1. Nursing care of patient with eye disorders
Glaucoma
Cataract 1

2. Glaucoma assessment
Refers to ocular conditions that are characterized by optic nerve damage. Is a leading cause of irreversible blindness. Is called the silent thief of sight; Aqueous humor flows between Iris and lens; nourishing cornea and lens.
Most of fluid flows out of anterior chamber through trabecular meshwork; 10 % through ciliary body –suprachoroidal space—venous circulation open angle 45 degree between Iris and cornea; a narrow angle places the iris closer to the trabecular meshwork.
Many types: open-angle glaucoma; angle closure glaucoma; congenital glaucoma;the most common is open angle (see Table 58-3, P. 2056).
Patients may not seek medical attention until experience blurred vision or halos around lights, loss of peripheral vision; aching around the eye 2

3. Pathophysiology continues
Assessment focuses on 4 examination
Tonometry: to measure the intraocular pressure
Ophthalmoscopy: to inspect the optic nerve
Gonioscopy: to examine the filtration angle of the anterior chamber
Perimetry: to assess the visual field
Changes in damaged optic nerve—pallor an cupping of optic nerve disc

4. Glaucoma medical management
The goal is to
Prevent optic nerve damage; lifelong therapy is necessary
Maintain IOP within a range unlikely to cause further damage
Pharmacologic therapy :
Topical beta blockers are preferred initially; One eye is treated
The other is used as control to evaluate efficacy of the treatment
Ocular medictions: Miotics (Cholinergics): increases aqueous fluid outflow by contracting ciliary muscle
Epinephrine, adrenergic agonist: reduces production of aqueous humor & increases outflow
Timolol, Beta blockers: decreases production of aqueous humor
Read Table 58-4, P 1771. 4

5. Laser trabeculoplasty:
Other approaches
Laser trabeculoplasty:
Laser burns applied to the inner surface of the trabecular meshwork to
Open the intra-trabecular space & widen canal of Schlemm
Ongoing assessment of IOP
Laser iridotomy for pupillary block glaucoma—an opening is made in the iris to eliminate the block; Potential complications: burns to cornea, lens or retina
Filtering procedure: creating opening or fistula in the trabecular meshwork to drain aqueous humor from anterior chamber to sub- conjunctival space; This allows aqueous humor to flow & exit a) mixing with tears or b) absorbed by conjunctival vessels
Drainage implant / shunt 5

6. Glaucoma nursing management
Patient education: importance of strict adherence to medication lifelong
A thorough assessment including problems to compliance
Discuss medications program; because of interaction effect: diuretic effect of Acetazolamide, Diamox, on antihypertensive agents— hypokalemia
Miotics & sympathomimetics result in altered focus; cautious about navigating surroundings
Assistance in ADLs because of loss of peripheral vision
Assurance & emotional support
Read chart 58-7,P for patient education. 6

7. Is lens opacity or cloudiness
Cataract
Is lens opacity or cloudiness
A major cause of blindness in the world (WHO, 2002)
Research links cataract to
Lower income and educational level
Smoking 35-packs or more a year
High triglycerides in men
Visual impairment progresses in both eyes at the same rate over years or months
Read 58-8, P for cataract risk factors 7

8. Clinical manifestations: painless blurry vision
Cataract
Clinical manifestations:
painless blurry vision
Patients perceive surrounding as dimmer—as glasses requires cleaning
Reduced sensitivity to glare, reduced visual acuity
Medical management:
No non-surgical treatment cures cataract
Smoking, long use of corticosteroids, DM increase risk for cataract 8

9. Cataract surgical management
The person’s visual and functional status should be considered
Surgery is performed in outpatient basis
It take less than 1 hour; and discharge within 30 minutes
Injection-free topical & intraocular anesthesia; small incision to the cornea is safe with minimal invasion
When both eyes have cataract; one is treated first.
Weeks and preferably months separate the 2 procedures
Surgery can be done through different approaches 9

10. Cataract preoperative nursing management
Routine blood tests, urine analysis
A common practice is to withhold anticoagulant therapy 5-7 days before surgery; unless at risk for ischemic attack
Four doses of Dilating drops are administered every 10 minutes; 1 hour before surgery
Additional dilating drops may be administered in the operating theater
Antibiotics, anti-inflammatory may be administered prophylactically 10

11. Cataract postoperative care
Wear protective pad for 24 hours
Teaching how to administer medications; recognize complications
Minimal discomfort—analgesics
Eyeglasses during day; metal shield during night, for 1-2 weeks
A clean, damp washcloth for morning discharge
Complication of cataract surgery—retinal detachment: teach to notify physician if new floaters; flashing lights; decreases in vision
Read Table 58-5, P. 1774, for complications of cataract surgery. 11

12. Home-related instructions
Wash hands before cleaning the postoperative eye
Clean the postoperative eye with a clean tissue; wipe the closed eye from inner canthus outward
Avoid lying on the side of the affected eye the night after surgery
Keep activity light (walking, reading, watching TV)
Not to lift or push objects heaver than 15 lb
Avoid bending for an extended period
Read chart 58-9; P. 1776