CHAPTER I

INTRODUCTION

1.1 Background
Health is a very valuable and important thing for every human being. Health
not only covers the health of the body but also other body parts such as the
eyes. The eye is the window of the world, we can know the world and know
things with our eyes. Starting from seeing the eyes, we will try to understand the
ins and outs of an object. Besides acting as a window on the world, it also acts as
one of the organs thet acts as a semse of sight. Eyes can be used to find out hhow
severe an illness occurs even though in general there are no signs of complications
from an illness.
The eye is an important organ for us to maintain and care for eye health is one
form of our gratitude to the creator. But not everyone is aware of the significance
of maintaining eye health. The result of negligence in maintaining eye health can
cause various eye diseases starting from lack of consumption of vitamin A,
abnormalities in the congenital eye organ, reflactive abnormalities and others.
Among these refractive disorders is myopia.
Genetic factors in myopia are complex. Myopia can be inherited
predominantly, recessively and sporadically. Children with both parents suffering
from myopia will be more at risk of suffering from myopia than children with one
Prent suffering from myopia or both parent without myopia. In this studi children
aged six to twelve years were found to have an incidence of anemia in children
with both parents dreaming of twelve to two%. While the incidence of myopia in
children with one of my parent is eight,two%, and in children with both parents it
is normal at two,seven%.
Myopia can cause vision disturbances where the sight is difficult to see objects
that are far away, or interfere with daily activities besides clien. It is expected that
with the creation of nursing care papers with these clients, they can provide
appropriate and carrect nursing care for sufferers of myopia and can reduce
ongoing severity in patients.

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1.2 Wtiting Purpose
The purpose of writing this paper is as follows :
a. General purpose
1. Students are able to understand the concept of nursing care in patients with
eye disorders especially myopia.
b. Special purpose
1. Explain the concept of disease which include anatomical physiology of
sensory perception systems, definition, etiological, pathophysiology , of
management complications which includes medical nursing and diet
management.
2. understand nursing care in patients with myopia disorders using the correct
nursing care methodology.

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 CHAPTER II
DISCUSSION

2.1 Anatomical Physiology Of The Eye

Eye parts :
a. Eyebrows
Eyebrows are two pieces of thick curved skin overgrown with fur. The eyebrows
are lower muscles, and protect the eyes from the blazing sun.
b. Eyelids
The eyelids is two slab, namely the tarsal plate which consists of very dense
fibrous tissue, and is covered with skin and bordered by the conjunctiva. The
tissue below does not contain fat. The upper eyelid is larger than the lower eyelid
and is mowed upward by the levatorpalpebrae. The petals of the petals are closed
circular muscle, lashes are linked to the edges of the eyelids and protect the eyes
from dust and light.
c. Eyeballs
Generally our eyes are described as balls, but are actually oval and not round like
a ball. The eyeball has an intermediate line of approximately two,five cm, the
front is clear and consists of three layers, namely :
1) Outer layer, fibrous which is the buffer layer.
2) Middle layer, vascular.
3) The inner layer, the nerves
There are six eye drive muscles, four of which are straight while the other two are
rather crooked. These muscles are located inside the orbitals, and moves from the
wall of the orbital bone to be linked to the sclerotic wrap of the eye behind the
cornea. Straight muscles consist of superior rectus eye muscles inferior medial
and lateral.these muscles move the eyes upward and outward alternately.
lower public muscles and superior muscles. Superior oblique muscles move the
eyes down and to the outside while the inferior object muscles move the eyes up
and to the outside. The eye moves simultaneously in the sense that both eyes
move together right or left up or down and so on.

