Visual disorders - Chapter 46 + 47
trachoma
-chronic conjunctivitis -caused by chlamydia trachomatis -scars the conjunctiva and is common cause of preventable blindness in the world -high incidence in warm, moist climates -at first is similar to bacterial conjunctivitis -tears, photophobia, eyelid edema -with disease progression, eyelid scars and turns inward, causing eyelashes to damage cornea management; -antibiotic therapy when organism is identified -ORAL AZITHROMYCIN -infection can be eliminated early in disease with a 4 week course of eye ointment
Medical manage of conjunctivitis
-depends on the type -mid and viral conjunctivits is self limiting -bacterial = antibiotic drops -viral not respondsive to any treatment -cold compress -dont touch your eyes -toxic conjunc you should flush eyes right away
ketatoconus and corneal opacities
-keratoconus is the degeneration of the corneal tissue resulting in abnormal corneal shape -can occur from trauma or inherited -infection and severe trauma can lead to this
keratoconjunctivitis sicca
-lacrimal system moistens eye surface with tears and removes tears from the eye. -dry eye syndrome -changes in tear production, composition, or distribution -RA, leukemia, sarcoidosis, sjogren's syndrome can cause this. as can radiation or chemical burns -injury to cranial nerve 7 can inhibit tears -foreign body sensation of the eye -burning and itching -photophobia (sensitive to light) -corneal light reflex dulled -tears can contain mucus strands management; -cyclosporine eyedrops (increase production) -artificial tears also can be used to reduce dryness -lubricating ointment is used at night -surgery may be needed if caused by eyelid positioning
Angle closure glaucoma
-less common than open -symptoms are sudden and rapid -iris pushed against drainage system blocking the flow of aqueous humor -diagnosis and treatment immediately -bradycardia -this is dangerous and can lead to permanent vision loss. an emergency
Rf for cataracts
-loss of lense
etiology and genetic risk of cataract
-may be present at birth or develop at any time -age related or caused by trauma -exposure to toxic agents -some degree of cataract formation is expected in all people over 70
Patient teaching
-medication compliance -must take your medications -can you administer this?
ocular melanoma
-melanoma is the most common malignant eye tumor in adults -30s and 40s -associated with exposure to UV light
retinal holes, tears, and detachments
-retinal hole is a break in the retina -trauma or by aging -retinal tear is a more jagged and irregular shape break in the retina -can result from traction of the retina -retinal detachment is the separation of the retina from the epithelium -these are classified by type and cause of their development
retinitis pigmentosa
-retinal nerve cells degenerate and pigmented cells of the retina grow and move into sensory areas of the retina, causing further degeneration earliest manifestation; -night blindness, often in childhood -over time this progresses to complete blindness treatment; -no therapy exists to prevent the degeneration process -avoid ISOTRETINOIN and ED drugs -wear glasses in the sun -vitamin A 15,000 units, DHA, omega 3 -beta carotene, lutein, zeaxanthin
corneal abrasion, ulceration, and infection
-scrape of scratch injury to the cornea -painful condition -foreign body, injury, contact lens abrasion -other problems contributing to corneal injury; malnutrition dry eye syndromes cancer therapies -abrasion allows organisms to enter the eye and can lead to infection -bacterial, protozoal, fungal infection can lead to corneal ulceration, which is a deep injury -this problem is an emergency, permanent damage can occur -avoid homemade contact lens solution
laceration of the eye
-sharp objects or projectiles -eyelid and cornea most common injury -initial eye closing and ice pack -corneal laceration is an emergency because eye contents may prolapse through the laceration -eye pain, photophobia, tearing, decreased vision, inability to open eyelid is all possible -antibiotics are given to reduce infection risk -scarring may develop -if scar alters vision, corneal transplant may be needed -enucleation (eye removal) may be indicated if prolapse occurs ACTION ALERT; -an object protruding from the eye is removed only be a doctor because it can be holding structures in place.
Visual acuity
-snellen chart -normal vision is 20/20 _legal blind is 20/200 -anything worst than 20/40 dont drive. Your dangerous.
Chalazion
-sterile inflammatory process. -eyelid swallon -slight pain and pressure Management; -warm compresses -surgery if severe enough -corticosteroid drops may be needed
WHICH PRECAUTION IS MOST IMPORTANT TO TEACH SOMEONE WHO IS 62 DIAGNOSED WITH DRY AMD?
