478047882-Disorders-of-the-Eye.pdf full explanation

Very well explained about disorders of eye

1. Nursing Management
Diagnostics
Signs and Symptoms
Nursing Diagnosis
Medical Management
Disorders
Factors
Disease Condition
DISORDERS THAT
INTERFERE WITH VISION

STRUCTURAL PROBLEM OF
THE EYE

INFECTION OR
INFLAMMATION OF THE
EYE

INNER EYE CONDITIONS

TRAUMATIC INJURY OF THE
EYE

Predisposing Factors
 Family History
 Age
 Hereditary
 Congenital cataracts or strabismus
 Stroke, multiple sclerosis or Meniere
 Head injuries
 Albinism
 Central nervous system diseases
 Very high refractive error


Precipitating Factors
 Scarring or thinning of cornea
 Eye injury
 Taking of drugs such
 Alcohol or drug abuse
 Inflammation of the inner ear
 Astigmatism
 Neurological disorder


Disorders of the Eye

2. ASTIGMATISM
Congenital or acquired unevenness of the
curvature of the cornea. This causes light rays
coming to the retina to not be all refracted in the
same way

Irregular curvature of the
lens
Uneven quality of vision

Refracting power is not
uniform in all meridians of
both lens or cornea

Diagnostic Tests
 Snellen Chart – Can be used to
measure visual acuity
 Phoroptor/Refractor – Contains
lenses of different strengths that
can be moved into your view
 Keratometry – Measures the
curvature of the cornea

Irregular curvature on the
cornea

Signs/Symptoms
 Uneven quality of vision
 May have difficulty reading or
following instructions
 May report headache and vertigo
after doing close work
 Eyestrain
 Headache

Treatment
 Corrective lenses – Helps to relieve the
symptoms and restore functional vision
 Contact lenses – Helps to actually smooth
out the curvature of the cornea
 Orthokeratology – Treatment that uses
rigid contact lenses to temporarily correct
the irregular curvature of the cornea
 LASIK Surgery, Photorefractive
Keratectomy (PRK), and Radial
Keratotomy (RK)
Nursing Diagnosis
 Disturbed sensory perception (visual) related
to visual problems
 Risk for fall related to decreased vision
 Fear and anxiety related to visual impairment
and loss of autonomy
 Knowledge deficit related to impaired vision

3. REFRACTIVE ERROR
Light Refraction refers to the matter in which
light is bent as it passes through the lens. This
causes a ray of light to fall directly on the retina.

Genetic Factors

DECREASED VISION

Changes in choroid and
retina

Elongation and Stretching of
Sclera

Increase of axial length of
the eyeball

Degenerative changes in
Retina

Diagnostic Tests
 Snellen Chart – Can be used to
measure visual acuity
 Phoroptor/Refractor – Contains
lenses of different strengths that
can be moved into your view
 Keratometry – Measures the
curvature of the cornea

Myopia (Nearsightedness) Hyperopia (Farsightedness)
Signs/Symptoms
 Hyperopia
o Blurry vision at a close
range and clear at a far
range
 Headaches or dizziness after
completing schoolwork
 Myopia
o Blurry vision at a far range
and clear at a close range
o Tries to focus on objects by
squinting eyes
o After LASIK Surgery:
Disturbed tear function for
1 or more months and need
to be managed by artificial
tears


Treatment
 Hyperopia
o Normal hyperopia of a
preschooler needs no correction.
For some, this diminishes at about
5 years old as a result of
developmental changes.
o Glasses with convex lens
 Myopia
o Corrective (Concave) lenses
o Laser surgery [Laser in Situ
Keratomileusis] (LASIK)
 LASIK Surgery, Photorefractive
Keratectomy (PRK), and Radial
Keratotomy (RK)

Signs/Symptoms
 Myopia
o Blurry vision at a far range and clear at
a close range
o Tries to focus on objects by squinting
eyes
o After LASIK Surgery: Disturbed tear
function for 1 or more months and
need to be managed by artificial tears

4. NYSTAGMUS

Nystagmus is rapid, irregular eye movement,
either vertically or horizontally; a symptom of an
underlying disease condition
 Infantile: most
often develops by 2-
3 mo of age; The
eyes tend to move
in a horizontal
swinging fashion. It
is often associated
with other
conditions, such as
albinism, congenital
absence of the iris
(the colored part of
the eye),
underdeveloped
optic nerves and
congenital cataract

 Acquired: Develops
later in childhood or
adulthood. The
cause is often
unknown, but it
may be due to
central nervous
system and
metabolic disorders
or alcohol and drug
toxicity

Diagnostic Tests
 Ear exam
 Neurological exam
 Brain MRI
 Brain CT scan
 Recording of the eye movement
 Pt history
 Visual acuity measurements
 Refraction

 Spasmus nutans:
usually occurs at 6
mo - 3 yo but can
improve at 2-8 yo;
Children with this
form of nystagmus
often nod and tilt
their heads

Signs and Symptoms
 Uncontrollable eye
movement
 Inability to focus
 Light sensitivity
 Trouble balancing
 Dizziness

Treatment
 Corrective lenses
 Eye muscle surgery
 Use large-printed books
 Use of magnifying
devices
 Increased lighting

Nursing Diagnosis
 Risk for injury related to
impaired sensory
function.
 Disturbed sensory
perception related to
structural damage.
 Knowledge deficit
related to impaired
vision.

