eye management

nursing mamagement and education for eye medications

-Before the administration of ocular medications, the nurse warns the patient that blurred vision, stinging, and a burning sensation are symptoms that ordinarily occur after instillation and are temporary. -Risk for interactions of the ocular medication with other ocular and systemic medications must be emphasized; therefore, a careful patient interview regarding the medications being taken must be obtained. -Emphasis must be placed on hand hygiene techniques before and after medication instillation. -The tip of the eye drop bottle or the ointment tube must never touch any part of the patient's eye. -The medication must be recapped immediately after each use. -The patient or the caregiver at home should be asked to demonstrate actual eye drop or ointment instillation and punctal occlusion.

how to administer eye drops

-Eye drops should be instilled at a distance of approximately 1 in from the eye. 1.Before instilling the eyedrops, instruct the patient to look up and away. 2.The lower lid is gently pulled down to instill the drops in the conjunctival sac. 3.Immediately after instilling eye drops, apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 3-5 minutes. 4.Using a clean tissue, gently pat the skin to absorb excess eyedrops that run onto the patient's cheeks. -Medication is administered into the conjunctival sac, rather than on the eyeball, which can cause discomfort. -Gentle pressure on the inner canthus (punctal occlusion) is done to decrease the risk of systemic absorption of the medication.

Ocular Irrigants and Lubricants

-Irrigating solutions are used to cleanse the external lids to maintain lid hygiene, to irrigate the external corneal surface to regain normal pH (e.g., in chemical burns), to irrigate the corneal surface to eliminate debris, or to inflate the globe intraoperatively. -Lubricants, such as artificial tears, help alleviate corneal irritation, such as dry eye syndrome

What protective factors of the eye prevent full absorption of medication?

-Limited size of the conjunctival sac. The conjunctival sac can hold only 50 μL, and any excess is wasted. The volume of one eye drop from commercial topical ocular solutions typically ranges from 20 to 35 μL. -Corneal membrane barriers. The epithelial, stromal, and endothelial layers are barriers to absorption. -Blood-ocular barriers. Blood-ocular barriers prevent high ocular tissue concentration of most ophthalmic medications because they separate the bloodstream from the ocular tissues and keep foreign substances from entering the eye, thereby limiting a medication's efficacy. -Tearing, blinking, and drainage. Increased tear production and drainage due to ocular irritation or an ocular condition may dilute or wash out an instilled eye drop; blinking expels an instilled eye drop from the conjunctival sac

Macular Degeneration.

-Macular degeneration is the leading cause of severe, irreversible vision loss in people over 60 years of age. -Commonly called AMD, it is characterized by tiny, yellowish spots called drusen beneath the retina. -Most people older than 60 years of age have at least a few small drusen. -There are two types of AMD, commonly known as the dry type and wet type.

Identify the nursing interventions for AMD. (there will only be a focus on education).

-Most patients benefit from the use of bright lighting and magnification devices and from referral to a low-vision center. -Some low-vision centers send representatives to the patient's home or place of employment to evaluate the living and working conditions and make recommendations to improve lighting, thereby improving vision and promoting safety. -Amsler grids are given to patients to use in their home to monitor for a sudden onset or distortion of vision. These may provide the earliest sign that macular degeneration is getting worse. Patients should be encouraged to use these grids and to look at them, one eye at a time, several times each week with glasses on.

When administering mydriatic and cycloplegic agents, what is some considerations the nurse must be aware?

-Mydriasis, or pupil dilation, is the main objective of the administration of mydriatic and cycloplegic agents -The patient may have difficulty reading. The patient is advised to wear sunglasses (most eye clinics provide protective sunglasses). The ability to drive is dependent on the person's age, vision, and comfort level. -Mydriatic and cycloplegic agents affect the central nervous system. Their effects are most prominent in children and elderly patients; these patients must be assessed closely for symptoms, such as increased blood pressure, tachycardia, dizziness, ataxia, confusion, disorientation, incoherent speech, and hallucination. These medications are contraindicated in patients with narrow angles or shallow anterior chambers, and in patients taking monoamine oxidase inhibitors or tricyclic antidepressants

Identify the medical management of Cataracts

-Nonsurgical (medications, eyedrops, eyeglasses) treatment has not been found as curative for people with cataracts nor does it prevent age-related cataracts -When both eyes have cataracts, one eye is treated first, with at least several weeks, preferably months, separating the two procedures -Intracapsular Cataract Extraction -Extracapsular Cataract Extraction

Management of conjunctivitis depends on?

