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Cataract
Glaucoma
Retinal detachment
Diabetic retinopathy
Age related macular degeneration
Graves disease
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- an opacity of the lens that distorts the imageprojected onto the
retina & that can progress to blindness
CAUSESCAUSES Aging process (Senile cataracts)
Inherited (Congenital cataracts)
Injury (Traumatic cataracts)
Can occur as a result of another eye disease(Secondary cataracts)
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MEDICAL
MANAGE
MENT
MEDICAL
MANAGE
MENT-- surgical removal of the lens, one eye at a timesurgical removal of the lens, one eye at a time
-- a lens implantation may be performed at the timea lens implantation may be performed at the timeofof
surgical proceduresurgical procedure
EXTRACAPSULAR EXTRACTIONEXTRACAPSULAR EXTRACTION
- the lens is lifted out without removing the lenscapsule
- may be performed with PhacoemulsificationPhacoemulsification
PHACOEMULSIficationPHACOEMULSIfication- the lens is broken up by ultrasonic vibrations &
extracted
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- increased IOP as a result of inadequate drainage ofaqueous
humor from the canal of Schlemm or overproduction of aqueous
humor
- the condition damages the optic nerve & can resultin blindness
TYPESTYPES
1.1. primary/secondaryprimary/secondary2.2. Acute/chronicAcute/chronic3.3. Open/closedOpen/closed
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ASSESSMENTASSESSMENT Elevated IOP (Normal pressure is 10-21 mm Hg)
Blurred vision
Halos around white lights
Frontal headaches/pain
Photophobia
Increased lacrimation
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NURSING CARE FOR CHRONIC GLAUCOMANURSING CARE FOR CHRONIC GLAUCOMA
Instruct the client the importance ofmedications
a. MIOTICS:MIOTICS: to constrict the pupils
b. CARBONIC ANHYDRASE INHIBITORS:CARBONIC ANHYDRASE INHIBITORS: todecrease theproduction of aqueous humor
c. BETABETA--BLOCKERS:BLOCKERS: to decrease theproduction of aqueous
humor & IOP Instruct the client the need for life-longmedication use
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NURSING CARE FORNURSING CARE FOR
CHRONIC GLAUCOMACHRONIC GLAUCOMA Prepare the client for TRABECULOPLASTYTRABECULOPLASTY as prescribed
- to facilitate aqueous humor drainage
Prepare client for TRABECULECTOMYTRABECULECTOMY as prescribed- allows drainage of aqueous humor into the
conjunctival spaces bythe creation of an opening
Iridectomy
cyclocryotheraphy
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- occurs when the layers of the retina separate becauseof
accumulation of fluid between them
- also occurs when both retinal layers elevate away
from thechoroid as a result of a tumor
TYPESTYPES
PARTIAL RETINAL DETACHMENTPARTIAL RETINAL DETACHMENT-- becomes complete if left untreated
COMPLETE RETINAL DETACHMENTCOMPLETE RETINAL DETACHMENT
- when detachment is complete, blindness may occur
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ASSESSMENTASSESSMENT
Flashes of light Floaters
Increase in blurred vision
Sense of curtain being drawn
Loss of a portion of the visual field
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MEDICAL MANAGEMENTMEDICAL MANAGEMENT
SEALING RETINAL BREAKS BY CRYOSURGERYSEALING RETINAL BREAKS BY CRYOSURGERY
- a cold probe applied to the sclera to stimulate an inflammatoryresponse
leading to adhesions
DIATHERMYDIATHERMY
- the use of electrode needle & heat through the sclera to stimulate aninflammatory response leading to adhesions
LASER THERAPYLASER THERAPY- to stimulate an inflammatory response to seal small retinal tears
beforethe detachment occurs
SCLERAL BUCKLINGSCLERAL BUCKLING
- to hold the choroid & retina together with a splint until scar tissueforms
closing the tear
INSERTION OF A GAS OR SILICONE OILINSERTION OF A GAS OR SILICONE OIL
- to encourage attachment because these agents have a specificgravity less
than vitreous or air & can float against the retina
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Progressive damage to retina and the retinal
vessels when it is occluded
Inadequate blood supply, sections of the
retina deteriorate causing permanent visionloss
All diabetic are at risk
Hypertensive people are also a candidate
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y Types
1. Nonproliferative retinal vessels are hyper
permeable and weak
2. Proliferative capillaries are leaking
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Spiders or cobwebs floating in vision
Dark or red streaks blocks the vision
Vision loss
Fluctuating vision loss
Dark spot in the center of the vision
Poor night vision difficulty adjusting from
bright light to dim
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Photocoagulation to stop the leakage of
blood and fluid in the retina using high
energy laser beam under local anesthesia
Vitrectomy removal of blood filled vitreoususing a cutter piece by piece replaced by NSS
to maintain normal shape of eye
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Age-related macular degeneration (AMD)
The most common cause of vision loss in persons older
than age 60
Affects the macula leading to central visual deficits
Cause is unknown or hereditary
Blue rays accelerate the disease
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Types
Dry or nonexudative type is most common, 85%-90%
Slow breakdown of the layers of the retina with theappearance of drusen
Wet type
May have abrupt onset
Proliferation of abnormal blood vessels growing
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High dose anti oxidant Vit. C and E beta
carotene zinc
Injecting verteporfin (Visudyne)
Special sunglass blocks blue rays
Argon photocoagulation
Retinal transplantation
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is a malignant tumor on the retina, the light-
sensing part of the eye, and is highly curable if
treated early.
