Child who is affected with Bell's palsy, moistening of the effected eye has to be done to prevent?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Medical & Surgical Nursing

Hard

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

Bell's palsy causes paralysis of the orbicularis oculi muscle, making it impossible to close the eye completely (a condition called lagophthalmos).
This inability to close the eye leads to constant exposure of the cornea to air, causing it to dry out.
Inflammation of the cornea due to dryness is called exposure keratitis.
Moistening the eye with artificial tears or ointments is the primary intervention to prevent the development of keratitis and subsequent corneal damage.

Option A: Conjunctivitis is inflammation of the conjunctiva, not the cornea. While eye dryness can lead to irritation and secondary conjunctivitis, the primary and more severe, vision-threatening complication is keratitis.
Option B: Blindness is a potential end-stage complication of severe, untreated keratitis that leads to corneal scarring or perforation. It is not the initial condition that eye moistening aims to prevent.
Option D: Drooping of the eyelid (ptosis) is a direct sign of the muscle paralysis caused by Bell's palsy. It is a symptom of the condition itself, not a complication that can be prevented by moistening the eye.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Bell's Palsy and related nursing care as background academic context rather than a clinical decision trigger.
A nurse's primary role in managing a patient with Bell's palsy is to provide meticulous eye care and educate the patient and family on how to perform it at home.
Failure to protect the cornea can lead to permanent vision impairment, which is a preventable outcome. This is a critical patient safety issue.
What if? If the patient also reports severe eye pain, photophobia, and a gritty sensation, the nurse should suspect that keratitis has already developed and facilitate an urgent ophthalmology consultation.

How to Approach the Question

First, identify the core pathophysiology of the condition mentioned: Bell's palsy involves paralysis of the facial nerve (CN VII).
Think about the functions of the facial nerve. A key function is controlling the muscles that close the eyelids.
Connect the pathophysiology to the clinical problem: If the eyelid cannot close, the cornea is exposed.
Analyze the consequences of an exposed cornea: It will dry out.
Evaluate the options based on this consequence. The inflammation of a dry cornea is specifically called 'keratitis'.
Eliminate other options: Conjunctivitis is less severe, blindness is a later complication, and drooping is a symptom, not a preventable complication of dryness.

Concept Tested & Keywords

Concept Tested: Complications of Bell's Palsy and related nursing care.
Stem keywords: Bell's palsy, moistening, effected eye, prevent
Lead-in keywords: prevent
Clinical cues: The diagnosis of Bell's palsy implies facial nerve (CN VII) paralysis, which is a key clue to the underlying problem of incomplete eye closure.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1714-1716, 1742-1744