Final Study Guide - Eye PDF

**Final Study Guide - Eye** **Anatomy of the External Eye** - External structures of the eye and position of the lacrimal structures. A diagram of the human eye Description automatically generated **Anatomy-EOM and Eye Movement** - The extraocular muscles are responsible for eye movemen...

**Final Study Guide - Eye** **Anatomy of the External Eye** - External structures of the eye and position of the lacrimal structures. A diagram of the human eye Description automatically generated **Anatomy-EOM and Eye Movement** - The extraocular muscles are responsible for eye movement.  **Accommodation is the ability to focus and refocus.** **Gerontologic Considerations-Age related changes** - Dry eye - eyelids and lacrimal structures - refractive changes - cataracts age-related macular degeneration - low vision **Eye Assessment: History and Physical** - History - Common Complaints - Change in vision - Pain or discomfort - Discharge - Past History - Family History - Social History - Physical Assessment - Visual Acuity -- tested by Snellen chart. normal vision is 20/20 - External Eye Examination -- lid retraction or drooping will dry out eye, need to use artificial tear or ointment to keep lubricated - Diagnostic Examination - Direct Ophthalmoscopy - Amsler Grid -- used with macular degeneration to show progression - Tonometry - Perimetry Testing - Split-Lamp Exam - Color vision testing - Ultrasonography - Fluorescein Angiography - Goal is to preserve eye function for as long as possible. Nursing management of visually impaired patients involves emotional, physical, and social adaptation as well as providing appropriate resources. - Emmetropia - normal vision - Myopia -- nearsighted - Hyperopia - farsighted - Astigmatism - an irregularity in the curve of the cornea. **Nursing Management: Patients with Eye and Vision Disorders** **Impaired Vision** - any kind of vision loss, whether it\'s someone who cannot see at all or someone who has partial vision loss. **Refractive** **errors**- vision is impaired because a shortened or elongated eyeball prevents light rays from focusing sharply on the retina**.** **Low Vision**- is a general term describing visual impairment that requires patients to use devices and strategies in addition to corrective lenses to perform visual tasks. **Blindness -- BCVA (best corrected visual acuity) -- is 2400** - **Absolute blindness**- No light perception - **Legal Blindness -- BCBA - 2200** **Clinical Manifestations and Assessment** - Thorough H/P assessing low vision - Activities Affected by Visual Impairment with suggestions for Low-Vision Aids - Shopping, eating, identifying money, reading, writing, using a phone, crossing streets, using a computer, or driving - May use canes, eyeglasses, or magnifying glasses to help complete these activities **Medical Management** - Web Access for the Visually Impaired usually has a screen reader program or special software for visual impaired **Nursing Management** - Promoting Coping Efforts - Promoting Spatial Orientation and Mobility - Promoting Home and Community-Based Care - Nursing advocate for Social Services Referral-gov't assistance, disability benefits **Guidelines for Interacting with People Who Are Blind or Have Low Vision** - Talk with them any as any other person - Identify yourself - Touch persons arm or hand when you begin to speak - Face the person when you\'re talking - Be specific with directions - When you offer to assist someone, allow the person to hold onto your arm just above the elbow and to walk a half-step behind you. - When offering the person a seat, place the person's hand on the back or the arm of the seat. - When you are about to go up or down a flight of stairs, tell the person, and place their hand on the banister. - Make sure that the environment is free of obstacles; close doors and cabinets so they are not in the path. - Offer to read written information, such as a menu. If you serve food to the person, use clock cues to specify where everything is on the plate. - When the person who is blind or who has low vision is a patient in a health care facility: Make sure all objects the person will need are close at hand. Identify the location of objects that the person may need (e.g., "The call light is near your right hand"; "The telephone is on the table on the left side of your bed.") - Remove obstacles that may be in the person's pathway and could cause a fall. - Place all assistive devices the person uses close at hand; let the person feel the devices so that they know their location. - Do not distract the service animal unless the owner has given permission. - Ask the person, "How can I help you?" At some times, the person needs help, but at other times help may not be needed. **Glaucoma** - Pathophysiology -- is a group of ocular conditions characterized by optic nerve damage and increased interocular pressure. - Glaucoma is 1 of the leading causes of irreversible blindness worldwide without a cure. - Classifications - Open-Angle Glaucoma - Usually bilateral, but one eye may be affected more severely than the other. In all three types of open-angle glaucoma, the anterior chamber angle is open and appears normal. Chronic open-angle