Corneal foreign body is foreign material on or in the

cornea, usually metal, glass, or organic material.

Foreign bodies refer to any objects that are in the eye that
are not meant to be there. The foreign object may be in the
conjunctiva (a thin membrane that covers the actual eye) or in the
cornea (the clear, dome-shaped surface that covers the front of the
eye).
Foreign body related abrasions are defects in the corneal epithelium
that are left behind after the removal or spontaneous dislodging of a
corneal foreign body. Foreign body abrasions are typically caused by
pieces of rust, wood, glass, plastic, fiberglass, or vegetable material
that have become embedded in the cornea. Trauma accounted for 66
percent of these or 4 percent of all cases; corneal abrasions or corneal
or conjunctival foreign bodies accounted for 80 percent of the eye
trauma cases or 3 percent of all cases. A sampling of diagnoses in
family and general clinicians', internists', and pediatricians' offices in
the United States in 1985 found that eye complaints constitute 2
percent of all patient visits; traumatic conditions and foreign bodies
were the reason for 8 percent of these visits.
Tiny particles that strike the eye at moderate speed often become embedded
within the corneal surface. The patient reports a feeling of gravel or sand in
the eye—appropriately called the "foreign body sensation."
Tiny foreign bodies may be hard to spot without magnification provided by
loupes or biomicroscope.
A foreign object can lodge itself onto the cornea and cause significant
symptoms of pain, tearing, light sensitivity, and blurred vision. Except in cases of
obvious trauma where debris strikes the eyes, the most common corneal foreign body
is a rusted metallic particle. Small shards of metal seem to have an almost magnetic
attraction to the corneal surface, where they rapidly rust and become embedded. The
use of safety goggles with any type of drilling, hammering, etc. can be preventative.
As the rusted particle sits on the cornea, the eye becomes progressively
more irritated over a period of days with redness, pain, light sensitivity, and tearing.
Often the particle is visible on the eye, but it may be nearly microscopic. The
ophthalmologist has the equipment necessary in the office to remove these foreign
bodies. Usually a scar remains, and there is risk of infection.
Foreign bodies are one of the most frequent causes of visits for ophthalmic
emergencies. Sometimes, the foreign body may not be present at the time of
examination, having left the residual corneal abrasion with resultant pain.
Superficial corneal foreign bodies are much more common than deeply embedded
corneal foreign bodies. The possibility of an intraocular foreign body must always be
considered when a patient presents with a history of trauma.
In major league baseball, 33% of all eye injuries are corneal abrasions; in the National
Basketball Association, corneal abrasions account for 12% of all eye traumas.
 The incidence rate of ambulatory visits (983 per 100 000 person-years)
for eye injuries was 58 times higher than the incidence rate of hospitalizations
(17 per 100 000 person-years) for eye injuries. Orbital floor fractures, contusions,
and open wounds to the ocular adnexa and orbit accounted for 85% of eye
injuries resulting in hospitalization, while 80% of ambulatory visits were for
superficial wounds and foreign bodies. Hospitalization rates varied widely
across demographic subgroups. Men had twice the incidence rate as women,
and the youngest age group (17-24 years) had 6 times the incidence rate of the
oldest age group (35-65 years). Together, motor vehicle crashes and fights
caused nearly half of the hospitalizations. Ambulatory rates varied significantly
in relation to occupation but not to demography. Tradespeople (eg, metal body
machinist, welder, and metalworker) had incidence rates 3 to 4 times higher
than the overall population rate.
This case study I’ve chosen is somewhat different even
though it’s a minor injuries because I can get idea or knowledge about
eye injuries that would be helpful especially on how to take care on
our eyes. A simple injury but with a knowledgeable source.
General objectives:

In this case study we will be able to gain, obtain and

broaden our knowledge skills and attitude and to fully understand
the nature of the given complaint.

Specific objectives:

•To identify and fully understand what is corneal foreign body.

•To know the objectives of this case study.

