Term
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Definition
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Term
| Things to think about when assessing the eye: |
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Definition
History- any injury? Any genetic issues?
External assessment
Visual fields, & eye movement
Eye position- exophthalmos, enophthalmos
Eye lids and lashes
Blink response
Conjunctivae, sclera
Light reflex- accommodation v. light reflex |
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Term
| Visual acuity refers to __ and __ vision |
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Definition
Near and far(distant) vision
use the snellen chart |
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Term
| When looking at visual fields, think about |
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Definition
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Term
| For pupil function, we are looking for ___ and ___? |
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Definition
| accommodation and direct/indirect light reflex |
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Term
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Definition
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Term
| Ophthalmoscopes are used to view: |
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Definition
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Term
| To test color vision, use numbers made of: |
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Definition
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Term
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Definition
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Term
| Some changes to the eyes that occur as one ages: |
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Definition
Smaller pupils, do not dilate easily- night vision a problem
Lens less elastic- near object difficult to see
Lens becomes opaque- color perception
Decreased depth perception, peripheral
Eyes recessed in socket- tissue folds on lids
Decreased strength of muscles of eye movement |
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Term
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Definition
Conjunctiva covers inner lid and external eye
Inflammation from bacteria or virus
Extremely contagious- “Pink Eye”
Redness and itching, gritty sensation
Tearing and discharge
Inflamed preauricular nodes |
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Term
| Conjunctivitis is treated with: |
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Definition
| Treated with antibiotic drops and pills |
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Term
| How to handle eye infections: |
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Definition
For Pain:
Analgesics, warm compresses
Also, Protect from sun
Look for: Visual changes
Don't wear contact lenses, hand washing, blurring
Beware of risk for spread of infection |
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Term
| Precautions to take for conjunctivitis: |
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Definition
| Precautions: Hand washing, wash eyes separately (use diff cloths), may use baby tearless shampoo especially for blepharitis |
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Term
| Some vision problems that are correctable: |
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Definition
Myopia- nearsighted (Light focused in front of retina)
Hyperopia- far sighted (Light focused behind retina)
Presbyopia- loss of accommodation
Astigmatism- irregular corneal curvature
Strabismus- both eyes do not focus on object simultaneously |
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Term
| For myopia (nearsightedness) the light is focused (in relation to retina): |
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Definition
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Term
| For Hyperopia (far sightedness), the light is focused (in relation to retina): |
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Definition
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Term
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Definition
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Term
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Definition
| irregular corneal curvature |
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Term
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Definition
| Both eyes do not focus on object simultaneously |
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Term
| What word describes no light perception and no usable vision? |
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Definition
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Term
| Blindness is most related to what common diseases? |
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Definition
Macular degeneration
Cataracts
Glaucoma
Diabetic retinopathy
*Only 4% related to injury |
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Term
| What percentage of the blind population is related to injury? |
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Definition
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Term
| When are cataracts most common? |
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Definition
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Term
| What are some causes of cataracts? |
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Definition
Cumulative exposure to UV (sun)
Reduced O2 uptake by lens
Dehydration of lens, opacity
Immature to “ripe”
Immature= some light getting through, useful vision
Ripe= poor vision, poor light penetration
Trauma or chemical irritation |
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Term
| Do cataracts tend to be unilateral or bilateral? |
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Definition
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Term
| What are they symptoms of cataracts? |
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Definition
Blurred vision
Photophobia
Sensitivity to glare- light is scattered
Vision better in low light
Cloudy appearance of lens |
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Term
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Definition
| abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes. |
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Term
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Definition
Too much light entering the eye. Too much light can enter the eye if it is damaged, such as with corneal abrasion and retinal damage, or if a pupil(s) is unable to normally constrict (seen with damage to the oculomotor nerve).
