Chapter 19: Disorders of Visual Function

Which of these clients' statements would be most suggestive of retinal detachment? "This morning I woke up with the worst headache of my life." "All of a sudden I got the most intense pain behind my left eye." "I feel like there's a shadow that's blocking my vision." "I came in today because of this bleeding in the white part of my eye."

"I feel like there's a shadow that's blocking my vision." The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field. It is not associated with headache or bleeding.

An older adult client has been diagnosed with macular degeneration. Which statement by the client best demonstrates an accurate understanding of the new diagnosis? "I suppose this goes to show that I should have controlled my blood pressure better." "I think this is something that I might have caught from my husband." "My friend had this problem and a transplant did wonders for her vision." "I suppose that this may be one of the things that happens when you get older."

"I suppose that this may be one of the things that happens when you get older." Although some risk factors have been identified for macular degeneration, most diagnoses are attributed to increased age. The pathogenesis does not involve infection or hypertension, and a corneal transplant is not a recognized treatment modality.

A client reports being struck in the eye by flying debris falling off a building being demolished. Following fluorescein staining and use of biomicroscope, it is determined the eye has an injury to the Bowman membrane and stromal layer. Which explanation should the nurse provide to the client regarding the extent of this injury? "Since the stromal layer regenerates quickly, you should have no scarring." "Since you got here quickly, you should have no lasting damage to the eye." "You might heal a little slower, but there is little to no danger of developing an infection." "Your eye will heal slower with scar formation that impairs the transmission of light to some extent."

"Your eye will heal slower with scar formation that impairs the transmission of light to some extent." Trauma to the cornea can be extremely painful. Healing will be delayed since the stroma layer is damaged and there is danger of infection. Injuries to the Bowman membrane and the stromal layer heal with scar formation that impairs light transmission.

A client has been diagnosed with bilateral cataracts associated with having difficulty seeing clearly. Reviewing the medication history, which drug may be responsible for the development of this condition? Corticosteroids Vitamin D Ibuprofen Furosemide

Corticosteroids Cataracts can result from several medications. Corticosteroid drugs have been implicated as causative agents in cataract formation. Both systemic and inhaled corticosteroids have been cited as risk factors. Other drugs include phenothiazines, amiodarone, and strong miotic ophthalmic drugs.

The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor that fills the anterior and posterior chambers of the eye. What is this disease called? Retinopathy Glaucoma Cataract Amblyopia

Glaucoma Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye. Retinopathy is a disorder of the retinal vessels that interrupts blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina.

An older client is complaining of having difficulty seeing. The nurse suspects that the client has cataracts. What are the common manifestations of a cataract? Select all that apply. Increasingly blurred vision Visual distortion Constriction of the pupil in dim light improves vision Hyperopia

Increasingly blurred vision Visual distortion Age-related cataracts, which are the most common type, are characterized by increasingly blurred vision and visual distortion. Visual acuity for far and near objects decreases. Dilation of the pupil in dim light improves vision. With nuclear cataracts (those involving the lens nucleus), the refractive power of the anterior segment often increases to produce an acquired myopia.

During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition? Keratitis Arcus senilis Uveitis Conjunctivitis

Keratitis Keratitis, or inflammation of the cornea, can be caused by infections, hypersensitivity reactions, ischemia, trauma, defects in tearing, or trauma.

Retinoblastoma is the most common intraocular malignant neoplasm of children. Which presenting sign is most commonly noticed by the family? Leukocoria Strabismus Red, tearing, and painful eyes Limited or poor vision

Leukocoria Leukocoria (e.g., cat's-eye reflex, white reflex, or white pupil) is the most common presenting sign and is often noticed by the family; light entering the eye commonly reflects a yellowish-white color similar to that of the membranous covering of a cat's eye. Strabismus (squint) is the second most common sign. Red, tearing, and painful eyes are a late sign of the disorder. Limited or poor vision is also a late sign.

Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on which factor? The child has to be older than 5 years. Maturity of the visual system at time of onset. The child has to have bilateral congenital cataracts. The child has to be able to wear contact lenses.

Maturity of the visual system at time of onset. The reversibility of amblyopia depends on the maturity of the visual system at the time of onset and the duration of the abnormal experience.

