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A 
 
is a clouding that develops in the crystalline lens of the eye or in its envelope,
varying in degree from slight to complete opacity and obstructing the passage of light. Early in
the development of age-related cataract the power of the lens may be increased, causing near-
sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the
perception of blue colours. Cataracts typically progress slowly to cause vision loss and are
potentially blinding if untreated. The condition usually affects both eyes, but almost always one
eye is affected earlier than the other.
A  
 
, occurring in the elderly, is characterized by an initial opacity in the lens,
subsequent swelling of the lens and final shrinkage with complete loss of transparency.
Moreover, with time the cataract cortex liquefies to form a milky white fluid in a  

 

 
, which can cause severe inflammation if the lens capsule ruptures and leaks. Untreated,
the cataract can cause phacomorphic glaucoma. Very advanced cataracts with weak zonules are
liable to dislocation anteriorly or posteriorly. Such spontaneous posterior dislocations (akin to
the historical surgical procedure ofcouching) in ancient times were regarded as a blessing from
the heavens, because some perception of light was restored in the cataractous patients.

The lens lies behind the iris and the pupil (see diagram). It works much like a camera lens. It
focuses light onto the retina at the back of the eye, where an image is recorded. The lens also
adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is made
of mostly water and protein. The proteins are arranged in a precise way that keeps the lens clear
and let¶s light pass through it.
But as we age, some of the protein may clump together and start to cloud a small area of the lens.
This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it
harder to see.
Age-related cataract is responsible for 48% of world blindness, which represents about 18
million people, according to the World Health Organization (WHO). In many countries surgical
services are inadequate, and cataracts remain the leading cause of blindness. As populations age,
the number of people with cataracts is growing. Cataracts are also an important cause of low
vision in both developed and developing countries. Even where surgical services are available,
low vision associated with cataracts may still be prevalent, as a result of long waits for
operations and barriers to surgical uptake, such as cost, lack of information and transportation
problems.
Researchers suspect that there are several causes of cataract, such as smoking and
diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes
over the years.

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 J Cloudy or foggy vision
 J Blurry or distorted vision
 J Changes in color vision

   J •requent increases in eyeglass or contact lens prescriptions
J coor night vision (especially affected by headlights)
J crogressive loss of vision
J Halos or glare around lights
J Pouble vision
J A white or "milky" spot over the pupil of the eye
J Îoss of contrast
J Îoss of coordination
      J ôo specific clinical symptoms related to cataract

 J ôo specific clinical symptoms related to cataract
?


 J ôo specific clinical symptoms related to cataract

  J ôo specific clinical symptoms related to cataract

 J ôo specific clinical symptoms related to cataract
  J ôo specific clinical symptoms related to cataract

  J ôo specific clinical symptoms related to cataract

















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The Snellen Visual Acuity Test J Each eye is tested separately, with and
w/o glasses.
J Îetters and objects are of a size that can
be seen by normal eye at the distance of
6 m (20ft) from the chart.

Slit-Lamp Biomicroscopic Examination

(Opthalmoscopy)

† An instrument equipped with a special lighting J The pt. sits with the chin and forehead
systems and a binocular microscope. resting against equipment supports.
† Allows visualizing in details the anterior J The room is generally darkened, and the
segment of the eye, which includes the eyelids, pupils are dilated.
eyelashes, conjunctiva, sclera, cornea, tear J If the patient is wearing contact lenses,
film, anterior chamber, iris, lens and anterior have him remove them before the test,
portion of vitreous humor. unless the test is being performed to
† crovides magnification and confirms diagnosis evaluate the fit of the contact lenses.
of opacity. J When instilling dilating drops, tell the
patient that his near vision will be
blurred for 40 mins-2 hrs. Advise him to
wear dark glasses in bright sunlight until
his pupils return to normal diameter.
J Pon¶t administer dilating eyedrops to the
patient who has angle-closure glaucoma,
is hypersensitive to mydriatics, or has an
intraocular lens implants.


Refraction 

† Pefined as the bending of light rays by the J Explain to the patient the test is
cornea, aqueous humor, lens, and vitreous painless and safe and that it takes about
humor in the eye, refraction enables images to 30 mins.
focus in the retina and directly affects visual J Tell patient he shouldn¶t use any eye
acuity. drops, including prescription eye drops,
† This test is done routinely during a complete at least 24 hours before the test.
eye examination or whenever a patient J Explain that eye drops may be instilled
complains of a change in vision. to dilate the pupils and inhibit
† It defines the degree of impairment (refractive accommodation by the lens. 
error) and determines the degree of correction
required to improve visual acuity with glasses
or contact lenses.