glaucoma (COAG) Optic nerve damage, visual field defects, IOP \>21 mm Hg Decrease IOP 20--50%. Additional topical and oral agents added as necessary. - Angle-Closure (Pupillary Block) Glaucoma Obstruction in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of the peripheral iris to the trabecula. The obstruction results in an increased IOP. Acute angle-closure glaucoma (AACG) Rapidly progressive visual impairment, periocular pain, conjunctival hyperemia, and congestion. Pain may be associated with nausea, vomiting, bradycardia, and profuse sweating. Reduced central visual acuity, severely elevated IOP, corneal edema Pupil is vertically oval, fixed in a semi-dilated position, and unreactive to light and accommodation Ocular emergency, requiring administration of hyperosmotics, acetazolamide, and topical ocular hypotensive agents, such as pilocarpine and beta blockers. - **Risk Factors** - Family history of glaucoma - Race (African, Caribbean, Hispanic) - Older age (over 60 years of age) - Diabetes mellitus - Cardiovascular disease - Migraine syndromes - Nearsightedness (myopia) - Eye trauma - Prolonged use of topical or systemic corticosteroids - **Progression of Glaucoma** - Initiating events: Precipitating factors include illness, emotional stress, congenital narrow angles, long-term use of corticosteroids, and use of mydriatics (i.e., medications causing pupillary dilation). - Structural alterations in the aqueous outflow system: Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations. - Functional alterations: Conditions such as increased IOP or impaired blood flow create functional changes. - Optic nerve damage: Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply. This fourth stage inevitably progresses to the fifth stage. - Visual loss: Progressive loss of vision is characterized by visual field defects. - **Types:** - **Primary open-angle glaucoma**- - **Angle-closure glaucoma**- 3 types, - **Acute angle closure glaucoma (AACG)** - **Subacute angle-closure glaucoma** - **Chronic angle-closure glaucoma** - **Glaucoma Medical and Nursing Management** - Topical/Oral agents - **Beta Blocker eye drops**- If medical tx unsuccessful...laser surgery to dec IOP - Goal is to maintain IOP within a range to avoid any further damage; decrease IOP by 30% - Teaching plan: The nature of the disease and the importance of strict adherence to the medication regimen must be included in a teaching plan to help ensure compliance. A thorough patient interview is essential to determine systemic conditions, current systemic and ocular medications, family history, and problems with adherence to glaucoma medications. The effects of glaucoma-control medications on vision must also be explained. - Teaching Patients Self-Care - The medical and surgical management of patients with glaucoma slows the progression of glaucoma but does not cure it. The lifelong therapeutic regimen mandates patient education. - Continuing Care - Patient Education---Managing Glaucoma - Know your IOP measurement and the desired range. - Be informed about the extent of your vision loss and optic nerve damage. - Keep a record of your eye pressure measurements and visual field test results to monitor your own progress. - Review all your medications (including over-the-counter and herbal medications) with your ophthalmologist, and mention any side effects each time you visit. - Ask about potential side effects and drug interactions of your eye medications. - Ask whether generic or less costly forms of your eye medications are available. - Review the dosing schedule with your ophthalmologist and inform them if you have trouble following the schedule. - Participate in the decision-making process. Let your provider know what dosing schedule works for you and other preferences regarding your eye care. - Have the nurse observe you instilling eye medication to determine whether you are administering it properly. - Be aware that glaucoma medications can cause adverse effects if used inappropriately. - Eye drops are to be administered as prescribed, not when eyes feel irritated. - Ask your ophthalmologist to send a report to your provider after each appointment. - Keep all follow-up appointments. **Cataract** - **Risk Factors for Cataract Formation** - Aging: Loss of lens transparency Clumping or aggregation of lens protein (which leads to light scattering) Accumulation of a yellow-brown pigment due to the breakdown of lens protein Decreased oxygen uptake Increase in sodium and calcium Decrease in levels of vitamin C, protein, and glutathione (an antioxidant) - Associated ocular conditions: Retinitis pigmentosa Myopia Retinal detachment and retinal surgery Infection (e.g., herpes zoster, uveitis) - Toxic factors: Corticosteroids, especially at high doses and in long-term use Alkaline chemical eye burns, poisoning Cigarette smoking Calcium, copper, iron, gold, silver, and mercury, which tend to deposit in the pupillary area of the lens - Nutritional factors: Reduced levels of antioxidants, Poor nutrition, and Obesity - Physical factors: Dehydration associated with chronic diarrhea, use of purgatives in anorexia nervosa, and use of hyperbaric oxygenation Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock Ultraviolet radiation in sunlight and x-ray - Systemic diseases and syndromes: Diabetes mellitus Down syndrome Disorders related to lipid metabolism Kidney disorders Musculoskeletal disorders - **Pathophysiology\--** A cataract is a lens opacity or cloudiness. 