•To be familiarize with patient’s profile.

•To know further the client’s status through Clinical Appraisal.

•To assess the physical condition of the patient.

•To identify and analyze the laboratory exams.

•To review the anatomy and physiology and of the given disease.

•To identify the prognosis of the patient.

Name: Child H
Age: 1 year and 6 months
Sex: Female
Date of Birth: May 28, 2007
Civil Status: Child
Address: Balagtas, Batangas
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: December 06, 2008
Physician: Dr. Hernandez
Chief complaint: Red eye
Admitting Diagnosis: Corneal foreign body OS
Final Diagnosis: Corneal foreign body OS
A. Past Health History
Child H had received all the vaccines needed for her
immunization. She had no record of any allergies with food,
animals and insect bites. Child H has no illnesses until one
time she accidentally fall and irritate her eye because of the
presence of foreign body in her left eye. This is her first time to
be confined in the hospital.
B. Family History
Child H has a thirteen year old sister and a ten year old
brother. According to Child H’s mother no one in the family
has history of any disease. Aging is usually the cause of death
in the family. Furthermore, they have no record of mental
disorder.
C. Personal History
According to Child H’s mother, she starts offering food
since Child H reaches 6 months. Child H is breastfed but when
she reaches 1 year of age her mother decided to substitute it
with formula milk. Child H is fond of playing with her brother
and sister.
D. Social History
According to Child H’s mother , she is just a housewife, a
high school graduate while her husband is working in Saudi Arabia
also a high school graduate . She confess that her husband’s earnings
is not enough for her three kids. In spite of financial problem they
maintain a good relationship with each other. About the home safety
she told me that it was a well environment, what happened to her
child was an accident because of her negligence.
E. Psychological History
Financial problem is their major stressor, according to her
when problem comes she is very determined to solve it even if
sometimes she lost her hope. Her usual coping pattern is to borrow
money to her relatives. As I talked to her, I observed that she is
accommodating.
F. History of Present Illness
It was December 06, 2008 at around 1:10 pm when Child
H accidentally fell in the swing and irritate her eye because of the
presence of foreign body in her left eye. The attending physician
diagnosed it as Corneal Foreign Body.
Area assessed Method Findings Analysis
Skin Inspection Light brown Normal
Palpation No edema Normal
Moisture in skin folds Normal
Back to previous state when Normal
pinched
No lesion Normal
Hair and Scalp Inspection Black hair Normal
Palpation Evenly distributed hair Normal
No infection or infestation Normal
Absence of seborrhea Normal
Nails Inspection Convex curvature Normal
Palpation Returned to previous state when Normal
pinched
Ungroomed nails Abnormal. Poor
hygiene
Head Inspection Rounded Normal
Palpation Symmetric facial movement Normal
Absence of nodule/masses Normal
Eyes Inspection Red eye Abnormal. presence of
foreign body in the left
eye that causes eye
irritation.
Area assessed Method Findings Analysis
• Eyebrows Inspection Equal in size Normal
Hair evenly Normal
distributed
Symmetrically Normal
aligned
•Eyelashes Equally distributed Normal
•Eyelids Lids close Normal
symmetrically
Ears Inspection Color same as facial Normal
Palpation skin
Mobile and firm Normal
No tenderness Normal
With discharge Abnormal. Poor
hygiene. Excessive
cerumen may obstruct
the canal.
Nose Inspection Same as body color Normal
Palpation Symmetrically Normal
aligned
Not tender Normal
With discharges Abnormal. Indicate
colds
Mouth Inspection
Palpation
•Lips
•Teeth Whitish Normal
•Tongue Central position Normal
No tenderness Normal
Area assessed Method Findings Analysis