Overstimulation of the photoreceptors in the retina
Excessive electric impulses to the optic nerve
Excessive response in the central nervous system
Common causes of photophobia include migraine headaches, cataracts, or severe ophthalmologic diseases such as uveitis or corneal abrasion. |
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Term
| What should be done prior to cataract surgery? |
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Definition
Mydriatic medication pre-operatively to produce mydriasis or dilation of the eye
Anti-inflammatory eye drops
Educate patient on need to have someone available as will have limitation in vision due to eyepatch, can’t drive
Need to frequently instill drops after surgery |
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Term
| After cataract surgery, patient education includes: |
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Definition
Leave eye patch on with shield
For 24 hrs limit activity to sitting, resting in bed or limited walking in house
Do not rub eye
Do not lift more than 5 lbs
Do not strain, or bend over, lifting
Eye drops as ordered
No aspirin, take Tylenol for pain |
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Term
| After cataract surgery, additional teaching should include: |
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Definition
Report eye pain not relieved by Tylenol
Report headache, nausea, severe itching
Report swelling of eye
Eye patch should not put pressure on eye
Tearing is normal
Hazards of monocular vision
Unrelieved eye pain and nausea sign of increased intraocular pressure |
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Term
| TQ: The nurse is performing an assessment on a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: |
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Definition
| Blurred vision. A gradual, painless blurring of central vision is the chief clinical manifestation of cataract. Early symptoms include slightly blurred vision and a decrease in color perception. |
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Term
| Floating spots might mean a ___ or ____ |
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Definition
| retinal tear or intraocular bleed |
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Term
| Diplopia is not an ___ problem, but a ___ problem |
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Definition
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Term
| Initially, cataracts are painful or painless? |
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Definition
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Term
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Definition
Painless increased intraocular pressure
Optic nerve atrophy
Visual field loss
Common preventable cause of blindness |
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Term
| What population is more likely to suffer from glaucoma? |
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Definition
| 5 times more likely in African Americans than Caucasians |
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Term
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Definition
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Term
| What is the pathophysiology of glaucoma? |
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Definition
Decreased outflow of aqueous humor
Increased production of aqueous humor
Extra fluid caused increased pressure on retina- which is painless.
Decrease outflow + increased production = increased pressure on retina |
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Term
| What is open angle glaucoma? |
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Definition
Occurs over time
Vision changes are often not noticed
Loss of peripheral vision
Difficulty adapting to dark
Halos around lights
As pressure increases, acuity decreases |
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Term
| Open angle glaucoma occurs when: |
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Definition
| aqueous humor outflow through trabecular meshwork is impaired |
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Term
| Angle closure glaucoma occurs when: |
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Definition
the root of the iris occludes the trebecular meshwork
the angle of the iris blocks drainage of aqueous humor through the Canal of Schlemm.
It requires immediate intervention to prevent damaging increase in pressure |
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Term
| Characteristics of angle closure glaucoma? |
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Definition
Narrow angle, closed angle
With dilation of pupil the angle closes completely
This occurs quickly and the increased pressure causes damage to retina and permanent blindness
Happens in darkness, emotional distress which cause pupil dilation
Symptoms- sudden H/A, red conjunctiva, cloudy cornea, N&V |
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Term
| What drugs should be avoided in angle closure glaucoma? |
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Definition
| Must avoid mydriatic drugs- atropine, anticholinergics |
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Term
| Is angle closure glaucoma permanent? |
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Definition
| Yes, the increased pressure causes damage to retina and permanent blindness |
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Term
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Definition
| restores access of aqueous to the trabecular meshwork |
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Term
| Iridectomy often produces a ____ appearance to the pupil. |
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Definition
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Term
| How are medications helpful for glaucoma? |
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Definition
| they can control symptoms, but NOT a cure |
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Term
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Definition
Ex. (Miotic) pilocarpine gtts
Cholinergic drugs are medications that produce the same effects as the parasympathetic nervous system (rest and digest responses) |
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Term
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Definition
| A substance that causes constriction of the pupil of the eye |
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Term
| Parasympathetic (rest and digest) response of the eye involves: |
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Definition
