Anatomy of the Eye

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Questions and Answers

What is classified as 'absolute blindness'?

  • Vision that can be corrected with glasses
  • Inability to see light (correct)
  • Legal blindness with BCVA of 2200
  • Vision of 2400 with correction

At what BCVA is a person considered legally blind?

  • 1600
  • 2200 (correct)
  • 2000
  • 2400

Which of the following activities can be affected by visual impairment?

  • Making phone calls (correct)
  • Planning vacations
  • Playing video games
  • Negotiating business deals

What is one way to assist someone who is blind when offering them a seat?

<p>Place their hand on the back or arm of the seat (B)</p> Signup and view all the answers

Which of the following aids may be used to help individuals with visual impairments?

<p>Magnifying glasses (A)</p> Signup and view all the answers

What is a key nursing management role for individuals with visual impairments?

<p>Advocating for social services referral (B)</p> Signup and view all the answers

When interacting with a person who is blind, what should you do?

<p>Identify yourself and touch their arm to begin speaking (A)</p> Signup and view all the answers

What type of software is useful for individuals with visual impairments when accessing the web?

<p>Screen reader programs (B)</p> Signup and view all the answers

What characterizes atrophy of the optic nerve?

<p>Loss of nerve fibers and blood supply (C)</p> Signup and view all the answers

What is the primary goal of glaucoma treatment concerning intraocular pressure (IOP)?

<p>Maintain IOP within a certain range to prevent damage (A)</p> Signup and view all the answers

Which type of glaucoma is characterized by sudden onset and severe symptoms?

<p>Acute angle-closure glaucoma (AACG) (B)</p> Signup and view all the answers

What is necessary for effective patient education in glaucoma management?

<p>Knowledge of IOP measurement and medication adherence (C)</p> Signup and view all the answers

Which medication type is commonly used to lower intraocular pressure in glaucoma patients?

<p>Topical/Oral beta blocker eye drops (D)</p> Signup and view all the answers

What is a key component of the teaching plan for patients with glaucoma?

<p>Strict adherence to the medication regimen (D)</p> Signup and view all the answers

How should patients monitor their condition regarding glaucoma?

<p>Keeping a record of eye pressure and visual field tests (D)</p> Signup and view all the answers

What type of glaucoma management is indicated when medical treatment is unsuccessful?

<p>Laser surgery to decrease intraocular pressure (A)</p> Signup and view all the answers

What is the correct technique for cleaning the eyelid margins?

<p>Wipe from the inner to the outer canthus using a fresh gauze pad (B)</p> Signup and view all the answers

Why is proper positioning of the patient's head important during eye medication instillation?

<p>It allows for better medication absorption and delivery (D)</p> Signup and view all the answers

What should be avoided to maintain aseptic technique when applying medication?

<p>Touching the medication container to the lower lid (C)</p> Signup and view all the answers

What should be done immediately after instilling eye drops?

<p>Apply gentle pressure to the inner canthus (B)</p> Signup and view all the answers

What is the correct way to prepare a suspension eye medication?

<p>Shake the container to obtain the desired medication level (B)</p> Signup and view all the answers

When instilling ointment into the eye, where should it be applied?

<p>Into the lower conjunctival sac (C)</p> Signup and view all the answers

What is the primary reason for performing punctal occlusion after eye drops are instilled?

<p>To decrease the risk of systemic absorption (D)</p> Signup and view all the answers

What should be done before instilling eye drops into a patient's eye?

<p>Ask the patient to look up and away (B)</p> Signup and view all the answers

What characterizes open-angle glaucoma?

<p>It is usually bilateral but may affect one eye more than the other. (D)</p> Signup and view all the answers

Which of the following is NOT a risk factor for glaucoma?

<p>Frequent eye exams (D)</p> Signup and view all the answers

What is a symptom of acute angle-closure glaucoma?

<p>Periocular pain and nausea (A)</p> Signup and view all the answers

Which treatment is typically used during an ocular emergency for acute angle-closure glaucoma?

<p>Topical ocular hypotensive agents (C)</p> Signup and view all the answers

Which of the following describes myopia's relationship with glaucoma?

<p>Myopia is a recognized risk factor for glaucoma. (B)</p> Signup and view all the answers

What initiates the progression of glaucoma?

<p>Emotional stress and long-term corticosteroid use (A)</p> Signup and view all the answers

What happens to the aqueous outflow system during glaucoma progression?