-The management of conjunctivitis depends on the type. Most types of mild and viral conjunctivitis are self-limiting, benign conditions that may not require treatment -For more severe cases, topical antibiotics, eye drops, or ointments are prescribed. Patients with gonococcal conjunctivitis require urgent antibiotic therapy. If left untreated, this ocular disease can lead to corneal perforation and blindness. The systemic complications can include meningitis and generalized septicemia.

How does the patient with macular degeneration describe their vision?

-There is a wide range of visual loss in patients with macular degeneration, but most patients do not experience total blindness. Central vision is generally the most affected, with most patients retaining peripheral vision. -In dry AMD, the outer layers of the retina slowly break down. With this breakdown comes the appearance of drusen. When the drusen occur outside of the macular area, patients generally have no symptoms. When the drusen occur within the macula, however, there is a gradual blurring of vision that patients may notice when they try to read -Wet AMD may have an abrupt onset. The affected vessels can leak fluid and blood, elevating the retina. Patients report that straight lines appear crooked and distorted, or that letters in words appear broken.

viral conjuctivitis

-Viral conjunctivitis can be acute and chronic. -The discharge is watery, and follicles are prominent. -Severe cases include pseudomembranes. Pseudomembranes appear as tissue that covers the conjunctiva or sclera but are actually composed of mucus, fibrin, bacteria, or immune system cells. -The common causative organisms are adenovirus and herpes simplex virus. -causes extreme photophobia. -Symptoms include extreme tearing, redness, and foreign-body sensation that can involve one or both eyes. There is lid edema, ptosis, and conjunctival hyperemia (dilation of the conjunctival blood vessels) -Viral conjunctivitis, although self-limited, tends to last longer than bacterial conjunctivitis.

patient education for intraocular lens implant

-Wear glasses or metal eye shield at all times following surgery, as instructed by the provider. -Always wash hands before touching or cleaning the postoperative eye. -Clean the postoperative eye with a clean tissue; wipe the closed eye with a single gesture from the inner canthus outward. -Bathe or shower; shampoo hair cautiously or seek assistance. -Avoid lying on the side of the affected eye the night after surgery. -Keep activity light (e.g., walking, reading, watching television). -Resume the following activities only as directed by the surgeon: driving, sexual activity, unusually strenuous activity. -Remember not to lift, push, or pull objects heavier than 15 lb. -Avoid bending or stooping for an extended period. -Be careful when climbing or descending stairs. -Know when to contact the surgeon

how to administer eye ointment

1.Apply a ½-in ribbon of ointment to the lower conjunctival sac. 2.Immediately after ointment instillation, ask the patient to roll his or her eyes behind closed lids. -Medication is administered into the conjunctival sac, rather than on the eyeball, which can cause discomfort. -Rolling the eye helps to distribute the medication over the surface of the eyeball.

how to instil eye medication

1.Ensure adequate lighting. (Adequate lighting ensures the procedure will be carried out using appropriate technique.) 2. Perform hand hygiene. (Hand hygiene and aseptic technique is important to decrease the risk of contamination of supplies and the spread of further infection.) 3. Don clean gloves and, if necessary or required, gently clean any crusts or drainage from the eyelid margins, wiping from the inner to the outer canthus and using a fresh gauze pad or cotton ball moistened with warm water for each stroke. (Cleaning the eyes promotes patient comfort and promotes absorption of medications. Additionally, debris is removed from the nasolacrimal duct.) 4. Prepare medication. Read the label of the eye medication to make sure it is the correct medication. Shake suspensions or "milky" solutions to obtain the desired medication level. Verify which eye is to be treated. (Proper checking of medication and which eye is to be treated is an essential right. Mixing of medication in suspension is required.) 5. Assume proper position for instillation of eye medications. (Positioning of the patient's head in a supine position or, if sitting, hyperextended in a "sniffing position" allows for proper instillation of ophthalmic medication, particularly drops.) 6. Do not touch the tip of the medication container to any part of the eye or face. Hold the lower lid down; do not press on the eyeball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid. (Maintaining aseptic technique avoids contamination of materials, such as the medication container. Using the cheek bone as a fulcrum to steady the arm allows for improved medication delivery.) 7. Apply medication. Instill eye drops before applying ointments. 8. Wait 5 minutes before instilling another eye medication. (Allow for absorption of one medication to occur prior to applying another one.) 9. Perform hand hygiene. (Hand hygiene prevents further contamination post instillation.)