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. Cataracts are a common cause of treatable blindness with surgical removal being the most common procedure. - The three most common types of age-related cataracts are defined by their location in the lens: nuclear, cortical, and posterior subcapsular. The extent of visual impairment depends on their size, density, and location in the lens. More than one type can be present in one eye. - **Medical Management** - Non-surgical - Surgical - Intracapsular Cataract Extraction - Extracapsular Cataract Extraction - Phacoemulsification - Lens Replacement - Toxic Anterior Segment Syndrome - **Nursing Management** - Preoperative Care\-- It has been common practice to withhold any anticoagulant therapy (e.g., aspirin, warfarin) to reduce the risk for retrobulbar hemorrhage (after retrobulbar injection) for 5 to 7 days before surgery. Antibiotic, corticosteroid, and anti-inflammatory drops may be administered prophylactically to prevent postoperative infection and inflammation. - Postoperative care - The nurse explains that there should be 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. - Education--- - Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days. A clean, damp washcloth may be used to remove slight morning eye discharge, moving from inner to outer canthus. Because cataract surgery increases the risk for retinal detachment, the patient must know to notify the surgeon if new floaters (dots) in vision, flashing lights, a decrease in vision, pain, or an increase in redness occurs. - Wear glasses or metal eye shield always following surgery, as instructed by the provider. - Always wash hands before touching or cleaning the postoperative eye. - Clean the postoperative eye with a clean tissue; wipe the closed eye with a single gesture from the inner canthus outward. - Bathe or shower; shampoo hair cautiously or seek assistance. - Avoid lying on the side of the affected eye the night after surgery. - Keep activity light (e.g., walking, reading, watching television). - Resume the following activities only as directed by the surgeon: driving, sexual activity, unusually strenuous activity. - Remember not to lift, push, or pull objects heavier than 15 lb. - Avoid bending or stooping for an extended period. - Be careful when climbing or descending stairs. - Know when to contact the surgeon. - Contact the surgeon immediately if any of the following problems occur before the next appointment: (1) vision changes; (2) continuous flashing lights appear to the affected eye; (3) redness, swelling, or pain increase in the eye; (4) the amount or type of eye drainage changes; (5) the eye is injured in any way; (6) significant pain is not relieved by acetaminophen. **Retinal Detachment** - Retinal detachment is caused by an accumulation of fluid between the layers of the retina - Rhegmatogenous detachment is the most common form. **Clinical Manifestations and Assessment** - Patients may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. **Medical Management** - New surgical techniques and advances in instrumentation have led to an increased rate of success of surgical reattachment and better visual outcomes. **Nursing Management** - For the most part, nursing interventions consist of educating the patient and providing supportive care. - Promoting Comfort - Teaching about Complications - Patients must be taught the signs and symptoms of complications, particularly of increasing IOP and postoperative infection, such as eye pain, sudden change in vision, fever, lid swelling, or conjunctival and/or corneal injection (redness). Excessive pain, swelling, and bleeding must be reported immediately to the surgeon. **Macular Degeneration** - Macular degeneration is a leading cause of visual with two types: wet and dry Progression of age-related macular degeneration (AMD): pathways to vision loss. A diagram of a medical condition Description automatically generated with medium confidence - Pathophysiology - Most common is dry or nonexudative type, which has an insidious onset and leads to a mild to moderate loss of vision, although peripheral vision is preserved. In dry AMD, the outer layers of the retina slowly break down withthis comes the appearance of drusen. When the drusen occur outside of the macular area, patients generally have no symptoms. When the drusen occur within the macula, however, there is a gradual blurring of vision that patients may notice when they try to read. There is no known treatment that can cure this type of AMD. - Wet or exudative AMD is characterized by choroidal neovascularization (CNV), new growth of blood vessels beneath the retina, which if untreated causes severe vision loss in 70% to 90% of AMD cases. Wet AMD may have an abrupt onset. The affected vessels can leak fluid and blood, elevating the retina. Patients report that straight lines appear crooked and distorted, or that letters in words appear broken. Some patients