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 Sclerotic is the outer coating of the eye which is white in colour that protects
the interior of the eye and provides the shape to the eye.

  The front part of sclerotic is transparent to light and is termed as cornea. The
light coming from an object enters the eye through cornea

? Iris is just at the back of cornea. This controls the size of the pupil. It acts like
a shutter of a photographic camer and allows the regulated amount of light to
enter the eye.

 Eye lens is a double convex lens with the help of which image is formed at
retina by refraction of light.

  The eye lens is held by ciliary muscles. Ciliary muscles help the eye lens to
change its focal length.

 At the centre of the iris there is a hole through which light falls on the lens,
which is called pupil.

 
  The space between cornea and eye lens is filled with a transparent fluid called
aqueous humour.


 
  The space between eye lens and retina is filled with a jelly like transparent
fluid called vitreous humour.


 Retina serves the purpose of a screen in the eye, wherethe images of the
objects are formed. Retina is at the back of the eye lens. Retins is made of
light sensitive cells, which are connected to the optical nerve.



 Optic nerve carries the information to brain.

 
The region of eye containing the optic nerve is not at all sensitive to light and
is called blind spot. If the image of an object is formed in the blind spot, it is
not visible.

 
The central part of retina lying on the optic axis of eye is most sensitive to
light and is called yellow spot
  Eye lids are provided to control the amount of light falling on the eye. They
also protect the eye from dust particles etc

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High risk for injury related to poor ?  
 
vision and reduced extremity-eyes After the nursing interventions given, .
coordination. the patient will be able to: J Ascertain knowledge of safety J To prevent injury in
needs/injury prevention and home/community setting. 
  

 motivation
J Instruct SO to: J To promote safe physical


† Express understanding of the  environment and individual
³I can¶t see clearly, I sometimes factors involved in the
Maintain client¶s bed/chair in safety.
fall and outbalanced´ as verbalized lowest position;
possibility of injury;
by the client.
clace assistive devices (walker,
  

 crane);


 † Modify environment as Monitor environment for

indicated to enhance safety; potentially unsafe conditions and
J A white or "milky" spot
† Be free of trauma/injury modify as needed
over the pupil of the eye.



   


 J Refer the patient for an eye care J To have further assessment
specialist. and interventions regarding
 health conditions.

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Pisturbed Visual Sensory cerception ?  
 
r/t changes in sensory acuity. After the nursing interventions given, .
the patient will be able to: J Ascertain type/degree of visual J Affects choice and client¶s
loss. future expectations 
 

 J Encourage expression of feelings J Although early interventions

about loss/possibility of loss of can prevent blindness, the

 J carticipate in therapeutic vision client may have already
experienced partial or
regimen 
³I see dots everywhere, especially complete blindness.
around lights´ as verbalized by the J Reduces safety hazards
 

 J Recommend measures to assist
patient. related to changes in visual
client to manage visual limitation
fields
 J Maintain current visual
 

field/acuity without further 


loss. J Pemonstrate/have client to
J Eyedrop treatment is needed
J A white or "milky" spot administer eye drops using
to control IOc and prevent
over the pupil of the eye.  correct procedure
further loss of vision
 
  
    
 
 
J crepare for surgical intervention J Removing the lens through
as indicated like cataract surgery improves visual
extraction. acuity.


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Anxiety related to threat of ?  
 
permanent loss of vision and After the nursing interventions given, .
independence. the patient will be able to: J Assess anxiety level, suddenness J These factors affect client¶s
of symptoms and current perception of threat to self 
 

 knowledge of condition potentiating the cycle of
anxiety.
 
J Appear relaxed and report

 J Reduces anxiety related to
anxiety is reduced to a J crovide accurate, honest
information. Piscuss probability unknown/future
³ôobody wants to be blind!´ as manageable level; expectations and provides
that careful monitoring and
verbalized by the patient. J Use resources effectively treatment can prevent additional factual basis for making
visual loss informed choices about
  treatment.

J Encourage client to acknowledge J crovides opportunity of the

 concerns and express feelings
 client to deal with reality of
 situation, clarify
J A white or "milky" spot
over the pupil of the eye.  misconceptions and problem

J Apprehensive solve concerns
 J Identify helpful resources/people. J crovides reassurance that
 client is not alone in dealing
 with problems.

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There is no medical treatment for cataracts, although use of vitamin C and E and beta-
carotene is being investigated. Glasses or contact, bifocal, or magnifying lenses may improve
vision. Mydriatics can be used short term, but glare is increased. But there are take home
medications following a cataract extraction which usually includes an anti-inflammatory drop
containing antibiotic and cyclopegic to prevent ciliary spasm.
 
