Visual Sensory Disorders (Glaucoma, Cataracts, Dry Eye Syndrome, Conjunctivitis, Age-Related Macular Degeneration)

glaucoma

group of eye conditions characterized by increased IOP, leading to optic nerve damage & vision loss.

glaucoma

”silent thief of sight”

canal of Schlemm

what is blocked in glaucoma?

mechanical theory

Glaucoma Theory: High IOP directly damages the retinal layer.

ischemic theory

Glaucoma Theory: High IOP compresses optic nerve blood flow.

Primary Open-Angle Glaucoma

type: gradual blockage of drainage channels

Primary Open-Angle Glaucoma

Sx: gradual vision loss, no pain

Angle-Closure (Narrow-Angle) Glaucoma

sudden closure of drainage angle

Angle-Closure (Narrow-Angle) Glaucoma

Sx: severe eye pain, nausea, halos, blurred vision (medical emergency)

Congenital Glaucoma

Sx: enlarged eyes, excessive tearing, light sensitivity

glaucoma

Sx: tunnel vision, blurred vision, halos around lights

eye pain, headache

Acute symptoms of glaucoma

scotoma

a partial or total blind spot in your vision

beta-blockers (-olol)

first choice meds for glaucoma?

Laser trabeculoplasty; glaucoma

opens drainage channels; surgery for what disorder?

Trabeculectomy; glaucoma

creates a new drainage pathway; surgery for what disorder?

cataracts

clouding of the eye lens, causing blurred vision.

cataracts

leading cause of blindness worldwide

cataracts

Sx: increased sensitivity to glare & light scattering; reduced contrast sensitivity; monocular diplopia

Phacoemulsification; cataracts

removes cataracts and replaces the eye's lens with an artificial lens; surgery for what disorder?

aphakic glasses

rare; distorts images, limits peripheral vision

contact lenses

good vision, but requires handling & care

IOL implant

most common & effective; provides nearly normal vision

Assess for use of alpha-antagonists like tamsulosin which can cause floppy iris syndrome

most important pre-op care for cataracts?

retinal detachment, infection

Complications of cataracts surgery?

6-12 weeks

how long will full healing & visual stabilization take after cataracts surgery?

LASIK; refractive disorder

creates a corneal flap, reshapes the underlying cornea; surgery for what disorder?

Phakic Intraocular Lenses (IOLs); refractive disorder

implanted lenses for moderate to severe myopia; surgery for what disorder?

Conductive Keratoplasty (CK); refractive disorder

uses radiofrequency to reshape the cornea for mild hyperopia; surgery for what disorder?

irregular astigmatism and central islands

potential complications for corneal/refractive surgeries

Retinal Detachment

separation of the retinal pigment epithelium from the sensory retina.

Rhegmatogenous

caused by a hole or tear in the retina, allowing fluid to enter and separate layers.

Rhegmatogenous

most common type of retinal detachment

Tractional

caused by fibrous bands pulling on the retina.

Exudative

caused by fluid buildup under the retina.

retinal detachment

Sx: Curtain vision, photopsia, floating spots, no pain

Scleral Buckling; retinal detachment

silicone band wrapped around eye to push detached retina back into place; surgery for what disorder?

Vitrectomy; retinal detachment

removes vitreous gel to access and repair a detached retina; surgery for what disorder?

if gas bubble is used, patient must remain prone to keep pressure on retina

nursing alert post-surgery in retinal detachment?

age-related macular degeneration

Leading cause of irreversible blindness worldwide.

age-related macular degeneration

Affects central vision but preserves peripheral vision.

Dry (Non-Neovascular, Non-Exudative) AMD

slow, gradual breakdown of the retina. Drusen deposits accumulate, leading to blurry central vision. NO CURE, but progression may be slowed.

Wet (Neovascular, Exudative) AMD

Choroidal neovascularization, then these vessels leak fluid & blood, causing rapid vision loss.

Wet (Neovascular, Exudative) AMD

Sx: Straight lines appear wavy or distorted. Letters in words appear broken

VEGF Inhibitor (-zumab); laser therapy may stop leakage from abnormal blood vessels

Management for wet AMD?

Amsler Grid Monitoring; diet rich in leafy greens, fish, and antioxidants to slow progression

Nursing mt and diet for loss of central vision?

Dry eyes (Keratoconjunctivitis Sicca)

condition where there is decreased tear production and increased tear evaporation

Dry eyes (Keratoconjunctivits sicca)

Sx: photophobia, foreign-body sensation, burning/stinging, redness, and dry eyes

artificial tears (day) + lubricating ointment (night);

cyclosporine eye drops (Restasis) to increase tear production;

punctal occlusion to reduce tear drainage

Meds/treatment for dry eyes?

Conjunctivitis (“pink eye”)

caused by bacteria, virus, allergens, or toxic substances?

Conjunctivitis

Sx: redness, itching, foreign-body sensation, photophobia

Bacterial

purulent (yellow-green) discharge

Viral

watery, highly contagious discharge

Allergic

stringy, mucous-like, severe itching discharge

topical antibiotic drops (erythromycin)

management if bacterial conjunctivitis?

self-limiting, cold compress

management if viral conjunctivitis?

antihistamine eye drops, corticosteroids

management if allergic conjunctivitis?

immediate eye irrigation with sterile water/saline

management if toxic conjunctivitis?