Eye Structure Cataracts Glaucoma St.pptx

Nursing Care of Clients with Eye Disorders By Kim A. Stiles, PhD, RN, CNE, AHN-BC With thanks to Poonam Khare 1 Eye Anatomy Review Posterior chamber 2 https://www.allaboutvision.com/resources/anatomy.htm Changes with Aging see Table 22.1, Lewis p. 412 Floaters Entropion or Ectropion https://icrcat.c...

Nursing Care of Clients with Eye Disorders By Kim A. Stiles, PhD, RN, CNE, AHN-BC With thanks to Poonam Khare 1 Eye Anatomy Review Posterior chamber 2 https://www.allaboutvision.com/resources/anatomy.htm Changes with Aging see Table 22.1, Lewis p. 412 Floaters Entropion or Ectropion https://icrcat.com/en/eye-conditions/entropion/ https://www.retinaky.com/floaters-flashes-and-retinal-tears/ https://lsceye.sg/blog/am-i-imagining-worms-floating-in-my-vision/ https://www.floridaeyeclinic.com/eyelid-surgery-orlando/ 3 Changes with Aging Arcus senilis https://cypresseyecentre.com/arcus-senilis-cornea-arcus/ 4 Eye emergency: Retinal Detachment https://www.innovaocular.com/en/problema-de-vision/retinal-detachment 5 Glaucoma A group of disorders characterized by – Increased IOP and consequences of elevated pressure – Optic nerve atrophy – Peripheral visual field loss 6 Etiology and Pathophysiology Balance between aqueous production (inflow) and reabsorption (outflow) needed for normal level of IOP Glaucoma is related to elevation of IOP Normal IOP is 10-12 mm Hg. 7 POAG ACG 8 Diagnostic Studies Tonometry measurements: normal IOP=1021 Slit lamp microscopy: visualizes anterior chamber angle Peripheral and central vision test Opthalmoscopy-look at changes in optic disc 9 Etiology and Pathophysiology Primary open-angle glaucoma (POAG) – 90% of primary glaucoma cases – Outflow of aqueous humor is decreased in trabecular meshwork 10 www.divyadrashtieyecare.com/images/13.jpg 11 POAG Tx: Drug Therapy Alpha-adrenergic agonist-apraclonidine hydrochloride(Lopidine), brimonidine(Alphagan) Beta blockers -timolol maleate Timoptic),levobunolol(Betagan) Carbonic Anhydrase inhibitorsbrinzolamide(Azopt),dorzolomide(Trusopt) – Oral CAI-Acetazolamide( Diamox) Miotics (pilocarpine nitrate, Pilagan) Prostaglandin agonists or analogs -latanoprost(Xalatan), bimatoprost(Lumigan) Rho Kinase Inhibitors- netarsudil (Rhopressa) 12 POAG Tx: Procedures -- Argon laser trabeculoplasty Therapeutic option to lower IOP Laser stimulates scarring and contraction of trabecular meshwork – Trabeculectomy – Removal of part of iris and trabecular meshwork – Aqueous humor percolates out area of missing iris – With or without filtering implant 13 ACG Etiology and Pathophysiology Angle-closure glaucoma (ACG) – 10% of glaucoma cases – Angle closure reducing the flow of aqueous humor – Can be slow onset or acute (AACG) 14 AACG Clinical Manifestations Acute angle-closure glaucoma (AACG) – Sudden pain around eyes – N/V – Seeing colored halos around lights – Blurred vision – Ocular redness – Corneal edema 15 AACG: Emergency Tx – Carbonic anhydrase inhibitors (table 22.15) Systemic: Acetazolamide (Diomox) Topical: brinzolamide (Azopt) dorzolamide (Trusopt) – Oral/IV hyperosmotic agents: glycerin (Ophthalgan), isosorbide (Ismotic), and mannitol (Osmitrol) 16 AACG: LT Tx & Prevention Laser peripheral iridotomy OR Surgical iridectomy Creates new opening in iris to outflow channels 17 Secondary Glaucoma Secondary glaucoma – Results from other systemic conditions that block outflow – Associated with inflammatory processes – Trauma – Prolonged steroid use Managed by meds and treating underlying problems 18 Nursing Management: Health Promotion Eye Exam Recommendations Ages 40-54: every 2-4 years Ages 55-64: every 1-3 years Greater than 65: every 1-2 years. More often if high risk. 19 NCLEX Review Question When teaching a patient with primary open-angle glaucoma about the disorder, the nurse explains that 1. the retinal nerve is damaged by an abnormal increase in the production of aqueous humor. 