Care of clients with retinal detachment Retinal detachment

is

the separation of the retina from the choroid, a membrane dense with vessels that is located between the retina and the sclera.

the thin layer sensitive tissue that lines the back position of the eye When the retina detaches, it is deprived of its blood supply & source of nourishment & loses its ability to function. This can impair vision to the point of blindness.

is

Types of Retinal Detachment:

Rhegmatogenous retinal detachment occurs due to a break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium Retinal breaks are divided into three types - holes, tears and dialyses. Holes form due to retinal atrophy especially within an area of lattice degeneration. Tears are due to vitreoretinal traction. Dialyses which are very peripheral and circumferential may be either tractional or atrophic, the atrophic form most often occurring as idiopathic dialysis of the young. Exudative, serous, or secondary retinal detachment occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break. In evaluation of retinal detachment it is critical to exclude exudative detachment as surgery will make the situation worse, not better. Although rare, exudative retinal detachment can be caused by the growth of a tumor on the layers of tissue beneath the retina, namely the choroid. Tractional retinal detachment A tractional retinal detachment occurs when fibrous or fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.

Predisposing Factor: Age, Cataract extraction, Degeneration of retina, trauma, severe myopia, previous retinal detachment in the other eye, family history of retinal detachment Clinical Manifestation: Shadow or curtain falling across the field of vision Shadows or black area in the field of vision are the result of separation of visual preceptors from the neuro pathway No pain Onset is usually sudden & maybe accompanied by a burst of black spots of floaters indicating that bleeding has occurred as a result of detachment May also see flashes of light caused by separation of the retina

Surgical Mgt: Laser Photocoagulation If the retina is torn or detachment is slight, a laser can be used to burn the edges of the tear and halt progression. If the detachment is small, the laser can seat the retina against the choroid. Laser surgery is usually performed as an outpatient procedure under local anesthesia.

Cryopexy

Uses nitrous oxide to freeze the tissue behind the retinal tear, stimulating scar tissue formation that will seal the edges of the tear usually performed as an outpatient procedure under local anesthesia.

Pneumatic Retinopexy

Most effective for detachment that occur in the upper portion of the eye. The eye is numb with local anesthesia & a small gas bubble is injected into the vitreous body. Cryopexy or laser is used to seal the retina into place.

Scleral Buckling Surgical procedure to place the retina back in the contact with choroid.

Nursing Mgt: Help the client cope with the fears and reality of loss of vision & adopt to changes in vision Encourage the client to resume a regular diet & fluids as tolerated Postoperative eye medications generally include an antibiotic- steroid combination eye drop to prevent infection & reduce inflammation Either warm or cold compresses maybe applied for comfort several times a day

Retinal Vascular Disorder Complications: Retinopathy



is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease. Causes of retinopathy are varied: diabetes arterial hypertension prematurity of the newborn direct sunlight exposure retinal vein or artery occlusion pheochromocytoma

MGt: Treatment for diabetic retinopathy depends on the type of diabetic retinopathy you have, its severity and how well it may have already responded to previous treatments. Early diabetic retinopathy If you have nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine if you need treatment.

Macular Degeneration is a degenerative disease of the retina (a thin layer of nerve cells that lines the back of the eyeball) that causes progressive loss of central vision. risk of developing macular degeneration increases with age most often affects people in their sixties and seventies

Risk Factors: Age, gender, race, smoking, family history Signs and Symptoms: Increasing blurriness of printed words Decrease in the intensity or brightness of colors Difficulty recognizing faces Visual distortions Decrease in or loss of central vision

Care with clients with orbital and ocular trauma Ocular trauma

Common cause of unilateral visual loss in young people. Often as a result of accident in and around the home.