Neck Inspection Coordinated Normal

Palpation movement
No lymph nodes Normal
Thyroid gland Palpation No enlargement of Normal
thyroid gland
Chest and Lungs Auscultation RR=38 breaths/min. Normal
(normal 20-40)
Crackles noted Abnormal. Indicates
presence of secretions
causing failure of lungs
to expand.
Heart Auscultation 124 beats/min. Normal
(normal 80-140)
Diastole and systole Normal
heard
Breast Inspection Skin uniform in color Normal
Palpation Equal in size Normal
No tenderness Normal
Abdomen Inspection Symmetrical contour Normal
Palpation Active bowel sounds Normal
less than 7 seconds
No tenderness Normal
Same as color skin Normal
Upper extremities Inspection
Palpation
•hand Strong grip Normal
Area assessed Method Findings Analysis

•Pulse Distal pulses are Normal

palpable

Lower extremities Inspection No edema Normal

Palpation
Summary
General Survey
•General Appearance: With good body movement .
•Body and Breath odor: Foul mouth odor noted. Abnormal it indicates
poor hygiene.

Psychological Presence
•Dress grooming and personal hygiene: Does not have proper hygiene.
•Mood, manner and speech: Not cooperative and unable to speak
because the patient is still a young toddler.

Vital Signs
• Temperature: 36.6°C

(Normal=37°C)

• Cardiac Rate: 124 beats/min.

(Normal=80-140 beats/min.)

• Respiratory Rate: 38breaths/min.

(Normal=20-40 breaths/min.)

• Weight : 10 kilograms
Summary
The method used in assessing the patient are inspection
auscultation, percussion and palpation. As I assessed the patient’s condition
I’ve noticed some abnormalities.
Upon inspecting and palpating the patient’s skin I’ve noticed that
there is no edema, skin back to previous state when pinched and the color of
the skin is light brown, no presence of lesion. There is red eye due to Corneal
foreign body in her left eye. Assessment for hair, scalp head are normal. The
ears have discharges as well as the nose which indicate as an improper
hygiene. Crackles heard as I auscultate the patient’s chest which indicate
presence of secretions causing failure of lungs to expand, but her respiratory
rate is within normal range 38 breaths/min. as well as the heart beats with 124
beats/min. Also within the normal range. Upper and lower extremities has a
normal findings.
Tests Result Normal Values Analysis
WBC 11.77 5000-1000 X 10 9/L Abnormal. Elevated
WBC counts indicate
bacterial infection.
Monocytes 0.010 0.1-0.5 X 10 9/L Normal

Lympocytes .691 1.5-4.0 X 10 9/L Lymphocytosis

Basophils 0.010 0.02-0.05 X 10 9/L Basophilia

Eosinophils 0.14 0-0.7 X 10 9/L Eosinophilia

Platelet 371 150-400 X 10 9/L Normal

Tests Result Normal Values Analysis
Color Light yellow Light yellow amber Normal

Characteristics Slightly turbid Presence of pus,

bacterial cell
Specific Gravity 1.015 1.015-1.025 Normal

Reaction 6.0 Normal(4.5 - 8) Normal

Albumin Negative Negative Normal

Sugar Negative Negative Normal

Pus cell 0-2/HPF (0-4 HPF) Normal

RB 0-2/HPF (0-4 HPF) Normal

Amorphous sulfate Highly acidic
Summary
Hematology III:
According to her, her elevated WBC is abnormal which indicates bacterial
infection. As I analyse, her lymphocytes, basophils and eosinophils are
below the normal range and that is abnormal. Monocytes and Platelet are
normal

Urinalysis:

For her Urinalysis I found out that her urines have some abnormalities
like the presence of pus or bacterial cell and her amorphous sulfate is
highly acidic.
 The front portion of the eye is covered with a thin,
transparent membrane called the cornea, which protects the interior
of the eye.
The cornea is composed of five layers: epithelium,
Bowman's layer, stroma, Descemet's membrane, and endothelium.
The epithelium is five or six cell layers thick and richly supplied with
free nerve endings only, since specialized receptors would
compromise corneal clarity. Bowman's layer is a collagenous layer 8
to 10 μg thick to which the basal epithelial cells adhere via
hemidesmosomes. The stroma constitutes about 90% of the total
corneal thickness. It consists almost entirely of an extracellular
matrix of collagen (and other glycoproteins), interspersed with
fibroblasts and keratocytes. The regularity and organization of the
collagen fibril orientation are responsible for corneal clarity. The
cornea becomes cloudy when edema or new collagen synthesis alters
the spacing of these fibrils. The endothelium is a monolayer of
hexagonal cells rich in cytoplasmic organelles, especially
mitochondria. These cells actively pump fluid across an osmotic
gradient from the corneal stroma to the aqueous cavity and thus are
responsible primarily for maintenance of corneal clarity. These cells
do not replicate and therefore steadily decrease in number with
advancing age or disease.
Cellular mediators of infection must migrate in from adjacent limbal vessels unless
the cornea has been vascularized by an earlier process. Corneal physiology is best
summarized by the renowned corneal specialist Dr. Herbert E. Kaufman: “The
cornea breathes air and eats aqueous.”

Anterior chamber - the front section of the eye's interior where aqueous humor
flows in and out of providing nourishment to the eye and surrounding tissues.
Aqueous humor - the clear watery fluid in the front of the eyeball.
Blood vessels - tubes (arteries and veins) that carry blood to and from the eye.
Caruncle - a small, red portion of the corner of the eye that contains modified
sebaceous and sweat glands.
Choroids - the thin, blood-rich membrane that lies between the retina and the sclera;
responsible for supplying blood to the retina.
Ciliary's body - the part of the eye that produces aqueous humor.
cornea - the clear, dome-shaped surface that covers the front of the eye.
Iris - the colored part of the eye. The iris is partly responsible for regulating the
amount of light permitted to enter the eye.
Lens (also called crystalline lens) - the transparent structure inside the eye that
focuses light rays onto the retina.
Lower eyelid - lower, inferior, skin that covers the front of the eyeball when closed.
Macula - the focusing portion of the eye that allows us to see fine details clearly.
Optic nerve - a bundle of nerve fibers that connect the retina with the brain. The
optic nerve carries signals of light, dark, and colors to the area of the brain (the visual
cortex), which assembles the signals into images (i.e., our vision).
Posterior chamber - the back part of the eye's interior.
Pupil - the opening in the middle of the iris through which light passes to the
back of the eye.
Retina - the light-sensitive nerve layer that lines the back of the eye. The retina
senses light and creates impulses that are sent through the optic nerve to the
brain.
Sclera - the white visible portion of the eyeball. The muscles that move the eyeball
are attached to the sclera.
Suspensory ligament of lens - a series of fibers that connect the ciliary body of the
eye with the lens, holding it in place.
Upper eyelid - top, movable, superior fold of skin that covers the front of the
eyeball when closed, including the cornea.
Vitreous body - a clear, jelly-like substance that fills the back part of the eye.
 Modifiable Factor Non Modifiable Factor