2. aqueous humor cannot drain from the eye, causing pressure damage to the optic nerve. 3. as the lens enlarges with aging, it pushes the iris forward, covering the outflow channels of the eye. 4. the lens blocks the pupillary opening, preventing the flow of aqueous humor into the anterior chamber. 20 Cataracts Opacity within crystalline lens-blocks or changes the passage of light needed for vision. May be in one or both eyes. Third leading cause of preventable blindness in U.S. Cataract removal is most common surgical procedure in the U.S. 21 Clinical Manifestations of Cataracts www.metwesteyecentre.com.au/.../cataracts.jpg 22 Etiology and Pathophysiology Senile Cataract – Most cataracts are senile – Caused by altered metabolic process leading to Accumulation of water Altered lens fiber structure 23 Etiology and Pathophysiology Other factors: – – – – – – – Blunt or penetrating trauma Smoking Alcohol Use Congenital factors Radiation/UV light exposure Steroids Ocular inflammation 24 Types of Cataracts 25 https://www.facebook.com/WiseFamilyEye/photos/did-you-know-there-are-three-types-of-cataracts1-nuclear-sclerotic-cataract-the-/2323262204370189/ Diagnostic Studies History and physical exam Visual acuity measurement Ophthalmoscopy Slit lamp microscope Glare testing 26 Non-Surgical Treatment – Change in glasses Rx – Reading glasses or magnifiers – Increased lighting – Lifestyle adjustment: avoiding driving at night 27 Surgical Treatment Cataract Removal, the only “cure” so far. – Preoperative phase Physical assessment: especially for older adults. NSAID eye drops: reduce inflammation & edema Mydriatic eye drops: produces pupillary dilation Cycloplegics: paralyzes accommodation, and produces mydriasis. Possible antianxiety meds. 28 Surgical Treatment – Intraoperative phase Local anesthetic given Phacoemulsification: Ultrasonic vibrations are used to dissolve the cataract into fragments that are suctioned out. Incisions are selfhealing, no sutures. Extracapsular cataract extraction: severe cataract removed in one piece. Sutures needed, recovery longer. Most pts have IOL implanted behind iris. Antibiotics & corticosteroids given 29 Surgical Treatment – Postoperative phase Antibiotic, anti-inflammatory (corticosteroid) eye drops 6-8 week follow-up Final glasses prescription Activity restrictions Nighttime eye shielding 30 Nursing Management Nursing Assessment Assess patient’s ability to understand and comply with treatment Assess patient’s psychologic reaction to sight threatening disorder Assess family’s ability to provide patient care Assess visual acuity, visual fields, IOP 31 Nursing Management Nursing Diagnoses Noncompliance Vision loss (see Appendix E, Ackley book) Knowledge deficits: Meds, activities Acute pain 32 Nursing Management Planning Expected goals – – – – – No progression of visual loss Understand disease process and rationale Comply with all aspects of therapy No postoperative complications: pain, infection Safely function in environment 33 Nursing Management Nursing Actions IOP management: medications, activity restriction Manage photophobia: darken environment, dark glasses Pt teaching: meds, safety, activities, expectations re vision improvement 34 Resource Harding, M. M. (2023). Ch. 22: Assessment and management: Visual problems. In M. M. Harding, J. Kwong, D. Hagler, & C. Reinisch (Eds.) Lewis’s medical-surgical nursing (12th ed., pp. 407-435. Elsevier. 35