Chapter 46 Visual disorders

radial keratotomy

a surgical procedure in which tiny incisions are made in the cornea that cause it to flatten and reduce the refraction disorder

myopia

nearsightedness, results from an eyeball that is too long or when the cornea has too much curve present, thus allowing the focused image to fall in front of the retina.

- ensure the patient correctly wears corrective lenses - provide adequate lighting to maximize visual acuity (may place additional strain on the eyes and adversely impact visual acuity if the lighting isn't good)

nursing actions for visual acuity disorders

risk for infectious transmission Pain

nursing diagnoses for conjunctivitis

presbyopia

occurs almost exclusively with aging, and results from the loss of lens elasticity and occurs around age 45. This loss of elasticity makes it more difficult for the lens to bed in order to focus on closely held objects.

refraction

one of the four functions of the eye that controls clarity of vision no matter what the distance is.

slight elevation in temp (related to infection)

only vital sign change in conjunctivitis

deep corneal abrasion

penetrate the Bowman's membrane (the smooth layer of the eye located just under the epithelium) and usually take longer to heal

- notify practitioners of increased pain, temperature, or other unusual feelings (because these could indicate a structural complication or an infection) - Follow-up appointments are also very important (to ensure that proper healing is taking place) - ******* Restrictions on lifting, bending, and Valsalva maneuvers are important instructions for some surgeries to prevent increased intraocular pressure (IOP) from occurring. ************

postoperative considerations for visual acuity disorders: *

45

presbyopia is considered a normal process of aging and occurs in midlife around the age of ?

objects held close to the face

presbyopia results in the inability to focus on?

Contact lens wearers

present with corneal abrasion more frequently than others

spontaneous defects

previous eye abrasions, trauma, or underlying defects can make a person more prone to this type of corneal abrasion

myopia hyperopia astigmatism presbyopia

primary refractory disorders (4)

shape of the eye and role of the cornea

provide most of the ability of the eye to focus clearly on objects near and far.

risk for injury

related to inability to correctly focus, and /or use of anesthetic on the eye

anxiety

related to visual impairment and inability to correctly focus on objects

traumatic conjunctivitis

results from a direct injury such as a laceration, abrasion, or chemical injury (it is considered a secondary response).

astigmatism

results from a misshaped cornea

- STICKY eye mucous drainage - photophobia - foreign body sensation (also: tearing, red pink conjunctiva)

s/s of chlamydial conjunctivitis that are different from others

- Eye pain (sometimes severe) - Photophobia - Squinting - Tearing - Blurred vision -Sensation of foreign body - Redness

s/s of corneal abrasion according to PPT**

elongated lens

shape of eyeball in presbyopia

tetanus vaccination ***

should be verified and administered in corneal abrasion if the patient is not considered up-to-date because any open surface of the body can provide a port of entry for this bacteria to enter.

red or pink sclera intense itching burning tearing puffy eyelids

symptoms of allergic conjunctivitis

- topical steroid - mast cell stabilizing drops instilled directly into the eye (decrease inflammation and release of histamine) - topically instilled vasoconstrictor/antihistamine drops to the eye - removal of the allergen if known or possible -good hand washing

treatment for allergic conjunctivitis

- Administration of antibiotic ointment or drops directly into the eye (rare cases may require systemic antibiotics) - good hand washing practices

treatment of bacterial conjunctivitis includes ? ***

- May require continuous irrigation with normal saline solution; - corneal staining examination and antibiotic therapy depending on condition

treatment of chemical induced conjunctivitis ?

Systemic antibiotics in most cases for up to 1 month; good hand washing practices; medical treatment of the infected partner

treatment of chlamydial conjunctivitis includes ?

Discontinue wearing of lenses and determine underlying causes (solution allergies, age of lenses, bacterial contamination, trauma); good hand washing practices

treatment of contact lens conjunctivitis ?

Removal of trauma-inducing agent; may need antibiotic ointment or drops if significant epithelial disruption is present; good hand washing practices

treatment of mechanical conjunctivitis ?

- usually need corneal staining to determine extent of trauma; - may require antibiotic drops/ointment and pressure patch

treatment of traumatic conjunctivitis ?