-stop smoking
interventions and cataract
-surgery is the only cure -should be done ASAP once vision is reduced to the point ADLs can't be performed preoperative; -after surgery you must use different eyedrops several times a day for 2 to 4 weeks -aspirin, warfarin, clopidogrel, dabigatran may need to be discontinued prior to surgery -ophthalmic drugs instilled prior to surgery to dilate the pupils and cause vasoconstriction. -other eyedrops used to induce paralysis of the eye to prevent lens movement operative procedure; -phacoemulsifcation is what extracts the lens -probe inserted through the capsule and sound waves break the lends into small pieces and new lens is placed postoperative; -antibiotic and steroid ointments are instilled right after surgery -usually discharged soon thereafter -wear dark glasses outdoors until the pupil can respond to light -mild itching it normal, so is a bloodshot eye -eyelid may be slightly swollen -cool compresses may help -pain early after surgery is a sign of increased intraocular pressure or hemorrhage -restrict activities that would increase pressure -infection can occur and watch for eye redness, decrease in vision, increase in tears or photophobia -dramatic improvement in vision within a day after surgery -final best vision will happen 4 to 6 weeks postop ACTION ALERT; -report any reduction of vision after surgery in operated eye right away
ectropion
-turning outward and sagging of the eyelid caused by muscle relaxation or weakness -often with aging -corneal drying and ulceration -constant tears or sagging lower eyelid treatment; -surgery to restore lid alignment -eye is covered with a patch postop
surgical management and refractive errors
-LASIK surgery -corrects near sight, far sight, and astigmatism -this can fix vision within an hour after surgery -complete healing in 4 weeks complications; -infection -corneal clouding -chronic dry eyes -refractive errors -blurred vision, halo around lights, and other refractive errors months to years after surgery
surgical management and glaucoma
-used when drugs for open angle do not work laser trabeculoplasty; -burns the trabecular meshwork, scarring it and causing meshwork fibers to tighten -tight fibers increase size of spaces between the fibers, improving flow of aqueous humor and reducing IOP trabeculectomy; -procedure creating a new channel for fluid outflow -if neither of these things work, a shunt can be used -fine tube placed into the front chamber of the eye -fluid can drain through the tube into the area around the flat plate where it collects and is reabsorbed potential complications of surgery; -choroidal hemorrhage -choroidal detachment
community care and cataract
-usually discharged within 1 hour after surgery -must be able to insert eye drops complications after surgery while at home; -sharp sudden eye pain -bleeding or discharge that is green or yellow -lid swelling -bloodshot sclera after initial appearance cleared -avoid things that may increase IOP -avoid getting water in your eyes for 3 to 7 days -light eye patch at night to prevent rubbing -don't do anything that moves your head to much
APPLICATION OF AN OCULAR COMPRESS
-wash your hands -fold a clean washcloth into fourths -soak washcloth with running tap water that is warm -place cloth over closed eye -keep cloth in place with light pressure -refold and use a different fourth and repeat -repeat this 3 x or as many times as prescribed
Color vision
-when change in color vision is reported, should be evaluated -UNFINISH
Retinal detachment cont.
-worst is at 12pm position -grabity causes it to worse -blood can appear -not painful Goal of surgery; - prevent further tearing -reattach sensoru retina to the back part of the eye Surgery types; -laser surgery -cryotherapy -pneumatic retinopexy. Gas bubble or liquid in cavity helps push retina back into the eye. Prone position for most of the day and night 1 to 3 weeks. Takes time to readhere. -antibiotic eyedrops postop for the risk of infection
A client has a corneal abrasion in the right eye. What does the nurse instruct the client about eye care?
Avoid the use of contact lenses during the therapy. The client should be taught to avoid the use of contact lenses during drug therapy and until the infection has cleared. Eye drops are generally applied only to the infected eye. All open containers of contact lens solutions must be discarded as these may be contaminated. Separate eye drop bottles, labeled "left" and "right" are used only if the client has infection in both eyes.
patient centered care and ocular melanoma
manifestations; -may not appear easily -tumor discovered during routine exam -blurred vision can occur -IOP can increase -iris color changes if tumor invades the iris -sudden loss of visual field can result from retinal detachment diagnostics; -ultrasonagraphy or MRI for size and location treatment; -enucleation (surgical removal of entire eye) is the most common surgery -ball implant is inserted as a base prosthesis -radiation therapy can be eye sparing procedure
A client has a bilateral corneal disorder and must instill anti-infective eyedrops every hour for the first 24 hours. Which comment by the client indicates a need for further instruction by the nurse?