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Term
| Sympathetic (fight or flight) response of the eye involves: |
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Definition
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Term
| What is a beta-adrenergic blocker? |
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Definition
Beta-adrenergic blockers- timoptic gtts
Beta blockers (sometimes written as β-blockers) or beta-adrenergic blocking agents, beta-adrenergic antagonists, or beta antagonists, are a class of drugs used for various indications. Particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction (heart attack), and hypertension. As beta adrenergic receptor antagonists, they diminish the effects of epinephrine (adrenaline) and other stress hormones. |
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Term
| Beta blockers block the action of: |
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Definition
| Beta blockers block the action of endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular, on β-adrenergic receptors, part of the sympathetic nervous system which mediates the "fight or flight" response |
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Term
| Several systemic meds that decrease production of aqueous humor? |
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Definition
Diamox (Acetazolamide Oral)
Acetazolamide is used to treat glaucoma, a condition in which increased pressure in the eye can lead to gradual loss of vision. Acetazolamide decreases the pressure in the eye. |
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Term
| A treatment for closed angle glaucoma: |
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Definition
| For Closed Angle- diuretics to bring intraocular pressure down quickly- mannitol (osmotic diuretic) |
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Term
| What is Timoptic (timolol maleate)? |
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Definition
Beta adrenergic antagonist, miotic- drops
Relaxes iris- constricts (miosis)
Reduces production of aqueous humor
Antihypertensive, antianginal, migraines- oral
NSAIDS antagonize hypotensive effects |
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Term
| How often are Timoptic (timolol maleate) drops typically given? |
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Definition
| Usually given every 12 hrs |
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Term
| What are adverse effects of Timoptic (timolol maleate) drops? |
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Definition
| Adverse effects- bronchospasm (COPD), bradycardia, syncope (loss of consciousness/fainting) |
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Term
| What are examples of NSAIDs? |
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Definition
| Examples of NSAIDs include aspirin, indomethacin (Indocin), ibuprofen (Motrin), naproxen (Naprosyn), piroxicam (Feldene), and nabumetone (Relafen). |
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Term
| What is Pilocarpine hydrochloride? |
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Definition
Cholinergic drug
Contraction of ciliary muscle, increasing outflow of aqueous humor, induces miosis (constriction)
Usually given 3-4 times per day |
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Term
| After instilling Pilocarpine hydrochloride, patient should: |
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Definition
| Apply gentle pressure to nasolacrimal duct for 1-2 minutes after instilling to prevent systemic effects |
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Term
| Adverse effects of Pilocarpine hydrochloride? |
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Definition
| Adverse effect- anticholinergic: Bronchospasm (COPD), tachycardia, dry mouth, urinary retention |
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Term
| Nursing issues with glaucoma: |
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Definition
Loss of vision is permanent- grieving
Treatment prevents further loss of vision
Teach instillation of eye drops- frequent and lifelong
Remember cross-contamination with drops
Issues with diuretics- K loss, dehydration |
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Term
| Loss of vision with glaucoma is reversible or permanent? |
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Definition
| PERMANENT, but tx can prevent further loss of vision |
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Term
TQ: The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? A. Decrease fluid intake to control the intraocular pressure.
B. Avoid over use of eyes.
C. Decrease the amount of salt in the diet.
D. Eye medication will need to be administered lifelong. |
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Definition
| D. Eye medication will need to be administered lifelong. The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life. |
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Term
| What is retinal detachment? |
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Definition
Painless separation of retina from choroid (vascular layer between sclera & retina) – dense with blood vessels- deprived of blood supply
More often with advanced age, trauma
Shadow or black area in vision, flashes of light as retina pulls away
Areas of detachment look bluish-gray |
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Term
| Characteristic of retinal detachment? |
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Definition
Shadow or black area in vision, flashes of light as retina pulls away
Areas of detachment look bluish-gray |
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Term
| How is retinal detachment treated? |
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Definition
No medical treatment
Laser Photocoagulation-burns edges and prevents further damage.
Pneumatic Retinopexy-instillation of gas bubble that rises to the location of the tear and puts pressure on the retina to connect to the choroid.
Scleral Buckling-surgical procedure to place retina back in contact with choroid from outside of eye. |
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Term
| What is Scleral Buckling? |
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Definition
| Scleral Buckling-surgical procedure to place retina back in contact with choroid from outside of eye. (for retinal detachment) |
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Term
TQ: The nursing is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of retinal detachment?
