Problems of the Eye – Macular Degeneration, Cataracts, Glaucoma/Medications and Urinary Problems

Cataract definition

Opacity/clouding of lens → painless progressive vision decline

Cataract key symptoms

Blurry vision, ↓ color perception, glare/night driving difficulty, photophobia, double vision

Cataract risk factors

Age, DM, sunlight/UV, steroids, smoking, previous eye trauma

Cataract postop teaching

Avoid ↑ IOP (bending, lifting, straining, sneezing, vomiting)

Cataract postop red flags

Sharp eye pain + N/V, yellow/green drainage, sudden ↓ vision, flashes/floaters → emergency

Cataract postop normal findings

Mild itch, dry crusty drainage OK, bloodshot eye, mild swelling

Cataract drops

Steroid + antibiotic + dilators, strict schedule, keep tip clean

Cataract vision recovery

Final visual improvement takes 4-6 weeks

Glaucoma definition

↑ IOP → optic nerve damage → permanent blindness if untreated

Glaucoma major risk groups

Age 60+, Black/Latino, family history

POAG vs PACG

POAG gradual/painless; PACG sudden severe eye pain emergency

Primary open-angle glaucoma symptoms

Gradual peripheral loss, foggy vision, halos late, ↑ IOP 22-32

Primary angle closure glaucoma symptoms

Sudden severe pain, brow pain, N/V, halos, ↓ vision, non-reactive pupil, IOP >30

Glaucoma drug goal

Prevent further optic damage by ↓ IOP (does NOT restore vision)

Glaucoma lifelong teaching

Eye drops for life, adherence is everything

Glaucoma drop timing

Wait 5-10 min between drops to prevent washout

Punctal occlusion

Press inner canthus 1-2 minutes to ↓ systemic absorption

Beta blocker glaucoma drops

Timolol; ↓ AH production; watch for bradycardia & bronchoconstriction

Beta blocker avoid in

Asthma, COPD, HF, bradycardia

Prostaglandin glaucoma drops

Latanoprost, Travoprost; ↑ AH outflow

Prostaglandin side effects

Brown iris color change, eyelash growth

Alpha agonist glaucoma drops

Brimonidine; ↓ AH formation, ↑ outflow

Carbonic anhydrase inhibitor glaucoma drops

Dorzolamide; ↓ AH production; stinging, bitter taste

Pilocarpine use

Miosis; acute PACG emergency

Glaucoma surgical indication

When meds cannot control IOP

Laser trabeculoplasty

Permanent AH drainage channel creation to allow outflow

Macular degeneration definition

Degeneration of macula → central vision loss

Dry AMD

Most common; gradual central loss; no cure; slow progression

Wet AMD

New leaky vessels; rapid loss; needs prompt treatment

AMD risk factors

Age 55+, smoking, UV/sun, HTN, DM, high cholesterol

AMD hallmark

Metamorphopsia (lines look wavy)

Amsler grid use

Detect worsening AMD; report missing/wavy boxes

Dry AMD treatment

High dose antioxidants, zinc, lutein, diet support

Wet AMD treatment

VEGF inhibitors (Lucentis, Avastin, Eylea)

VEGF injection frequency

Every 1-3 months

VEGF adverse effects

Endophthalmitis, ↑ IOP, floaters, blurred vision

Cranberry use AMD

Slows degeneration and protects macula

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Urinary incontinence definition

Involuntary urine loss impacting ADLs/quality of life

Stress incontinence

Cough/laugh/sneeze leakage due to weak pelvic floor

Stress incontinence treatment

Kegels, estrogen cream, weight loss, sling surgery

Urge incontinence (OAB)

Sudden urge → large volume loss; key in door syndrome

Urge treatment

Bladder training, limit caffeine, anticholinergics (oxybutynin)

Overflow incontinence

Dribbling + incomplete emptying + distended bladder

Overflow treatment

Intermittent cath, Crede maneuver, treat obstruction

Functional incontinence

Physical/cognitive barriers → can't reach toilet

Functional treatment

Habit training, briefs, bedside commode

UTI risk factors

Female, stasis, BPH, stones, sex, catheters, low estrogen

UTI hallmark symptoms

Frequency, urgency, dysuria, cloudy foul urine

UTI older adult signs

Confusion, sudden incontinence, malaise (no fever often)

UTI labs

UA + leukocyte esterase + nitrites; culture if complicated

UTI antibiotics

Nitrofurantoin, Bactrim, Cephalosporins

Phenazopyridine teaching

Turns urine orange, only symptom relief not treatment

CAUTI prevention

Sterile insertion, remove ASAP, bag below bladder, no routine irrigation

Do NOT use powder

True for catheter hygiene

Urolithiasis definition

Stones; severe flank pain, N/V, diaphoresis

Stone passage teaching

Strain urine, 3L fluids/day, ambulate

Stone pain drugs

IV morphine, ketorolac, tamsulosin (relaxes ureter)

ESWL teaching

Shock waves break stones; bruising normal

Pyelonephritis symptoms

Fever, chills, flank pain, CVA tenderness, tachycardia

Pyelo UA findings

+ leukocyte esterase, nitrites, WBCs

Pyelo treatment

Fluids, antibiotics, acetaminophen (not NSAIDs)

Glomerulonephritis hallmark

Proteinuria + hematuria + HTN

GN cause

Post-strep infection or autoimmune (lupus)

GN treatment

Penicillin, steroids, HTN control, fluid restriction

Nephrotic syndrome hallmark

Massive proteinuria, hypoalbuminemia, edema

Nephrotic syndrome treatment

ACE inhibitors, diuretics, lower cholesterol

Hydronephrosis

Back pressure kidney dilation → emergency

Retention definition

Inability to empty bladder

Retention causes

BPH, neurogenic bladder, anticholinergics

Retention assessment

Post-void residual; >100 = retention

Bladder scan use

Checks retention noninvasively