Environment Age

Small Particles Lodge in Cornea

Inflammatory Cascade

Dilatation of Subsequent edema of lids

surrounding vessels , conjunctiva cornea

Red Eye

Corneal Foreign Body OS

 Corneal foreign bodies generally fall under the category of
minor ocular trauma. Small particles may become lodged in the
corneal epithelium or stroma, particularly when projected toward
the eye with considerable force.
The foreign object may set off an inflammatory cascade,
resulting in dilation of the surrounding vessels and subsequent
edema of the lids, conjunctiva, and cornea. White blood cells also
may be liberated, resulting in an anterior chamber reaction and/or
corneal infiltration. If not removed, a foreign body can cause
infection and/or tissue necrosis.
Assessment Nursing Scientific Planning Intervention Rationale Evaluation
Diagnosis Explanation
Subjective: Parental Feeling of After 1° of •Ascertain •To identify After 1° of
“Hindi ko Role guilt due to nsg.interve parent’s misconcepti nsg.interve
siya Conflict accident or ntion the understand ons/strengt ntion the
nabantayan related to negligence mother will ing of hs. mother had
dahil feelings of is normal demonstrat child’s demonstrat
umalis ako guilt about feelings of a e developme ed
at nagsisisi accident. parent confidence ntal stage confidence
ako.” because not in her and in her
all times ability to expectation ability to
even the care for her s for the care for her
Objective: watchful child. future. child.
•Confused eye parents •Promoted •Enhances
•Feeling of can make parental sense of
guilt child safe if involvemen control.
accident t in
occur no decision
one should making &
be blame. care as
much as
possible.
•Promoted •To help
use of individuals
assertivene to deal
ss with
relaxation situation/
skills. crisis.
•Assisted •To know
parent to the proper
learn treatments
proper for her
administrat child’s
ion of early
medication recovery.
as
indicated.
•Discusse •Dealing
d with
attachmen child/
t home care
behaviour pressures
s such as can strain
co- the bond
sleeping, between
feeding parent
child and and child.
baby
wearing.
•Parent •To help
may need them re-
counsellin establish
g to their
understan feelings of
d that worth as
accident parents.
can
happen
under the
most
watchful
care.
Assessment Nursing Scientific Planning Intervention Rationale Evaluation
Diagnosis Explanation
Subjective: Inability to Environme After 1° of •Discussed •To After 1° of
“Napuwin maintain a nt is nsg. home determine nsg.
g ang mata safe, modifiable Interventio environme ability to Interventio
niya kaya growth- factor n the nt as care for self n the
sya nadala promoting which can mother appropriat and to mother
dito dahil environme be a source will e. identify had
hindi nt. of cause of verbalize potential verbalized
nabantaya injuries or understand health and understand
n ng ayos.” accident. ing of safety ing of
individual hazards. individual
Objective: risk factors risk factors
•Injury at that •Ascertain •To that
left eye contribute knowledge prevent contribute
•Hyperacti to of safety injury in to
ve patient possibility needs or home and possibility
of injury. injury promote of injury.
prevention safe
and physical
motivation. environme
nt and
individual
safety.
•Discussed •To guide
the need and
for and supervise
sources of the
supervision children
.
Assessment Nursing Scientific Planning Intervention Rationale Evaluation
Diagnosis Explanation

Subjective: Alteration An After 1° of •Monitored •Frequent After 1° of

“Nakita ko in comfort physical nursing vital signs assessment nursing
na mapula with red state interventio of vital interventio
na ang eye related characteriz n the signs n the
mata ng to presence ed by client’s provide client’s
anak ko.” of foreign feeling of level of informatio level of
body in left discomfort, discomfort n about discomfort
eye. restlessness will be any had been
Objective: . lessen. improveme lessened.
•Red eye nt or
•Ambulato deterioratio
ry n in the
•hyperactiv child’s
e condition.
•Provided •To
comfort promote
measures, non
calm pharmacol
activities. ogical
manageme
nt
•Suggested •To
parent be comfort
present child.
during
procedure .
•Encourage •To
adequate prevent
rest period fatigue.
Name of Classificatio Indication Contraindi Adverse Nursing Monitorin
Drug n & Action cation reaction Responsib g
ility Responsib
ility
Chloramphe •Anti- Meningitis • Contra- CNS: •Obtain •May
nicol infectives bacteremia indicated in confusio n, specimen for decrease
•Inhibits or other patient’s delirium, culture & hgb level
Chloromycet bacterial severe hypersensiti headache, sensitivity •May
in sodium protein infections. ve to drug. mild tests before decrease
succinate synthesis by • Use depression giving first granulocyte
binding to the cautiously in EENT: dose. & platelet
5os subunit of those taking decreased •Obtain drug count.
the ribosome; other drugs visual acuity level •May falsely
bacteriostatic that cause optic neuritis measuremen elevate urine
bone inn patients t PABA levels
marrow with cystic •Monitor if given
suppression fibrosis. patient for during a
or blood signs and bentiromide
disorder. symptoms. test for
pancreatic
function.
Name of Drug Classification Indication Contraindicati Adverse Nursing Monitoring
& Action on reaction Responsibility Responsibility

