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.