can be treated with the argon laser to stop the leakage from these vessels. However, this treatment is not ideal because vision may be affected by the laser treatment, and abnormal vessels often grow back after treatment. - Medical Management - Pearls for Practice: Vitamins and Macular Degeneration: The Age-Related Eye Disease Study (AREDS) demonstrated that daily high-dose multivitamin supplements containing vitamins and minerals that include vitamin C (500 mg), vitamin E (400 IU), zinc oxide (80 mg), and copper (2 mg) are beneficial in reducing the risk of vision loss in patients. - Nursing Management - Nursing management is primarily educational. Most patients benefit from the use of bright lighting and magnification devices and from referral to a low-vision center. **Orbital Trauma** - Head Injury - Soft Tissue Injury and Hemorrhage - Orbital Fractures - Foreign Body Health Promotion---Preventing Eye Injuries - In and Around the House Advise patients to: Make sure that all spray nozzles are directed away from themselves before pressing down on the handle. Read instructions carefully before using cleaning fluids, detergents, ammonia, or harsh chemicals, and to wash hands thoroughly after use. Use grease shields on frying pans to decrease spattering. Wear special goggles to shield their eyes from fumes and splashes when using powerful chemicals. Use opaque goggles to avoid burns from sunlamps. - In the Workshop Advise patients to: Protect their eyes from flying fragments, fumes, dust particles, sparks, and splashed chemicals by wearing safety glasses. Read instructions thoroughly before using tools and chemicals and follow precautions for their use. - Around Children Advise patients to: Pay attention to age and maturity level of a child when selecting toys and games, and to avoid projectile toys, such as darts and pellet guns. Supervise children when they are playing with toys or games that can be potentially dangerous. Teach children the correct way to handle potentially dangerous items, such as scissors and pencils. - In the Garden Advise patients to: Avoid letting anyone stand at the side of or in front of a moving lawn mower. Pick up rocks and stones before going over them with the lawn mower (stones can be hurled out of the rotary blades and rebound off curbs or walls, causing severe injury to the eye). Make sure that pesticide spray can nozzles are directed away from the face. Avoid low-hanging branches. - Around the Car Advise patients to: Put out all smoking materials and matches before opening the hood of the car. Use a flashlight, not a match or lighter, to look at the battery at night. Wear goggles when grinding metal or striking metal against metal while performing auto body repair. Take standard safety precautions when using jumper cables (wear goggles; make sure the cars are not touching one another; make sure the jumper cable clamps never touch each other; never lean over the battery when attaching cables; and never attach a cable to the negative terminal of a dead battery). - In Sports Advise patients to: Wear protective safety glasses, especially for sports such as racquetball, squash, tennis, baseball, and basketball. Wear protective caps, helmets, or face protectors when appropriate, especially for sports such as ice hockey. - Around Fireworks Advise patients to: Wear eyeglasses or safety goggles. Avoid using explosive fireworks. Never allow children to ignite fireworks or stand near others when lighting fireworks. Douse firework duds in water instead of attempting to re **Ocular Trauma** - Ocular trauma is a common cause of blindness especially among children and young adults - Medical Management - Splash Injuries - Splash injuries are irrigated with normal saline solution before further evaluation occurs. In cases of a ruptured globe, cycloplegic agents (agents that paralyze the ciliary muscle) or topical antibiotics must be deferred because of potential toxicity to exposed intraocular tissues. - Foreign Bodies and Corneal Abrasions - After removal of a foreign body from the surface of the eye, an antibiotic ointment is applied and the eye is patched. The eye is examined daily for evidence of infection until the wound is completely healed. Contact lens wear is a common cause of corneal abrasion. Topical anesthetic eye drops must not be given to the patient to take home for repeated use after corneal injury because their effects mask further damage, delay healing, and can lead to permanent corneal scarring. Corticosteroids are avoided while the epithelial defect exists. - Penetrating Injuries and Contusions of the Eyeball - the patient is hospitalized with moderate activity restriction. An eye shield is applied. Topical corticosteroids are prescribed to reduce inflammation. An antifibrinolytic agent, aminocaproic acid, stabilizes clot formation at the site of hemorrhage. Aspirin is contraindicated. - Intraocular Foreign Bodies - IOFB is diagnosed and localized by slit-lamp biomicroscopy and indirect ophthalmoscopy, as well as CT or ultrasonography. MRI is contraindicated because most foreign bodies are metallic and magnetic. - Ocular Burns - In treating chemical burns, every minute counts. Immediate tap-water irrigation should be