"I have two bottles of eyedrops because I will require a lot of medication." If both eyes are infected, separate bottles of drugs are needed for each eye. The client should be taught to clearly label the bottles "right eye" and "left eye" and to not switch the drugs from eye to eye. The client should not wear contact lenses during the entire time that these drugs are being used because the eye then has fewer protections against infection or injury. In addition, the drugs can cloud or damage contact lenses. If the drugs are to be instilled every hour for the first 24 hours, the client will have to wake up every hour during the night to apply the drops. The client should completely care for one eye, wash the hands, and by using the drugs for the remaining eye, care for that eye. As always, handwashing should be done before and after eye care.
A client is returning home after cataract surgery with a patch over the affected eye. Which statement by the client's spouse indicates a need for further instruction on providing a safe home environment?
"I will rearrange the furniture for better flow before my spouse gets home." Changes in item location should not be made without input from the client with reduced vision. Books on tape is a good diversion for recuperating clients with reduced vision. Any objects that may present a tripping hazard should be removed at once. A nonskid mat may be used to prevent falls in the bathtub.
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Cataracts
-24 million people -usually over 40 -by age 80 50% population -painless blurring Treatment; -remove cataract replace the lens
drug list and glaucoma
-PROSTAGLANDIN AGONISTS; (reduce IOP) bimatoprost lataoprost tafluprost travoprost unoprostone -check cornea for any injury or trauma. -over time eye may darken and eyelashes elongate in the eye getting drugs -DO NOT MEDICATE A HEALTHY EYE -ADRENERGIC AGONISTS; (limit production) apraclonidine brimonidine dipivefrin hydrochloride -watch for htn (taking meds for htn?) -wear dark glasses outdoors (dilation) -do not put on lenses and wait 15min prior to putting in lenses -BETA ADRENERGIC BLOCKERS (limit prod.) betaxolol hydrochloride carteolol levobunolol timolol timoptic GFS -COPD present? -check bs more often if you have DM -can cause unsafe drops in BP and HR -CHOLINERGIC AGONISTS (limit production) carbachol echothiophate pilocarpine -can make it hard to see things -CARBONIC ANHYDRASE INHIB. (prod.) brinzolamide dorzolamide -allergy to sulfa drugs? -shake before applying -wait 15 min prior to putting on lenses DRUG ALERT; -most eyedrops for glaucoma can be absorbed systemically and cause systemic problems. watch for any systemic changes that may occur and make sure you put them in correctly. -punctual occlusion is the method of pulling the eyelid down and pinching it into the nose to avoid systemic absorption
Trachoma
-chlamydia -leading cause of preventable blindness in the world -hand to eye contact -red and inflammed eyes and increased tear formation -photophobia -middle stage of disease inflammation increases
refractive errors
-ability of the eye to focus images on the retina (back of the eye) depends on the length of the eye from front to back and the refractive power of the lend system -refraction is the bending of light rays -myopia is nearsightedness -eye over refracts the light and bent images and they fall in front of, not on the retina -hyperopia (hypermetropia) is farsightedness -refraction is weak, causing images to be focused behind the retina -presbyopia is an age related problem -lens lost its elasticity and is less able to change shape to focus the eye for close work -images fall behind the retina -astigmatism is an uneven curvature of the cornea -image does not focus on the retina
history and cataract
-age is important because its most prevalent in older adults predisposing factors; -trauma of the eye -exposure to radioactive material -systemic disease (dm) -prolonged use of corticosteroids -intraocular disease -family history
Macular degeneration
-age related condition -over age 65 -characterized by yellow spots -central vision gets ruined -no cure just treatment
primary angle closure glaucoma (PACG)
-also known as acute glaucoma -sudden onset and is an emergency -forward displacement of the iris -presses against cornea and closes the chamber -sudden prevention of outflow manifestations; -sudden severe pain around the eye -pain radiates over the face -headache or brow pain, nausea, vomiting -colored halos around lights -sudden blur in vision -sclera may become red and cornea foggy -opthalmoscopic exam will show a shallow anterior chamber, cloudy aqueous humor, and a moderately dilated nonreactive pupil
bacterial conjunctivitis
-also known as pink eye -S. aureus most common cause manifestations; -blood vessel dilation -edema -tears -discharge (watery progress to thick mucus) -cultures may be obtained to i.d the organism -ophthalmic antibiotics prescribed to eliminate infection -prevent infection spread from the other eye or to other people -wash your hands after touching eye or using eyedrops -do not touch your unaffected eye -don't share things you rub your face on -avoid makeup and applicators and throw out stuff you may have used during onset of infection
hordeolum
-also known as stye -infection of the eyelid sweat glands (external hordeolum) -or of the eyelid sebaceous gland (internal hordeolum) -will be red, swollen, and painful area on the surface of the lid -visual perception is unaffected -if the lesion opens purulent drainage will be released and the pain will subside -most common cause = staph aureus, staph epidermidis, streptococcus management; -warm compress 4x daily and antibacterial ointment -remind patient not to use heavy machinery with any ointment in the eye
CARING FOR PEOPLE WITH REDUCED VISION
-always knock and introduce yourself -reduced vision should be documented -determine to which degree they can see -orient them to the environment -do not move anything without there consent -remove all clutter between them and the bathroom -describe food placement like a clock face -open lids and bowls for them -don't speak loud to these people they are hard of seeing not hard of hearing -offer your arm to walk and step ahead during ambulation -if a call light is on there night stand don't move it to on their bed.
