10. 1 disorders of retina

Retinal Detachment

1. MEDICAL SURGICAL NURSING- II UNIT – II NURSING MANAGEMENT OF PATIENTS WITH DISORDERS OF EYE TOPIC : DISORDERS OF RETINA PRESENTED BY Mrs. SOUMYA SUBRAMANI, M.Sc.(N) LECTURER, MSN DEPARTMENT CON- SRIPMS, COIMBATORE.

2. DISORDERS OF RETINA

3. INTRODUCTION . Eyes deliver four-fifths of the information that our brain receives. However, when it comes to eye diseases, one might miss marking any symptoms, since they are not easily detected or may be painless. There are several common and rare eye conditions which affect vision. A healthy retina is essential for clear vision.  Retinal diseases are common as they can affect any part of the eye retina. As retinal diseases affect the vital eye tissue, it causes serious problems, affects vision, some even leading to blindness . 

4. I n t r oduction The role of vision in our lives is difficult to define, because it is so deeply personal and intimate Whenever there is a failure in the vision, its not only the eyes, that are said to be in darkness but the whole life is in darkness. Loss of vision means loss of independence. Among the various causes of blindness, retinal detachment is one which is an ocular emergency.

5. A N A T OMY OF RETIN A IN EYE:

6. Retina The retina is the inner most layer of the eye. It is composed of nerve tissue. The optical system of the eye focuses light on the retina much like light is focused on the film in a camera.

7. LAYERS OF R ETINA The retina is composed of 10 layers Pigmented epithelium Photoreceptors; bacillary layer (outer and inner segments photoreceptors ) External (outer) limiting membrane Outer nuclear

8. LAYERS OF R ETINA Outer plexiform Inner nuclear Internal limiting membrane Inner plexiform layer Ganglion cell layer Nerve fiber layer

9. LAYERS OF R ETINA

10. HOW DOES RETINA FORMS IMAGES ?

11. DEFINITION Ret i n al deta c hm ent is a d i so r d e r o f the ey e in whi c h t h e re t ina se pa r at es f r o m the la y e r underneath . A detached retina is a serious and sight-threatening event . And unless the retina is reattached soon, permanent vision loss may result. RETINAL D ET AC H ME N T

12. EPIDEMIOL O GY Detachment is more frequent in middleaged or elderly populations, with rates of around 20 in 100,000 per year The lifetime risk in normal individuals is about 1 in 300 Retinal detachment is more common in people with severe myopia (above 5–6 diopters), in whom the retina is more thinly stretched. In such patients, life time risk rises to 1 in 20 .

13. TYPES OF RETINAL DETACHMENT

14. T YPES O F RET I N A L D ET A CHME N T Rh e g m a t o g e n o u s re t i n a l d e t ach m e n t: R h egmatogen o u s detachment s ar e caused b y a hol e o r tear i n the retina tha t a l l o w s fluid to p as s throug h an d coll e ct un d erneat h the reti n a, pu l l i n g the r etin a a w a y f ro m un d erly i n g tissues. Th i s type o f d etachmen t can occu r whe n scar tissue grow s o n the re tina' s surf ace , caus i n g the r etina to p u l l a w a y f ro m the b ac k o f the e ye.

15. Retinal breaks are divided into three types – holes, tears and dialyses. CONTI..

16. Tractional retinal detachment –It occurs when fibrous or fibrovascular tissue, pulls the sensory retina from the retinal pigment epithelium.

17. T r ac t io n a l Th is ty p e o f d e t a c hme n t c an oc c u r when s c ar ti s su e g r o w s o n the r e ti n a's sur f a c e, c ausi n g the r e ti n a t o pu l l a w a y f r o m the bac k o f the e y e . T r a cti o n al d e t a c hme n t i s typ i c all y see n i n peop l e who h a v e poor ly c o n t r o l led d iab e t es o r othe r c on d i t i o n s.

18. It occurs due to inflammation, injury or vascular abnormalities Fluid accumulating underneath the retina without the presence of a hole, tear, or break. E x ud a ti v e d e t a c hme n t c an be c aused b y a g e - r el a t ed macu lar de g ene r a ti o n , i n jur y t o the e y e, tumo r s o r i n f lamm at o r y diso r de r s . Rare Exudative, serous, or secondary retinal detachment

19. RIS K F AC T OR S Ag i n g — ret i na l d eta c hmen t i s more c o m m o n i n p e op l e over ag e 50 Previo u s ret i na l d eta c hmen t i n o ne eye Family h ist ory o f ret i na l d eta c hment E x treme near s ightedness (m y op i a) Previo u s ey e surger y , s u ch a s catara ct removal Previo u s s e vere ey e i n j ury Previous othe r ey e di s ea s e o r d is orde r , in c luding retin os c hi si s , uveitis o r thin ning o f t h e pe ri p he r a l ret i n a (lattice de g en erat i on)

