CATARACTS

CATARACTS
• A lens opacity or cloudiness

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 Cataract
• Risk factors
• 1. Aging, DM, Toxic factors*, etc causes
lens opacification
• 2. Visual impairment progresses as the
opacification blocks the visual field

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 Risk factors for cataract
• Aging – loss of lens transparency
• - Clumping or aggregation of lens protein
( which leads to light scattering.
• Accumulation of yellow brown pigment
due to breakdown of lens protein.

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 Yellow brown pigment

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 Risk factors
• Associated retinitis pigmentosa
• Retinal detachment
• Infection
• myopia

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 Retinitis pigmentosa is a common
group of heritable retinal
degenerative diseases that result in
progressive visual loss secondary to
photoreceptor cell death.

Myopia is also known

as nearsightedness,
which means that you
can see nearby objects
clearly but distant Myopia
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objects appear blurry.
As the vitreous gel in the back of the eye starts to liquefy, it can
separate from the retina, a condition called vitreous detachment.
If the vitreous gel adheres too firmly to the retina, a retinal tear
can occur with a vitreous detachment. A retinal detachment
occurs when fluid leaks through the tear and separates the retina
from the back.
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 • vitreous -- a clear,
jelly-like substance
that fills the globe of
the eyeball.
• The vitreous humor
helps the eye hold its
spherical shape.
Finally, the light rays
land and come to a
sharp focusing point
on the retina.
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 Risk factors

• Physical factors
• blunt Trauma , Electrical shock,
• Ultraviolet radiation sunlight or x-ray.

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 Cataract
• ASSESSMENT
• Clinical manifestations
• 1. painless, blurry vision (cloudy vision)
• 2. patient perceives that surroundings are
dimmer
• 3. reduced visual acuity

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 Cataract
• DIAGNOSTIC TEST
• 1. Snellen chart for visual acuity
• 2. ophthalmoscopy

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 Cataract
• MEDICAL AND SURGICAL
MANAGEMENT
Cataract surgery- extraction and lens
replacement
No useful drug to combat cataract

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 Cataract
• NURSING INTERVENTION
1. Provide pre-operative care
• Withhold aspirin therapy for 5-7 days,
NSAIDS for 3 days
• Dilating drops are administered every 10
minutes for 4 doses at least 1 hour before
surgery

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 Cataract
• NURSING INTERVENTION
2. Provide pre-operative care
Dilating agents include:
Atropine
Phenylephrine

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 Cataract
• NURSING INTERVENTION
2. Provide Post-operative care
• POSITION: Place patient side lying on the
UNAFFECTED side
• Administer pain medication, topical
antibiotics and anti inflammatory agents
• Advise to wear glass x 24 hours or metal
shield nightly x 1-4 weeks

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 Cataract
• NURSING INTERVENTION
• Clean eyes with single stroke from inner to
outer canthus
• Avoid lifting, pushing or pulling >15
pounds
• Avoid prolonged stooping and bending
• Teach s/sx of complication of surgery**

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 Retinal detachment

-Commonly in the RPE ( retinal pigment epithelium)

Clinical manifestation- patient report manifestation of shade or
curtain coming across the vision of one eye, cobwebs, bright
flashing light or greater number of floaters.
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• Are extremely nearsighted
• Have had a retinal detachment in the other
eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have other eye diseases or disorders, such
as degenerative myopia

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• Retinoschisis
• is a disease of the nerve tissue in the eye. It
affects the retinal cells in the macula (the
central fixation point of vision at the back of
the eye). Retinoschisis is technically a form
of macular degeneration.

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 Retinal detachment
-After visual acuity
-Commonly use for diagnosis:
-Indirect opthalmoscope as well slit
lamp biomicroscopy.
-For evaluation
a. Stereo fundus photography
b. Fluorecein angoigraphy

High definition digital

fundus camera
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 Retinal detachment
• Retinal Detachment Due to a retinal break
or tear that allows the liquid vitreous that
fills the center of the eye ball to pass
through the break and detach the retina. This
is the most common type of detachment.

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 Retinal Detachment
• This is the most common type of retinal
detachment and usually occurs when the
vitreous separates from the back wall of the
eye. The vitreous is the clear gel that fills
the central cavity of the eye. The formed
vitreous gel liquefies with age and
eventually falls away or separates from the
retina. This is called a
posterior vitreous detachment (PVD) and is
a normal event occurring in most people
sometime between 40–70 years of age.
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 Retinal detachment
• Exudative Retinal Detachment Due to
leakage from under the retina which creates
fluid (exudate) that detaches the retina.
Tumors and inflammatory disorders can
create exudative detachments.
• Many conditions can cause an exudative
detachment including tumors, inflammatory
disorders, connective tissue diseases and
macular degenerative conditions.