A. Complaints of a burst of black spots or floaters.
B. A sudden sharp pain in the eye.
C. Total loss of vision.
D. A reddened conjunctiva. |
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Definition
| A. Rationale: Complaints of a sudden burst of black spots or floaters indicates that bleeding has occurred as a result of the detachment. No pain is associated. Retinal detachment is a medical emergency and even more so if vision acuity is still normal. |
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Term
| Is retinal detachment painless or painful |
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Definition
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Term
| What is diabetic retinopathy? |
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Definition
Leading cause of blindness
Progressive disorder causing microscopic damage to the blood vessels of retina
Microaneurysms of capillaries, dilated & tortuous veins
Aneurysms rupture and cause small areas of scar tissue
Progressive retinal ischemia stimulated new vessels to grow- ineffective |
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Term
| What is the leading cause of blindness? |
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Definition
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Term
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Definition
| An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel |
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Term
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Definition
| A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels |
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Term
| "Cotton wool spots" are also known as: |
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Definition
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Term
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Definition
(from Latin macula, "spot" + lutea, "yellow") is an oval-shaped highly pigmented yellow spot near the center of the retina of the human eye. Near its center is the fovea, a small pit that contains the largest concentration of cone cells in the eye and is responsible for central, high resolution vision.
Because the macula is yellow in color it absorbs excess blue and ultraviolet light that enter the eye, and acts as a natural sunblock (analogous to sunglasses) for this area of the retina. . |
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Term
| Progressive destruction of the macula is called? |
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Definition
| Whereas loss of peripheral vision may go unnoticed for some time, damage to the macula will result in loss of central vision, which is usually immediately obvious. The progressive destruction of the macula is a disease known as macular degeneration and can sometimes lead to the creation of a macular hole. |
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Term
| What is the function of the macula? |
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Definition
| Structures in the macula are specialized for high acuity vision. Within the macula are the fovea and foveola which contain a high density of cones (photoreceptors with high acuity). |
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Term
| Treatment options for retinopathy are: ___ and ____. |
|
Definition
Photocoagulation- stop leaking of fluid onto retina
Vitrectomy- remove bloody vitreous, replace it with normal saline to maintain shape of eye |
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Term
| Nursing care after laser surgery: |
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Definition
Outpatient procedure
Vision blurry for a day, can't drive
Mild pain, headache, sensitivity to light for a few days-OTC pain meds, and patch
Spots in vision from laser disappear over time
Minimize increased intraocular pressure |
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Term
| What is macular degeneration? |
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Definition
Age-related degeneration of macula
Central vision loss
“Dry”- atrophy of outer retina and underlying tissues
“Wet”- serous fluid from choroid leaks into retina and macula
No known cure
Dietary supplements show some promise |
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Term
| What is "dry" macular degeneration? |
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Definition
“Dry”- atrophy of outer retina and underlying tissues
Dry- thinning of retinal tissue with yellowish spots of debris from cell breakdown- scar tissue |
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Term
| What is "wet" macular degeneration? |
|
Definition
“Wet”- serous fluid from choroid leaks into retina and macula
Wet- domes of fluid appear on retina causing visual change of distorted lines, with dark, blurry white out in center of vision |
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Term
| What are recommended supplements to take for patients with macular degeneration? |
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Definition
Supplements- Vit C + Vit E + Beta-carotene + zinc, and egg yolks (leutene)
No effective treatment or cure |
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Term
| What is retinitis Pigmentosa? |
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Definition
Progressive, genetic disease
Loss of peripheral vision progressing to total blindness
Caused by production of unstable protein
Loss of night vision in childhood, early
No treatment or cure
Should have genetic counseling |
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Term
| What causes retinitis pigmentosa? |
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Definition
| production of unstable protein |
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Term
| What is an early sign of retinitis pigmentosa? |
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Definition
| Loss of night vision in childhood, early |
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Term
| Patients with ___ should have genetic counseling. |
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Definition
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Term
| Things to know about corneal transplant: |
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Definition
Keratoplasty- is the use of donor corneas to improve clarity of vision (cadavers)
Local anesthesia
Visual return is slow, sutures distort the vision
Rejection is a problem |
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Term
| What to do for a blunt trauma to the eye: |
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Definition
Treatment begins immediately
See physician immediately to determine extent of injury
Ice
Visual acuity assessed |
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Term
| What to do for a penetrating eye emergency: |
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Definition
Never remove (try to isolate, protect, so object can not be moved/touched)
Notify physician immediately
Visual acuity assessed |
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Term
| What to do for a chemical eye emergency: |
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Definition
Irrigate X 10 min immediately
visual acuity assessed |
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Term
| Common step in treatment for blunt, penetrating, and chemical eye emergency: |
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Definition
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