3
 Usually both eyes harden simutaneurously at a common point but there is a result
of paralysis in one or several muscle, then in cannot be directed at once again then
arises what is called the squint or strabismus eyes. Such conditions can be in the
form of innate or acquired later if the sufferer cannot be helped using glasses or
with education again, operations can be carried out which mush be followed by
training exercises and re-eduction.
d. Sclera
Sclera is a strong wrapper and fibrus. Sclera forms the white of the eye and
connects to the front with a clear membrane window, the cornea. Sclera protects
the very fine eye structure, and helps maintain the shape of the eye seeds.
e. Koroid
The choroid or middle layer contains blood vessels, which are arteriaophthalmic
branches, branches of the internal carotid artery. This vascular layer forms an
iris with a hole in the middle, or the pupil (bead) of the eye. The pigmented
membrane behind the iris emits its color, and thus determines whether an eye is
blue, brown, gray, and so on. The choroid connects to the front with the iris, and
just behind the iris the membrane thickens to form the siliare corpus, so that the
corpus siliare is located between the choroid and the iris. The ciliary corpus
contains circular muscle fibers and fibers that are located like the fingers of a
circle. Circular muscle contractions also cause the pupils to contract.
All of these together form the uvea tract, which consists of the iris, corpus
siliare, and choroidal membrane. Inflammation in each successive part is called
iritis, cyclitis, and choroiditis or together called uveitis. If one part of the tract is
inflamed, the disease will immediately spread to other parts of the tract around
it.
f. Retina
The retina is the nerve layer in the eye, which consists of a number of fiber
layers, namely nerve cells, trunks and cones. Everything is included in the
construction of the retina, which is a delicate neural network that delivers nerve
impulses from the outside to the optical disc, which is the point where the optic
nerve leaves the eye seeds. This point is called blind spots because it does not
have a retina. The most sensitive part of the retina is the macula, which is
located just external to the optic disc, directly facing the center of the pupil.
If we examine the eye seeds from the front to the back, you will see the
following parts:
g. Cornea
The cornea is a transparent front and continues with a white, translucent sclera.
The cornea consists of several layers. The edge layer is a layered epithelium that
is connected to the conjunctiva. Anterior chamber (anterior oculus camera)
Which lies between the cornea and iris.

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h. Iris
The iris is a colored curtain in front of the lens that connects with the choroid
membrane. Iris contains two groups of unconscious muscle fibers or smooth
muscles, one group shrinks pupil size, while another group widens the pupil size.
i. Pupil
The middle spot is black, which is the gap in the iris, where light enters to reach
the retina. Posterior chamber (posterior kaletalmeraokula) Located between the
iris and lens. Both the anterior chamber and the posterior chamber are filled with
acuary humor.
j. Akueus humor
This fluid comes from the corpus siliare and is reabsorbed into the bloodstream
at the angle between the iris and the cornea through a fine vein known as the
schlemm channel.
k. Lens
The lens is a biconvert transparent object (convex front behind) consisting of
several layers. The lens is located just behind the iris. The membrane known as
the ligamentumpensorium is located in front of or behind the lens, which
functions to connect the lens to the corpus silisre. When the ligament, the
suspensory lens loosens, the lens shrinks and thickens, instead the thickening of
the pendent tube, the lens becomes flat. The loosening of the lens is controlled
by the contraction of the cilia muscles.
l. Viteus humor
The blood behind the eye seeds, starting from the lens to the retina, is filled with
gelatinous, full whitish albumen, the vitreus humor. Vitreus humor functions to
give shape and robustness to the eyes, and maintain the relationship between the
retina and sclerosis.
The optic nerve or tendon of the second cranial nerve is the sensory nerve for
vision. These nerves arise from ganglion cells in the retina which combine to
form the optic nerve. This nerve moves backward medially and crosses the
canalopticus into the cranium cavity, then towards the chiasmaoptikum.
The eye is the sense of sight. The eye is formed to receive stimuli of the beam of
light on the retina, then by mediating the nervusoptic fibers to divert this
stimulation to the center of vision in the brain to be interpreted.
The tear gland consists of multiple glands. Which is located at the outer corner,
above the orbital cavity. These glands secrete tears at the upper and outer edges
of the eye, then pour on the conjunctiva of the lacrimal gland duct. When the
eyelids are blinked, the tears will flood the entire surface of the eyeball. Most of
the liquid evaporates, while the rest flows from the inner corner of the eye to the
lacrimal canal, then enters the nose through the nasolacrimal canal. Tear flow
increases because of the presence of stimulants (such as tear gas for example)
and because of emotions (Evelyn C. Pearce, 2010: 380-388).
2.2 Definition of Myopia
Miopi is caused by the lens of the eye is too convex so that the shadow of a distant
object falls in front of the retina. Miopi is also called nearsightedness, because it