WHICH ACTION IS MOST LIKELY GOING TO INCREASE COMMUNICATION FOR SOMEONE WHO HAS LOW VISION?
-being very specific with descriptions and directions
ACTIVITIES INCREASING INTRAOCULAR PRESSURE
-bending from the waist -running, jogging, jerking the head, dancing -lifting things more than 10 lbs -sneezing or coughing -blowing the nose -straining to have a bm -vomit -sex -dependent position of the head -tight shirt collars -reading, writing, sewing makes your eyes move quickly
Tumors
-benign or malignant -usually secondary -can spread to optic nerve -not common -usually mets from somewhere else
reduced visual sensory perception
-blindness is 20/200 vision teaching and interventions; -move head slightly up and down can enhance vision -use your better eye to see things and position yourself properly -safety is a major concern -don't move things on these people at home -use tape and a heavy black marker to mark 350 degree setting on the oven -mark 70 degrees on a thermostat -if in the hospital orientate these people. they hate new environments -use a focal point like a chair to guide them throughout the room -mention things like slice of ham at 6' clock ACTION ALERT; -never leave a person with reduced vision in the center of an unfamiliar room
Hyphema
-blood into inner chamber of the eye
Lasik surgery
-book covers it -usually a choice over glasses or contacts -most popular surgery of eyes -fixes all refractive issues Some risks include; -loss of vision due to infection -halos around objects -retinal detachment -dont wear contacts for up to 5 days prior to surgery Postop; -antibiotic drops -glasses for a while -saline drops -MBHC (myopia biconcave hyperopia convex)
nonsurgical management and glaucoma
-can be prevented with early detection drug therapy; -eye drops can reduce production -increase absorption -constrict pupils to allow for better circulation -these drugs do not improve lost vision but prevent further damage -most eye drops cause tearing, a mild burn, blurred vision, red sclera for a few minutes -must take these drugs as ordered -wait 5 to 10 minutes between each drug if there is more than one -keep tip clean and out of your eye
cataract
-cataract is a lens opacity that distorts images -aging gradually causes a loss of water and increase in density -lens density increases with drying and compression -with time, lends density increases and transparency is lost -visual sensory perception greatly reduced -both eyes may have cataracts with different rates of progression
INSTILLATION OF OPTHALMIC OINTMENT
-check name and expiration date of ointment -if both eyes are to retrieve treatment and only 1 is infected, use 2 tubes -wash your hands and put on the gloves -tilt head backward and look up -pull eyelid down -hold the tube like a pencil -rest your wrist against the cheek -inner to outer and don't make contact with the eye -close eyes but dont squeeze -gently wipe away any excess -shouldn't do anything dangerous with this oitment
WHICH ASSESSMENT IS MOST IMPORTANT FOR SOMEONE GETTING TRAVOPROST INTO THE EYE?