Prugs Prug Mechanism of Side Effects Nursing
Classification Action Responsibilities

Betamethasone is a Sodium and J Assess

corticosteroid with fluid involved
mainly retention, systems
glucocorticoid potassium periodically
activity. It prevents and calcium J Assess patient
and controls depletion. for signs of
inflammation by Muscle adrenal


   Corticosteroid controlling the rate wasting, insufficiency
of protein weakness, J Monitor intake
synthesis, osteoporosis. and output
depressing the GI ratios and
migration of disturbances daily weight
polymorphonuclear and bleeding J If dose is
leukocytes and ordered daily,
fibroblasts, and administer in
reversing capillary the morning to
permeability and coincide with
lysosomal the body¶s
stabilisation. normal
secretion of
cortisol.
By blocking J fast or J use cautiously
muscarinic receptors, uneven in patients
cyclopentolate heart with history of
produces dilatation rate; glaucoma;
of the pupil J warmth, systemic
 

 Cycloplegic
(mydriasis) and redness, absorption
Mydriatics prevents the eye from or tingly may cause
accommodating for feeling anticholinergi
near vision under the c effects such
(cycloplegia). skin; as confusion,
J severe unusual
skin rash; behavior,
J slow or flushing and
shallow hallucinations
breathing
;




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Cataract ? ± Withhold any ± Instruct patient to wear
Extraction: The entire lens is anticoagulants the a protective eye patch
removed and fine patient is for 24 hours after
1. Intracapsular sutures are used to receiving, if surgery to prevent
2. Extracapsular close the incision medically accidental rubbing or
appropriate. poking of the eye. After
 Aspirin should be 24 hours, eyeglasses
Involves smaller withheld for 5 to 7 should be worn during
incisional wounds days, nonsteroidal the day and a metal
(fewer traumas to the anti-inflammatory shield worn at night for
eye) & maintains the drugs (ôSAIPs) 1 to 4 weeks.
posterior capsule of for 3 to 5 days, 
the lens, reducing and warfarin ± crovide postoperative
post-operative (Coumadin) until discharge teaching
complications. the prothrombin concerning eye
  time of 1.5 is medications, cleansing
   Uses an ultrasonic almost reached. and protection, activity

  device that device that  level and restrictions,
liquefies the nucleus ± Administer diet, pain control,
and cortex which are dilating drops positioning, office
then suctioned out every 10 minutes appointments, expected
through a tube. for four doses at postoperative course,
  least 1 hour before and symptoms to report
 The lens, which surgery. immediately to the
 
 focuses light on the Antibiotic, surgeon.
retina, must be corticosteroid, and 
replaced for the ôSAIP drops ± Instruct patient to
patient to see clearly. may be restrict bending and
3 lens replacement administered lifting heavy objects.
options: prophylactically 
1. Aphakic to prevent ± Caution patient that
Eyeglasses postoperative vision may blur for
2. Contact Îenses infection and several days to weeks.
3. IOÎ implants inflammation. 
 ± Inform patient that
vision gradually
improves as the eye
heals; IOÎ implants
improve vision faster
than glasses or contact
lenses.

± Reinforce that vision
correction is usually
needed for remaining
visual acuity deficit.





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 © Anti-inflammatory drop containing an antibiotic ex: 



   (a corticosteroid) combined with antibiotic
 
  neomycin.
© A cycloplegic may also be prescribed to prevent ciliary spasm:
   

 twice daily and should be stored in a
refrigerator between uses.

 
© Modified or structured environment to ensure patient¶s safety

 
 because vision may be blurry for several weeks after the
surgery.

 
© crotective eye patch to avoid accidental rubbing or poking of
  the eye.
© Continuation of prescribed medications.

 
© Wearing of eye patch 24 hours after surgery.
 © Sunglasses should be worn while outdoors during the day
because the eye is sensitive to light.
 
 

© Slight morning discharge, some redness, and a scratchy feeling
may be expected for a few days.
© Because cataract surgery increases the risk for retinal
detachment, the patient must know to notify the surgeon if new
floaters (dots) in vision, flashing lights, decrease in vision, pain
or increase in redness occurs.

 
© The patient needs to have a scheduled check up to see the



  
progress of vision or detection of any complications.

 
© There are no dietary restrictions. However, the restrictions as

 per pre-existing medical problems, if any, are to continue. 
© The patient must avoid constipation by taking high fiber diet
and plenty of fluids.

 
© Spiritual practices according to one¶s faith and religion.

 


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