Review of Eye Conditions: Retinal Detachment and Glaucoma

Retinal Detachment

• Medical Emergency
• Diagnostic Tests:
  • Visual acuity measurement
  • Direct and indirect ophthalmoscopy: to detect pallor and retinal detachment.
  • Ultrasound: diagnose retinal detachment.
  • Slit lamp: to check for any existing lesions.
• Medical Management:
  • Early corrective intervention.
  • If the macula remains intact and the patient's central vision remains: intervention within 24 to 48 hours.
  • If the macula is detached and the patient's visual field is decreased: intervention within 7 to 10 days.
• Procedures to fix retinal detachment: The sooner, the better.
• Post-Procedure Management:
  • Eye drops: cycloplegic, anti-infective.
  • Eye patches: applied over the operative eye or both eyes, allowing the eyes to rest for one to two days.
  • Head positioning post-op may vary depending on the procedure:
    • If air is injected into the vitreous: the head is positioned with the unaffected eye upward, and the patient lying on the abdomen or sitting for 45.0 days.
  • Dark glasses: prescribed after removal of the eye patch to decrease discomfort with photophobia.
• Post-operative Teachings:
  • Precautions regarding bending and scooping.
  • Showering: depends on the doctor's order.

Glaucoma

• A group of disorders characterized by increased IOP, optic nerve atrophy, and progressive loss of peripheral vision.
• Typically found in people that are middle-aged and older.
  • Seldom seen in people that are younger than 35, but can occur in infancy.
• Types of Glaucoma
  • Open-angle glaucoma (POAG): primary open-angle glaucoma.
    • Represents 90% of glaucoma cases.
    • Due to decreased outflow of aqueous humor.
    • Drainage channels become occluded.
    • The progression is slow.
    • Symptom: loss of peripheral vision in the later stage.
  • AACG:
    • Produces excruciating pain in or around the eye.
    • Leads to decreased vision, nausea, and vomiting.
    • Sclera is arrythmetous.
    • The pupil is enlarged and fixed.
    • Colored halos around lights present with an acute increase in IOP.
• Diagnostic test
  • Tonometry: measures intraocular pressure (IOP).
    • Normal range: 10-22
    • POAG: IOP is usually between 22 and 32
    • In AACG the IOP may be 50 or higher.
• Medical Management:
  • Keep IOP low to prevent further damage.
  • Treated medically by the use of beta blockers, miotics.
    • Miotics: constrict the pupil and draw the iris away from the cornea, allowing aqueous humor to drain out of the canal of Schlemm.
  • Medical Marijuana may help with IOP.
• Nursing Interventions:
  • Safety
  • Promote compliance of therapy.
  • Reinforce discharge instructions.
  • Early detection is key.
    • Ophthalmologic examination every two to four years for people between the ages of 40 and 64.
    • Every one to two years for those that are older than 65.
    • African Americans should have more frequent exams due to the incidence and aggressive nature of glaucoma in this population.