The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include: Medial deviation Downward deviation Lateral deviation Upward deviation

Medial deviation Disorders of eye movement are described according to the direction of movement. Esotropia refers to medial deviation, exotropia to lateral deviation, hypertropia to upward deviation, hypotropia to downward deviation, and cyclotropia to torsional deviation.

When conditions occur that impair retinal blood flow, such as hyperviscosity of the blood or a sickle cell crisis, what can occur in the eye? Microaneurysms Hypertensive retinopathy Microinfarcts Neovascularization

Neovascularization Neovascularization occurs in many conditions that impair retinal blood flow, including stasis because of hyperviscosity of blood or decreased flow, vascular occlusion, sickle cell disease, sarcoidosis, diabetes mellitus, and retinopathy of prematurity.

Cortical blindness is the bilateral loss of the primary visual cortex. What is retained in cortical blindness? Red spots seen behind the eyelids Pupillary reflexes Phytosis Myopia

Pupillary reflexes Crude analysis of visual stimulation at reflex levels, such as eye- and head-orienting responses to bright moving lights, pupillary reflexes, and blinking at sudden bright lights, may be retained even though vision has been lost.

What is the eye movement allowing the ability to smoothly follow an object called? Saccade Pursuit Convergence Divergence

Pursuit Eye movements can be categorized into smooth pursuit movements, saccadic movements, optic tremor, and vergence movements. Smooth pursuit movements are tracking movements that serve to maintain an object at a fixed point in the center of the visual fields of both eyes. Saccadic eye movements are sudden, jerky, conjugate movements that quickly change the fixation point. Convergence and divergence, which assist in maintaining a binocularly fixed image in near vision, have a major role in accurate depth perception.

An older adult client comes to the clinic complaining of seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect? Glaucoma Retinal detachment Cataracts Conjunctivitis

Retinal detachment The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.

A care aide at a long-term care facility has informed a resident's physician that the 80-year-old woman's eyes appear to be inflamed and that her eyelids are caked with sticky secretions. The woman has been subsequently diagnosed with posterior blepharitis. Which treatment is the physician likely to initiate? Surgical repair of the woman's blocked meibomian glands Warm compresses to be applied regularly to her eyes in addition to oral antibiotics Regularly scheduled cleansing of the woman's eyes with normal saline Intravenous steroids coupled with topical antibiotic ointment

Warm compresses to be applied regularly to her eyes in addition to oral antibiotics Treatment of posterior blepharitis is determined by associated conjunctival and corneal changes. Initial therapies can include warm compressing of the lids, and use of flaxseed or fish oil tablets to provide omega-3 benefits to meibomian oil secretions. Long-term, low-dose systemic antibiotic therapy guided by results of bacterial cultures along with short-term topical steroids may also be needed.

An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition? "One of my eyes has redness and purulent drainage." "I had intense eye pain coupled with photosensitivity." "I have blurred vision in both my eyes and my vision is distorted." "I feel like I have a buildup of pressure in my eyeball."

"I have blurred vision in both my eyes and my vision is distorted." Age-related cataracts, which are the most common type, are characterized by increasingly blurred vision and visual distortion. Symptoms of conjunctivitis include a foreign body sensation, a scratching or burning sensation, itching, and photophobia or light sensitivity. Severe pain suggests corneal rather than conjunctival disease. A discharge, or exudate, may be present. It is usually watery when the conjunctivitis is caused by allergy, a foreign body, or viral infection and it is usually mucopurulent (mucus mixed with pus) in the presence of bacterial or fungal infection. Trauma that causes abrasions of the cornea can be extremely painful. Glaucoma is a chronic, pressure-induced degenerative neuropathy that produces changes in the optic nerve and visual field loss.

A 69-year-old client comes to the clinic for a routine checkup. Upon examination, the nurse practitioner informs the client that she has cataracts. The client then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner? "Strong bifocal lenses can often cure cataracts." "Surgery is the only effective treatment for cataracts." "The doctor was correct and you are doing everything you can to help with this condition." "You are wrong and should not listen to your doctor."