5
cannot clearly see distant objects. Myopic patients who are able to clear objects
close. To help myopic patients use sunken lens glasses (negative lenses).
(Abdullah, Mikrajuddin, et al., 2007).
Myopia is a refractive disorder because the refractive ability of the eye is too
strong for the length of the anteroposterior eye so that the light comes parallel to
the eye axis without accommodation focused in front of the retina. This makes it
difficult to see distant objects and is called nearsightedness (Indriani Istiqomah,
2004: 204).
2.3 Classification Myopia
In myopia the length of the anteroposterior eyeball can be too large or the
refractive strength of refractive media is too strong. Known some forms of
myopia such as:
a. Refractive myopia
Increasing the refractive index of visual media as occurs in intestinal cataracts
where the lens becomes more convex so that refraction is stronger. Same as
myopia bias or myopia index, myopia that occurs due to refraction of the corneal
visual media and lenses that are more powerful.
b. Axial myopia
Myopia due to the length of the eyeball axis, with normal corneal curvature and
lens. According to the degree of severity myopia is divided into:
a. Mild myopia, where myopia is smaller than 1-3 diopters
b. Moderate myopia, where myopia is more than 3-6 diopters
Severe or high myopia, where myopia is greater than 6 diopters according to
myopia known form:
a. Stationary myopia
Myopia that persists after adulthood.
b. Progressive myopia
Continued myopia in adulthood due to increased eyeball length.
Malignant myopia
Progressive myopia which can lead to retinal detachment and blindness or similar
to pernicious myopia = malignant myopia = degenerative myopia (Sidarta Ilyas,
2010: 76).
2.4 Etiology
Refractive abnormalities are a condition when the rays come parallel to the axis of
the eye in a situation that is not accommodating which should be reflected right on

6
the retina (macula lutea) so that maximum visual sharpness is not reflected by the
eye right on the retina (macula lutea) either in front, behind or not it is compared
to one point. This disorder is the most common form of visual abnormalities and
can occur due to abnormalities in the lens or eyeball shape.
Myopia can be caused by:
1. Increased refractive index of visual media that occurs in cataracts where the
lens of the eye becomes more convex so that refraction is stronger.
2. Refraction of the corneal visual media and lens that is too strong.
3. Due to the length of the eyeball ball axis (Sidarta Ilyas, 2010: 76).
2.5 Miopi risk factors
Risk factors for myopia usually show that age, parental myopia status, duration of
use of the Visual Display Unit (VDU), reading distance, duration of reading, TV
viewing distance, and outdoor activities are miopi risk factors while gender, TV
viewing duration, lamp history sleeping 0-2 years, and study room lighting is not
a risk factor for myopia. There is a relationship between parental myopia status,
use of VDU, reading distance and outdoor activity with myopia.
2. 6 Pathophysiology
The occurrence of excessive axis elongation in myopia pathology is still
unknown. Similarly, the relationship between elongation and complications of this
disease, such as degeneration of chorioretina, retinal detachment and glaucoma.
Columbre and his colleagues, on the assessment of the development of the eyes of
chicks which, in their normal growth, intraocular pressure extends to the eye
cavity, which functions as a barrier.
If this opposing force determines the growth of the christmas ocularpost in the
human eye, and there is no evidence to oppose it, two mechanisms of
pathogenesis can be concluded for excessive elongation of myopia.
According to travel myopia is known form:
a. Stationary myopia, myopia which persists after adulthood
b. Progressive myopia, increasing myopia in adulthood due to increasing eyeball
length
c. Myopiamaligna, progressing myopia, which can lead to retinal detachment and
blindness or the same as myopiapernisiosa with myopiamaligna is the same as
degenerative myopia.
d. Myopiadegenertif or myopiamaligna is usually when myopia is more than 6
diopters accompanied by abnormalities in fundusoculi and at the length of the
eyeball to form Stafilomapostikum which is located in the temporal part of the
papilla accompanied by carioretina atrophy.

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Retinal atrophy runs later after scleral atrophy and sometimes membranes rupture
which can cause stimulation for neovascularisubretina. In myopia, Fuch spots can
occur in the form of epithelial pigment hyperplasia and bleeding, atrophy of the
external retinal sensory layer, and adult optic nerve papillary degeneration will
occur. (Sidarta Ilyas, 2010: 77).
2.7 Complications
Complications that can arise in patients with myopia are retinal detachment and
squint. Juling is usually esotropia or squint inward due to continuous eye
convergence (Sidarta Ilyas, 2010: 78).
2.8 Clinical Manifestations
Patients with myopia will say that they see clearly when they are close and look
too close, while looking far away or called the patient is nearsightedness.
Patients with myopia will complain of headaches, often accompanied by squints
and narrow petal gaps. A person with myopia has a habit of squinting his eyes to
prevent spherical aberration or to get a pinhole effect. (Sidarta Ilyas, 2010: 77).
Clinical symptoms of myopia:
a. Subjective:
1. Escape if you look far.
2. Like seeing threads or mosquitoes in the field of view.
3. The eyes get tired, dizzy and sleepy (asthenovergen astenopia).
b. Objective:
1. Papidriasis.
2. The front chamber is deeper.
3. Eksoftalmus
4. Thin retina, looks like a tiger (Tigeroid). (Indriani Istiqomah, 2004: 204).
2.9 Supporting investigation
According to Indriani Istiqomah (2004: 208) Examinations that can help find
out about myopia are as follows:
1. Subjective refraction, the "trialanderror" method using a snellen card, the
eyes are examined one by one, determined by the vision of each eye, in
adults and visus not 6/6 corrected with a negative spherical lens.
2. Objective refraction, the retinoscope with the working lens S +2.00 checks
to monitor the fundus reaction which moves in opposition to the
movement of the retinoscope (against momentum) then corrected with the
spherical lens to achieve neutralization, the autorefractometer (computer).