-check the cornea for abrasion or open areas -wasn't measure BP -wasn't measure IOP -wasn't assess heart rate
macular degeneration
-deterioration of the macula (central vision area) -can be age related (AMD) or exudative -age related macular degeneration (AMD) has two types; dry AMD and wet AMD dry AMD; -more common -progresses faster among smokers -htn, female, short, family history, long term diet poor in carotene and vitamin E are all R/F -can progress into exudative macular degen. wet AMD; -growth of new blood vessels -these blood vessels are weak and leaky -exudative macular degeneration is also a type of wet macular degeneration but occurs at any age -can happen in 1 or 2 eyes -sudden decrease in vision -newly formed blood vessels invade injured area and cause fl and blood to collect under the macula like a blister -causes scarring and visual distortion
nonsurgical management and refractive errors
-diagnosed with refraction testing -eye chart while lenses of different strengths are systematically placed in front of the eye -these refractive errors are fixed with eyeglasses or contact lenses that focus light rays on the retina -hyperopic vision is corrected with a convex lens that moves the image forward -myoptic vision is fixed with biconcave lens to move the image back to the retina
interventions and macular degeneration
-dry AMD has no cure -management is focused on slowing progression of vision loss -take b12, carotenoids lutein and zeaxanthin -exudative or wet AMD is geared toward slowing process of the disease -laser therapy may seal leaking blood vessels and limit there damage to the eye
allergic conjunctivitis
-edema, sensation of burning, bloodshot eyes -excessive tears, itching -vasoconstrictor and corticosteroid eyedrops -avoid makeup near the eye until manifestations are gone
diagnostic assessment
-elevated IOP is measured by tonometry -normal IOP = 10-21 -tonometry will be 22-32 with open angle -tonometry will be 30 or high with closed angle -visual field testing with perimetry is performed -visualization by gonioscopy to determine whether the angle is open or closed
Retinal detachment
-emergency situation -can lead to blidness -seperation from back lining of the eye Risk factors; -myopia that is severe -trauma -diabetic retinopathy -catatact surgery or trauma -advanced age Signs and symptoms; -sudden onset -curtain or shadow closing -increase in floaters -immediately evaluated or loss of vision can occur
entropion
-entropion is the turning inward of the eyelid causing the lashes to rub against the eye. -can be caused by eyelid muslce spasms or a deformity of the eyelid after trauma. -more common in older people due to loss of tissue support -pt report of feeling something in there eye -pain and tears may be present -conjunctiva will be red treatment; -surgery corrects eyelid position by either tightening the orbicular muscle and moving the eyelid to a normal position. -can also prevent inward rotation of the eyelid -eye is covered with a patch postop -may need antibiotic oitment
Assessment
-eye problem -past medical history -family history -personal and social history -family history is important. Do you wear glasses -diabetes history or htn? -computer for work? Bright lights
trauma to the eye with foreign bodies
-eye will be examined with fluorescein, followed by irrigation with NS
Glaucoma
-glaucoma is a group of disorders sharing certain features. Commonly includes high pressure within the eye -gradual sneek if blindness -damage to optic nerve -loss of peripheral vision (goes first) -possibly blindness -can be due to too much fluid or malabsorption of fluid. -leads to increased pressure -tonometry test for pressures -normal is 10-21mm mercury -more prevalent for old people -no cure but control it -family history of glaucoma -dm htn or cvd -myopia present? -eye trauma can be a rf
glaucoma
-group of issues resulting in increased IOP -usually present as 1mL of aqueous humor -5mL is made and reabsorbed daily -normal balance must have production and outflow to be adequate of this aqueous fluid -IOP becomes too high, extra pressure compresses retinal blood vessels. results in poor oxygenation -sensitive nerve tissues begin to die. -if too many die, vision loss is permanent. -tissue damage starts on the periphery and moves inward -glaucoma is usually painless -pt may be unaware of the visual reduction
Color blindness
-hard time with red and green -safety concerns with this -can affect your career
Hordeolum
-infection of the inside of the lid. -drainage can be present -caused by staph aureus. -red eye, edema, collection of drainage. -painful Treatment; -warm compress -incision and drainage may be needed followed by antibiotic
