Sensory changes older adult

👁 Cataracts 3rd leading cause of blindness

A cataract happens when the lens inside the eye becomes cloudy. ☁👁

The lens is normally clear so light can pass through and help you see. When someone gets a cataract, the lens starts to look white or milky, which can make their vision blurry.

What happens? 🔍

• 👵 Cataracts are very common as people get older, so they are sometimes called age-related or “senile” cataracts.

• About 50% of people ages 65–74 develop cataracts.

• 💧 Changes in the amount of water and proteins inside the lens cause the lens fibers to become cloudy.

• 👁 The pupil may start to look white or milky.

• 🌫 Vision becomes blurry or cloudy.

• If it becomes severe, it can cause major vision loss or blindness.

👁 Cataracts treatments

If the cataract becomes bad enough to affect someone's daily life, doctors can do cataract surgery.

During surgery, the cloudy lens is removed and usually replaced with a clear artificial lens. 👁✨

👁 Cataracts — Signs & Symptoms

Cataracts usually get worse slowly over time, not all at once. 🕒

• 👓 Gradual decreased vision — the person slowly has more trouble seeing clearly.

• 🎨 Colors may look different — colors can look faded, dull, or less bright.

• 💡 Glare — bright lights, headlights, or sunlight may bother the eyes more.

• 🌫 Blurred or hazy vision — things may look foggy or cloudy.

• 📖 As vision gets worse, the person may start using large-print books or stronger glasses to help them see.

If the patient has glare and blurry vision, you tell them to place the light behind them, over their shoulder, to reduce glare.

👁 Cataracts — Interventions

• 👓 Stronger visual support can help at first, such as glasses or magnifiers.

• 🏥 If the cataract gets worse, the cloudy lens can be removed with surgery, usually as an outpatient procedure.

Before surgery 💊

The eye is prepared with drops:

• Mydriatics like phenylephrine help dilate the pupil 👁

• Cycloplegics temporarily paralyze the ciliary muscle, which helps keep the pupil from focusing/moving as much during the procedure

During surgery 🔬

The cloudy lens is removed and replaced with a clear intraocular lens (IOL).

So think:

Cloudy lens out ➜ clear artificial lens in ✨

After surgery 🩹

• 💧 Antibiotic eye drops help prevent infection.

• 💧 Corticosteroid eye drops help decrease inflammation and swelling.

• Eye drops should be placed in the conjunctival sac (center), not directly on the cornea.

• 🛡 The eye may be protected with an eye shield, especially to prevent rubbing or pressure.

🧠 NCLEX memory tip

Before cataract surgery = DILATE the pupil 👁

After cataract surgery = PROTECT the eye + prevent infection/swelling 🛡💧

👁 Glaucoma

Glaucoma is when the pressure inside the eye gets too high. This pressure is called intraocular pressure (IOP). 💧👁

Normally, the eye makes a clear fluid called aqueous humor. This fluid helps feed and protect parts of the eye, then it drains out.

When the fluid cannot drain properly, it starts to build up. That causes more pressure inside the eye. ⚠

Two main types

• Open-angle glaucoma 🐢 (POAG)
  This is the chronic, slow type and is the most common. The drainage system is open, but fluid does not drain well.

• Angle-closure glaucoma 🚨(PACG)
  This is the acute, sudden type. The drainage pathway becomes blocked, so pressure rises quickly. This is an eye emergency and needs immediate treatment.

Glaucoma = fluid can’t drain → pressure builds → optic nerve gets damaged 💧➡⬆👁

Why is high pressure dangerous? 🧠

Too much pressure can damage the optic nerve, which carries visual information from the eye to the brain.

Over time, this can lead to permanent vision loss or blindness. 👁❌

What does aqueous humor do? 💧

Aqueous humor:

• Helps maintain normal eye pressure

• Provides nutrients like glucose and proteins

• Helps remove waste

• Protects the cornea and lens

• Normally flows through the front of the eye and then drains out

👁 Glaucoma — Risk Factors

• 👨‍👩‍👧 Family history — glaucoma can run in families.

• 🌍 African American and Hispanic/Latino background — these groups have a higher risk.

• ❤ High blood pressure (HTN) can increase risk.

• 👁 A larger lens can make it harder for fluid to drain.

• 🔥 Iritis means inflammation inside the eye, which can interfere with fluid drainage.

• 🤧 Allergies and some endocrine/hormone problems may also be associated with glaucoma.

• 💊 Anticholinergic medications can dilate the pupil, which may make angle-closure glaucoma worse in someone at risk

🚨 NCLEX tip

Be especially careful with medications that dilate the pupil in a patient who has or is at risk for angle-closure glaucoma.

