Vision problems and Eye Disorders

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Three protions of the eye:

* sclera (white part of the eye)

*tunic (3 different parts) iris, sclery body and choroid.

*Retian- area where rods and cones located. Parts of retian is rods (pheripereal vision) and cones (color).

Carotid artery supplies blood to the eye.

*cornea-->lens-->optic nerve (light goes in)

Describe diagnostic test used for assessment of the eye and vision

* Visual acuity test-read chart Snellen. Person should be at 20 ft. What the person can see at 20 ft.

* Tonometry(glaucoma)- Measures intraocular tesnion by use of a tonometer.

*assessment of Visual Fields(conrontational test)- Sit facing client. Eyes cover by nurse and patient cover his/her opposite eye.  Nurse moves finger and both should see the finger at approximately the same time.

Describe diagnostic test used for assessment of the eye and vision

(cont'd 2)

*Opthamascopy exam- Can view the interior structure of the eye.

*Corneal Staining- Isntllitation of fluorescin dye into the conjunctival sa to outline irregualrtites of the corneal surface.

* Slit Lamp Exam(room as to be dark)- examiner can localize the psotion of any abnormaitly in the cornea,lens, or anterior vitreous humor.

List 4 Observation that could indicate an eye/Vision problem

1. Persistent redness of the eye.

2. Disturbances of vision

   a. fogginess..cataracts

    b. loss of side vison..glaucoma

    c. sudden devleopment of many floating      spots...retinal detachment.

     d. Ventral blindspot-ARMD (age related macualr degeneration)

3. Itching with draniage-->conjucntivities

4. Crossing of eyes

5. Pain

List 4 Observation that could indicate an eye/Vision problem

(cont'd 3 )

5. pupil irregualrities

6. growth in the eyelids

Identify action and intervention for commonly used opthalmic preparations

1. Topical anesthetic: Pontocaine (drug)-->produces anestheia(action){numbness in eye & decreased vison}--->Patch eye to prevent injury. Lacrimal pressure.

2. Topical Steroids(antinflammatory): Inflamase Forte 1% solution {predulose}-->Prevents scar tissue formation, inhibits inflammation(action)-->Tell client not to use left over meds

Identify action and intervention for commonly used opthalmic preparations

3. Miotics: Pilocarpine (drug--drops/disk)-->Constricts the pupil and thereby permits the outflow of aqueous humor.  This will decrease pressure in eyeball--->Vison may be temporarily blurred. Lacrimal pressure.

4. Beta blocker: Timoptic Betagon(drug) --->reduces aqueous humor formation and formation and therefore will help dcrease IOP (glaucoma)--->Lacrimal Pressure medication may cause orthostatic hypotension.

Identify action and intervention for commonly used opthalmic preparations

(cont'd 3)

Mydratics: Neo-synephrine.atripine,epinefrin--->dilates pupils. May be used for eye exam and ebfore surgery-->tell client to wear sunglasses until effects of drug wear off(interventions). Lacrimal pressure.

Mydratic and cycloplegic: Cyclogyl{adjust for near or far}-->Dilates pupils eye exam--->lacrimal pressure(intervention)

Identify action and intervention for commonly used opthalmic preparations

(cont'd 4)

Antiinfectives: Gentamicin--->Kills bacteria and other organisms. Used to prevent infection-->Continue as Rx-No lacrimal pressure (interventions)

The following are especially important

1. Know the reactions for the use of the drug.  An importnat nursing function is to evaluate for effectiveness of medications.

2. Read the order carefully and be sure you understand it.

3. Asepsis is essential.  If an eye is infected, use seperate bottle.

4. Only use medications labelled OPTHALMIC.

The following are especially important

(CONT'D)

5. Store eye medication in a seperate area from others.

6. Be a Rsik manager.

7. Be sure label is not smeared or obliterated.

8. Check date.  Don't use solutions that are cloudy or have changed color.

The following are especially important

(CONT'D 3)

9. Identify cleint by name and wristband.

10. Identify correct eye!!

     a. OD

      b. OS

      c. OU

If client questions order or says it's the wrong eye, CHECK IT OUT!!

11. Many eye meds may be absorbed into the blood stream and cause systemic reactions.

State uses of eye pads and eye shield and identify how you applye either.

Eye pad: Used to limit movement of eye after surgery.

 Eye shield: Worn to protect eye from injury. Shape metal shield to fit comfortably, tape edges, place over the eye pad.

   *shield only at night.

    *Rest on bone, never touches the eye.

Describe what occurs in: Corneal abrasion, strabismus, detached retina, amd cataracts, including treatments and nursing implications

(corneal abrasion)

Corneal Abrasion:

Cause: May result from injury to cornea. MAy progress to an ulcer.

Treatment:

   1. Fluorescin dye may be instilled into the cjunctiva sac to diagnose. Slit lamps to be used.

 2. Mydratics= to dilate eyes

 3. Antibiotics

Nurisng Implications for Corneal Abrasion

Cover the eye.

