A corneal ulcer is an open sore or defect in the cornea that can lead to vision impairment or loss if not properly treated. This nursing diagnosis focuses on identifying symptoms, preventing complications, and promoting healing while preserving vision.
Causes (Related to)
Corneal ulcers can develop from various factors:
- Bacterial, viral, or fungal infections
- Contact lens complications
- Physical trauma to the eye
- Severe dry eye syndrome
- Pre-existing conditions such as:
- Bell’s palsy
- Rheumatoid arthritis
- Vitamin A deficiency
- Herpes simplex keratitis
- Environmental factors include:
- Chemical exposure
- UV radiation damage
- Foreign body exposure
- Poor contact lens hygiene
Signs and Symptoms (As evidenced by)
Corneal ulcers present with distinctive signs that require prompt recognition and intervention.
Subjective: (Patient reports)
- Severe eye pain
- Foreign body sensation
- Light sensitivity (photophobia)
- Decreased vision
- Excessive tearing
- Blurred vision
- Eye redness
- Discharge from the eye
Objective: (Nurse assesses)
- Visible corneal defect
- Conjunctival injection
- Corneal opacity
- Anterior chamber reaction
- Eyelid edema
- Decreased visual acuity
- Purulent discharge
- Corneal infiltrates
Expected Outcomes
Successful management of corneal ulcers includes:
- The patient will demonstrate improved visual acuity
- The patient will report decreased pain and discomfort
- Infection will resolve without corneal scarring
- The patient will maintain corneal integrity
- The patient will demonstrate proper eye care techniques
- The patient will comply with the medication regimen
- The patient will prevent future corneal injury
Nursing Assessment
Evaluate Visual Status
- Assess visual acuity
- Document the size and location of the ulcer
- Monitor for changes in vision
- Check pupillary response
- Note any discharge
Monitor Pain Levels
- Assess pain characteristics
- Document pain triggers
- Evaluate the effectiveness of pain management
- Monitor for signs of distress
- Track pain progression
Assess Compliance
- Review medication administration
- Check contact lens practices
- Monitor follow-up attendance
- Evaluate understanding of care
- Document adherence to treatment
Check for Complications
- Monitor for infection spread
- Assess for corneal perforation
- Watch for the anterior chamber reaction
- Check for hypopyon
- Document any vision changes
Review Risk Factors
- Assess contact lens history
- Document trauma history
- Note systemic conditions
- Review medication history
- Check occupational hazards
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to corneal inflammation and ulceration as evidenced by reports of severe eye pain, photophobia, and protective behaviors.
Related Factors:
- Corneal tissue damage
- Inflammatory response
- Exposed nerve endings
- Increased intraocular pressure
Nursing Interventions and Rationales:
- Administer prescribed pain medications
Rationale: Provides relief from acute eye pain - Assist with eye protection from light
Rationale: Reduces photophobia-related discomfort - Monitor pain levels regularly
Rationale: Ensures effectiveness of pain management
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved comfort
- The patient will maintain the prescribed pain management regimen
Nursing Care Plan 2: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to compromised corneal integrity as evidenced by the presence of corneal ulcer and potential for microbial invasion.
Related Factors:
- Broken corneal surface
- Presence of microorganisms
- Compromised tear film
- Poor wound healing
Nursing Interventions and Rationales:
- Administer antimicrobial medications
Rationale: Prevents or treats infection - Teach proper hand hygiene
Rationale: Reduces risk of contamination - Monitor for signs of spreading infection
Rationale: Enables early intervention
Desired Outcomes:
- The patient will show no signs of infection progression
- The patient will maintain corneal integrity
- The patient will demonstrate proper hygiene techniques
Nursing Care Plan 3: Impaired Vision
Nursing Diagnosis Statement:
Impaired Vision related to corneal damage as evidenced by decreased visual acuity and reports of blurred vision.
Related Factors:
- Corneal opacity
- Ulcer location
- Inflammatory response
- Corneal edema
Nursing Interventions and Rationales:
- Monitor visual acuity changes
Rationale: Tracks progression of the condition - Assist with environmental safety
Rationale: Prevents injury during vision impairment - Provide vision aids as needed
Rationale: Supports safe daily activities
Desired Outcomes:
- The patient will maintain or improve visual acuity
- The patient will adapt to vision changes safely
- The patient will prevent further vision loss
Nursing Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to unfamiliarity with corneal ulcer management as evidenced by incorrect medication administration and poor compliance with treatment plan.
Related Factors:
- Limited experience with eye care
- Complex medication regimen
- Misunderstanding of condition severity
- Language or cultural barriers
Nursing Interventions and Rationales:
- Provide education about the condition
Rationale: Improves understanding and compliance - Demonstrate proper eye drop technique
Rationale: Ensures effective medication delivery - Review prevention strategies
Rationale: Reduces risk of recurrence
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper medication technique
- The patient will identify preventive measures
Nursing Care Plan 5: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to impaired vision and environmental hazards as evidenced by difficulty with depth perception and navigation.
Related Factors:
- Visual impairment
- Photophobia
- Altered depth perception
- Environmental obstacles
Nursing Interventions and Rationales:
- Assess home safety needs
Rationale: Identifies potential hazards - Teach protective eye measures
Rationale: Prevents further injury - Assist with mobility as needed
Rationale: Ensures safe navigation
Desired Outcomes:
- The patient will maintain safety during activities
- The patient will use protective measures appropriately
- The patient will avoid further eye injury
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Byrd LB, Gurnani B, Martin N. Corneal Ulcer. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539689/
- Cheng, A. S., Giri, P., Byanju, R., Pradhan, S., Ligal, A., Bhandari, G., Bhandari, S., Kandel, R. P., Poudyal, B., Srinivasan, M., Upadhyay, M., Whitcher, J. P., Lietman, T. M., Keenan, J. D., & O’Brien, K. S. (2024). Corneal ulcers and the risk of visual impairment in a matched cohort study in Nepal. AJO International, 1(1), 100012. https://doi.org/10.1016/j.ajoint.2024.100012
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Rathi VM, Thokala P, MacNeil S, Khanna RC, Monk PN, Garg P. Early treatment of corneal abrasions and ulcers-estimating clinical and economic outcomes. Lancet Reg Health Southeast Asia. 2022 Sep;4:None. doi: 10.1016/j.lansea.2022.100038. PMID: 36092742; PMCID: PMC9439957.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
