Cataracts and Glaucoma

cataract

A cataract is clouding of the eye's crystalline lens. The lens works to focus light onto the retina at the back of the eye, allowing for clear vision both up close and far away. The clouding of this structure decreases vision and leaves patients at risk for injury

Vision checks for ages 65 and up

1-2 years

Pre op teaching for cataracts

1.Administer eye drops. Mydriatic (dilating) and cycloplegic (paralyze ciliary muscles to keep the eye dilated) eye drops are often prescribed in preparation for surgery. 2.Exact preoperative instructions to be obtained from the provider, including NPO status, administration of preoperative eye drops, arrangements for a friend or family member to drive the patient home.

phacoemulsification

Phacoemulsification procedure. An incision is made near the lens, and a thin probe is placed that uses ultrasound to break up clouded fragments, which are aspirated out. A replacement lens is then placed.

primary open angle glaucoma

Primary open angled glaucoma: 90% of cases. Outflow of aqueous humor is decreased in trabecular meshwork, becomes clogged like a sink Develops slowly and without symptoms, no pain or pressure, pt usually doesn't notice until peripheral vision is compromised. tunnel vision in advanced cases.

patho for cataracts

The lens is the clear part of the eye that focuses light on the retina for precise, accurate vision. In the normal eye, the light passes through the crystal-clear lens to the retina. The lens is composed of mostly water and proteins. The specific proteins within the lens produce a chemical reaction to maintain the clarity of the lens. Alteration in the lens proteins occurs over the years as a person ages, yielding a gradual clouding of the lens secondary to the chemical change.

S/S Hyperopia (farsightedness)

Blurred vision when looking at close-up objects, aching eyes or feeling of eye strain, headache during reading

The nurse is performing regular eye assessment in a 50-year-old patient. Which assessment finding indicates to the nurse that the patient requires further evaluation?

The patient reports persistent sensitivity to light

Assessment and Analysis of Glaucoma

Vision loss Nausea/vomiting Headache

The nurse is teaching about the care plan of a patient with an eye infection. Which statement indicates effective understanding?

Wash your hands before and after instilling eye drops

presbyopia

With age, this condition involves the ciliary muscles and lens losing their elasticity, lens are unable to bend causing people over the age of 40 to need "reading glasses" at some point in time.

astigmatism (Can't see shit)

a condition in which the eye does not focus properly because of uneven curvatures of the cornea. Patients with astigmatism have difficulty seeing fine details either close-up or from a distance.

Myopia (nearsightedness) Cant see faraway

a condition resulting from a refractive error in which light rays entering the eye are brought into focus in front of the retina.Patients with myopic vision have blurred vision of distant objects and therefore have difficulty seeing faraway objects.

Hyperopia (farsightedness) Unable to see close objects

a refractive error in which light rays entering the eye are focused behind the retina.These patients have trouble seeing near objects.

Risk factors for Cataracts

age UV lights DM/autoimmune disease Race and ethnicity alcohol consumption/smoking family history Obesity High b/p

Canals of Schlemm

are located around the perimeter of the iris, and they allow aqueous fluid to drain back into the bloodstream. The meshwork located along the canals of Schlemm regulates the eye's internal pressure.

Vision checks for ages 40-64

every 2-4 years

vision checks for ages 20-39

every 3-5 years

S/S of angle closure glaucoma

include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision. This form of glaucoma is a medical emergency and requires prompt medical intervention. Eye drops are usually instilled immediately to try to reduce the rising IOP.

Retina

innermost layer, converts light waves into nerves impulses resulting in visual reception.

nystagmus

involuntary, jerking movements of the eyes

Glaucoma pathophysiology

is not just a single eye disease but a group of eye conditions that present with increased IOP and result in damage to the optic nerve, leading to loss of vision. High IOP, greater than 21 mm Hg, is most often the culprit. Increased IOP can be the result of inadequate draining of aqueous humor from the canal of Schlemm, or it can be caused by an overproduction of aqueous humor. Early diagnosis is a key factor in minimizing or preventing visual loss.