"Surgery is the only effective treatment for cataracts." There is no effective medical treatment for cataract. Strong bifocal lenses, magnification, appropriate lighting, and visual aids may be used as the cataract progresses, but surgery is the only treatment for correcting cataract-related vision loss. Telling the client that bifocals will cure cataracts is false as well as telling her that her doctor was correct. The other option is not a therapeutic response by the nurse.

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing: Acute angle-closure glaucoma Primary open-angle glaucoma Subacute angle-closure glaucoma Acute-onset wide-angle glaucoma

Acute angle-closure glaucoma The sudden onset of eye pain, blurred vision, and a headache on the affected side indicate acute angle-closure glaucoma, which is an ophthalmic emergency. Subacute angle-closure glaucoma manifests as recurrent short episodes of unilateral pain, conjunctival redness, and blurring of vision associated with halos around lights. Open-angle glaucoma is usually asymptomatic and chronic.

What is ocular muscle imbalance resulting in "lazy eye" called? Myopia Hyperopia Amblyopia Presbyopia

Amblyopia Ocular muscle imbalance resulting in "lazy eye" is known as amblyopia. Myopia is the error in refraction resulting from altered focus on an image in front of the retina due to lens thickness. If the anterior-posterior dimension of the eyeball is too short, the image is theoretically focused posterior to (behind) the retina. This is called hyperopia or farsightedness. The term presbyopia refers to a decrease in accommodation that occurs because of aging.

A 42-year-old client reports increasing difficulty reading the labels on packages. He states that he has to continually hold it further and further away from his face in order to see the type clearly. Which eye disorder is this client most likely experiencing? An age-related change in accommodation. The accumulated effects of ultraviolet light exposure. The normal decline in retinal function that occurs in adulthood. Undiagnosed diabetic retinopathy.

An age-related change in accommodation. The term presbyopia refers to a decrease in accommodation that occurs because of aging. This is unrelated to UV light exposure and diabetes does not normally cause a specific decline in accommodation. Presbyopia is not the result of changes in retinal function.

The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply. Chronic hypoglycemia Chronic hyperglycemia Hypertension Hypotension Smoking

Chronic hyperglycemia Hypertension Smoking Diabetic retinopathy is one of the leading causes of blindness. Chronic hyperglycemia, hypertension, hypercholesterolemia, and smoking are risk factors for the development and progression of the disorder.

A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed: Conjunctivitis Retinal detachment Acute glaucoma Corneal edema

Conjunctivitis Conjunctivitis causes bilateral tearing, itching, burning, foreign body sensation, and morning eyelash crusting and eye redness. The primary symptom of retinal detachment is painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, are early symptoms. Attacks of glaucoma (increased intraocular pressure) are manifested by ocular pain, excruciating headache, blurred or iridescent vision, and corneal edema with hazy cornea, dilated (mydriasis), and fixed pupil; with repeated or prolonged attacks, the eye becomes reddened. With corneal edema, the cornea appears dull, uneven, and hazy; visual acuity decreases; and iridescent vision (i.e., rainbows around lights) occurs.

Vitreous humor occupies the posterior portion of the eyeball. It is an amorphous biologic gel. When liquefaction of the gel occurs, as in aging, what can be seen during head movement? Blind spots Meshlike structures Floaters Red spots

Floaters With the loss of gel structure, fine fibers, membranes, and cellular debris develop. When this occurs, floaters (images) can often be noticed because these substances move within the vitreous cavity during head movement. Blind spots, meshlike structures, and red spots are not seen during head movement with a loss of the gel structure of the vitreous humor.

A nurse is conducting a home safety assessment for an older adult client. Which items present potential safety hazards due to common vision changes in the older adult? Select all that apply. Glare from sunlight coming through the windows Abrupt changes in lighting Green rugs throughout home Polished wood floors

Glare from sunlight coming through the windows Abrupt changes in lighting Polished wood floors Glare and abrupt changes in lighting impede vision in the older adult, increasing the risk for falls and injury. With this in mind, the nurse should determine that the following present safety hazards to the adult: glare from sunlight coming through the windows, abrupt changes in lighting, and polished wood floors (due to glare from the polish).