risk factors for developing glaucoma

1.Family history of glaucoma 2.African American race 3.Older age (over 60 years of age) 4.Diabetes mellitus 5.Cardiovascular disease 6.Migraine syndromes 7.Nearsightedness (myopia) 8.Eye trauma 9.Prolonged use of topical or systemic corticosteroids

What is the progression of Glaucoma

1.Initiating events Precipitating factors include illness, emotional stress, congenital narrow angles, long-term use of corticosteroids, and use of mydriatics (i.e., medications causing pupillary dilation). 2.Structural alterations in the aqueous outflow system Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations. 3.Functional alterations Conditions such as increased IOP or impaired blood flow create functional changes. 4.Optic nerve damage Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply. This fourth stage inevitably progresses to the fifth stage. 5.Visual loss Progressive loss of vision is characterized by visual field defects.

What risk factors are associated with cataract formation?

Aging: · Loss of lens transparency · Clumping or aggregation of lens protein (which leads to light scattering) · Accumulation of a yellow-brown pigment due to the breakdown of lens protein · Decreased oxygen uptake · Increase in sodium and calcium · Decrease in levels of vitamin C, protein, and glutathione (an antioxidant) Associated ocular conditions: · Retinitis pigmentosa · Myopia · Retinal detachment and retinal surgery · Infection (e.g., herpes zoster, uveitis) Toxic factors: · Corticosteroids, especially at high doses and in long-term use · Alkaline chemical eye burns, poisoning · Cigarette smoking · Calcium, copper, iron, gold, silver, and mercury, which tend to deposit in the pupillary area of the lens Nutritional factors: · Reduced levels of antioxidants · Poor nutrition · Obesity Physical factors: · Dehydration associated with chronic diarrhea, use of purgatives in anorexia nervosa, and use of hyperbaric oxygenation · Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock · Ultraviolet radiation in sunlight and x-ray Systemic diseases and syndromes: · Diabetes mellitus · Down syndrome · Disorders related to lipid metabolism · Kidney disorders · Musculoskeletal disorders

allergic conjunctivitis manifestations

Allergic conjunctivitis is characterized by extreme pruritus, epiphora (i.e., excessive secretion of tears), injection, and usually severe photophobia. A string-like mucoid discharge is usually associated with rubbing the eyes because of severe pruritus. Vernal conjunctivitis is also known as seasonal conjunctivitis because it appears mostly during warm weather.

Which type of macular degeneration is more prevalent?

Approximately 90% of people with AMD have the dry or nonexudative type, which has an insidious onset and leads to a mild to moderate loss of vision, although peripheral vision is preserved.

bacterial conjunctivitis manifestations

Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. There is conjunctival irritation, and injection in the fornices. The exudates are variable but are usually present on waking in the morning. The eyes may be difficult to open because of adhesions caused by the exudate. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases. In gonococcal conjunctivitis, the symptoms are more acute and may present with profuse and purulent exudate, lymphadenopathy, and pseudomembranes.

Toxic Conjunctivitis

Chemical conjunctivitis can be the result of medications; chlorine from swimming pools; exposure to toxic fumes among industrial workers; or exposure to other irritants

What population is most affective by impaired vision?

Chief causes of visual impairment or blindness include diabetic retinopathy and age-related eye diseases (i.e., cataracts, macular degeneration, and glaucoma).

bacterial conjunctivitis definition and causes

Chronic bacterial conjunctivitis is usually seen in patients with lacrimal duct obstruction, chronic dacryocystitis (infection of the nasolacrimal sac), and chronic blepharitis (eyelid inflammation). The most common causative microorganisms are S. pneumoniae, H. influenzae, and S. aureus.

What are the symptoms of conjunctivitis?