Safety

Artificial lubricant

Strabismus

A deviation of the eye. Normally the postion of the eyes at rest is straight on

Cause:

  i. Farsightdeness

  ii. nearsightedness

  iii. hereditary

 iv. Can lead to Ambloypia.(lazy eye) affects only one eye.

Strabismus

signs & symptoms

Double/blurred vision

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Strabismus

Treatment

i. Occlusion therapy(patching of the eye)

ii. Glasses

iii. Surgery muscle resection or recession may be done to rotate the ye to a different position

Strabismus

nursing implications

Orthopic training

Detached Retina

retina becomes detached from the choroid

Cause

i. Neoplasm- cancer of the eye

ii. Trauma-blunt force to the head.

iii. Aphakia- absence of the lens

iv.  degeneration changes

v.  Vascular disease hypertension

vi.  Intraocular inflammation (glaucoma)

Detached Retina

signs & symptoms

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a. Sudden appearance of flashing lights.

b. Floating spots

Detached Retina

later s/s

Shadow across the vision field.

Early treatment; bedrest; not lying down with eye down; no straining

Detached Retina

treatment

Crotherapy {freezing}

laser beam {thermal inflammation}

Scleral buckling {depress sclera toward the vitreous}. Introduce gas bubble in eye. Position them to prone

Detached Retina

nursing implications

* Cover the eye

*protect the eye

*bedrest

*with bathroom privileges.

Corneal abrasion

signs & symptoms

1. pain

2. redness

3. swelling {light sensitivity}

4. increase lacrimation {water}

Cataract (cause)

A clouding or opacity of the normally transparent lens. Become milky and white

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Most commonly associated with age. Develop over a period of time

Cataracts

Signs & symptoms

* Gradual impairment of vision

*Blurring

*sensitivity to glare

Cataracts

treatment

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Phacoemulsification: Removes the cataract through an approx. 1/8" incision where the cornea meets the conjuctiva, leaves the outer layer in place.  The capsule will support lens implant.

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Cataracts

treatment

(extracapsular extraction)

Extracapsular Extraction: The lens is opened and the nucleus is removed in one piece and the softer lens capsule is cauumed out, leaving the lens capable in tact for support of the new lens.

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Cataracts

nursing implications

* safety

*no heavy lifting

*monitor for increase pressure

*No coughing

*Quick movements

Cataracts

nursing implications

(con'td)

* No straning

*no lying on opposite sides

Macular Degeneration

facts

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* age related

*progressive loss of central vision

*leads to legal blindness

*affects 1.7 million people

*Leading cause of vison loss in those over 65

Macular Degeneration

facts

(cont'd)

*Fovea is damaged

Macular Degeneration

Symptoms

* distortion

*blurring

* loss of contrast sensitivity

*increase glare

*dimming of colour vision

*pheripereal vision is retained.

*no treatment

Macular Degeneration

(management)

Glaucoma

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Typically have an elevated IOP leading to optic nerve atrophy, loss of periphereal vision.

Glaucoma

Risk factors

Hereditary, diabetes, eye surgery, cortisone medications

Glaucoma

types of it

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1. Open angle- chronic, wide angle, simple

a. most common type.

b. angle between iris and cornea is normal.

c. flow of aqueous humor through trabecyular meshwork and into canal of schlemn is obstructed

d. Usually affects both eyes

Glaucoma

(close angle )

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acute narrow, angle, close angle

* Narrowing of the angle between the iris and the anterior chamber.

*When lens thickens during accomodation or iris thckens during pupil dilation, angle closes completely.

*Episodes are typically unilateral.

*Episodes often occur in association with darkness, emotional upset or other factors that cause pupil to dilate.

(considered an emergency)

Glaucoma

signs & symptoms

(open angle)

* gradual loss of periphereal vision

*usually painless

*foggy vision

*halos around lights

Glaucoma

(angle closure)

signs & symptoms

* abrupt onset of eye pain headache

*N & V (nausea and vomiting)

*rapid raise in IOP

*colored halos around lights

*fixed pupil

Glaucoma

angle closure

signs & symptoms cont'd

*reddened conjunctiva

* cloudy cornea

Teach cleints with Hx of agle closure glaucoma avoid meds such as atropine, anticholinergics, anthisthamine which have pupil dilating effect

Glaucoma

angle closure

treatment

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1. Medication--> myotics, beta blockers

2. surgical-->trabeculopasty and trabeculectomy- to enchance flow

3. irdotomy or iridectomy to prevent the rirs from occluding the anterior chamber

Tonometry

* Noncontact tonometer

*directs a puff of air against the cotnea.

*10-20 mmhg

*This causes an indentation

*Test measures intraocular tension

Corneal Staining

* Sterile paper wetted with dye is touched to the inner surface of the lower lid.

*blue dye

*Will show any irregularities of the corneal surface.

*Also used with slit lamp exam