Conjunctivitis: Pink Eye

Conjunctivitis

• Conjunctivitis is the inflammation of the conjunctiva, commonly known as "pink eye"
• Can stem from infections (bacterial, viral), allergies, or irritants

Anatomy and Physiology of Conjunctiva

• The conjunctiva covers the eye and lines eyelids
• Glands produce tears and are part of the lymphatic system
• The lymphatic system is involved in immune response
• The conjunctiva serves as a barrier, secreting mucus and tears for lubrication and protection

Signs and Symptoms of Conjunctivitis

• Redness in the eye is a key indicator
• Increased tear production and itching or burning sensations are also common
• Patients might experience a gritty feeling or eye discharge
• Swelling of the conjunctiva/eyelids and sensitivity to light (photophobia) can occur

Diagnosing Conjunctivitis

• Diagnosed by examining the eyes, reviewing medical history, and symptoms
• A sample of the eye discharge may be taken for laboratory analysis to determine the specific cause
• This is particularly important if symptoms are severe or if an underlying condition is suspected

Treatment and Management of Conjunctivitis

• Bacterial conjunctivitis gets treated with antibiotic eye drops or ointments like Ciprofloxacin
• Viral conjunctivitis requires supportive care, such as artificial tears and cold compresses
• Allergic conjunctivitis requires antihistamine eye drops or oral antihistamines
• General relief measures include warm compresses, eye hygiene, and avoiding contact lenses

Nursing Care Management for Conjunctivitis

• Instruct patients about the cause, symptoms, and duration of conjunctivitis
• Patients must be provided medication administration guidelines, including dosage and schedule
• Inform patients about proper handwashing techniques and to avoid touching or rubbing eyes
• Recommend avoiding contact lenses until resolution and instruct on warm/cold compresses to alleviate discomfort
• Frequent use of artificial tears for lubrication should be encouraged, and watch for signs of complications
• Monitor and assess the effectiveness of treatments and patient adherence

Keratitis

• Keratitis the inflammation of the cornea caused by infection, injury, or autoimmune disorders

Anatomy and Physiology of the Cornea

• The cornea is a transparent, avascular structure covering the anterior eye
• Functions include refraction and protection with five layers
• Five layers include the epithelium, Bowman's layer, stroma, descemet's membrane, and endothelium

Signs and Symptoms of Keratitis

• Pain, redness, photophobia, tearing, blurred vision are key indicators
• Corneal ulceration or perforation can occur in severe cases

Diagnosing Keratitis

• Diagnosing methods include visual acuity, slit lamp examination, corneal staining, and culture and sensitivity testing

Treatment and Management of Keratitis

• The medical treatment consists of antibiotics, antivirals, antifungals, and corticosteroids specific to cause
• Surgery might be needed in the form of Corneal transplant for severe damage

Nursing Care Management for Keratitis

• Monitor vision and pain levels and administer prescribed medications
• Educate on proper eye hygiene and infection prevention

Glaucoma

• Glaucoma is a group of eye conditions causing optic nerve damage, often linked to increased intraocular pressure (IOP)
• The main cause is the buildup of pressure inside the eye known as intraocular pressure (IOP)
• The optic nerve is damaged and primary cause of increased IOP is a blockage or dysfunction in the eye's natural drainage system, the trabecular meshwork
• Age as well as family history can be factors

Anatomy and Physiology of Glaucoma

• Aqueous humor dynamics maintain IOP, and the blocked drainage causes an open angle or angle closure glaucoma

Signs and Symptoms of Glaucoma

• Open-angle is classified by gradual peripheral vision loss
• Severe pain, nausea, and blurred vision with halos are signs of angle-closure

Diagnosing Glaucoma

• Early detection is important to prevent irreversible vision loss
• Following exams are done including tonometry, ophthalmoscopy, visual field tests, gonioscopy, and pachymetry