chalazion
-inflammation of sebaceous gland in the eyelid -red and tender, followed by PAINLESS swelling -red and tenderness go away -most the time this protrudes on the inside of the eyelid -eye fatigue, light sensitivity, excess tears management; -warm compress 4x daily -instillation of ophthalmic antibiotics -can be removed surgically if needed chalazion = chill(painless) hordeolum = horror (painful)
Uveitis
-inflammation of uvial tract -iris of eye or corid layer -middle layer -nongranular matus vs granular matus - ati book -nongranular matus is more common -photophobia and eye pain and blurred vision. -small and irregular shape -uni or bilateral -wear sunglasses for photophobia -midreatic medications (atropine) -pradfort 1% eye drop 4-6x daily
conjunctivitis
-inflammation with or without infection -inflammation occurs from exposure to allergens or irritants -infectious conjunctivitis occurs from bacterial or viral infection which is easily transmitted
Conjunctivitis (pink eye)
-inflammed and red. -vessel dilation giving it its nickname -common ocular problem -itching and tearing -dont touch both eyes -uni or bilateral
interventions and ketatoconus
-mishaped cornea that is still clear, surgical management involves corneal ring implant adjusting the shape of the cornea -this is done under local anesthesia -improvement to best vision is immediate -removal, replacement, or adjustment of the ring tightness can help with refraction, especially in older people -surgery to improve clarity for a permanent corneal disorder that obscures vision is a keratoplasty (corneal transplant) -diseased corneal tissue is removed and replaced with tissue from a human donor donor: hob 30 degrees, small ice packs, antibiotic drops preop; -transplant is performed when donor cornea is available -examine the eyes for infection and report any redness or discharge operative procedure; -keratoplasties are usually performed with local anesthesia in an ambulatory setting -donor cornea is sutured into place on the eye -procedure takes an hour, patient discharged soon thereafter postoperative care; -patient teaching!@ -local antibiotics are injected or instilled -eye may be covered with a pressure patch or a shield -lie on nonoperative side to reduce intraocular pressure (IOP) -wear the shield at night for first month or when around things that may injure your eye -do not use an ice pack complications; -bleeding -wound leakage -infection -graft rejection (use corticosteroids) -examine the eye daily for any complications -purulent drainage, continuous leak of clear fluid areound the graft site, or excessive bleeding needs to be reported -decreased vision -reddening of the eye -pain -photophobia -light flashes or floaters can be present -if any of these things occur within the first 48 hours call the hospital
primary open angle glaucoma (POAG)
-most common form of primary glaucoma -affects both eyes -no manifestations early on -outflow is reduced through the chamber angle -because of this failure to flow, IOP increases -this develops slowly, with gradual loss of visual fields that may go unnoticed due to central vision being last to go -vision may sometimes be foggy with mild eye ache or headaches late manifestations; -irreversible damage has already begun to optic nerve -halos around lights -lose of peripheral vision -decreased visual perception
Meds for glaucoma
-most common treatment _decrease optic pressure -increase outflow or decrease production of humor. Or increase uveoscleral outflow Cholinergics (pilocarpine) Afrenergic agonists Beta blockers (timolol maleate) Alpha adrenergics (apraclonidine) Carbonic anhydrase (acetazolamide) Prostaglandin analogs (iatanoprost) Side effects; -burning or reddened eye -dark iris (latanoprost) -thick eye lashes -
clinical manifestations of cataracts
-no pain or eye redness is associated with age related cataract formation early manifestations; -slightly blurred vision -decreased color perception -glasses or contacts look smudged as it worsens; -blurred or double vision can occur -difficulty with ADLs -can lead to permanent blindness without surgical intervention
Refractive errors
-normally light comes into pupil iris will dilute and lens will focus this. Light rays go to back of the eye into the retina. -myopia is when distance is an issue. They can see close up. -hyperopia light rays go behind the retina. Distance is no problem but close things are blurry. -astigmatism everything is blurry. Issue in curve of cornea. Should be smooth but with this it is irregular and light rays get bent oddly. -easily fixed with glasses.
Assessment cont.