started on site before transport of the patient to an emergency department. **INFECTIOUS AND INFLAMMATORY CONDITIONS** **Conjunctivitis** - Conjunctivitis is the most common ocular disease worldwide and can be caused by various organisms - Clinical Manifestations and Assessment - Types of Conjunctivitis - Microbial Conjunctivitis - Bacterial Conjunctivitis - Viral Conjunctivitis - Allergic Conjunctivitis - Toxic Conjunctivitis Common Infections and Inflammatory Disorders of Eye Structures - Medical and Nursing Management - Management of Conjunctivitis - Bacterial Conjunctivitis - Acute bacterial conjunctivitis is almost always self-limiting, lasting 2 weeks if left untreated. If treated with antibiotics, it may last a few days, except for gonococcal conjunctivitis. Gonococcal conjunctivitis ceases within hours of topical antibiotic therapy, which may be discontinued 24 hours after treatment. For trachoma, usually broad-spectrum antibiotics are administered topically and systemically. Surgical management includes the correction of trichiasis (eyelashes growing inward toward the conjunctiva and cornea) to prevent conjunctival scarring. Adult inclusion conjunctivitis requires 1 week of antibiotics. Prevention of reinfection is important, and affected individuals and their sexual partners must seek treatment for sexually transmitted disease, if indicated. - Viral Conjunctivitis - Viral conjunctivitis is not responsive to any treatment. Cold compresses may alleviate some symptoms. It is extremely important to remember that viral conjunctivitis, especially epidemic keratoconjunctivitis, is highly contagious. Patient instructions should include an emphasis on hand hygiene and avoiding sharing of hand towels, face cloths, pillowcases, other linens, personal items, and eye drops. Tissues should be directly discarded into a covered trash can. Replace all eye cosmetics, if applicable.  All forms of tonometry must be avoided unless medically indicated. All multidose medications must be discarded at the end of each day or when contaminated. Infected employees and others must not be allowed to work or attend school until symptoms have resolved, which can take 3--7 days. - Allergic Conjunctivitis - Patients with allergic conjunctivitis, especially recurrent vernal or seasonal conjunctivitis, are usually given corticosteroids in ophthalmic preparations. Depending on the severity of the disease, they may be given oral preparations. Use of vasoconstrictors, such as topical epinephrine solution, cold compresses, ice packs, and cool ventilation, usually provides comfort by decreasing swelling. - Toxic Conjunctivitis - For conjunctivitis caused by chemical irritants, the eye must be irrigated immediately and profusely with saline or sterile water. - Patient Education\-- Instructions for Patients with Viral Conjunctivitis - Viral conjunctivitis is a highly contagious eye infection. - Your eyes will look red and will have watery discharge, and your lids will be swollen for about a week. - You will experience eye pain, a sandy sensation in your eye, and sensitivity to light. - Symptoms will resolve after about 1 week. You may use light, cold compresses over your eyes for about 10 minutes four to five times a day to soothe the pain. - You may use artificial tears for the sandy sensation in your eye, and mild pain medications, such as acetaminophen. - You need to stay at home. Children must not play outside. You may return to work or school after 7 days, when the redness and discharge have cleared. You may obtain a doctor's note to return to work or school. - Do not share towels, linens, makeup, or toys. - Wash your hands thoroughly and frequently, using soap and water, including before and after you apply artificial tears or cold compresses. - Use a new tissue every time you wipe the discharge from each eye. You may dampen the tissue with clean water to clean the outside of the eye. - You may wash your face and take a shower as you normally do. - Discard all of your makeup articles. You must not apply makeup until the disease is over. - You may wear dark glasses if bright lights bother you. - If the discharge from your eye turns yellowish and pus-like, or you experience changes in your vision, you need to return to the health care provider for an examination. **ORBITAL CELLULITIS** - Pathophysiology - Orbital cellulitis is inflammation of the tissues surrounding the eye. - Clinical Manifestation and Assessment - The symptoms include pain, lid swelling, conjunctival edema, proptosis, and decreased ocular motility. With such edema, optic nerve compression can occur and IOP may increase. - Medical and Nursing Management - Immediate administration of high-dose, broad-spectrum, systemic antibiotics is indicated. Cultures and Gram-stained smears are obtained. Monitoring changes in visual acuity, degree of proptosis, central nervous system function (e.g., nausea, vomiting, fever, cognitive changes), displacement of the globe, extraocular movements, pupillary signs, and the fundus is extremely important. **TREATMENT MODALITIES FOR EYE INJURIES AND DISORDERS** **Surgical Procedures -** Orbital Surgeries - Enucleation - the removal of the entire eye and part of the optic nerve - Evisceration - surgical removal of the intraocular contents through an incision or opening in the cornea or sclera - Exenteration - removal of the eyelids, the eye, and various amounts of orbital contents. **PHARMACOLOGIC TREATMENT** - Ocular Medication Administration - GUIDELINES FOR NURSING CARE---Instilling Eye Medications - Ensure adequate lighting. - Perform hand hygiene. Hand hygiene and aseptic technique is important to decrease the risk of contamination of supplies and the spread of further infection. - Don clean gloves and, if necessary or required, gently clean any crusts or drainage from the eyelid margins, wiping from the inner to the outer canthus and using a fresh gauze pad or cotton ball moistened with warm water for each stroke. Cleaning the eyes promotes patient comfort and promotes absorption of medications. In addition, debris is removed from the nasolacrimal duct. - 4.Prepare medication. Read the label of the eye medication to make sure it is the correct medication. Shake suspensions or "milky" solutions to obtain the desired medication level. Verify which eye is to be treated. Proper checking of medication and which eye is to be treated is an essential right. Mixing of medication in suspension is required. - 5.Assume proper position for instillation of eye medications. Positioning of the patient's head in a supine position or, if sitting, hyperextended in a "sniffing position" allows for proper instillation of ophthalmic medication, particularly drops. - 6.Do not touch the tip of the medication container to any part of the eye or face. Hold the lower lid down; do not press on the eyeball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid. Maintaining aseptic technique avoids contamination of materials, such as the medication container. Using the cheek bone as a fulcrum to steady the arm allows for improved medication delivery. - 7.Apply medication. Instill eye drops before applying ointments. For eye drops: Eye drops should be instilled at approximately 1 in from the eye. Before instilling the eyedrops, instruct the patient to look up and away. The lower lid is gently pulled down to instill the drops in the conjunctival sac. Immediately after instilling eye drops, apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 3--5 minutes. Using a clean tissue, gently pat the skin to absorb excess eyedrops that run onto the patient's cheeks. For eye ointment: Apply a ½-in ribbon of ointment to the lower conjunctival sac. Immediately after ointment instillation, ask the patient to roll their eyes behind closed lids. Medication is administered into the conjunctival sac, rather than on the eyeball, which can cause discomfort. Gentle pressure on the inner canthus (punctal occlusion) is done to decrease the risk of systemic absorption of the medication. Rolling the eye helps to distribute the medication over the surface of the eyeball. - 8.Wait 5 minutes before instilling another eye medication. Allow for absorption of one medication to occur prior to applying another one. - 9.Perform hand hygiene. - Commonly Used Ocular Medications - Topical Anesthetics - Mydriatics and Cycloplegics\-- **Table 48-5** Mydriatics and Miotics - Antiglaucoma Medications - Anti-Infective Medications - Corticosteroids and Nonsteroidal Anti-Inflammatory Drugs - Antiallergy Medications - Ocular Irrigants and Lubricants Nursing Management - The objectives in administering ocular medications are to ensure proper administration to maximize the therapeutic effects and to ensure the safety of the patient by monitoring for systemic and local side effects. Pediatric Eye Conditions **Clinical Manifestations of Visual Disorders** Etiology, Clinical Manifestations, and clinical therapy reviewed. **Congenital Cataracts** **Etiology** - occurs when all or part of the lens of the eye becomes opaque which prevents refraction of light rays onto retina **Clinical Manifestations** - can affect one or both eyes and may be congenital or acquired. Clouding of lens indicates presence of cataract. Symptoms include distorted red reflexes, vision loss, white pupil. May be present alone but sometimes associated with other conditions such as fetal alcohol syndrome, down syndrome, or turner\'s syndrome **Clinical Therapy** - must be diagnosed at a young age for successful treatment, many cases are missed. Specific treatment depends on whether one or both eyes are affected, extent of clouding and presence of other ocular abnormalities. Eye protectors and restraints are used postoperatively to prevent injury, antibiotic and steroid drops may be used for several weeks. **Strabismus** **Etiology** - Esotropia - inward deviation of the eyes AKA cross eyed Exotropia - outward deviation of the eyes AKA wall eyes **Clinical Manifestations** - eyes appear misaligned to observer. May occur only when child is tired. Symptoms include squinting and frowning when reading, closing eyes to see or having trouble picking up objects, may have dizziness and headaches. **Clinical Therapy -** occlusion therapy (patching the good eye for one to two hours daily to force the use of the weak eye), surgery of the rectus muscle to correct muscle imbalance, eye drops to cause blurring of the good eye, or vision therapy.