<p>There are structural alterations affecting its dynamics. (A)</p> Signup and view all the answers

What is a common symptom associated with chronic open-angle glaucoma?

<p>Gradual loss of peripheral vision (C)</p> Signup and view all the answers

What is the primary purpose of using topical anesthetic eye drops after a corneal injury?

<p>To mask further damage (D)</p> Signup and view all the answers

Which of the following conditions is treated with immediate tap-water irrigation?

<p>Ocular burns (A)</p> Signup and view all the answers

What is the recommended management for acute bacterial conjunctivitis?

<p>It may be self-limiting without treatment (C)</p> Signup and view all the answers

Why is MRI considered contraindicated for diagnosing intraocular foreign bodies (IOFB)?

<p>Because most foreign bodies are metallic (D)</p> Signup and view all the answers

What is the main purpose of using aminocaproic acid in ocular injuries?

<p>To stabilize clot formation (D)</p> Signup and view all the answers

Which type of conjunctivitis resolves rapidly with topical antibiotic therapy?

<p>Gonococcal conjunctivitis (C)</p> Signup and view all the answers

What is a key characteristic of allergic conjunctivitis?

<p>Triggered by allergens (B)</p> Signup and view all the answers

What should be avoided while an epithelial defect exists in eye injuries?

<p>Corticosteroids (C)</p> Signup and view all the answers

What is a key objective in administering ocular medications?

<p>To maximize therapeutic effects and ensure patient safety (D)</p> Signup and view all the answers

Which of the following is NOT a type of commonly used ocular medication?

<p>Antidepressants (B)</p> Signup and view all the answers

What condition is characterized by clouding of the lens of the eye?

<p>Cataracts (C)</p> Signup and view all the answers

What is a symptom of strabismus?

<p>Misalignment of the eyes (C)</p> Signup and view all the answers

What is the purpose of using eye protectors and restraints postoperatively?

<p>To prevent injury (A)</p> Signup and view all the answers

Which of the following describes esotropia?

<p>Inward deviation of the eyes (D)</p> Signup and view all the answers

What should be done before instilling a second eye medication?

<p>Wait 5 minutes (A)</p> Signup and view all the answers

Which condition is associated with symptoms like squinting and frowning when reading?

<p>Strabismus (C)</p> Signup and view all the answers

Flashcards

Legal Blindness BCVA

A visual acuity of 20/200 or less in the better eye, after correction, or a visual field of 20 degrees or less.

Absolute Blindness

No light perception.

Low-Vision Aids

Tools and technologies that assist people with reduced vision in completing daily activities.

Coping Efforts (Low Vision)

Strategies to manage the challenges of reduced vision.

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Spatial Orientation (Low Vision)

Developing skills to understand and navigate one's surroundings.

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Home and Community Care (Low Vision)

Support and adaptations needed in daily life for people with reduced vision.

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Social Service Referral

Connecting people with low vision to government assistance and disability benefits.

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Interacting with People who have Low Vision

Important considerations for talking with and assisting someone with low vision.

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What is glaucoma?

A group of eye conditions causing optic nerve damage and increased pressure inside the eye.

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Open-Angle Glaucoma

A type of glaucoma where the drainage angle of the eye is open but fluid flow is still blocked.

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Angle-Closure Glaucoma

A type of glaucoma where the drainage angle is blocked by the iris (colored part of the eye).

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What are some glaucoma risk factors?

Factors that increase your chance of developing glaucoma include family history, race, age, diabetes, cardiovascular disease, migraine, nearsightedness, eye injury, and long-term corticosteroid use.

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What triggers glaucoma progression?

Glaucoma can be triggered by events like illness, stress, narrow eye angles, long-term steroid use, and eye drops for dilation.

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How does glaucoma damage the eye?

Changes in fluid flow and pressure lead to tissue and cell changes in the eye, ultimately damaging the optic nerve.

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What are the functional alterations in glaucoma?

Glaucoma causes functional changes in the eye, like increased pressure and impaired blood flow, further damaging the nerve.

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What is the goal of glaucoma treatment?

The main goal is to lower eye pressure to prevent further damage. This is achieved through medications, lasers, or surgery.

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Optic Nerve Damage

A serious condition where the optic nerve, responsible for transmitting visual information to the brain, deteriorates due to loss of nerve fibers and blood supply.

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Visual Field Defects

A loss or distortion of vision within a specific area of the visual field, indicating potential optic nerve damage.

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Primary Open-Angle Glaucoma

A type of glaucoma characterized by a slow, gradual increase in intraocular pressure (IOP), leading to gradual vision loss. It's the most common form.

