1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 42: Caring for Clients with Eye Disorders

2. Approximately 18 million people in the United States have some degree of visual impairment – which include approx 1 million who are legally
BLIND

3. Refractive Errors Emmetropia: Normal vision Myopia Hyperopia
Presbyopia
Astigmatism
Box 42-1 pg 607
Figure 42-1 pg 607 Eyeball shape affects visual acuity in some refractive errors.

4. Refractive Errors Pathophysiology, Etiology
Etiology - Inherited; Surgical error
Presbyopia: Natural degenerative changes
Assessment Findings: Blurred vision; Recurrent headaches
Diagnostics: Snellen, Jaeger charts; Retinoscopy
Medical Management: Eyeglasses; Contact lenses
Surgical Management: RK; LASIK; PRK; ICRS; IOLs; CK
Nursing Management

5. Blindness, Visual Impairment
BCVA ≤20/200, even with corrective lenses
Visual Impairment: BCVA between 20/70 and 20/200 (in better eye with glasses)
Causes: Congenital; Injury; Optic nerve damage; Disorders; Tumors
Medical Management: Corrective lenses; Rehabilitation; Independent living skills
Nursing Management
REVIEW: Client & Family teaching: & 42- 2, pg 608
REVIEW: Gerontologic Considerations, pg 609
REVIEW: Nursing Process for Blind Client, pg

6. Eye Trauma Pathophysiology, Etiology
Weather; Chemicals; Injury; Endophthalmitis
Assessment Findings: Signs and Symptoms
Pain; “Gritty” feeling; Tearing; Blurred vision; Asymmetric eyes; Diplopia; Edema; Bleeding; Purulent drainage
Diagnostic Findings
Fluorescein dye; Slit-lamp examination
Radiography; CT scan

7. Figure 42-2 pg 611 Everting the eyelid
Eye Trauma
Medical, Surgical Management
Emergency first aid; Antibiotic ointment or drops; Eye patch placement
Hospitalization
Surgical repair
Nursing Process for Eye Trauma, pg
Client & Family Teaching 42-3, Instilling eye meds
REVIEW: Stop, Think and Respond pg 612
Figure 42-2 pg 611 Everting the eyelid

8. Conjunctivitis
Pathophysiology, Etiology: Bacterial,Viral; Rickettsial infection
Easily transmitted; Can lead to blindness
Assessment Findings: Redness; Tearing; Burning; Itching; Purulent drainage; Enlarged lymph nodes
Medical Management: Antibiotic, antiviral meds; Warm soaks, irrigations; Decongestants; Antihistamines
Nursing Management: Read bullet points pg

9. Uveitis Pathophysiology, Etiology: Inflammatory changes
Identified with specific diseases or autoimmune disorders
Assessment Findings: Blurred vision; Photophobia; Eye pain; Red, congested eye; Pupil reacts poorly to light
Diagnostic Findings: Slit-lamp examination
Medical Management: Oral, topical corticosteroids; Mydriatic, antibiotic eyedrops; Analgesics; Sunglasses
Nursing Management

10. Keratitis, Corneal Ulcer
Pathophysiology, Etiology: Corneal trauma; Infectious agents
Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness
Diagnostic Findings: Flashlight illumination; Slit- lamp exam; Fluorescein drops, strips
Medical, Surgical Management: Topical anesthetics; Mydriatics; Antibiotics; Keratoplasty
Nursing Management: no contact lens, keep eye clear of exudate

11. Blepharitis
Pathophysiology, Etiology: Hypersecretion; Infectious agents
Assessment Findings: Inflamed lid margins; Patchy flakes; Missing eyelashes; Purulent drainage
Diagnostic Findings: Scraping lid margins; Microscopic examination
Medical Management: Topical antibiotic; Cleansing: Eye, face, and hair
Nursing Management

12. Hordeolum (Sty) Pathophysiology, Etiology: Staphylococcus aureus
Assessment Findings: Tender, swollen, red pustule
Medical, Surgical Management: Warm soaks; Topical antibiotic
Severe cases: Incision; Drainage
Diagnostic Findings: Exudate culture identifies pathogen (seldom used)
Nursing Management: separate towels, cleanliness

13. Chalazion (cyst)
Pathophysiology, Etiology: meibomian gland becomes obstructed and the release of sebaceous secretions is blocked; cyst
Assessment Findings: swollen, hard, can block vision if too large
Medical, Surgical Management: Warm soaks; massage
Severe cases: excision
Nursing Management: review bullet points on pg 614

14. Macular Degeneration
Pathophysiology, Etiology: breakdown of or damage to the macula
Dry: Gradual onset; Wet: Abrupt onset
Leading cause of vision loss in clients >60 yrs
Assessment Findings
Dry: Blurred vision; Central vision affected
Wet: Vision distortion; Central vision affected
Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation (new); Diet, vitamins
Nursing Management

15. Glaucoma
Pathophysiology, Etiology: Aqueous fluid imbalance; Elevated IOP
Assessment Findings: Signs and Symptoms
Open-angle: May be asymptomatic, Eye discomfort; Temporary blurred vision; Halos; Reduced peripheral vision
Acute angle-closure: Hard, painful, sightless eyes; N/V; Red conjunctiva; “Steamy” cornea
Diagnostic Findings: Optic disc visualization; Anterior chamber inspection; Tonometry; Visual field exam

16. Glaucoma
Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine
REVIEW: Drug Therapy Table 42-1, pg 618
Nursing Management: meds are lifelong - if doctors orders followed, glaucoma can be controlled
REVIEW: Stop, Think, Respond, 42-2, pg 619

17. Cataracts
Pathophysiology, Etiology: Aging process; Congenital; Lens injury; Secondary condition
Assessment Findings: Halos; Difficulty in reading; Color vision changes; Reduced, distorted vision
Diagnostic Findings: Snellen chart; Ophthalmoscopic and slit-lamp examination; Tonometry

18. Cataracts
Surgical Management: Intracapsular or extracapsular extraction; Phacoemulsification
Post-op vision restoration: Corrective glasses; Contact lens; IOL implant
Nursing Management: Review bullet points, pg 620; Review Nutritional Notes 42-2 pg 620
REVIEW: Nursing Care Plan 42-1 pg 621 & X

19. Retinal Detachment
Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery; Figure 42-8, pg 622
Assessment Findings: Signs and Symptoms
Blind spots; Flashes of light; Floaters; Complete vision loss
Diagnostic Findings: Ophthalmoscope
Surgical Management: Laser surgery; Cryopexy; Diathermy; Retinopexy; Scleral buckling; Pneumatic retinopexy
Nursing Management

20. Enucleation Surgical Removal of an Eye due to Injury; Disease
Tumor; Severe pain (damaged, sightless eye)
Medical, Surgical Management
Metal or plastic ball in capsule of connective tissue
Pressure dressing; Shell-shaped prosthesis
Nursing Management: Watch for hemorrhage, infection

21. End of Chapter