- cold compresses for pain relief and to decrease swelling or irritation - eye lubricant - ocular decongestants - good handwashing

treatment of viral conjunctivitis includes ?**

toxic conjunctivitis

typically develops following administration of a medication or direct contact with a corrosive or noxious chemical.

steroids or mast cell stabilizing drops

used for allergic conjunctivitis, instilled directly into the eye (decrease inflammation and release of histamine) ***

corneal staining and visualization under a Wood lamp

used to confirm diagnosis of a corneal abrasion ***

antibiotic drops and eye drops

used to help decrease **muscle spasms and treat infection** as soon as corneal abrasion is diagnosed ***

irrigation

used to treat conjunctivitis if a toxic substance is involved

Laser thermal keratoplasty (LTK)

uses a Holmium laser to reshape the cornea (Figure 46.2D). The Holmium laser is an infrared or thermal laser that uses heat to shrink the corneal tissue.

conductive keratoplasty

uses radiofrequency energy and does not remove any corneal tissue. An instrument with a tiny probe on the end is placed at specific points around the peripheral portion of the cornea. These points then emit energy that causes collagen to contract, shrinking the circumference of the cornea and changing the shape of the curve.

- watery discharge - presents with common colds (sore throat, URI) - spreads easily - tearing - lid crusting - pink, red sclera - inflamed, puffy eyelids - itchy

viral conjunctivitis presents with these s/s

elevation in pulse or BP related to pain or anxiety

vital sign changes in visual acuity disorders don't typically happen, but there could be ?

- visual acuity test - anesthetizing the eye (usually with tetracaine 1%) - corneal staining with fluorescein stain - visualization under a wood lamp to confirm diagnosis

what are the 4 components of a comprehensive exam for a corneal abrasion

Provide client with a clean tissue Wash hands and put on gloves Tilt client's head back with eyes open/looking upward Retract lower lid downward Gently instill prescribed number of drops into conjunctival sac Don't contaminate medication! Instruct patient to gently close eyes Apply gentle pressure on nasolacrimal duct for 30 to 60 seconds Wait 3-5 minutes before giving additional eye drops

what are the proper steps of eye drop administration ?**

corneal shape

what changes in shape in myopia, hyperopia, and astigmatism?

Eyeglasses, contact lenses, or orthokeratology

what medical treatments are available for astigmatism (non surgical)?

Convex corrective lenses in eyeglasses or contact lenses

what medical treatments are available for hyperopia (non-surgical)?

corrective lenses (glasses or contact)

what medical treatments are available for myopia (non-surgical)?

"Reading glasses" or magnification

what medical treatments are available for presbyopia (non-surgical)?

eye lubricant and ocular decongestants

what meds can be used in viral conjunctivitis ?to help reduce swelling and inflammation **

Holding reading material far away so that letters are clear

what might someone with presbyopia do?

astigmatism

a condition that occurs when the lens or cornea (or both) is curved more steeply in an oval instead of a round shape. This distortion often occurs in combination with myopia or hyperopia. The uneven curvature prevents light rays entering the eye from focusing to a single point on the retina.

epithelial layers

a corneal abrasion is limited to ?

conjunctivitis

a nonspecific term used to describe an inflammation of the conjunctivae of the eye. Most commonly known as pink eye, this condition is usually caused by a wide range of conditions and is present throughout the world. It affects all ages, races, genders, and socioeconomic statuses.

orthokeratology

a nonsurgical option to reshape the cornea that requires the patient to wear a special contact lens that slowly reshapes the cornea and corrects the myopia over time.

before/after ***

Assess visual acuity _______ treatment for visual disorders

infected mother to the newborn.

Chlamydial conjunctivitis may be transmitted during birth from an ?

traumatic corneal abrasion

Common causes of this type of abrasion are fingernail scrapes/pokes, animal paws inadvertently hitting the eye surface, pieces of paper or cardboard coming in contact with the eye surface, makeup applicators (a mascara wand is a common source), hand tools, and branches and leaves coming in contact with the eye surface. Can also be caused by a foreign body which becomes lodged under the eyelid

superficial corneal abrasion

a painful scratch or scrape to the cornea of the eye in which epithelial cells are removed.

corneal abrasion

Disruption of the cornea, may be superficial or deep. makes up 10% of eye related visits

slit lamp or instrument

a practitioner may use this to determine if their is a foreign body present in the eye when treating conjunctivitis

chlamydial conjunctivitis

a sexually transmitted infection that is most commonly transmitted through hand-to-eye spread of infected genital secretions.

hyperopic

Often, babies and young children are slightly ______ (type of refraction disorder), a condition that tends to improve as the eye grows.

lens correction may not be sufficient

Patients need to be instructed to notify a practitioner for visual disturbances or continued headaches indicating that ???. Yearly follow-up with a practitioner is recommended for all patients with corrective lenses.

remove lenses at night

Patients wearing contact lenses also need to be instructed to _______ to prevent eye damage (an exception is contact lenses approved for long-term use).

spontaneous injury.

Persons who have had previous eye trauma including tears can develop a ?? corneal abrasion

trauma, foreign bodies, contact lens, spontaneous defect.