20. Hom o c y s t ei nu r i a Mal i gna n t h y p er t ens i on Me t a st a tic c an c e r , wh ich sp r e a d s t o the e y e ( e y e c ance r ) R e ti n ob l a s t oma Se v e r e m y opi a Smok i n g and passi v e smok i n g

21. PA THO PHYSIOLOGY

22. s u d d e n fl a s h e s o f lig ht th a t a p p e a r wh e n lo o k in g to t h e s id e. s u d d e n l y s e e in g m a n y fl o a t e r s, whi c h a r e s m al l b i ts o f d e b r is t h a t a p p e a r a s b l a c k f l e c k s o r str i n g s fl o a t in g b ef ore y o ur ey e Blurred vision p art i a l v i s io n lo ss , Seeing a shadow or a curtain descending from the top of the eye or across CLINICA L MANIFES T A TIONS

23. Elicit history for any of the following: History of trauma Previous ophthalmologic surgery Previous eye conditions (eg, uveitis and vitreous hemorrhage) Duration of visual symptoms and visual loss DIAGNOSI C E V AL U A TION

24. Physical examination should include the following: Checking of visual acuity External examination for signs of trauma and checking of the visual field Assessment of pupil reaction Measurement of intraocular pressure in both eyes Slit-lamp examination Examination of the vitreous for signs of pigment or tobacco dust DIAGNOSI C E V AL U A TION

25. DIAGNOSI C E V AL U A TION R e ti n al e x ami n a ti o n . An i n s tr u me n t with a b r i g h t l ig h t and sp e ci al l en s es t o e x amine the bac k o f y ou r e y e, i n cl u d i n g the r e ti n a. Th is ty p e o f d e v i ce p r o v ide s a hi ghly d e t ail ed v ie w o f y ou r who le e y e, all o wi n g the doc t o r t o se e a n y r e ti n al ho les, t ea r s o r d e t a c hme n ts. Ult r as o un d i magi n g . T hi s t e s t use d i f the bl eed i n g ha s oc c ur r ed i n the e y e, maki n g i t di f ficu l t t o se e y ou r r e ti n a.

26. Significance of timely treatment Visual improvement is much greater when the retina is repaired before the macula is detached . Once the retina is reattached, vision usually improves and then stabilizes.

27. T R EATMENT General principles of treatment : Find all retinal breaks Seal all retinal breaks Relieve present (and future) vitreo retinal traction

28. Me d ica l m a n a g em e nt D r o ps as p r escr i be d o f C y cl op e n t o l a t e h y d r och l o r i d e ( C y cl ogyl ) a c y cl op legic a g e n t th a t c auses di l a ti o n o f the pup i l and r e s t o f the muscles o f a c c omm o d a ti on D r o ps as p r escr i be d o f a n t i b i ot i cs Ge nt amic in ; p r ed n i s o l o ne ace t at e t o p r e v e n t e y e i n f ect ions Othe r Dr u gs: A n tie m e tics and anal g es i cs a r e o r de r ed t o m a na g e nause a , v om it in g , and pa i n.

29. Surgical Methods Cryopexy and laser photocoagulation Scleral buckle surgery Pneumatic retinopexy Vitrectomy

30. Sur g ica l ma n a g em e nt Photo c oa g ul ation If a h o le o r t ear i n r e ti n a bu t the r e ti n a i s s ti l l a tt a c hed, doc t o r m a y per f or m a p r ocedu r e c all ed pho t o c oa g ul a ti o n with a l ase r . T h e l aser burn s a r oun d the t ear s i t e, and the r esu l ti n g s c arr ing a f f i x es r e t i n a t o the bac k o f e y e . .

31. Cr y op e xy Another o p t i o n i s c r y op e x y , whi ch i s f r e e z i n g with i n t en s e c o l d . F or th i s t r e a tme n t, y ou r do c t o r wi ll a ppl y a f r e e zi n g p r ob e outs i d e o f y our e y e in the a r ea o v er the r e ti n al t e ar s i t e, and the r esul t i n g s c arri n g wi ll he lp ho ld y ou r r e ti n a i n pl a c e .

32. Cryopexy Cryotherapy (freezing) is used to wall off a small area of retinal detachment Uses nitrous oxide to freeze the tissue behind the retinal tear This prevents fluid passing through the hole.

