glucoma and cataract.docx

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Glaucoma & Cataract Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define Glaucoma, and Cataract Enumerates their types Clinical manifestati...

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Glaucoma & Cataract Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define Glaucoma, and Cataract Enumerates their types Clinical manifestations Diagnostic assessments and studies Risk factors and important points Medical managements Glaucoma The term glaucoma is used to refer to a group of ocular conditions characterized by elevated IOP. If left untreated, the increased IOP damages the optic nerve and nerve fiber layer, but the degree of harm is highly variable. Risk factors Black or Asian race Cardiovascular disease Diabetes Family history of glaucoma Migraine syndromes Myopia (nearsightedness) Obstructive sleep apnea Older age Previous eye trauma Prolonged use of topical or systemic corticosteroids Thin cornea Important notes: Normal IOP is between 10 and 21 mm Hg Endophthalmitis (i.e., intraocular infection). The two common clinical forms of glaucoma in adults are wide- and narrow-angle glaucoma. Wide Angle Usually bilateral, but one eye may be more severely affected than the other. In wide angle glaucoma, the anterior chamber angle is open and appears normal. Narrow Angle 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. The types of examinations used in glaucoma include tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, and central visual field testing Clinical Manifestations Glaucoma is often called the “silent thief of sight” because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until they experience blurred vision or “halos” around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache. Medical Management The aim of all glaucoma treatment is prevention of optic nerve damage. Lifelong therapy is necessary because glaucoma cannot be cured. Treatment focuses on pharmacologic therapy, laser procedures, surgery, or a combination of these approaches, all of which have potential complications and side effects. Medical management of glaucoma relies on systemic and topical ocular medications that lower IOP. Many ocular medications are used to treat glaucoma, including miotics, beta-blockers, alpha2-agonists (i.e., adrenergic agents), carbonic anhydrase inhibitors, and prostaglandins. Cholinergics (i.e., miotics) increase the outflow of the aqueous humor by affecting ciliary muscle contraction and pupil constriction, allowing flow through a larger opening between the iris and the trabecular meshwork. Beta-blockers and carbonic anhydrase inhibitors decrease aqueous production. Prostaglandin analogues reduce IOP by increasing aqueous humor outflow. CATARACTS A cataract is a lens opacity or cloudiness. A cataract is a cloudy or opaque lens. On visual inspection, the lens appears gray or milky. By 80 years of age, more than half of all Americans have cataracts. Cataracts are a leading cause of blindness in the world. Pathophysiology Cataracts can develop in one or both eyes at any age. The three most common types are traumatic, congenital, or senile cataract (Norris, 2019). There are a variety of risk factors, the most common one being age. Clinical Manifestations Painless, blurry vision is characteristic of cataracts. The person perceives that surroundings are dimmer, as if their glasses need cleaning. Light scattering is common, and the person experiences reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity. Other effects include myopic shift (return of ability to do close work [e.g., reading fine print] without eyeglasses), astigmatism (refractive error due to an irregularity in the curvature of the cornea), monocular diplopia (double vision), and color changes as lens becomes more brown in color. Assessment and Diagnostic Findings Decreased visual acuity is directly proportionate to cataract density. The Snellen visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are used to establish the degree of cataract formation. The degree of lens opacity does not always correlate with the patient’s functional status. Medical Management No nonsurgical treatment (e.g., medications, eye drops, eyeglasses) cures cataracts or prevents age-related cataracts. Optimal medical management is prevention. Risk factors Aging Associated Ocular Conditions Infection (e.g., herpes zoster, uveitis) Myopia Retinal detachment and retinal surgery Retinitis pigmentosa Toxic Factors Alkaline chemical eye burns, poisoning Aspirin use Calcium, copper, iron, gold, silver, and mercury, which tend to deposit in the pupillary area of the lens Cigarette smoking Corticosteroids, especially at high doses and in long-term use Ionizing radiation Nutritional Factors Obesity Poor nutrition Reduced levels of antioxidants Physical Factors Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock Dehydration associated with chronic diarrhea, the use of purgatives in anorexia nervosa, and the use of hyperbaric oxygenation Ultraviolet radiation in sunlight and x-ray Systemic Diseases and Syndromes Diabetes Disorders related to lipid metabolism Down syndrome Musculoskeletal disorders Renal disorders