Disorders of the Eye

Disorders of the Eye

Objectives • Describe common disorders of the eye • Describe inflammatory conditions of the lid, conjunctiva, and cornea • Describe the clinical manifestations of common disorders and inflammatory conditions of the eye

Objectives • Discuss nursing assessment and nursing interventions for eye conditions • Discuss Diagnostic Tests, medical management, and prognosis for eye conditions • Discuss patient teaching needs

Blindness and Near-Blindness • Etiology/pathophysiology • Loss of visual acuity that ranges from partial to total loss of sight (includes no light perception) • Functional blindness = some light perception but no usable vision

Blindness or Near-Blindness • Can be: Congenital or Acquired • Legal blindness refers to a maximum visual acuity of: • 20/200 with corrective eyewear (normal 20/20) • Visual field range less than 20 degrees (normal 180)

Blindness or Near-Blindness • Congenital blindness results from various birth defects • Acquired blindness in adults: • Diabetic retinopathy • Glaucoma • Cataracts • Retinal degeneration • Acute trauma

Blindness or Near-Blindness • Acquired Blindness • Clinical manifestations/assessment • Diplopia • Pain • Floaters and light flashes • Pruritus; burning of the eyes • Loss of peripheral vision • Halos (rainbow colors seen around lights) • A sense of orbital pressure • Bulging of the eyes • Difference in appearance of an eye structure • Emotional symptoms

Blindness or Near-Blindness • Medical Management • Corrective eyeware • Assistive devices such as canes, guide dogs, magnifying systems, and telescopic lenses • Surgical correction

Nursing Implications, Considerations, and Responsibilities

Blindness or Near-Blindness • Assessment • Note patient complaint of blurred vision • Determine onset, severity and duration of symptoms • Note any factors that relieve symptoms • Observe for squinting and rubbing the eyes • Note compensation measures (eg. Use of magnifying glass) • Impaired self-care

Effect of Visual Impairment Mild losses may require only some adaptations Serious losses affect independence, mobility, employment, and interpersonal relationships People grieve for the lost function just as they might grieve after the death of a loved one Factors that affect a person’s response to this loss include personality, usual coping style, effect of vision loss on the person’s life, and the circumstances of the loss

Care of the Visually Impaired Patient • Be aware of visually impaired person’s thoughts and feelings about handicaps/disabilities • Assume that people with visual impairments can be independent and productive • The person needs help with some tasks but should be treated as an adult • The extent of vision loss determines the types of assistance needed

Care of the Visually Impaired Patient • Interventions • Comprehensive approach • Educate, Assist, Counsel • Prevention of complications • Nursing Diagnosis (AEB, R/T) • Risk for Injury r/t environmental hazards • Disturbed Sensory Perception • Ineffective Coping • Self-Care Deficit • Ineffective Therapeutic Regimen Management

Figure 51-11

Refraction • Light rays bend (refract) as they pass through the lens • Enables light from the environment to focus on the retina • Refractory errors indicate that the light is not hitting the correct spot on the retina

Refractory Errors • Etiology/pathophysiology of common refractory errors • Astigmatism – defect in the curvature of the eyeball surface • Strabismus—inability of the eyes to focus in one direction; cross-eyed • Myopia-nearsightedness; eyeball is elongated • Hyperopia- farsightedness; eyeball is too short

Astigmatism • Clinical Manifestations: • Blurring of vision = primary manifestation • Assessment: not c/o eye discomfort; mainly blurring, difficulty focusing • Diagnostic Tests: opthalmoscopy, retinoscopy, visual acuity test, and refraction tests.

Astigmatism • Medical Management: • corrective eyewear • surgical correction • Nursing Intervention and Patient Teaching: • Assistance with ADLs prn • Make sure eyewear is clean • Safety when eyewear is not worn

Strabismus • Strabismus: inability of the eye to focus in the same direction [“cross-eyed”] • Clinical Manifestations: eyeball position is not symmetrical d/t neurological or muscular dysfunction • Assessment: c/o difficulty in following an object; same is observed • Diagnostic tests, Medical Management, and Nursing Interventions: same as for Astigmatism

Myopia • The medical term for nearsightedness • The lens is situated too far from the retina • Light rays come together to focus in front of the retina instead of on the retina • The retina only receives a fuzzy image People with myopia have difficulty seeing distant images clearly • Snellen test useful • New glasses needed approximately every 2 years • Refractory surgery: ages 20-60

Myopia • Medical Management • Keratorefractive Surgery • Surgery to alter the corneal curvature • Surgeon uses a special microsurgical knife or laser to open and replace a flap of corneal tissue • Photorefractive Keratectomy (PRK) • Laser is used to reshape the corneal surface • LASIK (Laser-in-situ Keratomileasis)

Myopia • Nursing Intervention and Patient Teaching • Preop – Instruct pt. to stop wearing hard contact lens 1-2 dayss before surgical evaluation • Eye drop routine

Myopia • Post Op • Eye patch post op • Can be up and around at home though should be encouraged to rest the first day • Assistance PRN • Medication Instruction: oral analgesics • Instruct s/sx complications: infection, when to contact MD • Reinforce need to keep MD follow-up appointments • Usually seen the next day; then at 1 week post-op; then monthly for 1 year