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2.10 Management
The management of myopia is to try the light that enters the eye focused right
on the retina. Management of myopia can be done by:
a. Optical way
1) Glasses (concave lens)
Correction of myopia with glasses, can be done using a concave (negative
/ negative) lens because the beam of light passing through a concave lens
will spread. If the surface of the refraction of the eye has too high
refractive power or if the eyeball is too long as in myopia, this condition
can be neutralized by placing a concave spherical lens in front of the eye.
A concave lens that will diversify the beam of light before it enters the
eye, so that the focus of the shadow can be reversed towards the retina
(Guyton, 1997)
2) Contact lenses
This tool is the second form for correction of refractive abnormalities. This
tool is placed on the cornea and behind the eyelid. Care must be taken to
provide enough oxygen to the cornea. Tear fluid is flowed under contact
lenses to moisturize the cornea and lift debris when blinking. This tool
improves refraction abnormalities by changing the shape of the cornea
which will increase the ability of refraction, and by giving specific
refractive strength and desired shape to the front of the eye so that
incoming light can be precisely focused on the retina (Inriani Istiqomh,
2004: 211-212) .

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 CHAPTER III
NURSING CARE

3.1 Health History

Conduct studies as follows :
a. Patient identity, including :
1) Name :
2) Gender :
3) Age :
4) Job :
5) Tribe :
6) Religion :
7) Education :
8) Marital status :
9) Address :
10) Person in charge :
b. Main complaint
Blurred vision or vision, difficulty focusing on the view, epiphora, dizziness,
often tired and drowsy, on the client myopia has asthenovergen asthenopia.
c. Medical history
Family health history
Generally a history of militus diabetes and axial myopia is found in hereditary
factors.
Past medical history
In myopia there may be central retinitis and retinal detachment. Also examine the
existence of a vitamin A deficit that can reduce stem and cone cells and the
production of humorous accus and corneal clarity.
Current history
4) Daily habits: nutrition, rest, exercise
5) History of allergies
6) History of drug consumption

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d. Physical examination
Physical assessment of the sense of sight includes:
1) Examination of the eyelids, should be located evenly on the surface of the eye
2) Eyelash inspection, position and distribution
3) Inspection of the conjunctiva
4) Sclera color inspection
5) Examination of the cornea, normally the cornea looks smooth with a reflection
of light like a mirror, bright, symmetrical and single.
6) Assessment of visual acuity
Do it in a room that is not too bright with a snellen card
7) Assessment of eye movements
One patient's eye is closed with a carton or hand, then the examiner and the
patient are asked to focus the eyes that are not closed on one stationary object
while the cardboard / hand closed eyes remain open. Then the cardboard or hand
is suddenly removed, and abnormal eye movements will appear.
e. Supportive examination
1) Subjective refraction, the "trialanderror" method using snellen cards, eyes
examined one by one, determined vision of each eye, in adults and visus not 6/6
corrected with a negative spherical lens.
2) Objective refraction, the retinoscope with the working lens S +2.00 checks to
monitor the fundus reaction which moves in opposition to the movement of the
retinoscope (against momentum) then corrected with the spherical lens to achieve
neutralization, the autorefractometer (computer). (Indriani Istiqomah, 204: 208).
3) Photograph of the fundus or retina.
4) Eye sharpness check.
5) Visual field examination or campimetry (perimetry).
6) Quality retinal examination (ERG = electroretinogram).
7) Ultrasound (ultrasonography) of the eyeball and circumference of the mass of
the eye organ in the tumor, eyeball length, thickness of the glass (vitreous).
Retinometry (maximum likelihood of sharp eye remaining)
3.2 Nursing diagnosis
The diagnosis that can be taken in the case of myopia is as follows:
a. Sensory perception disorders are related to changes in ability