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Retinal detachment treatments
Vitrectomy is a
microsurgical procedure in
which specialized
instruments and techniques
are used to repair retinal
disorders, many of which
were previously considered
inoperable. The initial step
in this procedure is usually
the removal of the vitreous
gel through very small
(˜1.4mm) incisions in the
eye wall, hence the name
“vitrectomy”.
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 Retinal detachment treatment
trans pars plana
vitrectomy (TPPV)

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Retinal detachment treatment
• Scleral buckle – to
indent the scleral
wall from the outside
of the eye and bring
the two lateral layers
in contact with each
other
• There is only an
increase incidence of
diplopia,
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complications such as
 • The gas bubble floats
in the eye, and it can
be positioned against
the retinal tear
responsible for the
retinal detachment by
holding the head in a
certain position.

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 Retinal detachment Nursing
management
• 1. Provide accurate information in a calm
voice; client's anxiety is
• high as a result of the sudden, unexpected
vision loss
• 2. Keep the client on bed rest in position as
ordered
• 3. Provide the client with a call bell and
answer promptly
• 4. Maintain protective eye patch
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 Retinal detachment nursing
intervention
• 5. Instruct client to avoid activities that
increase intraocular pressure such as
coughing, straining, and stooping
• 6. Observe for signs of hemorrhage
postoperatively (severe pain, restlessness)
• 7. Diminish lights in the room
• 8. Explain that return to a sedentary
occupation may occur in approximately 3
weeks and to a more active job in 6 to 8
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 Retinal detachment nursing
intervention
• Teaching about complications
• - increase IOP
• Development of other retinal detachment
• Development of cataracts
• Loss turgor in the eye.
• Post. Operative infection

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 Macular degeneration
Macular degeneration (ADM) is a
degenerative condition of the
macula (the central retina).

It is the most common cause of

vision loss in the United States in
those 50 or older, and its
prevalence increases with age.

AMD is caused by hardening of

the arteries that nourish the retina.
This deprives the sensitive retinal
tissue of oxygen and nutrients that
it needs to function and thrive. As
a result, the central vision
deteriorates. Copyright JMDairo08
 Risk factor for macular degeneration
• -Increasing age • Use thyroid
• - Smoking history hormones
• Hypertension
• Familial incidence
• ( more common in
Caucasians than
Africans

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 Macular degeneration

• Two types of macular

degeneration
• A. Dry or non-
exudatative type the
most common type.
• B. Wet or exudatative
type .

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DRY MACULAR DEGENERATION affects the retina, the light
sensitive layer of the eye.
It typically begins with tiny deposits of a yellowish material known
as "drusen" in the macula area. As these yellowish deposits form
under the retina, they can result in distortion, blurring of vision and
gradual vision loss of varying degrees.
As the condition progresses, the macula becomes permanently
thinned and scarred. There is no treatment for dry macular
degeneration; however, recent research indicates that certain
vitamin and mineral supplements decrease the progress of the
disease. Research for viable treatment options is ongoing. In the
meantime, use of magnifiers and other low vision adaptations
should be investigated.

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WET MACULAR DEGENERATION is a severe progression of
the dry type. As more and larger deposits of drusen develop
under the retina, larger areas of the macula are damaged. Blood
vessels growing up from below the retina leak blood under the
macula. These abnormal blood vessels may break and cause
bleeding. Pressure from these pockets of blood damage the light
sensing cells, detroying the ability to see straight ahead. Scars
often form, further destroying the sensitive macular area. Wet
(also called “neovascular”) macular degeneration is the more
unusual and more severe form of macular degeneration, capable
of causing sudden, rapid loss of vision.

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Wet macular degenerative

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• Nursing management
• Education
• Bright lighting
• Assess the house of the client for safety.
• Amsler grid are given to patient to use to
monitor for sudden onset of distorted vision

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 Amsler grid
Normal vision Macular degenerative

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 Conjunctivitis

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 Conjunctivitis
• Pink eye may be triggered by a virus,
bacteria, an allergic reaction (to dust, pollen,
smoke, fumes or chemicals) or, in the case
of giant papillary conjunctivitis, a foreign
body on the eye, typically a contact lens.
• Bacterial and viral infections elsewhere in
the body may also induce conjunctivitis.