Filtering surgery or trabeculectomy

is usually done in a hospital or outpatient surgery center under local sedation. The surgeon uses specialized instruments and places an opening in the sclera of the patient, removing a small piece of the trabecular meshwork. This opening allows for the aqueous humor to freely exit the eye and lowers the IOP

amblyopia

lazy eye

uvea

middle coat of the eyeball; includes the iris, ciliary body, and choroid

Normal tension glaucoma

optic nerve damage despite normal IOP.it is believed to occur either because of a fragile optic nerve (a condition that might be inherited) or a decrease in blood flow to the optic nerve itself (vascular disease including vasospasm and ischemia)

Medical Management for Cataracts

physical examination of the patient and includes a visual acuity test and direct ophthalmoscope examination with a slit lamp to observe the eye closely. Opaqueness is often readily seen by the provider during an examination. The most effective treatment of cataracts is surgical removal of the opaque lens.

A patient is diagnosed with normal tension glaucoma. Which physiological abnormality is most likely observed in this patient?

Damage to the fragile optic nerve.

Which test is most likely to help the primary healthcare provider to evaluate the extent of opacity present in a patient with cataracts?

slit lamp examination

aqueous humor

the clear fluid, similar to water, found in the anterior chamber of the eye. Helping to maintain pressure and nourishing the cornea and lens with oxygen and nutrients, this fluid drains back into the circulation through the canals of Schlemm.

laser trabeculoplasty

used in treating open-angle glaucoma. The patient is given an anesthetic eye drop, and a high-energy laser beam is used to open clogged drainage canals, thereby allowing the aqueous humor to drain more easily from the eye. This procedure is usually performed in the provider's office or eye clinic, and only one eye is treated at a time if both eyes are involved

Drainage implants.

used most commonly with secondary glaucoma or pediatric glaucoma, commonly take place in a hospital or outpatient clinic. The surgeon inserts a small silicone tube in the eye to help drain the aqueous humor

Secondary glaucoma

usually results from an eye injury, inflammation, tumor or advanced cases of cataracts, or diabetes. Medications such as steroids, when used chronically, are also noted to cause this type of glaucoma

eye damage prevention

wear sunglasses protective eye wear eye exams Hand washing.

Risk factors for glaucoma

• African American individuals over age 40 • People with a family history of glaucoma • Everyone over age 60, especially Mexican Americans • Medical conditions such as diabetes and hypothyroidism • Patients with myopia • Prolonged corticosteroid use

Nursing DX

• Disturbed visual sensory perception related to disturbance in optic nerve function secondary to increased intraocular pressure • Anxiety related to decreasing visual field presence • Knowledge deficit regarding the progressive nature of glaucoma • Impaired home maintenance related to activity restrictions and impaired vision

NRSG DX for cataracts

• Disturbed visual sensory perception secondary to opacity of the eye lens • Risk for injury due to clouding of visual fields • Anxiety related to inability to clearly see objects in visual fields

Risk factors specific to normal-tension glaucoma include:

• People with family history of this type of glaucoma • Persons of Japanese ancestry • Persons with heart disease such as irregular heart rhythm • More common in women than men

Glaucoma testing

• Physical assessment via ophthalmoscope and use of a tonometer Bulging vessels in the internal eye can also be seen on examination with an ophthalmoscope. • Diagnostic results Intraocular pressures registering above the expected 10 to 22 mm Hg are a common finding. Visual acuity tests yield decreases in visual acuity. • Visual acuity Visual acuity tests yield decreases in visual acuity. The patient may describe fogginess of vision.

POST OP Teaching for Cataract Surgery

During the first 24 to 48 hours following cataract surgery, patients should take the following precautions: • Do not rub or apply pressure to eye. • Avoid sneezing, coughing, bending over, vomiting, or lifting objects heavier than 5 lb. • Prevent constipation (straining to have a bowel movement increases IOP and can cause bleeding). • Contact the physician immediately for severe pain, visual change, or increase in eye discharge. • Avoid eye straining. • Follow provider's instructions for eye dressing and use of eye shield at bedtime. • Wipe excess tearing from inner to outer canthus with a clean soft tissue. • Glasses must be worn if lens implant not inserted by the surgeon. Place bed at 35-45 degree angle Position on back or non-op side

Sclera

External layer providing the tough protective layer of the eye

s/s of astigmatism

Headache, blurred vision at all distances, feeling of fatigue or eye strain

S/S of presbyopia

Holding reading material far away so that letters are clear, blurred vision at normal reading distance, feeling of eye strain or headaches after reading or doing close work (may also occur with myopia and hyperopia)

A 20-year-old patient reports blurred vision of near objects and feeling eye strain after reading. Which condition does the patient most likely have?