11
focus the light on the retina
b. The feeling of comfort (dizziness) is related to the effort to focus the view
c. The risk of injury is related to limited vision
3.3 Interventions
The interventions of each of the above diagnoses are as follows:
a. Sensory perception disorders are related to changes in ability
focus the light on the retina
Aim :
1) Client's visual acuity increases with the help of tools
2) Clients recognize sensory disturbances that occur and compensate for changes
Intervention:
1) Explain the cause of visual impairment. Rational: knowledge
about the causes of reducing anxiety and increasing client knowledge
so that the client is cooperative in nursing actions.
2) Perform a visual acuity test. Rational: knowing the client's basic vision and its
development after being given action.
3) Collaboration with medical teams in the provision of contact lenses or assistive
or surgical glasses (radical keratotomy).
b. The feeling of comfort (dizziness) is related to the effort to focus the view
Aim :
1) The client's sense of comfort is fulfilled
Criteria for results:
Client complaints (dizziness, tired eyes) are reduced or lost.
Clients recognize symptoms of sensory disorders and can compensate for changes
that occur.
Intervention:
Explain the cause of dizziness, tired eyes. Rational: reducing anxiety and
increasing client knowledge so that clients are cooperative in nursing actions.
2) Encourage the client so that the patient has enough rest and does not carry out
continuous reading activities. Rational: reduce eye fatigue so dizziness decreases.

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3) Use enough lights or lighting (from above and behind) when reading. Rational:
reduce excessive glare and accommodation.
4) Collaboration: giving glasses to improve client's vision.
c. The risk of injury is related to limited vision
Aim :
There is no injury.
Criteria for results:
Clients can carry out activities without experiencing injury
Clients can identify potential hazards in the environment
Intervention:
Explain about the possibilities that occur due to decreased vision. Rational:
changes in visual acuity and depth of perception can increase injury risk until the
client learns to compensate.
2) Notify clients to be more careful in carrying out activities.
3) Limit activities such as driving a vehicle at night. Rational :
reduce the potential danger because of blurred vision.
Use correction glasses or maintain eye protection as indicated to avoid injury
(Indriani Istiqomah, 2004: 208-211).

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 CHAPTER IV
COVER

4.1 Conclusions
From the above paper we can conclude that myopia is an eye refraction disorder
caused by the lens of the eye is too convex which causes the shadow to fall in
front of the retina. The cause is not yet known with certainty but there are some
conditions that can cause myopia such as allergies, endocrine disorders, lack of
vitamin and nutritional intake, and congenital parents.
In patients with myopia can experience signs of frequent dizziness, blurred vision
when looking far away, difficulty reading with long distances, squinting when
looking away. Some of these sufferers are helped by using optical lenses such as
glasses with negative lenses and contact lenses. As well as by way of surgery to
reduce eye lens jaw.
4.2 Suggestions
Miopi can occur to anyone, including children, for that it is recommended to
always maintain eye health by carrying out regular eye examinations, consuming
vitamins and nutrients that are many useful for eye health.
Minimizing the risk of myopia by resting the eyes when the eyes feel tired and for
myopia sufferers who wear contact lenses should always be cleaned.

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 BIBLIOGRAPHY

Carpenito, LJ. 2009. Application Nursing Diagnosis at Clinical Practice.

Translated by KS Levels. Jakarta: EGC
Istiqomah, IN. 2005. Nursing Care Clients Your Eye Disorders. Jakarta: EGC
Nugroho, T. 2011. Medical Nursing Surgery, Childhood, Surgery, and Disease
In. Yogyakarta: Nuha Medika
Tamsuri, A. 2011. Clients of Eye & Vision Disorders. Jakarta

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 DAFTAR PUSTAKA

Carpenito, LJ. 2009. Diagnosis Keperawatan Aplikasi Pada Praktik Klinik.

Dialihbahasakan oleh Kadar KS. Jakarta: EGC

Istiqomah, IN. 2005. Asuhan Keperawatan Klien Gangguan Mata Anda. Jakarta:

EGC

Nugroho, T. 2011. Asuhan Keperawatan Medikal Bedah, Anak, Bedah, dan

Penyakit

Dalam. Yogyakarta: Nuha Medika

Tamsuri, A. 2011. Klien Gangguan Mata & Penglihatan. Jakarta

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