-ocular history -visual acuity -external eye exam -pain obrupt or prolonged? -medications? -past medical conditions -nastagnis Disgnostics; -opthalmoscopy (cornea,lens,retina) -silt lamp (interior of eye) -tonometry (ocular pressure) -color
penetrating injury
-often leads to permanent eye loss -glass, high speed metal or woods, BB pellets, bullets are common causes of penetration -MRI is contraindicated due to metal containing projectile causing more injury -surgery is usually needed to remove the object
Scleral buckle
-old treatment that is still done for retinal detacjment -keep retina to back of the eye -not done as often
health promotion and maintenance
-onset can be earlier with UV light -wear sunglasses outdoors -can be from direct eye injury
interventions and retinal holes, tears, and detachments
-onset of a retinal detachment is sudden and painless -sudden bright flash of light (photopsia) -floating dark spots in the affected eye -curtain being closed in front of them -if a hole or tear is discovered before it detaches, the defect can be closed or sealed -closure prevents fluid collecting under the retina and reduces risk of detachment -treatment involves making a scar binding the retina and choroid together -can use a laser photocoagulation or freezing probe (cryopexy) preoperative care; -restrict activity prior to and head movement -eye patch over affected eye to reduce movement -topical drugs given to inhibit constriction operative procedure; -under general anesthesia -scleral buckling, repair the wrinkles or folds in the retina and relieve tugging pressure on the retina -a gas or silicone oil placed inside the eye can be used to promote retinal reattachment -these agents float up against the retina holding it in place until healing occurs postoperative procedure; -eye patch is used -head must be in a position prescribed by the doctor -report any sudden increase in pain -avoid things that would increase IOP -avoid reading, writing, sewing, anything that causes rapid eye movement for a week report any signs of detachment; -visual acuity eye pain pupils fail to constrict to light
clinical manifestations and glaucoma
-opthalmoscopic exam shows cupping and atrophy of the optic disc. becomes wide and deep and turns white or gray -with POAG visual fields first show a small loss of peripheral vision gradually progressing manifestations of PACG; -sudden severe pain around the eye -pain radiates over the face -headache or brow pain, nausea, vomiting -colored halos around lights -sudden blur in vision -sclera may become red and cornea foggy
Diagnostics of glaucoma
-opthmoscopy is the cupping and atrophy of optic disc -tonometry measure IOP -perimetry visual field losses (visual field test). Get a clicker and use it everytime you see the light. -gonioscopy is the magnifying lens to examine cornea and iris
patient centered care and corneal abrasions and infection
-pain, reduced vision, photophobia, eye secretions -cloudy or purulent fl may be present on lids or lashes -wear gloves when examining the eye -cornea looks hazy or cloudy with ulceration -fluorescein stain = patchy areas appear green -microbial culture and corneal scrapings can determine the causative organism -anti infective therapy, antibiotics, antifungal, antiviral, prescribed to eliminate organisms -broad spectrum until the cause is known -drug therapy may continue for 3 weeks or more to ensure eradication of the infection
Which client is most in need of immediate examination by an ophthalmologist?
40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights The 40-year-old client with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights is exhibiting signs and symptoms of increased intraocular pressure (IOP). This is a priority because the optic nerve can be damaged, which can cause possible blindness. Acute angle-closure glaucoma can occur in those 40 years of age and older. The 58-year-old client reporting an inability to see colors well is exhibiting early signs of cataracts and will need to be seen, but this is not the priority. The 76-year-old with seborrhea of the eyebrows and eyelids is exhibiting signs and symptoms of blepharitis and will need to be seen, but this is also not the priority. The 39-year-old with contacts is exhibiting signs and symptoms of corneal abrasion, possibly from cataracts, and will need to be seen soon, but the client exhibiting increased IOP is still the priority.
Allergic vs toxic
Allergic; -both eyes involved -excessive tearing Toxic; -caused by chemical irritant -medications -chlorine from pools -exposure of toxic fumes,hairsprays -tearing burning and flush your eyes!
What refractive error occurs when the curve of the cornea is uneven?
Astigmatism When light rays do not refract equally in all directions, the image cannot adequately focus on the retina; in turn, this causes visual problems. Astigmatism occurs when the curve of the cornea is uneven. Myopia (nearsightedness) occurs when the eye over-refracts light and the bent images fall in front of, not on, the retina. Hyperopia (farsightedness) happens when refraction is not strong enough and images fall behind the retina. Presbyopia (an age-related problem) happens due to decreased lens elasticity, causing images to fall behind the retina as well. Due to this decrease in elasticity, the lens is not able to change shape to focus for close-up work.
Bacyerial vs viral form
Bacterial; -acute or chronic -redness purulent drainage, burning Virus; -
A client is prescribed bimatoprost (Lumigan) for management of glaucoma in the left eye. What does the nurse instruct the client?
Check the cornea for signs of abrasions or trauma. The client should be instructed to check the cornea for signs of abrasions or trauma before using bimatoprost because the eyedrops must not be used if the cornea is damaged. The eyedrops are instilled only in the affected eye, not in both eyes. A change in eye color is normal when the drug is used. It is normal for the eyelashes to elongate in the eye in which the drug is instilled; the eyelashes do not fall out.
What is the action of miotics in the client with glaucoma?
Enhance aqueous outflow Miotics are used to improve the flow of fluid (aqueous humor) and decrease intraocular pressure (IOP) in clients with glaucoma. Steroid drops, not miotics, decrease the inflammatory process. Vitreous humor fills the space between the lens and the retina, is stagnant, and is not replenished as the aqueous humor is. Miotics make the pupil smaller, which creates more room between the iris and the lens.