Clinical features important to evaluate are the type of discharge (watery, mucoid, purulent, or mucopurulent), presence or absence of lymphadenopathy (enlargement of the preauricular and submandibular lymph nodes where the eyelids drain), important symptoms such as a foreign-body sensation, irritation, a scratching or burning sensation, a sensation of fullness around the eyes, crusting of the eyelids, itching, visual blurring, and photophobia

Identify common ocular medications

Common ocular medications include topical anesthetic, mydriatic, and cycloplegic agents that reduce IOP; anti-infective medications, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), antiallergy medications, eye irrigants, and lubricants.

Pathophysiology of Glaucoma

Glaucoma is a group of ocular conditions characterized by optic nerve damage. The optic nerve damage is related to the intraocular pressure (IOP) caused by congestion of aqueous humor in the eye. the average IOP is generally at or below 21 mm Hg.

allergic conjunctivitis physiology

Immunologic or allergic conjunctivitis is a hypersensitivity reaction that occurs as part of allergic rhinitis (hay fever), or it can be an independent allergic reaction. Patients often present with a history of atopy, a genetic predisposition toward hypersensitivity reactions. Atopic conditions include allergies (e.g., food and seasonal), asthma, and atopic dermatitis (e.g., eczema).

Intracapsular Cataract Extraction

In intracapsular cataract extraction, the entire lens (i.e., nucleus, cortex, and capsule) is removed and fine sutures are used to close the incision. It is infrequently performed today but is still indicated when there is a need to remove the entire lens, such as with a subluxated cataract (i.e., partially or completely dislocated lens).

Identify the medical management of impaired vision.

Low-vision aids include optical and nonoptical devices. The optical devices include convex lens aids, such as magnifiers and spectacles; telescopic devices; anti-reflective lenses that diminish glare; and electronic reading systems, such as closed-circuit television and computers with large print.

Angle-Closure Glaucoma

Obstruction in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of the peripheral iris to the trabecula. The obstruction results in an increased IOP.

Antiallergy Medications

Ocular hypersensitivity reactions are extremely common and result primarily from responses to environmental allergens. Corticosteroids are commonly used as anti-inflammatory and immunosuppressive agents to control ocular hypersensitivity reactions.

would a patient with cataracts present?

Painless, blurry vision is characteristic of cataracts. The person perceives that surroundings are dimmer, as if his or her glasses need cleaning. Light scattering is common, and the person experiences reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity. Other effects include myopic shift, astigmatism, monocular diplopia (double vision), color shift (the aging lens becomes progressively more absorbent at the blue end of the spectrum), brunescens (color values shift to yellow-brown), and reduced light transmission.

Emmetropia

Patients for whom the visual image focuses precisely on the macula and who do not need eyeglasses or contact lenses (normal vision).

How would the patient with a retinal detatchment describe their vision?

Patients may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do not complain of pain.

What postoperative complications of retinal detatchment surgury should the patient know about?

Postoperative complications may include increased IOP, endophthalmitis (inflammation of the internal layer of the eye), development of other retinal detachments, development of cataracts, and loss of turgor of the eye. Patients must be taught the signs and symptoms of complications, particularly of increasing IOP and postoperative infection, such as eye pain, sudden change in vision, fever, lid swelling, or conjunctival and/or corneal injection (redness). Excessive pain, swelling, and bleeding must be reported immediately to the surgeon.

What is Retinal detachment?

Retinal detachment refers to the separation of the RPE from the sensory layer. The four types of retinal detachment are rhegmatogenous, traction, a combination of rhegmatogenous and traction, and exudative. Rhegmatogenous detachment is the most common form. In this condition, a hole or tear develops in the sensory retina, allowing some of the liquid vitreous to seep through the sensory retina and detach it from the RPE Tension, or a pulling force, is responsible for traction retinal detachment. In general, patients with this condition have developed fibrous scar tissue from conditions such as diabetic retinopathy, vitreous hemorrhage, or the retinopathy of prematurity. The hemorrhages and fibrous proliferation associated with these conditions exert a pulling force on the delicate retina.

Extracapsular Cataract Extraction

The extracapsular cataract extraction technique involves smaller incisional wounds (less trauma to the eye) and maintains the posterior capsule of the lens. A portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex. The posterior capsule and zonular support are left intact. An intact zonular-capsular diaphragm provides the needed safe anchor for the posterior chamber intraocular lens (IOL)

What precautions should the patient take after treatment of a retinal detatchment?

