CH 44 EYE Disorders

Title Pathophysiology Treatment & Care

Cataracts
(Disorder that causes lens or its capsule
to lose its transparency and/or become
opaque)
As clouding develops, visual impairment
occurs. Usually affects both eyes, but
visually impairment is different in each
eye. Typically associated with aging,
however it can be congenital, caused by
eye injury, or secondary to a systemic
disease (diabetes).
Only treatment is surgical removal of
the lens, and ONLY when significant
vision loss has occurred. An intraocular
lens is generally implanted (glasses or
special contacts are also used). Eye
surgery is done outpatient under local
anesthesia. Valium can be given for
anxiety. Pre Op patients can relieve
medications to prepare eye for surgery:
mydriactic (dilates) & cycloplegic
(paralyzes cillary muscle). *Must have
someone else drive you home, & driving
is restricted for a few days. *After
surgery avoid coughing & sneezing. Dark
glasses to relieve glare.
Glaucoma
(Tunnel Vision)
(Abnormally high pressure of fluid
inside eyeball)
Fluid accumulates in anterior chamber.
If pressure continues it could bring on
blindness. Two forms: Primary (acute) &
Closed (chronic).
PRIMARY: angle where the iris & cornea
join is open but the canal is blocked and
aqueous humor cannot drain from the
eye. Causes rise in IOP, slow loss of
peripheral vision, and ultimate
blindness. *Most preventable form,
usually bilateral.
CLOSED: attacks of suddenly increased
IOP (bulging iris).
SECONDARY: results from ocular or
Drug therapy to reduce IOP.
Betagan, Betopic decrease IOP. These
drugs have systematic effects that
include: bradycardia, hypotension,
BRONCHOSPASM, respiratory failure
(esp. with clients with asthma).
Administering eye drops for glaucoma:
Press lightly for 1 min on lacrimal sac
after instilling the drops to decrease
systemic effect of medication. If more
than one eye drop is used, wait 5
minutes between each instillation of
each type.
CH 44 EYE Disorders

systemic disorder that elevates IOP, this
can happen quickly without warning & it
is a medical EMERGENCY. African
Americans over 40 years old are 5x
more likely to have glaucoma than
Caucasians.
Retinal Detachment
(Retina separates from choroid)
Partial separation becomes complete if
not treated. Painless because there are
no pain receptors in retina.
Surgical procedure: Scleral Buckling
(sometimes used). Reduces the scleral
surface & allows contact between
choroid & retina. Pneumatic
Retinopexy used for uncomplicated
detachment. Draws small amount of
fluid from anterior chamber and gas is
injected into posterior chamber. Gas
pushes the retinal tear and seals it off. **
Fluid under the retinal tear is absorbed
& gas is released from eye over several
weeks. Prone position. Treat nausea,
vomiting, and pain. Bilateral eye
patches.
Infections KERATITIS: inflammation of cornea due
to infection, irritation, injury, or
allergies. Symptoms: eye pain, Red
watery eyes, photophobia (sensitive to
light).

STYE (Hordeolum): pustule
inflammation on eyelash follicle or
sebaceous gland on the lid margin,
commonly by staphylococcal.
KERATITIS: optical anesthetics for pain,
mydriactics to dilate pupils, dark
sunglasses, antibiotics.

STYE: warm compresses & antibiotics.
Severe cases require drainage, once pus
is drained the pain is relieved and
healing begins.

CHALAZION: surgical incision if cyst is
CH 44 EYE Disorders

Symptoms: pain, redness, swelling of
specific area of eyelid.

CHALAZION: cyst of meibomian gland.
Hard cyst is filled with fatty material.
Pain & swelling for weeks.

CONJUNCTIVITIS (PINK EYE):
inflammation of conjunctiva. Caused by
bacteria, viral, or rickettsial, allergens,
or irritants. Symptoms: burning itching
eyes, discharge, swelling pain, and
redness.
large or infected, interferes with vision,
or closure of eyelids. Cyst remains when
inflammation subsides.

PINK EYE: warm compresses (saline or
boric acid), instilling antibiotic or
antiviral drops. If allergen
antihistamines Rx. ** Proper hand
hygiene or nurse and client. NO
STERIODS they can mess up the cornea.
Refractive Errors Myopia: Nearsightedness (cant see
distance)
Hyperopia: Farsightedness (cant see
up close) vision beyond 20 feet is
normal.
Astigmatism: football shape. Visual
distortion.
Strabismus: inability of eyes to focus in
same direction) eye constantly deviated
to one side.
Presbyopia: inability of lens to change
curvature and focus on near objects.
Eyes cant focus on near objects but
remains accommodated for far objects

Rx glasses or contacts. Radial
keratotomy is surgical procedure that
corrects myopia and astigmatism. LASIK
& PRK use lasers to correct near & far
sightedness.
Eye Injuries Injuries to eye require IMMEDIATE
attention from an ophthalmologist.
Flush sterile saline from sclera and let
flow across to cornea. If particle is not
CH 44 EYE Disorders

If there is foreign object in the eye cover
and go to ER, do not try to remove.

removed or located Sterile fluorescein
drops or strips are instilled to find
particle. Welder, swimmers need to
wear protective goggles.
Impaired Vision Blindness evokes an image of total
darkness & used for legal purposes
when vision is 20/200 or less with
corrective lenses in better eye. Those
with 20/70 & 20/200 in better eye with
use of glasses are referred to as partial
blindness.
Magnifying glasses, telescopes, large
print books, braille books, timers,
ticking clocks & seeing eye dog.
Age-Related Macular Degeneration
(Atrophy or deterioration of macula)
Loses central vision, but has peripheral
vision. Risk Factors: Caucasian, smoking,
family Hx, female, Obese. Two Forms:
DRY: vessels not ruptured (most start
with this form). Blurred vision that goes
away with brighter light. Drusen, small
yellow deposits on retina and macula,
indicates breakdown. WET: vessels
rupture & leak blood and fluid. Found in
10% of people with AMD. Straight lines
appear crooked.
AVASTIN treats both, monthly
injections, slows progression. Vitamin C,
Vitamin E, Beta-carotene, Zinc, Copper,
Ocubite med OTC. WET can be treated
with laser surgery. Provide safe
environment & announce your presence.

Sclera: white of the eye
Cornea: window of the eye

6 OCCULAR MUSCLES

**** Tears contain lysozyme, muramidase, that destroys pathogens.

CH 44 EYE Disorders


Eye changes in adults: tear production decreases, Grey ring around eyes (if younger than 40 indicates high cholesterol build
up), pytosos, fat decreases (sunken eyes), wrinkling, bags.

EYE SURGERY:
-Elevate head of bed to decrease pressure
-No bending forward
-No lifting (gallon of milk)
-No straining vagus nerve (stool softener will be Rx to prevent straining)
-No lying on affected side
-Treat nausea
-Wear dark glasses

NORMAL INTRAOCCULAR PRESSURE: 10-20 or 12-22
Mydriatic: Pupils Dilate
Miotic: Pupils Contract
Pytosis: droopy eyelids

EYES CHECKED:
Q Year Contacts
Q 2 Years Glasses

Blown Pupil indicates stroke.
PERRLA (pupils equal, round, reactive to light, and accommodation)

*Fluorescein angiography- Visualizes structures in the retina and choroid (particle lost in eye)
*Snellen Test- normal value 20/20 for visual acuity
*Tonometry- monitors treatment of glaucoma, measures IOP.

CH 44 EYE Disorders

CH 44 EYE Disorders