This type of cancer can be present in one or both
eyes.
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A pupil that appears white - called
leucocoria,
The eyes may not move or focus in the same
direction. Eye pain.
The pupil is constantly dilated.
Red eye(s).
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An eye exam and imaging test given
These tests include ultrasound, MRI scans, CT
scans, bone scans, spinal tap and bone
marrow tests.
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Photocoagulation. A laser is used to kill blood
vessels that feed the tumor.
Cryotherapy. Extremely low temperatures areused to kill cancer cells.
Chemotherapy-
with bilateral type- treated with a preservation
attempt. Tumor chemoreduction withcarboplatinnand other drugs may reduce the tumor
volume making them amenable to local therapies[5]
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Laser therapy (Uses infrared laser light to
precisely destroy the blood vessels surrounding
a tumor.)Radiationtherapy. as a last resort Radiation
may be given externally or internally.
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Enucleation. Treatment of choice.
Thermotherapy
Brachytherapy with beta-emitting eyeapplicators have also been a successful major
treatment.
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- a person is legally blind if the best visual acuity with correctivelenses in the better eye is 20/200 or less or a visual field of 20degrees or less in the better eye
NURSING CARENURSING CARE
When speaking to a client who has limited sight or blind, the nurseuses a normal tone of voice
Orient the client to the environment Use a focal point & provide further orientation to the environmentfrom the focal point
Allow the client to touch objects in the room Use the clock placement of foods on the meal tray to orient theclient
Promote independence as much as possible
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An endocrine disorders
Exist with or without thyroid dysfunction
Retracted both upper and lower lids
Staring or frightened expression (stellwags
sign)
Lid lag (graefes sign)- lowering of lid when
looking down
Infrequent blinking
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Fine tremor with lid closure
Jerky movements on lid opening
Globes enlarge increase size of ocular
muscles
Edema of eye tissues
Excess orbital fat
Proptosis
Double vision
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Control of thyroid abnormalities
Diuretics
Steroids
Radiotherapy
Lid surgery
Tarsorrhapy
Decompression of the orbitOcular muscle surgery
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- bleeding into the soft tissue as a result of aninjury
- causes a black eye & the discolorationdisappears in
approximately 10 days
- pain, photophobia, edema & diplopia mayoccur
NURSING CARENURSING CARE Place ice on the eye immediately
Instruct the client to receive an eye examination
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- an object such as dust that enters the eye
NURSING CARENURSING CARE Have the client look upward, expose the lower lid, wet a cotton-tipped applicator with sterile NSS & gently twist the swab overthe particle & remove it
If the particle cannot be seen, have the client look downward,place a cotton applicator horizontally on the outer surface of
the upper eye lid, grasp the lashes, & pull the upper lid outward& over the cotton applicator, if the particle is seen, gently twistover it to remove
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-- an injury that occurs to the eye in which an objectan injury that occurs to the eye in which an objectpenetrates the eyepenetrates the eye
NURSING CARENURSING CARE Never remove the object because it may be holding ocularNever remove the object because it may be holding ocular
structures in place, the object must be removed by MDstructures in place, the object must be removed by MD
Cover the object with a cupCover the object with a cup
Dont allow the client to bendDont allow the client to bend Dont place pressure on the eyeDont place pressure on the eye
Client is to be seen by MD statClient is to be seen by MD stat
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- an eye injury in which a caustic substance enters the eye
NURSING CARENURSING CARE
Treatment should begin stat
Flush the eyes at the site of injury with water for at least 15-20 mins At the site of injury, obtain a small sample of the chemical involved
At the ER, the eyes is irrigated with NSS or an opthalmic irrigationsolution
The solution is directed across the cornea & toward the lateralcanthus
Prepare for visual acuity assessment
Apply an antibiotic ointment as prescribed
Cover the eye with a patch as prescribed
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ENUCLEATIONENUCLEATION-- removaloftheentireeyeballremovaloftheentireeyeball
EXENTERATIONEXENTERATION-- removaloftheeyeball& surroundingtissuesremovaloftheeyeball& surroundingtissues
Performed for the removal of ocular tumors
After the eye is removed, a ball implant is inserted toprovide a firmbase for socket prosthesis & to facilitate the best cosmetic
result
A prosthesis is fitted approximately 1 month after surgery