Penicillin G •Anti- Moderate to •Contraindic CNS: seizure •Before •May

infectives severe ated for anxiety giving drug decrease hgb
•Inhibits cell infection. patients confusion. ask pt. about level.
wall hypersensiti CV: allergic •May
synthesis. ve to drug/ thrombophle reaction to increase
penicillin. bitis. penicillin. eosinophil
•Use GI: nausea, •Obtain count.
cautiously in vomiting. specimen for •May
patients with GU: culture and decrease
other drugs nephropathy sensitivity platelet
allergies Hematologic tests before count, WBC,
especially to : anemia giving firsts granulocyte.
cephalospori eosinophilia dose. •May cause
ns because leukopenia. • observe false-
possible patient positive CSF
cross- closely. protein test
sensitivity. result.
Name of Drug Classification Indication Contraindicati Adverse Nursing Monitoring
& Action on reaction Responsibility Responsibility

Tetanus •Immunodila •Primary •Contraindic CNS: slight •Obtain None

Toxoid tors immunizatio ated in those fever, history of reported.
•Promotes n to prevent with headache, allergies and
immunity to tetanus. immunoglob malaise. reaction to
tetanus by •Booster ulin CV: immunizatio
inducting dose to abnormalitie tachycardia, n.
antitoxin prevent s. hypotension. •Determine
production. tetanus. • Also in pt. Musculoskel date of last
with etal: aches, tetanus
thrombocyto pains. immunizatio
penia/ other Skin: n.
coagulation erythema,
disorders nodule at
that could injection site,
contraindicat urticaria.
e IM
injection
unless
benefit
outweigh
risk.
 Child H who had been diagnosed with Corneal Foreign
Body had a good prognosis. The patient undergone operation for
removal of foreign body under IV sedation that only take for two
minutes. The patient manifest early signs of healing and her mother
is now assisted for home care treatment for preparedness for
discharge.
M Advised the patient’s mother to continue medication as prescribed.
 Fusidic acid eye drop 2x a day for 7 days

E Advised the mother about the patient’s safety while playing or on activity.

T Demonstrated on how to perform postural drainage and back tapping.

H Bathe the baby with luke warm water , the clothes regularly clean and
cut the nails of the baby.

O Informed the patient’s mother to have a follow up check up.

D Advised the mother to increase the patient’s fluid intake.

S Emphasized to them the importance of always praying to God and making

God the center of their lives.
 This case study wont be possible without the persons who
share their time knowledge and support in the process of doing this.
To Mrs. Cecilia Pring, Dean of the college of Nursing, for
her great management and vision with every nursing student.
To Ms. Aimee Amponin, Level III Coordinator, for her
advises that help a lot for everyone of us.
To Mrs. Anabelle M. Ituralde, our Clinical Instructor for
her great guidance and supervision with every procedures and
interventions we’ve done. For sharing and imparting learnings that
serve as an additional knowledge to us.
To our Parents for their trust, for their courage that we can
do everything, for the full support especially the financial support
and definitely for their unconditional love.
Above all to Almighty God who always send his spirit to
guide us every seconds of our life.
Thanks may not be enough to say my gratitude but it is
the simplest way to give thanks with all the help and support you
give.
So again THANK YOU!.
Delmar’s Pediatric Nursing Care Plan, 3rd edition, Luxner

Delmar’s Manual of Laboratory and Diagnostic Test, Rick Daniels

Health Assessment in Nursing 3rd edition. Janet Weber & Jane Kelly

Maternal and Child Health Nursing. Pilliteri, Adele; Volume

2.Lipincott

Nurses Pocket Guide. 11 edition. Doenges, Marilyn; F.A Davis

Company.Philadelphia

Nursing 2008 Drug Handbook. 28th edition. Lippincott

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