SPECIAL SENSES (EYES)

What is Refractive Errors?

When light entering the eyes does not focus on the retina

Primary site of refraction

Cornea

Secondary sit of refraction

Lens

What happens if the eyeballs are not sphere-shaped?

Refractive Error

Windshield of the eye

Cornea

Give color to the eyes

Iris

Hole that dilates and constricts

Pupils

What is Vitreous Humor?

Jelly like substance that gives shape to the eye

Normal shape of the eye

Sphere

What converts light ray into nerve impulses?

Retina

Vision of myopia

Short/Nearsighted

Vision of Hyperopia

Farsighted

Vision of Astigmatism

BOTH

Eyeball shape of Myopia

Elongated

Eyeball shape of Hyperopia

Shortened

Eyeball shape of Astigmatism

Abnormal

Refractive ability of Myopia

Strong

Refractive ability of Hyperopia

Weak

Refractive ability of Astigmatism

Uneven curvature of cornea and lens

Focal points of Myopia

Anterior of Retina (harap)

Focal points of Hyperopia

Posterior of Retina (likod)

Focal points of Astigmatism

Many focal points

Corrective Lens of Myopia

Divergent/Concave (Pinalayo)

Corrective Lens of Hyperopia

Convergent/Convex (Pinalapit)

Corrective Lens of Astigmatism

Sequence of testing eyes duringVisual Acuity Test

Right, Left, and then both

What material is used in Visual Acuity Test?

Snellen’s Chart

Distance of patient from the Snellen’s Chart

20 feet/6 feet away

What is a cataract?

There is cloudiness or opacity of the lens

What is the outcome of having increase Opacity in the lens?

Blurry Vision

2 main functions of the Lens

1. Refraction

2. Accommodation: Ability to focus on near/distant object

Type of Cataracts

Congenital

Senile

Traumatic

Secondary

Location of Lens

between iris/pupils and vitreous humor

Structure of the Lens

Colorless, Transparent, Biconvex

What does the lens contain?

Cristalline (proteins) — which affects opacity

What happens with the cristallines in the lens that results to opacity?

It binds or clumps together leading to ⬆ opacity and ⬇ function of refraction

Instrument equipped with special lighting system with binocular microscope

Slit Lamp Examination

Confirmatory test for cataracts

Slit Lamp Examination

Priority nursing intervention for people with cataract

SAFETY

Intracapsular Lens Extraction

removal of all parts of the lens

Extracapsular Lens Extraction

removal of all parts of the lens, EXCEPT posterior capsule

The use of ultrasonic devices to liquify the nucleus and cortex, followed by micro suction

Phacoemulsification

Cryosurgery

use of pencil-like instrument with a supercooled metal tip to extract lens

Temperature of metal tip in cryosurgery for cataract operation

-35°C

1st choice for Lens Replacement in cataracts

Intraocular Lens Implants

1st choice for Lens Replacement in cataracts

Aphakic Eyeglass

% of Magnification in Aphakic Eyeglass

25% (zoom)

Aphakic Glasses makes patient risk for ____

Injury

Contact Lens makes patient risk for _____

Infection

Pre-op nursing interventions before cataract surgery

Apply eye drops

After giving Myadriatics always WOF

Photophobia (sensitivity to light)

What to avoid when there is (+) Photophobia?

Avoid direct sunlight, Wear sunglasses

Goal after eye-related surgery

Prevent infection and ⬆ IOP

Position after surgery

Semi-fowler’s or Side Lying position on the unaffected side

Keep the eyes ___

Dry

Signs of bleeding

Floaters

Signs of infection

Rubor, Dolor, Calor, Tumore, Drainage

What is rubor, dolor, and calor?

Redness, Pain, Heat

Sign if ⬆ IOP

Sudden eye pain, head ache, restlessness, and blurry vision

What is glaucoma?

⬆ IOP caused by congestion of aqueous humor

Increase in aqueous humor results in _______

Optic Nerve Damage

Normal IOP

10-21 mmHg

What is an Aqueous Humor?

Liquid produced by the ciliary body

Function of Aqueous Humor

nourishes the cornea and maintains the normal intraocular pressure

CAG OR OAG: Most common type of glaucoma

OAG

CAG OR OAG: Gradual Obstruction of trabecular meshwork

OAG

CAG OR OAG: Painless

OAG

CAG OR OAG: Caused by ⬆ RBC+WBS and Retinal Detachment

OAG

CAG OR OAG: Painful

CAG

CAG OR OAG: Blocked outflow of aqueous humor

CAG

CAG OR OAG: Rapid progression and is an EMERGENCY

CAG

CAG OR OAG: Caused by Neovascularization and Mydriasis

CAG

Neovascularization

The process of forming new blood vessels

Mydriasis

Dilation of the pupil of the eye

How does Neovascularization affect CAG?

The new blood vessels grow over the drainage angle of the eye, blocking the normal flow of aqueous humor

How does Mydriasis affect CAG?

This occurs because pupil dilation can push the iris forward, potentially blocking the flow of fluid (aqueous humor) out of the eye and leading to increased pressure

Pathognomic sign of OAG

Tunnel Vision

Pathognomic sign of CAG

Halos around lights and Ocular Erythma

Diagnostic Test for Glaucoma

Tonometry

Tonometry

Measures IOP

Contact or Non-contact Tonometry: Painful

Contact

Contact or Non-contact Tonometry: Most Accurate

Contact

Contact or Non-contact Tonometry: Administer Anesthetic eye dropa

Contact

Contact or Non-contact Tonometry: Painless

Non-contact

Contact or Non-contact Tonometry: Puff or air eyedrop

Non-contact

Nursing interventions after Tonometry

Document time of IOP measurement

After tonometry instruct client to _____

Avoid eye rubbing

Treatment goal for Glaucoma

decrease production or increase outflow of aqueous humor

Medications that works by increase in outflow by removing obstruction in the trabecular meshwork

Prostagladin Analogs (Latanoprost)

Medications that works by increase in outflow with constriction of pupils

Miotics (Pilocarpine)

Miotics are used ____ which increases risk of toxocity

Lifetime, Everyday

Miotics antidote

Atropine Sulfate

⬇ Aqueous Humor production

Beta Blockers

⬇ Aqueous Humor production

Carbonic Anhydrase Inhibitor (Acetazolamide)

Laser Trabeculoplasty

Repair to remove OBSTRUCTION Trabecular Meshwork

Trabeculectomy

Removal of Trabecular Meshwork

Laser Iridotomy

Incision on the Iris using a laser to decrease IOP

Diet after Glaucoma surgery

Low sodium (Na+)

Priority intervention after Glaucoma surgery

Prevent further increase of IOP

Retinal Detachment

separation of neurosensory area of the retina from the retinal pigment epithelium