Treatment and Management of Glaucoma

• Medical treatment involves eye drops (beta blockers, prostaglandins), or oral medications
• Surgical treatment involves Trabeculectomy and laser therapy

Nursing Care Management for Glaucoma

• Educate on medication adherence and monitor for side effects
• Follow-up appointments for IOP checks

Cataract

• A cataract is the clouding of the lens, leading to vision impairment
• The most common cause of cataracts is aging
• After age 40, the proteins in the eye's lens naturally begin to break down
• Increased risk factors include a family history of cataracts, diabetes, serious eye injury, eye surgery

Anatomy and Physiology of a Cataract

• The lens anatomy consist of transparent shape that is Biconvex
• Lens focuses, and focuses light onto the retina
• Pathophysiology includes protein clumping reducing lens transparency

Signs and Symptoms of Cataracts

• Symptoms include blurred vision, glare sensitivity, faded colors, and double vision

Diagnosing Cataracts

• Diagnosing methods include visual acuity, eye structure exams, and retinal exams

Treatment and Management of Cataracts

• Medical non-surgical management is limited to early stages but eyeglasses or contact lenses are effective
• Anti-glare sunglasses or lenses and magnifying glasses
• Surgical treatment consists of cataract surgery

Nursing Care Management of Cataracts

• Nurses must assess for patient understanding and compliance
• Monitors the post-op, ensures correct medication use, and provides patient education

Retinal Detachment

• Retinal detachment is the separation of the retina from the underlying tissue, disrupting vision
• Causes include vitreous fluid, eye trauma, eye surgery, other eye conditions, family history

Anatomy and Physiology of Retinal Detachment

• Retina is a thin, light-sensitive layer with traction or fluid accumulation beneath the retina

Signs and Symptoms of Retinal Detachment

• Key indicators include flashes of light, floaters, shadow over vision
• Emergency involves complete vision loss if untreated

Diagnosing Retinal Detachment

• Diagnosis methods include Visual acuity exam, slit-lamp exam, ophthalmoscopy, and ultrasound scans

Treatment and Management of Retinal Detachment

• Medical Treatment is used manage retinal detachment or when surgery is no longer necessary
• Consists of Laser treatment, cryotherapy, pneumatic retinopexy
• Surgical Treatment, necessary to reattach the retina is cases of more advanced detachment, may involve scleral buckling and Vitrectomy

Nursing Care Management of Retinal Detachment

• Patients must be educated on early symptom recognition
• Nursing care may position patients and provide medication for adherence and coping

Refractive Errors

• Refractive errors occur when the eye cannot focus light properly on the retina

Anatomy and Physiology of Refractive Errors

• Eye structures consist of the cornea, lens, retina, and refractive index
• Pathophysiology includes abnormal curvature or lens elasticity

Signs and Symptoms of Refractive Errors

• Blurred vision is common including eye strain, headaches, and difficulty with near or distant vision

Treatment and Management of Refractive Errors

• Medical treatment includes glasses and contact lenses
• Surgical, LASIK, PRK, and lens replacement are possible

Nursing Care Management of Refractive Errors

• Nursing care includes performing vision screening and educating the patient regarding corrective options

Strabismus

• Strabismus is the misalignment of the eyes where they do not point in the same direction simultaneously
• Common name is “Crossed Eyes” and can be Esotropia (inward), Exotropia (outward), Hypertropia (upward), Hypotropia (downward), Intermittent or Constant

Signs and Symptoms of Strabismus

• Misaligned eyes, double vision, squinting or tilting, eye strain and reduced depth perception may occur
• Eye strain or headaches

Diagnosing Strabismus

• Cover test to assess eye alignment
• Assessing the Hirschberg test, Visual Acuity Test, Retinoscopy, and Prism Testing are methods for diagnosing

Treatment and Management of Strabismus

• Medical treatment may involve Description Glasses or Contact Lenses, Vision Therapy, and Prism Lenses
• Surgical, Strabismus Surgery may be needed