As part of the community health department, a nurse is educating a group of diabetic clients about prevention of blindness. Which topics should be covered during this class? Select all that apply. Importance of yearly eye exams Need to have liver enzymes checked annually Tight control of blood glucose levels Keep BP below 130/85 (American Heart Association Guidelines) Never eat dessert when you have eaten pasta for the meal

Importance of yearly eye exams Tight control of blood glucose levels Keep BP below 130/85 (American Heart Association Guidelines) Current guidelines recommend that persons with diabetes have yearly eye examinations. Preventing diabetic retinopathy from developing or progressing is considered the best approach to preserving vision. Growing evidence suggests that careful control of blood glucose levels in persons with diabetes mellitus may retard the onset and progression of retinopathy. There also is a need for intensive management of hypertension and hyperlipidemia, both of which have been shown to increase the risk of diabetic retinopathy in persons with diabetes.

The nurse is conducting a community education class on amblyopia. The nurse determines that the participants understand the concepts when they identify which time period as the time when amblyopia is generally diagnosed? Infancy Adolescence Young adulthood After an eye injury

Infancy Amblyopia (i.e., lazy eye) is a decrease in visual acuity resulting from abnormal visual development in infancy and early childhood. There is no known connection between the condition and either injury or diabetes.

The nurse is conducting a health promotion class on the prevention of blindness and vision impairment. The nurse determines that participants understand the information when they identify which vision disorder as most likely to have an infectious etiology? Keratitis Cataracts Glaucoma Macular degeneration

Keratitis Cataracts, glaucoma, and macular degeneration are not caused by infectious organisms. However, keratitis may be caused by viruses, bacteria, fungi, and amebae.

Impaired function of which eye structure is responsible for blurred vision and loss of fine tuning of focus? Lens Retina Trabecular network Lacrimal gland

Lens Impaired function of the lens is responsible for blurred vision and loss of fine tuning of focus. The lacrimal system includes the major lacrimal gland, which produces tears. In open-angle glaucoma, the outflow of aqueous humor is obstructed at the trabecular meshwork. The afferent stimuli for pupillary constriction arise in the ganglionic cells of the retina.

A client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye? Blindness in one eye Loss of half of the visual field in one eye Loss of a quarter of the visual field in one eye Loss of the temporal or peripheral visual fields on both sides

Loss of half of the visual field in one eye Blindness in one eye is called anopia. If half of the visual field for one eye is lost, the defect is called hemianopia; if a quarter of the field is lost, it is called quadrantanopia. Loss of the temporal or peripheral visual fields on both sides results in a narrow binocular field, commonly called tunnel vision.

A client who is being treated in the critical care unit is experiencing a slowing of blood flow to the central retinal artery, ultimately resulting in edema of the client's optic papilla. Which assessment would most likely address the etiology of this health problem? Monitoring of the client's intracranial pressure Culture and sensitivity testing of the client's eye exudate Monitoring of the client's mean arterial pressure Palpation for cervical lymphedema

Monitoring of the client's intracranial pressure The client is experiencing papilledema, which is most often caused by an increase in ICP. It is noninfectious and is unrelated to systemic blood pressure or lymphedema.

With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder? Cataracts Hyperopia Presbyopia Astigmatism

Presbyopia Presbyopia describes the changes in vision that occur because of aging. No loss of lens fibers occurs, but instead, additional fibers are added to the outermost portion and the lens thickens, the fibers become less elastic, the range of focus or accommodation is diminished, and reading glasses become necessary for near vision. Hyperopia or farsightedness occurs when the anterior-posterior dimension of the eyeball is too short and the image is focused posterior to (behind) the retina. Myopia or nearsightedness occurs when the anterior-posterior dimension of the eyeball is too long and the image is focused anterior to the retina. Astigmatism is non-uniform curvature of the refractive surface, usually caused by a defect in the cornea. Cataracts form with normal aging when the nucleus and the cortex of the lens enlarge as new fibers are formed in the cortical zones; old fibers become more compressed and dehydrated. During the early stages of cataract formation, a yellow pigment and vacuoles accumulate in the lens fibers.

Binocular vision depends on the coordination of how many pairs of extraocular nerves that provide for the conjugate eye movements? One Two Three Four

Three Binocular vision depends on the coordination of three pairs of extraocular nerves that provide for the conjugate eye movements, with optical axes of the two eyes maintained parallel with one another as the eyes rotate in their sockets.