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Acute Angle Closure Glaucoma (AACG)

The most severe form of angle-closure glaucoma, characterized by rapid onset of severe eye pain, blurry vision, halos around lights, and red eyes. Requires immediate medical attention.

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Glaucoma Management Goal

To maintain IOP within a safe range to prevent further damage to the optic nerve, often aiming for a 30% decrease in IOP.

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Glaucoma Patient Education

A crucial part of managing glaucoma, involving the patient understanding the nature of the disease, medication regimen, potential side effects, and ongoing monitoring.

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Glaucoma & Lifelong Management

Although treatments can slow progression, glaucoma is not curable. Patients must adhere to lifelong therapeutic regimens.

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Eyelid Margin Cleaning

Gently cleaning crusts or drainage from the eyelid margins, wiping from the inner to outer canthus with a fresh gauze pad or cotton ball moistened with warm water for each stroke.

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Eye Cleaning Benefits

Promotes patient comfort, absorption of medications, and removes debris from the nasolacrimal duct.

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Eye Medication Preparation

Read the medication label, shake suspensions, verify the correct eye for treatment.

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Eye Medication Position

Head in supine position or hyperextended in a 'sniffing' position for proper instillation.

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Aseptic Technique for Eye Medication

Do not touch the tip of the container to the eye or face.

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Eyelid Holding Technique

Hold the lower lid down, do not press on the eyeball, anchor the finger on the cheek bone.

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Eyedrop Application

Instill eye drops 1 inch from the eye, instruct the patient to look up and away, apply pressure on the inner canthus after instillation.

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Eye Ointment Application

Apply a ½-inch ribbon to the lower conjunctival sac, ask the patient to roll their eyes behind closed lids after application.

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Conjunctivitis

Inflammation of the conjunctiva, the clear membrane covering the white part of the eye and the inside of the eyelid. It's a common eye condition caused by various organisms.

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Bacterial Conjunctivitis

A type of conjunctivitis caused by bacteria. It's often characterized by a thick, pus-like discharge and may cause redness and swelling.

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Viral Conjunctivitis

Conjunctivitis caused by a virus. It's usually characterized by a watery discharge and may be accompanied by other symptoms like swollen lymph nodes.

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Allergic Conjunctivitis

Conjunctivitis triggered by an allergic reaction to things like pollen, dust mites, or animal dander. Symptoms include itching, redness, and watery eyes.

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Trachoma

A type of bacterial conjunctivitis caused by Chlamydia trachomatis. It's a leading cause of blindness worldwide and can cause scarring of the eyelids and cornea.

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Gonococcal Conjunctivitis

A type of conjunctivitis caused by the Neisseria gonorrhoeae bacteria. It's a serious infection that can lead to blindness if left untreated.

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Trichiasis

A condition where eyelashes grow inward towards the conjunctiva or cornea, causing irritation and potential damage.

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Acute Bacterial Conjunctivitis

A common type of bacterial conjunctivitis that usually clears up within a few days with antibiotic treatment.

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Ocular medications: How are they applied?

Ocular medications, like eye drops, are usually applied to the eye by tilting the head back, pulling down the lower eyelid to create a pouch, and then instilling the drops into the pouch. Afterward, the eye should be gently closed for a few seconds to allow the medication to spread evenly over the surface.

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Ocular Medications: What is the wait time between applications?

To ensure absorption and prevent potential interactions, a minimum of 5 minutes should be allowed between instilling different types of eye medications.

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What are Mydriatics and Cycloplegics?

Mydriatics and Cycloplegics are types of ocular medications that dilate the pupil and paralyze the ciliary muscle, respectively. These medications are often used during eye exams to visualize the inner structures of the eye.

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What is a Cataract?

A cataract is a clouding of the lens of the eye, preventing light from passing through clearly and causing blurry vision.

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What are some symptoms of Cataracts?

Symptoms of a cataract include distorted red reflexes, vision loss, and a white pupil.

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What is Strabismus?

Strabismus, also known as 'crossed eyes' or 'wall eyes', is a condition in which the eyes are misaligned, causing a misdirection of gaze.

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What are the two main types of Strabismus?

The two main types of Strabismus are Esotropia (inward deviation of the eyes) and Exotropia (outward deviation of the eyes).

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What are some clinical manifestations of Strabismus?

Individuals with Strabismus may have symptoms including squinting, frowning while reading, closing one eye to see, difficulty picking up objects, dizziness, and headaches.