Signs of possible severe injury:

Pain Subconjunctival hemorrhage Conjunctival laceration Iris defect Lowered IOP Extrusion of ocular contents

Orbital Fracture/ Balack eye

A break in one of the bones that make up the orbit. Since the orbit is the seat of the globe (the eye), an orbital fracture can be a serious, sight-threatening break. A black eye, with swelling and black and blue discoloration around the injured eye; possible redness and areas of bleeding on the white of the eye and on the inner lining of the eyelids Double vision, decreased vision or blurry vision Difficulty looking up, down, right or left Abnormal position of the eye (either bulging out of its socket or sunken in)

Symptoms:

Foreign Objects

A foreign object in the eye, such as dirt, an eyelash, a contact lens, or makeup, can cause eye symptoms. Objects may scratch the surface of the eye (cornea) or become stuck on the eye. If the cornea is scratched, it can be hard to tell whether the object has been removed, because a scratched cornea may feel painful and as though something is still in the eye. Most corneal scratches are minor and heal on their own in 1 or 2 days.

Symptoms:

Small or sharp objects traveling at high speeds can cause serious injury to many parts of the eyeball. Objects flying from a lawn mower, grinding wheel, or any tool may strike the eye and possibly puncture the eyeball. Injury may cause bleeding between the iris and cornea (hyphema), a change in the size or shape of the pupil, or damage to the structures inside the eyeball. These objects may be deep in the eye and may require medical treatment

Ocular Burn It should be irrigated with copious amounts of physiologic solution or water immediately After irrigation the eye is dilated by antibiotics are instilled as prescribed ( collagenase inhibitors such as acetylcysteine ( Mucomyst) or sodium edentate EDTA as prescribed to treat severe alkali burns.

Alkali Burns Alkali substances are lipophilic and penetrate more rapidly than acids. Saponification of cell membrane fatty acids causes cell disruption and death. In addition, the hydroxyl ion hydrolyzes intracellular glycosaminoglycans and denatures collagen. The damaged tissues stimulate an inflammatory response, which damages the tissue further by the release of proteolytic enzymes.

Acid Burns Acid burns cause protein coagulation in the corneal epithelium, which limits further penetration. Hydrofluoric acid is an exception. It is a weak acid that rapidly crosses the cell membrane as it remains non ionized. In this way, hydrofluoric acid acts like an alkali, causing liquefactive necrosis. In addition, fluoride ions are released into the cells. Fluoride ions may inhibit glycolytic enzymes and may combine with calcium and magnesium to form insoluble complexes.

Care with clients with infectious and inflammatory condition Dry eye syndrome is a condition in which tear production is inadequate, most commonly occurs in women between 50-60 years of age. 3 primary causes are lacrimal gland malfunction, mucin deficiency, & mechanical abnormalities that prevent the spread of tears across the surface of the eye. Manifestation: Burning Itching eyes Sensation of something in the eye Mgt: Artificial tears ( eyedrop & lubricants) Using airtight goggles at night to prevent tear evaporation

Mgt:

Artificial tears ( eyedrop & lubricants) Using airtight goggles at night to prevent tear evaporation

Conjunctivitis

Inflammation of the conjunctiva from various microorganism Redness Tearing Exudation of eyelid many progress to eyelid drooping Abnormal tissue growth Antibiotic eyedrops

Manifestation:

Mgt:

Uveitis

Inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. Redness of the eye Blurred vision Sensitivity to light Dark, floating spots along the visual field Eye pain

Symptoms:

Orbital Cellulitis

Is an acute infection of the tissues immediately surrounding the eye including the eyelids, eyebrow and cheek. Fever Painful swelling of upper and lower eyelids Eye pain especially with movement Decreased vision Bulging eyes General malaise CBC, Blood culture, Spinal tap

Symptoms:

Diagnostic Test:

Keratitis

Whenever the epithelium is damaged, the cornea becomes quite susceptible to infection; even small abrasions provide a point of entry for bacteria. Develop whenever the cornea is not adequately moistened and protected by the eyelids.

Mgt:

Acetaminophen may be required for pain management Cycloplegics & mydriatics may be prescribed to alleviate pain and inflammation Collagen shield may be used when short term corneal protection

Chalazion also known as a meibomian gland lipogranuloma, is a cyst in theeyelidthat is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid

Signs and symptoms:

Swelling on the eyelid Eyelid tenderness Sensitivity to light Increased tearing Heaviness of the eyelid

Mgt:


Topical antibiotic eye drops or ointment (e.g. chloramphenicol or fusidic acid)

Salamat sa pakikinig guyZZ!!!

Ang mga gumawa::: Gringo LanDO SubAs Ginger