LU 5 : Common Eye Problems in Adult

What is cataract ?

A cataract is the opacity of the lens that impair the vision

Explain the pathophysiology of cataract

• it occurs due to degenerative opacification of the crystalline lens at any age

• it can develop in both eyes and usually one eye is more compromised

• visual impairment usually progress at the same rate in both eyes

What are the risk factors for cataract ?

1. Aging

2. Myopia

3. Infection

4. Aspirin

5. Cigarette smoking

6. Chemical burns

7. Corticosteroids

8. Diabetes

9. Poor nutrition

10. Blunt trauma

What are the types of cataract ?

• i) Acquired Cataract

• senile cataract - age related

• pre-senile cataracts

• traumatic cataracts

• secondary cataracts

• ii) Congenital Cataract

• Inborn cataract

• Neonates’s genetic defects

What are the clinical manifestations of cataract ?

• blurred vision : usually the first symptoms of cataract

• glare : refers to the pain felt when the patient looks into the light

• halos : vision of light is still there after looking away from bright light

• double vision : early symptoms of cataract

• poor night vision

What are the complications of cataract ?

• increase intraocular pressure (IOP)

• blindness

What are the assessment and diagnostic findings for cataract ?

• snellen visual acuity test

• opthalmoscopy

• slit-lamp biomicroscopic examination

What are the treatment for cataract ?

• glasses

• better lighting

• surgery

What are the surgical management for cataract ?

• Depends on the maturity of the cataract

• For dense cataract : Extracapsular cataract extraction (ECCE) removal of anterior lens and cortex

• For immature cataract : Phacoemulsification cataract surgery (PHACO) employs ultrasound energy to emulsify the nucleus

What are the nursing intervention for cataract ? in terms of

• preoperative health education

• preoperative care

• postoperative care

• Preoperative health education : i) supine position ii) bring a responsible adult who can drive iii) eye patch will be on affected eye iv) do not touch eyes after surgery

• Preoperative care : i) use of anticoagulant is withheld ii) administer dilating drop every 10 minutes for four doses at least 1 hour before surgery iii) antibiotic is given to prevent postoperative infection

• Postoperative care : i) eye protection (discharge health education ii) administer medication such as steroid drops iii) recognize signs of complications such as red painful eyes

What are the discharge health education ?

• Activities : i) do not do any strenuous activities for a few weeks ii) avoid rigorous exercises iii) do not drive iv) stay away from dusty areas

• Protective eye patch : i) to prevent accidental rubbing or poking the eye ii) wear 24 hours after surgery, followed by worn at night for 1-4 weeks iii) wear sunglasses when explore to bright light

• Expected side effects : i) slight morning discharge and some redness may be expected for a few days ii) use clean, damp washcloth may be used to remove slight morning eye discharge

• Notify the physician if new floaters in vision, decrease in vision or pain

What is Glaucoma ?

• is a condition marked by high intraocular pressure (IOP) that damages the optic nerve

• normal IOP range is 10-21 mmHg

• persistent IOP is above 21 mmHg could be suspicious of glaucoma

Where does fluid forms / location of aqueous formation ?

ciliary body of the eye

Where does fluid exits / location of aqueous drainage ?

trabecular meshwork

What are the types of glaucoma ?

• congenital (can manifest anytime from birth)

• inherited (cause unknown)

• secondary (due to other cause or trauma)

What are the risk factors and complications of glaucoma ?

• risk factors : diabetes. hypertension, high myopia, men

• complications : progressive optic nerve damage causing loss of vision

What are the types of primary glaucoma ?

• Chronic open-angle glaucoma or Primary Open-Angle Glaucoma (POAG)

• Acute angle closure glaucoma or Primary Angle-Closure Glaucoma (PACG)

Explain the pathophysiology of Chronic open-angle glaucoma

• obstruction to outflow of aqueous humor through the trabecular meshwork into Schlemm’s canal leads to increase IOP

• Its usually bilateral.

• Increased IOP eventually destroys optic nerves that lead to blindness

Explain the pathophysiology of Acute closed-angle glaucoma

• the intraocular pressure rises rapidly due to a sudden blockage of the trabecular meshwork

• typically involves sudden, complete, unilateral closure with pupil dilation stimulated by a dark environment, emotional stress

• it is an acute, painful condition that can cause permanent eye damage within several hours

What are the sign and symptoms of chronic open-angle and close-angle glaucoma ?

• Chronic open-angle glaucoma : i) no early symptoms ii) gradual loss of peripheral vision iii) mildly aching eyes iv) halos around lights

• Acute close-angle glaucoma : i) headache ii) pain iii) increased IOP iv) nausea and vomiting v) loss of peripheral vision

What are the laboratory and diagnostic done for glaucoma ?

• measure IOP

• check visual field

• applanation tonometry using tonopen

• slit lamp examination

What are the medical management for acute-angle-closure glaucoma ?

• Beta-adrenergic blockers : to reduce the formation of aqueous humor in the ciliary body in the eye (eg Timolol Maleate)

• Cholinergic agents (topical) : short term management for glaucoma with papillary block (eg Topical pilocarpine)

• Alpha-2-adrenergic agonists (topical) : reduce IOP (eg Alphagan or Brimonidine)

• Osmotic diuretics : reduce IOP (eg : oral glycerol and IV mannitol)

• Carbonic anhydrase inhibitors : reduce IOP (eg Acetazolamide (Diamox)

• Prostaglandin : reduce IOP (eg Latanoprost (Xalatan)

What are the surgical management for glaucoma ?

• Ophthalmic laser surgery : primary treatment to lower IOP

• Trabeculectomy : to allow drainage

What are the patient health education for glaucoma ?

• Educate patient on the importance of lifelong medication

  adherence

• Demonstrate proper eye drop administration technique

• Advise on lifestyle modifications to avoid increasing IOP

• Schedule and reinforce the need for regular follow-up

  appointments

• Assess for and address side effects or complications of

  treatment

What is diabetic retinopathy ?

high blood sugar levels that may injure the blood vessels of the retina

What are the two stages of diabetic retinopathy ?

• NDPR (non-proliferative diabetic retinopathy) : i) early stage of diabetic eye disease ii) tiny blood vessels leak iii) can cause macular ischemia

• PDR (proliferative diabetic retinopathy) : i) advanced stage of diabetic eye disease ii) retina start growing new blood vessels iii) very serious and can affect the central and peripheral vision

What are the sign and symptoms of diabetic retinopathy ?

• loss of visual acuity

• floaters

• flashes of light

• eye pain

What are the complication of diabetic retinopathy ?

• decrease in vision

• maculopathy

• retinal hemorrhage

• vitreous hemorrhage

• retinal detachment

• IOP

• blindess

What are the treatment for diabetic retinopathy ?

• laser photocoagulation

• surgery