The nurse should advise patients to avoid heavy lifting or strenuous activity that could increase intraocular pressure. Reading may be restricted until the surgeon gives permission. Patients wear sunglasses during the day and an eye patch at night. If a vitrectomy was performed with scleral buckling, patients are required to sleep with their head elevated. Air travel must be avoided until the gas bubble, injected during surgery into the vitreous cavity to position the retina, is absorbed. Driving may be restricted until vision stabilizes.

Wet or exudative AMD

Wet or exudative AMD is characterized by choroidal neovascularization (CNV), new growth of blood vessels beneath the retina, which causes severe vision loss in 90% of AMD cases

Hyperopia

When people have a shorter depth to their eyes, the visual image focuses beyond the retina; the eyes are shallower and are called hyperopic. People with hyperopia are farsighted. These patients experience near vision blurriness, whereas their distance vision is excellent.

Corticosteroids and Nonsteroidal Anti-Inflammatory Drugs

The topical preparations of corticosteroids are commonly used in inflammatory conditions of the eyelids, conjunctiva, cornea, anterior chamber, lens, and uvea.

Antiglaucoma Medications

Therapeutic medications for glaucoma are used to lower IOP by decreasing aqueous production or increasing aqueous outflow.

Identify the medical management of Glaucoma.

Treatment focuses on pharmacologic therapy, laser procedures, surgery, or a combination of these approaches. Lifelong therapy is almost always necessary because glaucoma cannot be cured. The goal is to maintain an IOP within a range unlikely to cause further damage.

Open-Angle Glaucoma

Usually bilateral, but one eye may be affected more severely than the other. In all three types of open-angle glaucoma, the anterior chamber angle is open and appears normal

patient education for conjunctivitis

Your eyes will look red and will have watery discharge, and your lids will be swollen for about a week. You will experience eye pain, a sandy sensation in your eye, and sensitivity to light. Symptoms will resolve after about 1 week. You may use light, cold compresses over your eyes for about 10 minutes four to five times a day to soothe the pain. You may use artificial tears for the sandy sensation in your eye, and mild pain medications, such as acetaminophen (Tylenol). You need to stay at home. Children must not play outside. You may return to work or school after 7 days, when the redness and discharge have cleared. You may obtain a doctor's note to return to work or school. Do not share towels, linens, makeup, or toys. Wash your hands thoroughly and frequently, using soap and water, including before and after you apply artificial tears or cold compresses. Use a new tissue every time you wipe the discharge from each eye. You may dampen the tissue with clean water to clean the outside of the eye. You may wash your face and take a shower as you normally do. Discard all of your makeup articles. You must not apply makeup until the disease is over. You may wear dark glasses if bright lights bother you. If the discharge from your eye turns yellowish and pus-like, or you experience changes in your vision, you need to return to the health care provider for an examination.

Blindness

a BCVA that can range from 20/400 to no light perception (NLP). The clinical definition of absolute blindness is the absence of light perception. Legal blindness is a condition of impaired vision in which a person has a BCVA that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less.

Astigmatism

an irregularity in the curve of the cornea. Because astigmatism causes a distortion of the visual image, acuity of both distance and near vision can be decreased.

How would a patient present with Glaucoma?

most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

Myopia

nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. People who are myopic experience blurred distance vision.

patient teaching for glaucoma management

· Know your IOP measurement and the desired range. · Be informed about the extent of your vision loss and optic nerve damage. · Keep a record of your eye pressure measurements and visual field test results to monitor your own progress. · Review all your medications (including over-the-counter and herbal medications) with your ophthalmologist, and mention any side effects each time you visit. · Ask about potential side effects and drug interactions of your eye medications. · Ask whether generic or less costly forms of your eye medications are available. · Review the dosing schedule with your ophthalmologist and inform him or her if you have trouble following the schedule. · Participate in the decision-making process. Let your provider know what dosing schedule works for you and other preferences regarding your eye care. · Have the nurse observe you instilling eye medication to determine whether you are administering it properly. · Be aware that glaucoma medications can cause adverse effects if used inappropriately. Eye drops are to be administered as prescribed, not when eyes feel irritated. · Ask your ophthalmologist to send a report to your provider after each appointment. · Keep all follow-up appointments.