A child with a penetrating eye injury comes to the school clinic. Which action should the nurse implement?

• A. Apply a Fox shield to the affected eye and patch the other eye.
• B. Remove the object impaled in the eye and then apply a regular eye patch.
• C. Irrigate the affected eye copiously with a cool sterile saline solution.
• D. Place an ice bag over the eye until the healthcare provider is seen.

Answer: (A)

Protecting the eye and immobilizing it to prevent further damage is the essential first step in a penetrating ocular injury. A rigid shield like a Fox shield sits over the injured eye and avoids applying pressure to the globe, which helps prevent extrusion or worsening injury if the object is still present. Patching the other eye further reduces movement of both eyes by removing visual input that could cause the child to move or rub the injured eye.

Intervening actions such as removing the object, attempting irrigation, or applying pressure or cold compresses can worsen the injury or introduce infection. Removing the impaled object in a nonclinical setting can cause more damage; irrigation might drive debris deeper or disturb tissues around the wound; and pressure or ice can cause additional tissue injury. If an eye injury is penetrating, definitive care should be provided by healthcare professionals, but initial protection with a shield and the opposite eye covered is the safest course in a school clinic.