👁 Primary Open-Angle Glaucoma — Signs & Symptoms

This is the slow, chronic type of glaucoma. It develops little by little over time. 🐢

• 😶 Usually no symptoms at first

• 👁 It is often found during a routine eye exam

• 💧 Eye pressure may be increased

• 👀 It usually affects both eyes

• 🌑 The person slowly loses peripheral vision first, meaning side vision

• As it gets worse, the person may develop tunnel vision

• Later on, central vision can also be lost

🚨 Important

Once the optic nerve is damaged, that vision loss cannot be restored.

That is why regular eye exams are important, because the person may not notice anything is wrong until damage has already happened.

🧠 Easy way to remember

Open-angle glaucoma = slow + silent + loss of side vision 👁🌑

Early: no symptoms

Later: peripheral vision loss

Advanced: tunnel vision and eventually central vision loss

🚨 Primary Angle-Closure Glaucoma — Acute

This is the sudden, dangerous type of glaucoma. The drainage angle in the eye suddenly becomes blocked, so fluid cannot drain and the eye pressure rises very fast. 👁💥

This is a medical emergency because it can cause permanent blindness if it is not treated quickly.

Signs & symptoms

• 😣 Severe eye pain

• 🔴 Red, painful eye

• 🤕 Headache

• 🤢 Nausea and vomiting

• 🌫 Blurred vision

• 👁 Usually affects one eye at a time

• The pupil may look abnormal or partly dilated

Why does it happen?

The aqueous humor gets trapped inside the eye because the drainage pathway closes. That causes the pressure inside the eye to shoot up. 💧⬆

🧠 Easy way to remember

Angle-closure = CLOSED drain = pressure shoots up FAST 🚫💧⬆

🚨 NCLEX tip

If you see:

Sudden severe eye pain + red eye + headache + nausea/vomiting + blurred vision

Think acute angle-closure glaucoma and treat it as an emergency

👁 Glaucoma Treatment

The main goal of glaucoma treatment is to lower the pressure inside the eye (IOP), so the optic nerve does not get damaged. 💧⬇👁

💊 Medications used for glaucoma (all eye drops)

• Timolol — a beta blocker (not first line)

  • Helps lower eye pressure.

  • ⚠ Can be absorbed into the body and cause a slow heart rate (bradycardia) or bronchospasm, so use caution in people with heart or lung problems.

• Acetazolamide / Methazolamide — carbonic anhydrase inhibitors

  • Help the eye make less aqueous humor, so pressure goes down. 💧⬇

  • For acute glaucoma

• Brimonidine (Alphagan)

  • Helps decrease fluid production and can also help fluid drain better.

• Latanoprost (Xalatan) (First line)

  • Helps increase drainage of aqueous humor, lowering eye pressure.

  • NSAID

👴 Older adults

Older adults should be watched closely because eye drops can still enter the bloodstream and cause effects throughout the body.

For example, timolol can cause:

• ❤ Bradycardia

• 🫁 Bronchospasm

👁 Glaucoma — Nursing Care

The big nursing focus is making sure the patient knows how to use eye drops correctly and why regular eye exams matter. 💧👀

• Put the drops into the lower conjunctival sac.

• 🚫 Do not let the dropper tip touch the eye, eyelid, or lashes because that can contaminate it.

• After putting in the drop, have the patient close the eye gently.

• Then apply gentle pressure to the inner corner of the eye near the nose. This helps keep the medication from draining into the bloodstream and lowers the chance of systemic side effects. 👃💧

• If more than one eye drop is ordered, wait about 2 minutes before the next drop so the first medication is not washed out.

• 📅 Teach the patient to get routine eye exams, because glaucoma can slowly damage vision before the person notices symptoms.

🧠 Easy way to remember

Drop in lower sac → close eye → press inner corner → wait before next drop 💧👁

🚨 NCLEX tip

If asked how to decrease systemic absorption of eye drops:

Apply gentle pressure to the nasolacrimal duct at the inner corner of the eye. ✅

👁 Macular Degeneration

Macular degeneration is an eye problem that mostly happens in older adults, especially people over age 60. 👵👴

It happens because the retina ages, especially the macula, which is the part of the eye that helps you see things clearly in the center of your vision. 👁🎯

What happens?

• The center of vision gets blurry or dark

• Side vision may still be okay

• It can make it hard to:

  • 📖 Read

  • 👤 Recognize faces

  • 🚗 Drive

  • See fine details

The picture on the slide shows that the person can still see around the outside, but the middle looks blurry or missing.

🧠 Easy way to remember

Macular degeneration = loss of CENTRAL vision 🎯❌

So:

• Glaucoma = peripheral vision loss 🌑

• Macular degeneration = central vision loss 🎯

• Cataracts = cloudy/blurry vision ☁👁

💡 NCLEX tip

If a patient says, “I can see around the edges, but I can’t see clearly in the middle,” think macular degeneration.

👁 Macular Degeneration Risk factors

Things that can increase the chance of macular degeneration include:

• 👨‍👩‍👧 Family history

• ☀ Long-term UV light exposure (so wear sunglasses)

• 🚬 Cigarette smoking

• 👁 Light-colored eyes (bc we let more light in)

• 👵 Older age