VIANZON, REYNALDO JR.

, M
BSN 4
ELECTIVE 2
1. CATARACT
Description
A cataract is a clouding of the lens in the eye leading to a decrease in vision. It is
commonly due to aging, but may also occur due to trauma, radiation exposure, be present
from birth, or occur following eye surgery for other problems. Risk factors include
diabetes, smoking tobacco, prolonged exposure to sunlight, and alcohol. Either clumps of
protein or yellow-brown pigment may be deposited in the lens reducing the transmission
of light to the retina at the back of the eye.
Etiology
Due to:
-Aging
-Associated Ocular Conditions (Myopia, Renitinis Pigmentosa, Retinal Detachment and
surgery
-Toxic Factors ( Long term use of Corticosteroids, Alkaline chemicals, Smoking,
Calcium, copper, iron and mercury which tend to deposit in the pupillary area of the lens)
-Nutritional Factors (Reduced levels of antioxidants, Poor nutrition, Obesity)
-Physical Factors (Dehydration, Perforation of sharp object to the lens, UV Radiation and
X-ray)
-Systemic Diseases and Syndromes (Diabetes mellitus, Down syndrome, Disorders
related to lipid metabolism, Renal disorders, Musculoskeletal disorders)
Pathophysiology
Cataracts can develop in one or both eyes at any age for a variety of causes. Visual
impairment normally progresses at the same rate in both eyes over many years or in a
matter of months. The three most common types of senile (age-related) cataracts are
defined by their location in the lens: nuclear, cortical, and posterior subcapsular. The
extent of visual impairment depends on the size, density, and location in the lens. More
than one type can be present in one eye. A nuclear cataract is associated with myopia
(nearsightedness), which worsens when the cataract progresses. If dense, the cataract
severely blurs vision. Periodic changes in prescription eyeglasses help manage this
problem. A cortical cataract involves the anterior, posterior, or equatorial cortex of the
lens. A cataract in the equator or periphery of the cortex does not interfere with the
passage of light through the center of the lens and has little effect on vision. Cortical
cataracts progress at a highly variable rate. Vision is worse in very bright light. Studies
show that people with the highest levels of sunlight exposure have twice the risk of
developing cortical cataracts than those with low-level sunlight exposure. Posterior
subcapsular cataracts occur in front of the posterior capsule. This type typically develops
in younger people and, in some cases, is associated with prolonged corticosteroid use,
inflammation, or trauma. Near vision is diminished, and the eye is increasingly sensitive
Signs&Symptoms
Painless, blurry vision is characteristic of cataracts. The patient perceives that

surroundings are dimmer, as if glasses need cleaning. Light scattering is common, and the
individual experiences reduced contrast sensitivity, sensitivity to glare, and reduced
visual acuity. Other effects include myopic shift, astigmatism,
monocular diplopia (double vision), color shift.
Diagnostic Procedure
1. Visual acuity test
2. Using a light and magnification to examine your eye (slit-lamp examination). A
slit lamp allows your eye doctor to see the structures at the front of your eye under
magnification.
3. Dilating your eyes (retinal examination). To prepare for a retinal examination,
your eye doctor puts dilating drops in your eyes to open your pupils wide. This
makes it easier to examine the back of your eyes (retina).
Nursing Diagnosis
1. Anxiety related to lack of knowledge.
2. Risk for injury related to blurred vision
3. Acute pain related to trauma to the incision and increased IOP
Nursing Management
-Medical Management (No nonsurgical treatment cures cataracts.)
-Surgical Management
1. Intracapsular Cataract Extraction.
2. Extracapsular Surgery.
3. Phacoemulsification.
4. Lens Replacement.
Nursing Intervention
PROVIDING POSTOPERATIVE CARE
After recovery from anesthesia, the patient receives verbal and written instruction
regarding how to protect the eye, administer medications, recognize signs of
complications, and obtain emergency care. Activities to be avoided are identified in Chart
58-6. The nurse also explains that there is minimal discomfort after surgery and instructs
the patient to take a mild analgesic agent, such as acetaminophen, as needed. Antibiotic,
anti-inflammatory, and corticosteroid eye drops or ointments are prescribed
postoperatively.
Medication
1. Eye drops to dilate the pupil
Reference:
Brunner & Suddarths Medical-Surgical Nursing (Pages 1761-1764)
2. GLAUCOMA
Description