Hyperopia (Blurred vision of near objects)

Miotic or cholinergic agents (Pilocarpine)

Increases the outflow of aqueous humor

Prostaglandin-type medications (Xalatan)

Increases the outflow of aqueous humor and thus decreases volume, therefore decreasing intraocular pressures

When instilling eye drops, the following precautions should be taken:

• Wash hands thoroughly and don nonsterile gloves. • Verify correct medication/time and number of drops. • Instruct patient to tilt head back with eyes open and looking upward. • Retract lower lid downward. • Invert the medication bottle and gently rest wrist on patient's cheek. • Gently squeeze bottle and instill prescribed number of eye drops into conjunctival sac, taking care not to contaminate the medication dropper/bottle by touching the eye sac or other foreign objects. • Instruct patient to gently close eyes. • Additional eye drops may be administered after 3 to 5 minutes to allow for absorption. • Application of gentle pressure with a clean tissue on the patient's nasolacrimal duct for 30 to 60 seconds decreases systemic absorption.

The nurse is performing an eye assessment in a 45-year-old patient. Which report from the patient should cause the nurse to notify the primary healthcare provider?

My peripheral vision is decreased. Indicates glaucoma

Which visual acuity disorder results from an eyeball that is too long, thus allowing the focused image to fall in front of the retina?

Myopia Rationale: Myopia, or near sightedness, is the disorder that results from an eyeball that is too long. When the eyeball is too long, it allows the focused image to fall in front of the retina.

A patient reports inability to see objects placed at a distance. Which condition does the patient most likely have?

Myopia ( cant see far away)

S/S Myopia (nearsightedness)

Myopia (nearsightedness) Blurred vision when looking at distant objects, headaches, feeling of eye strain, squinting when looking at objects more than a few feet away

Which patient is at the highest risk for the development of cataracts?

Patient exposed to UV light.

Autoimmune diseases r/t cataracts

Patients with autoimmune diseases are also thought to have a higher risk of developing cataracts because of their chronic steroid use.

Other risk for cataracts

Patients with certain eye conditions, such as MYOPIA, or patients with previous eye injuries or surgeries are also considered to be at higher risk for cataract development.

Eye conditions related to cataracts

Patients with certain eye conditions, such as myopia, or patients with previous eye injuries or surgeries are also considered to be at higher risk for cataract development.

Diabetes mellitus R/T cataracts

Patients with diabetes, both type 1 and type 2, are at a higher risk for developing cataracts and are more likely to develop them at a younger age. It is thought that these cataracts are due to elevated blood glucose levels. Patients with certain eye conditions, such as myopia, or patients with previous eye injuries or surgeries are also considered to be at higher risk for cataract development.

Race and ethnicity r/t cataracts

African Americans have twice the risk of Caucasians. Hispanic Americans are also noted to have a higher risk than Caucasians.

angle closure glaucoma

Angle-closure glaucoma is also known as acute glaucoma or narrow-angle glaucoma. In this relatively rare form of glaucoma, the eye pressure rises very quickly.

Glaucoma: Etiology

Anyone can develop glaucoma, and according to the World Health Organization, it is noted as a leading cause of blindness in the world. it is estimated that as many as 2.2 million Americans have been diagnosed with glaucoma, and approximately another 2 million people have the disease without knowing it.

extracapsular/intrascapular cataract extraction

A small incision is made, the clouded lens is removed, a replacement lens is placed, and the incision is sutured.

Cataract surgery outcome

Cataract surgery improves vision in up to 95% of patients and prevents blindness.

Epidemiology for Cataracts

Cataracts affect nearly 22 million Americans aged 40 and older. By age 80, more than half of all Americans have cataracts, and they are slightly more likely to affect women than men.

s/s of cataracts

Clouded, blurred, or dim vision Increasing night vision difficulty sensitivity to light and glare Halo vision around light sources fading or yellowing of colors DOUBLE VISION IN A SINGLE EYE

Pediatric Glaucoma

Congenital- dx during first year of life infantile- dx during first 3 years of life juvenile- occurring at age 3 throughout the young adult years

Environmental factors r/t cataracts

Long-term lead exposure is known to cause an increased risk for cataract development similar to an increased exposure to sunlight.

Which physiological change in a patient is associated with presbyopia?

Loss of lens and ciliary muscle elasticity

Glaucoma treatment (early stages)

Medical treatments for glaucoma include medications (early stages) that cause the eye to make less aqueous humor, as well as medications to help drain fluid in the eye, thereby decreasing the pressure in the eye.