There are four common causes of corneal abrasions: ??

viral conjuncitivis

a common condition involving inflammation of the conjunctivae secondary to the presence of a virus. Often seen with common colds, a virus affecting the upper respiratory tract, and sore throats, the eye usually exhibits a watery discharge and easily spreads from one eye to another.

allergic conjunctivitis

a condition involving inflammation of the conjunctivae secondary to an allergy-causing substance such as pollen or dander

dry eyes and underlying chronic illness (DM and autoimmune illness)

a spontaneous defect which can lead to corneal abrasion; can make the epithelial cells more prone to a scratch

visual acuity checks

are always performed before treatment and after treatment in the patient with conjunctivitis

near and distant

astigmatism means the visual changes occur when objects that are ?? occur blurry

myopia or hyperopia

astigmatism often occurs in combo with?

the microbe causes a gritty sensation in the eye as if sand is in their eye

bacterial conjunctivitis often causes this sensation in the eye

purulent eye discharge and matting of the eyelashes upon awakening in the morning.

bacterial conjunctivitis presents with this common symptom

contact lens related conjunctivitis

caused by hypersensitivity to one or more of the chemicals used to make the contact lens itself. Contact lens soaking solutions can also cause a hypersensitive reaction, thus yielding conjunctivitis. In addition, this condition is also caused by dirty lenses or debris under the lens in the eye.

blindness

chlamydial conjunctivitis is known world wide and in the past was considered to be the leading cause of ?

physical or chemical trauma

corneal abrasions result from either of these traumas

Snellen vision charts

diagnostic results for visual acuity disorders center on eye examination and visual acuity changes that are noted on _______ or more comprehensive examinations completed by eye care professionals in their office.

- wear sunglasses for pain relief - follow up in 24 - 48 hours - don't rub the eye !

discharge instructions for the client with corneal abrasion **

clean hands!!

essential to prevent the transmission of conditions from one eye to another or from one person to another; conjunctivitis is considered extremely contagious.

hyperopia

farsightedness, is the opposite issue, causing the image to fall behind the retina.

- blurred vision - aching eyes - head aches - feeling of eye strain - squinting - fatigue

general s/s of a visual acuity disorder

weeks or months

how long do clinical manifestations of chlamydial conjunctivitis last ?

within 24 to 48 hours of injury

how long does it take for corneal abrasions to heal?

- overworn - improper fit - improperly cleaned/disinfected - dirt/bacteria

how might a contact lens cause corneal abrasion?

at a distance

hyperopia means objects that are ??? are more clear

sunglasses

in conjunctivitis, these may offer comfort in bright light conditions*

towels and pillowcases

in conjunctivitis, these should be changed frequently and isolated from other family members to prevent possible transmission to another person.

eye patching

in corneal abrasion, considered controversial and may or may not be used. ***

smaller than normal

in hyperopia, the eyeball size is ??

advanced age

increases the risk of all four visual acuity disturbances as the eye goes under predictable changes

mechanical conjunctivitis

involves an irritation of the conjunctival surface caused by mechanical means such as an eyelash, foreign body, or other object of irritation.

photo refractive keratectomy (PRK)

involves removing a portion of the cornea with a laser to change its shape and therefore modify the refractive error

laser assisted in situ keratomileusis (LASIK)

involves the use of a laser or a special instrument called a microkeratome to create a thin circular flap in the cornea. The flap is then folded back out of the way, and the surgeon uses the laser to remove some of the corneal tissue. The laser is directed and then uses a cool ultraviolet (UV) light beam to precisely ablate (remove) very tiny bits of tissue from the cornea to reshape it.

bacterial conjunctivitis

is an infection of the conjunctivae caused by a microbe or bacteria.

1. Contact lens wearers 2. Participation in contact sports 3. Presence outdoors in windy conditions without protective eyewear 4. Any abrasive eye injury 5. Dry eye syndrome 6. Abuse of topical eye anesthetics and steroids 7. Autoimmune disorders 8. Recent eye surgeries

main risk factors for corneal abrasion

- Good handwashing - Cool compress - Sunglasses - No contact lenses - Remove offending agent - Irrigation if toxic - Change towels and pillow cases frequently - Discard eye makeup and don't wear again until conjunctivitis resolved (Lee, 2013) - Eye drops

main treatments for conjunctivitis according to PPT **

Allergic Bacterial (includes Chlamydia) Viral Mechanical Traumatic Toxic

many causes of conjunctivitis, which include? ***

culture

may be taken in conjunctivitis in conditions like chlamydia or other suspected infection

near objects are seen more clearly than far

myopia means objects that are ??? are seen more clearly