Ophthalmia neonatorum is a conjunctivitis of newborns associated with maternal sexually transmitted infections. When should ophthalmia neonatorum be suspected? When a conjunctivitis develops 24 hours after birth When a conjunctivitis develops 12 hours after birth When a conjunctivitis develops 48 hours after birth When a conjunctivitis develops 36 hours after birth

When a conjunctivitis develops 48 hours after birth Infection should be suspected when conjunctivitis develops 48 hours after birth. The conjunctivitis caused by silver nitrate occurs within 6 to 12 hours of birth and clears within 24 to 48 hours.

A nurse caring for a client with renal failure and associated malignant hypertension is concerned that the client may suffer partial or total visual loss due to papilledema noted on examination. The nurse realizes that papilledema is: a late sign and often indicates severely increased intracranial pressure. indicative of the potential of hypertensive crisis. an early sign for the development of glaucoma. an early indication of retinopathy and decreased intracranial pressure.

a late sign and often indicates severely increased intracranial pressure. Papilledema is a swelling of the optic papilla, which is located in the center of the optic nerve where the retinal artery and vein enter/exit the eye. Swelling in this area, noted on ophthalmic exam, indicates compromise of these vessels with possible damage to the optic nerve fibers. Unfortunately this is usually a late sign, not noticeable until the intracranial pressure is significantly elevated and damage to the optic nerve has already begun. Causes include brain tumors, increased cerebrospinal fluid, malignant hypertension, and subdural hematomas.

The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be: administration of topical beta-adrenergic antagonists to lower the pressure. to monitor vision for signs of closed-angle vision. laser peripheral iridotomy is performed immediately. oral diuretics should be administered immediately.

administration of topical beta-adrenergic antagonists to lower the pressure. The elevation in intraocular pressure in persons with open-angle glaucoma is usually treated pharmacologically or, in cases where pharmacologic treatment fails, by increasing aqueous outflow through a surgically created pathway. Medication is generally administered topically.

The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as: involuntary eye movements that preserve eye fixation on stable objects in the visual field. voluntary eye movements that preserve eye fixation on stable objects in the visual field. fixed eye movements that preserve eye fixation on unstable objects in the visual field. unilateral eye movements that preserve eye fixation on unstable objects in the visual field.

involuntary eye movements that preserve eye fixation on stable objects in the visual field. Nystagmus refers to the involuntary eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. As the body rotates, the vestibulocochlear reflexes cause a slow compensatory drifting of eye movement in the opposite direction, thus stabilizing the binocular fixation point.

The nurse is performing her morning assessment on a 69-year-old client on a medical-surgical unit. Upon assessing her pupils the nurse notices that they are equal and responsive to light but not to accommodation. The nurse is aware that with aging the lens becomes thicker and its capsule less elastic so she believes this to be the case. When accommodation is diminished in an older person as a result of aging this is referred to as: myopia. hyperopia. presbyopia. farsightedness.

presbyopia. The term presbyopia refers to a decrease in accommodation that occurs because of aging. Hyperopia is the same as farsightedness and myopia refers to nearsightedness (when the person can see close objects without problems but distant objects are blurred).

A client presents with varicella predominately occurring from the top of the nose to the eyelid margins. Which further assessments correlate to the development of varicella-zoster ophthalmicus? Select all that apply. bruising around the eyes, bilaterally uveitis with elevated intraocular pressure of 32 mm Hg tearing of the eye and photophobia bulging of the eye orbit and drying of the cornea eye pain and vesicular rash

uveitis with elevated intraocular pressure of 32 mm Hg tearing of the eye and photophobia eye pain and vesicular rash Herpes zoster ophthalmicus usually presents with malaise, fever, headache, and burning and itching of the periorbital area. These symptoms commonly precede the ocular eruption by a day or so. The rash is initially vesicular, becomes pustular and then crusts. Involvement of the tip of the nose and lid margins indicates a high likelihood of ocular involvement. Ocular signs include conjunctivitis, keratitis (irritation tearing and photophobia), and anterior uveitis, often with elevated intraocular pressure. Bruising is not common with this diagnosis. Bulging of the eye orbit (exophthalmos) is usually associated with thyroid problems (hyperthyroidism).