Hyperopia • Commonly known as farsightedness • The lens is too close to the retina • Light rays come together behind the retina producing a fuzzy image The hyperopic person sees clearly in the distance but has difficulty focusing on close objects • Convex corrective lenses needed • Diagnostic tests, medical management, Nursing interventions same as for Myopia. Pt. Teaching: care of corrective lenses or contact lenses

Amblyopia • Commonly referred to as “lazy eye” - an inaccurate label • Poor vision due to brain favoring one eye. The weaker eye tends to wander inward or outward even with correction • Common in children • Diagnosis confirmed when decreased visual acuity cannot be explained by an organic cause. • Treatment: corrective eyewear; eye patches to make the weaker eye work

Presbyopia • Inability to focus on close objects • Poor accommodation due to loss of elasticity of the ciliary muscles • Accommodation: adjustment of the lens for near and distant vision • Contraction or relaxation of the ciliary muscles, which causes the lens to change shape • It most often develops after age 40 • Corrective lenses are needed

Refractory Errors • Diagnostic tests • Opthalmoscopy • Retinoscopy • Visual acuity tests • Refraction tests

Inflammatory Disorders of the Eyelid

Blepharitis • Inflammation of eyelid along eyelid margin • Ulcerative Blepharitis: Caused by bacteria, most often by staphylococci • NonUlcerative Blepharitis: caused by psoriasis, seborrhea, or allergic response

Blepharitis • Symptoms: • Erythema of eyelid • Eyelid pain • Photophobia • Scales or crusts on the lid margins • Excessive tearing in nonulcerative type

Blepharitis • Assessment: • Ulcerative type: pt. c/o eye itching, lids adhering together during sleep • NonUlcerative: red eyes, patient rubs eyes, sensitivity to light, tear spillage

Blepharitis • Medical Management: • Antibiotic ointment (Erythromycin) • NOTE: Be certain that any medication applied to the eye is an ophthalmic preparation • Eyelids can be gently cleansed with baby shampoo solution

Nursing Interventions and Patient Teaching • Primary Objective prevention of spread of infection • Instruct on use of prescribed eye drops or ointment • Teach Handwashing, avoidance of irritating perfumes or smoke. The use of make-up should be avoided until all inflammation subsides – then use NEW make-up

Hordeolum • Commonly called a “stye” • Acute staphylococcal infection (abcess) of the eyelid margin that originates in a lash follicle or sebaceous gland of the eyelashes • Affected area of lid is red, swollen, and tender • Treatment - Apply warm, moist compresses several times a day 10-20 min • Repeated infections may be related to staphylococcal infections at some other location on the body • Physician may treat with ophthalmic antibiotics

Chalazion • Inflammation of the meibomian (sebum) glands in the eyelids (may become a cyst) • Swelling prevents fluid from leaving the glands, causing tenderness Treatment: • Warm compresses may bring some relief • Physician may order antibiotics if infection is present • Surgical removal of the gland necessary if condition persists

Conjunctivitis • An inflammation of the conjunctiva caused by: • Bacterial or viral infection • Allergy • Environmental factors • Commonly called pink eye

Conjunctivitis • Bacterial Conjunctivitis • Caused by streptococcal, staphlococcal, gonococcal, pneumococcal, chlamydial organisms • HIGHLY CONTAGIOUS! • HANDSare the most common transmitters of the bacteria • Infected people should practice good hand washing and should avoid sharing washcloths

Conjunctivitis • Symptoms: • Red conjunctiva, • Mild irritation (gritty feeling) • Edema of eyelid • Drainage overnight (crusty) • Diagnostic Test: conjunctiva scraped for bacteria and stained for microscopic exam

Nursing Interventions and Patient Teaching • Treat with warm compresses and topical antibiotics • Cleanse lid and lashes with NS • Warm compresses 2-4x/day • When allergies are present: cold compress to reduce edema • Eye irrigations • Gentamycin, Erythromycin, Tobramycin, Ciprofloxacin

Nursing Interventions and Patient Teaching • Instruct client to avoid contact with eyes or soiled material when infection present. Use individual washcloths • Wash hands before treatment, and when contact is made with eyes **WEAR GLOVES! • Avoid noxious fumes and smoke • Avoid using contact lenses during the inflammation period

Conjunctivitis • Viral conjunctivitis • Caused by: herpes simplex virus type 1, herpes zoster virus, or Chlamydia trachomatis • Characterized by redness and drainage • Round, raised white or gray areas on the conjunctiva • Infections caused by herpes simplex virus type 1 are treated with antiviral ointments (Acyclovir) or other topical medications

Keratitis • Etiology/pathophysiology • Inflammation of the cornea • Due to: Injury, irritants, allergies, viral infection, or diseases • Ulcers may form in the eye membrane layers scattered scarring of the corneal surface • Pneumococcus, staphylococcus, streptococcus, and pseudomonas are most common types of bacterial causes • Herpes simplex is most common viral cause

Disorders of the Eye