deep? If it is superficial, more like a corneal abrasion, it could heal fairly quickly with proper treatment. This type of eye injury is very painful as the nerves are so close to the surface. Part of the issue may have been the patching. Did you use a pressure patch to keep the effected eye from moving? Sometimes simply the movement of the eye against the closed lid can be enough to cause irritation and pain. What is the ointment? Unfortunately, topical anesthetic eye drops impede the healing process. Of course, an eye Dr (either a optometrist, or ideally, a ophthalmologist) would be the best. (In some states here in the U.S. optometrists can dispense drugs.)

Wave

[greatshakes]

Thanks for posts. Pupil is having a review again tomorrow and will get referral to an opthamologist hopefully. He is on chloramphenenicol or chlorsig ointment as the other drops irritated him. he was actually knocked in eye by football.

[Wave]

I wasn't familiar with this eye gtt, so I looked it up. Here's a link for those interested (as well as a good resource on the web):

http://www.rxlist.com/cgi/generic/chloramphenicolopung.htm

Wave

[greatshakes]

Hi all

The pupil with the corneal ulcer has seen a specialist and is much improved. thank you all for your help and I'll look up your website thanks wave.