Treatment for glaucoma
Glaucoma shunt; -open tube implanted
The nurse is providing postmortem care to a client who has donated a cornea. Which action is appropriate for the nurse to implement?
Instill antibiotic drops into the eyes. Antibiotic eyedrops, such as Neosporin (polymyxin B, neomycin, bacitracin) or tobramycin, should be instilled into the corneal donor's eyes to prevent infection. Small cold packs should be applied to the donor's closed eyes. Raising the head of the bed 30 degrees prevents blood from pooling in the eye region of the deceased client. The nurse is not the person to contact the recipient family; the donor organization will complete all the communication to the parties involved.
How does the nurse instruct a client in the management of bacterial conjunctivitis?
Instruct the client to discard make-up and applicators used at the time the infection developed. The client with bacterial conjunctivitis should discard make-up and applicators that were used at the time of infection. Contact lenses worn during the infection should also be discarded. Bacterial conjunctivitis is managed with antibiotic eyedrops. Pressure patches for conjunctivitis are not recommended.
Which term is used to describe an eye wound caused by sharp objects and projectiles?
LACERATION Eye wounds caused by sharp objects and projectiles are known as lacerations. This type of wound is commonly seen in the eyelids and the cornea. Melanoma is a common malignant eye tumor. Hyphema is a hemorrhage in the anterior chamber which occurs when force is applied to the eye. Eye wounds caused by traumatic contact with a blunt object are known as contusions.
A client with visual limitations has been admitted to the intensive care unit (ICU). Which action is most important to implement for this client?
Making all health care team members aware of the client's visual limitations All health care team members must be made aware of the client's visual limitations and need for assistance. Seeing-eye dogs are not usually allowed in the ICU. It is not necessary to keep the client bedridden. The client should be addressed in a normal tone of voice; the client's hearing is not affected.
common causes of glaucoma
PRIMARY GLAUCOMA; -aging -heredity -central retinal vein occlusion SECONDARY GLAUCOMA; -uveitis -iritis -neovascular disorders -trauma -ocular tumors -degenerative disease -eye surgery ASSOCIATED GLAUCOMA; -DM -htn -severe myopia -retinal detachment
Primary glaucoma (open angle glaucoma)
Open angle glaucoma -most common -flow of aqueous humor is slowe by obstruction increasing pressure -slow and chronic -by the time it is caught damage has been done -headaches and halos possible -usually there is no symptoms
Trauma
Penetrating eye injury
RETINAL DISORDERS
macular degeneration retinal holes, tears, detachments retinitis pigmentosa
A client has a purulent drainage in the inner canthus of the eye. Before examining the eye, what must the nurse do first?
Put on gloves. Gloves should be worn in the presence of drainage and should be put on before examining the eye. Administering a Snellen test or instilling antibiotic eyedrops is not the first thing that the nurse should do before examining the client's eye. Obtaining informed consent is not necessary for an eye examination.
A client has recently had cataract surgery. About which symptom does the nurse instruct the client to notify the health care provider?
Reduction in vision A reduction in vision after cataract surgery indicates a problem, and the client should notify the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected after cataract surgery.
A client has undergone surgery for entropion. What postsurgery instruction does the nurse give the client?
Report any pain or drainage under the patch dressing covering the eye. The client should be instructed to report any pain or drainage under the patch dressing covering the eye. The patch over the eye is removed only after the ophthalmologist has assessed the eye. The client should clean the suture with a cotton swab and prescribed solution, not warm water. Warm water and warm compresses are recommended for the client with a stye infection.
What important information does the nurse teach a client who is prescribed flurbiprofen (Ocufen) for an eye infection?
The client prescribed flurbiprofen must be taught to check for bleeding in the eye. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as flurbiprofen disrupt platelet aggregation and can cause bleeding. Topical steroids predispose the client for corneal ulceration. Antifungal agents and topical antiviral agents can cause burning and itching in the eyes as sensitivity to these drugs is common.
A client has undergone a keratoplasty. What postoperative care does the nurse teach the client?
Wear a shield at night for the first month after surgery. The client should wear a shield at night and in the presence of children and pets for the first month after surgery. This prevents accidental injury to the eye. The client must not use an ice pack over the eye as it puts pressure on the eyeball. The client should also avoid activities that increase intraocular pressure such as exercise and heavy work for 6 to 8 weeks.