Glaucoma is a group of eye disorders leading to progressive damage to the optic nerve,
and is characterized by loss of nerve tissue resulting in loss of vision. The optic nerve is a
bundle of about one million individual nerve fibers and transmits the visual signals from
the eye to the brain. The most common form of glaucoma, primary open-angle glaucoma,
is associated with an increase in the fluid pressure inside the eye. This increase in
pressure may cause progressive damage to the optic nerve and loss of nerve fibers. Vision
loss may result. Advanced glaucoma may even cause blindness. Not everyone with high
eye pressure will develop glaucoma, and many people with normal eye pressure will
develop glaucoma. When the pressure inside an eye is too high for that particular optic
nerve, whatever that pressure measurement may be, glaucoma will develop.
Pathophysiology
There are two accepted theories regarding how increased IOP damages the optic nerve in
glaucoma. The direct mechanical theory suggests that high IOP damages the retinal layer
as it passes through the optic nerve head. The indirect ischemic theory suggests that high
IOP compresses the microcirculation in the optic nerve head, resulting in cell injury and
death. Some glaucomas appear as exclusively mechanical, and some are exclusively
ischemic types. Typically, most cases are a combination of both.
Signs and Symptoms
It is painless and does not have acute attacks. The only signs are gradually progressive
peripheral vision loss, and optic nerve changes.
Diagnostic Procedure
1.Measuringintraocularpressure.Tonometryisasimple,painlessprocedurethat
measuresyourinternaleyepressure(intraocularpressure),afternumbingyoureyeswith
drops.It'susuallytheinitialscreeningtestforglaucoma.
2. Testforopticnervedamage.Tocheckfordamageinyouropticnerve,youreye
doctoruses
instrumentstolookdirectlythroughthepupiltothebackofyoureye.Thiscanreveal
slightchangesthatmayindicatethebeginningsofglaucoma.
3. Visualfieldtest.Tocheckwhetheryourvisualfieldhasbeenaffectedby
glaucoma,yourdoctorusesaspecialtesttoevaluateyourside(peripheral)vision
4. Visualacuity.Yourdoctorwilltestyourabilitytoseefromadistance.
5. Measuringcorneathickness(pachymetry).Youreyesarenumbedforthistest,
whichdeterminesthethicknessofeachcornea,animportantfactorindiagnosing
glaucoma.Ifyouhavethickcorneas,youreyepressurereadingmayreadhigher
thannormaleventhoughyoumaynothaveglaucoma.
NursingDiagnosis
1. Anxietyr/tthreatofpermanentvisionloss
2. RiskforInjuryr/tincreasedintraocularpressure,alteredperipheralvision
3. IneffectiveHealthMaintenancer/tdeficientknowledgeregardingpostoperative
restrictions
NursingManagement
Medical/Surgical

1.
2.
3.
4.
5.

Laser trabeculoplasty
Laser iridotomy
Filtering procedures
Trabeculectomy
Drainage implants

NursingIntervention
TEACHING PATIENTS ABOUT GLAUCOMA CARE
The medical and surgical management of glaucoma slows the progression of glaucoma
but does not cure it. The lifelong therapeutic regimen mandates patient education. The
nature of the disease and the importance of strict adherence to the medication regimen
must be explained to help ensure compliance. A thorough patient interview is essential to
determine systemic conditions, current systemic and ocular medications, family history,
and problems with compliance to glaucoma medications. Then the medication program
can be discussed, particularly the interactions of glaucoma-control medications with other
medications. For example, the diuretic effect of acetazolamide has an additive effect on
the diuretic effects of other antihypertensive medications and can result in hypokalemia.
The effects of glaucomacontrol medications on vision must also be explained. Miotics
and sympathomimetics result in altered focus; therefore, patients need to be cautious in
navigating their surroundings. Information about instilling ocular medication and
preventing systemic absorption with punctal occlusion is described in the section on
ophthalmic medications.
Medication
1. Cholinergics (miotics) - Increases aqueous fluid outflow by contracting the ciliary
muscle and causing miosis.
(constriction of the pupil) and opening of trabecular meshwork.
2. Adrenergic agonists (dipivefrin, epinephrine) - Reduces production of aqueous humor
and increases outflow.
3. Beta-blockers (betaxolol, timolol) - Decreases aqueous humor production.
Reference:
Brunner & Suddarths Medical-Surgical Nursing (Pages 1757-1761)
4.

PRESBYOPIA

Description
Presbyopia is the gradual loss of your eyes' ability to focus on nearby objects. It's a
natural, often annoying part of aging. Presbyopia usually becomes noticeable in your
early to mid-40s and continues to worsen until around age 65. You may become aware of
presbyopia when you start holding books and newspapers at arm's length to be able to
read them. A basic eye exam can confirm presbyopia. You can correct the condition with
eyeglasses or contact lenses. You might also consider surgery.
Etiology
Duetoagingandeyetrauma.

Signs and Symptoms

-A tendency to hold reading material farther away to make the letters clearer
-Blurred vision at normal reading distance
-Eyestrain or headaches after reading or doing close work
Diagnostic Procedure
1. RefractiontestThisisaneyeexaminationthatinvolvesadevicethatwouldbe
usedinordertodetermineifanindividualneedsprescriptionglassesorcontact
lenses.Thisisapartoftheroutineinordertoknowifthevisionisstillnormal
thatisinlinewiththe20/20criteria.
2. SlitlamptestThistestisusetoexaminetheconjunctiva,cornea,eyelids,iris
andthelens.Asmalllensisplacedneartotheeyesothatthebackoftheeyeis
visualized.
3. VisualAcuityAneyechartisplacedwithadistanceof20feet.Atrandom,the
physicianwillpointoutlettersornumbersinvarioussizes.Thesizesrepresentthe
distancewhereinyouwillhaveadifficultyinreadingortheextentonhowclear
anindividualcansee.
Nursing Diagnosis
1. Anxiety related to altered visual acuity
2. Acute pain related to eyestrains or headaches
Nursing Management
Medical/Surgical
1. Lasik Surgery
2. Prescription glasses
3. Contact lens