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Bacterial conjunctivitis is a common type of pink eye,
caused by bacteria that infect the eye through various
sources of contamination. The bacteria can be spread
through contact with an infected individual, exposure to
contaminated surfaces or through other means such as
sinus or ear infections.
The most common types of bacteria that cause bacterial
conjunctivitis include Staphylococcus aureus,
Haemophilus influenzae, Streptococcus pneumoniae and
Pseudomonas aeruginosa.

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Bacterial conjunctivitis
Bacterial conjunctivitis is usually associated
with a thick discharge or pus and can affect
one or both eyes.
As with any bacterial infection, antibiotics are
required to eliminate the bacteria. Treatment of
bacterial conjunctivitis is typically
accomplished with topical antibiotic eye drops
and/or eye ointments. The treatments are
usually continued for one to two weeks,
depending on the severity of the infection.
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 Bacterial conjunctivitis
• Management :
• Its almost self limiting lasting two weeks
• Except for the gonococcal and
staphylococcal conjunctivitis.
• If not treated corneal perforation and
blindness – urgent treatment
• Trachoma- broad spedtrum antibiotics
( topically or systemically ) surgical
management includes the correction of
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Viral conjunctivitis is another common type of
pink eye and, as mentioned above, is considered
the true "pink eye." Viral conjunctivitis is highly
contagious, because airborne viruses can be
spread through sneezing and coughing. Viral
conjunctivitis also can accompany common viral
upper respiratory infections such as measles, the
flu or the common cold.

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 Viral conjunctivitis
• May use artificial tear
• New tissue every time you wipe your eyes.
• Acetaminophen (Tylenol) for mild pain
medication.
• Discard all make up apply after the disease
is over.
• 3-7 days before the employee can work until
the symptoms disappear.
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Allergic conjunctivitis caused by eye allergies is very
common. Eye allergies, like other types, can be triggered by
allergens including pollen, animal dander and dust mites.
The most common symptom of allergic conjunctivitis is itchy
eyes, which may be relieved with special eye drops containing
antihistamines to control allergic reactions. These eye drops are
available over-the-counter and in prescription forms.

Management- Use of vasoconstriction such as

topical epinephrine solutions, cold compress,
ice packs and cool ventilation.

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Non-infectious conjunctivitis linked to eye irritation
causing a pink eye can result from many sources
including smoke, diesel exhaust, perfumes or certain
chemicals. Some forms of conjunctivitis also can be
related to sensitivities to certain ingested substances,
including herbs such as eyebright.

Management :
The eye must be irrigated immediately and profusely with
saline or sterile water.

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 Legally blind
• visual loss of acuity to read print;
• must use braille, may have light perception
• 20/200 or less than 20 degrees visual field.
Intervention:
E.When speaking – normal tone of voice
F.Alert the client when approaching
G.Orient the client in the environment
H.Allow the client to touch object in the
environment .
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 Legally blind
• Use clock placement of food.
• Brailles
• The client should hold on the nurse elbow
• The client should be one step behind.
• Teach the client use of cane that use for
blind

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An injury occurs to the eye in which the object
penetrates the eye.

Interventions:
Never remove the object it must be remove by the
physician
Cover the object with cup.
Do not allow the client to bend
Do not put pressure in the eye.
Client must be seen by physician immediately
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An eye injury in which a caustic substance enters the eye.

Intervention :
Treatment should begin immediately
Flush the eyes at the site of injury with water for at least 15-20
minutes.
At the scene obtain sample of chemical.
At the emergency room the eye should be irrigated with normal saline
solution for at least 10 minutes.
Solution should be directed in the across the cornea and towards the
lateral canthus.
Assess visual acuity
Give antibiotic as prescribe
Cover the eye with patch as prescribe.
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Donor eyes- usually from cadavers
-Must be enucleated soon after death
-Donors eyes must be preserve in a preserving
solution
-Storage , handling and coordination of donor
tissue and surgeons is provided by a network state
eye bank association across the country.

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Preoperative care for the recipient:
-The client should be told that the tissue availability is
only several hours to 1 day.
-Assist client anxiety
-Assess the eye for sign of infection
-Report any signs of redness, watery purulent drainage, or
edema around the eye.
-Instill antibiotic drops as prescribe
-Administered fluids and medications intravenously as
prescribe
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Post operative care:
-Eye is covered with pressured patch protective shield left till the
next day.
-Do not remove or change the dressing without the physicians
order.
-Monitor vital signs
-Monitor level of consciousness
-Assess the dressing
- Position the client head elevated and non operative side.
-Orient the client frequently
-Monitor for complication such as bleeding, wound leakage and
graft rejection.
-Eye shield for 1 month don’t rub the eye.
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•Thank you