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Study Notes

Anatomy of the External Eye

  • External structures of the eye and lacrimal structures are described
  • Features include the brow, upper lid, lower lid, inner canthus, outer canthus, caruncle, lacrimal gland, lacrimal sac, nasolacrimal duct, lacrimal canal, and punctum
  • The sclera, conjunctiva, iris, and pupil are also part of the external structures

Anatomy-EOM and Eye Movement

  • The extraocular muscles (EOM) control eye movement
  • These include the superior oblique, superior rectus, lateral rectus, inferior rectus, and inferior oblique muscles

Anatomy of the Internal Eye

  • The internal structures of the eye are detailed
  • Features include the retina, choroid, vitreous body, zonules, canal of Schlemm, anterior chamber, posterior chamber, cornea, pupil, lens, iris muscle, and ciliary body
  • Supporting structures, such as the retinal artery, retinal vein, and optic nerve, are also mentioned.

Accommodation

  • Accommodation is the ability to focus and refocus.

Gerontologic Considerations

  • Age-related changes include dry eye, changes in eyelids and lacrimal structures, refractive changes, cataracts, and age-related macular degeneration (AMD).

Eye Assessment: History and Physical

  • Common complaints include changes in vision, pain, discomfort, or discharge
  • Past medical history, family history, and social history are also important factors in assessment
  • Physical assessment includes visual acuity (using a Snellen chart), external eye examination, direct ophthalmoscopy, Amsler grid, tonometry, perimetry testing, color vision testing, and ultrasonography (including fluorescein angiography).

Nursing Management: Patients with Eye and Vision Disorders

  • Impaired vision is any type of vision loss, ranging from complete blindness to partial vision loss
  • Nursing management involves emotional, physical, and social adaptation, along with providing resources

Refractive Errors

  • Vision is impaired due to a shortened or elongated eyeball, preventing light rays from focusing sharply on the retina.
  • Low vision is visual impairment requiring assistive devices and strategies.
  • Best corrected visual acuity (BCVA) is measured—is 20/200 or less
  • Legal blindness is defined as BCVA of 20/200 or less
  • Legal blindness (BCVA) with correction is 20/200 or worse.

Clinical Manifestations and Assessments

  • Thorough history and physical exam are essential in assessing low vision.
  • Activities affected by low vision can include shopping, eating, identifying money, reading, writing, using a phone, and crossing streets.
  • Visual aids like canes, eyeglasses, magnifying glasses are helpful.

Medical Management

  • Web access for the visually impaired offers screen reader programs and other helpful software.

Glaucoma

  • A group of ocular conditions causing optic nerve damage and increased interocular pressure (IOP)
  • Two main types are described: open-angle and angle-closure glaucoma. Open-angle glaucoma is usually bilateral, while angle-closure can affect one eye more severely than the other.

Progression of Glaucoma

  • Initiating events include illness, stress, congenital narrow angles and corticosteroids
  • Structural and functional alterations occur
  • Optic nerve damage, characterized by loss of nerve fibers and blood, and visual field loss occur
  • Treatment focuses on decreasing IOP.

Cataract

  • Lens opacity, or cloudiness, can develop in one or both eyes at any age.
  • Risk factors include aging, specific disorders, and toxic factors (e.g., corticosteroids).

Orbital Trauma

  • Injuries can include head injury, soft tissue injury, and orbital fractures (including foreign bodies)
  • Prevention focuses on using safety gear (e.g., goggles) in the workplace and when around children.
  • Safety precautions during car maintenance, sports, or gardening activities are also advised.

Retinal Detachment

  • Caused by fluid accumulation between retina layers
  • Rhegmatogenous detachment is a common form
  • Symptoms include a shade or curtain crossing vision, cobwebs, bright flashes, and floaters

Macular Degeneration

  • Leading cause of vision loss with two types: wet and dry
  • Related to age
  • Pathophysiology involves the outer retinal layers slowly breaking down (dry) or development of abnormal choroidal neovascularization (wet).

Conjunctivitis

  • Inflammation of the conjunctiva.
  • Causes include viral or bacterial infections, allergies, or toxic exposure
  • Management involves supportive care and medications (antibiotics for bacterial cases).

Orbital Cellulitis

  • Inflammation of tissues surrounding the eye, particularly with severe pain, swelling, and decreased eye movement.
  • Treatment includes high-dose, broad-spectrum antibiotics and close monitoring for changes in visual acuity or other complications.

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