33. Scleral buck l e : Th is p r ocedu r e i n v o l v es pl a c i n g a s i l i c on e band (buck le) a r oun d the e y e t o ho ld the r e t i n a in p l a c e. T h i s ban d i s not v is i b l e and r ema i n s permane n tly a tt a c hed . A l aser o r c r y op e x y c an then b e use d t o sea l the t e a r .

34. Scle r al bukling su r gi c al t r e a tme n t

35. Scleral buckle surg ery Surgeon sews silicone bands to the sclera (the white outer coat ofthe eyeball) The bands push the wall of the eye inward against the retinal hole Cryotherapy (freezing) is applied around retinal breaks prior to placing the buckle

36. Scleral buckle surg ery Subretinal fluid is drained as part of the buckling procedure The most common side effect of a scleral operation is myopic shift. Myopic shift: the operated eye will be more short sighted after the operation

37. Pneumatic retinopexy Generally under local anesthesia Gas bubble (SF6 or C3F8 gas) is injected into the eye after which laser or freezing treatment The surface tension of the gas/water interface seals the hole in the retina Onc e the r e ti n a i s b a ck i n pl a c e, a l aser or f r e e zi n g p r ob e is used t o sea l the ho les.

38. VITREC T OMY SURGICAL TRE A TMEN T : V i t r ec t o m y: Th i s p r oc e du r e i s use d f o r l a r g er t ea r s . Dur i n g a v i t r ec t o m y , the v i t r eous i s r emo v ed f r o m the e y e and a bubb l e o f g as o r s il i c on e o i l i s pl a c ed i n the e y e . During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye .

39. COMP LIC A TION S I t chi ng Doub le v i s i on P t os is I t chi ng Bl ur r ed v is i on

40. NURSIN G DIAGNOSI S : Se ns o r y - p e rc e ptua l a l te r at i o ns (v i su a l ) r e l at e d t o d e cr e a s ed s e ns o r y r ece pt i o n . •An xi ety r e l ated to di s e ase c o n d i ti o n a nd t r e a tme n t. •Ri s k for injury re lated to Blind n es s.

41. NU R SING INTE R VEN T ION En c ou r a g e amb u l a t i o n and i nde p en d ence as t o l e r at ed. Admin i s t er med i ca ti o n f o r pa i n , nausea , and v om it i n g as d i r ec t ed. P r o v i d e qu ie t di v e r s i o n al a cti v i t i es, suc h as li s t en i n g t o a r adio or aud i o boo k s. T e a ch p r ope r t echn i qu e i n giv i n g e y e medi ca ti o n s. Adv is e p a tie n t t o a v o id r apid e y e m o v eme n ts f o r s e v e r al w ee k s as w el l a s s t r ai n i n g o r bendin g the hea d below the w ai s t.

42. Adv is e p a tie n t th a t dr i v in g i s r e s tr i c t ed u n ti l clea r ed b y op h thalmo l og i s t. T e a ch the p a tie n t t o r e c ogn i z e and i m med i at ely r eport s y mpt om s th a t i n di cat e r ecurr i n g d e t a c hme n t, suc h as f l o a ti n g spots , flash i n g l ig h ts, and p r o g r essi v e shado w s. Adv is e p a tie n t t o f o ll o w up

43. D o no t t ouc h a n y par t o f the e y e w i th the d r opper ; cl os e the e y e af t er i n s t i l l a t i on , and wi p e o f f the e x cess f l u i d f r o m the l i d s and chee k s. C l os e the e y e g e n tly s o the so l utio n s t a y s i n the e y e l on g e r . T e a ch the p a tie n t t o us e w arm o r c o ld c omp r esses f o r c o m f or t s e v e r al times a d a y . No t e th a t the p a tie n t shoul d w e ar either a n e y e s h i e l d or glasses dur i n g the d a y , dur i n g nap s , and a t ni g h t. T e a ch the p a tie n t t o a v o id vi g o r ou s a cti v i t i es and he a vy l ift in g f o r the i mmed i at e p o s t ope r a ti v e period. T e a ch the p a tie n t the s y mpt om s o f r e ti n al d e t a c hme n t and the a cti on t o t a k e i f i t o c cu r s a g ai n.

44. SUMMA R Y R e ti n al d e t a c hme n t i s a d i so r de r o f the e y e i n wh ich the r e ti n a sepa r at es f r o m the l a y er un d ern e a th. S y mpt om s i n cl u d e an i n c r ease i n the nu m be r o f f l o at e r s , flas h es o f li g h t, and w o r sen i n g o f the ou t er part o f the v isua l fie l d . Th is m a y b e describe d as a cu r t ain o v er par t o f the fie l d o f vi s i on.