5. AMBYLOPIA

 “lazy eye,” or subnormal vision in one
eye; the child may be using only one eye
for vision while “resting” the other eye

Deprivation amblyopia

Visual loss (amblyopia) in
eye with higher refractive
error

Refractive (anisometropic)
amblyopia

Diagnostic Tests
 Vision test

Strabismic amblyopia

Signs and Symptoms
 20/50 vision
 A child may cry when
one eye is covered
(covering the good
eye)

Treatment
 Occlusion therapy:
The good eye is
covered by a patch
held firmly in place
which forces the
child to use the
poor eye, thus
developing vision
in that eye
 Atropine: causes
pupil dilation and
blurred vision
 Strabismus surgery
 Vision therapy
 Prosthetic contact
lenses
 Atropine eye
drops
 Computer
programs that
stimulate neural
changes
(RevitalVision)

Nursing Diagnosis
 Disturbed sensory perception (visual) related to visual
problems
 Risk for fall related to decreased vision
 Fear and anxiety related to visual impairment and loss
of autonomy
 Knowledge deficit related to impaired vision

Clearer image favored

Difference in refractive
error between the two eyes

Misalignment of the eyes
results in abnormal
binocular interaction.

Eventual unconscious
suppression of visual
stimulation to an affected
eye creates amblyopia
Eyes fail to receive clearly
formed images on the retina

Due to a cataract, other
opacity, or obstruction
(hemangioma of lid)

6. STRUCTURAL PROBLEM OF
THE EYE

Predisposing Factors
 Congenital, age(common in elderly),
development of myasthenia gravis
 History of strabismus in family,
congenital



Predisposing Factors
 Injury to levator muscle, injury to
third cranial nerve.

PTOSIS
Movement of the eyelids'
muscle (levator muscle) is
affected, thus the
appearance of a droopy
eyelid occurs

amblyopia (from lack of use
of the closed eye).
Obstructs vision

Ptosis can be unilateral or
lateral

Diagnostic Tests
 Observation of eyelid movements
 Assessment of the functions of third
cranial nerve

Signs and Symptoms
 Children tend to wrinkle their
forehead and raise their eyebrows
more than usual in attempt to lift
eyelid further
 Cock head back to see under lower
lid
 Dilated pupil
 Inability to rotate the eye globe
upward, medially or downward
 Weakness of accommodation
(looking at near objects)

Treatment
 Surgical correction

Inability to raise the upper eyelid the usual
distance, so the eyelid always remains slightly
closed.

Nursing Intervention
 Provide support and
guidance to child
when walking around
Teach parents the
importance of
correcting ptosis at a
young age to prevent
irreversible effects of
amblyopia.
 Provide eye drops to
help moisten eyeballs
 Help child in eye
exercises

Nursing Diagnosis
 Impaired comfort related to lack of use of closed eye
that causes eyes to dry.
 Risk for chronic low esteem related to appearance of
drooping eyelids

7. STRABISMUS
Unequally aligned eyes (cross
eyes)

Deviations can be
 Exotropia
 Esotropia
 hypertropia

The resting position of the
one eye, is not aligned to be
forwards.

Diagnostic Tests
 Eye Test
 Cover test
 Hirschberg
test

Caused by imbalance of the
extraocular muscles that
control the movement of
the eyeglobes
Signs and Symptoms
 Abnormal
appearance of the
resting level of eyes
 Eyestrain
 Headache
 Tired, irritated eyes
 Nausea
 Vomiting

Nursing Intervention
 Aid children in
ambulating to
avoid injury
 Aromatherapy to
help ease nausea
and vomiting
 Eye exercises
(orthoptics)

Nursing Diagnosis
 Risk for injury related to impaired sensory function.
 Disturbed sensory perception related to structural
damage.
 Knowledge deficit related to impaired vision.

Resting position can be:
 divergent (turned
out)
 convergent (turned
in)
 vertical strabismus
(pupil may be
higher than the
other)

Strabismus can be:
 Monocular or same
eye deviates
constantly
 Alternating
strabismus where
one eye and then
the other deviates

Treatment
 Glasses or lenses
to basic correct
visual defect
 Surgery to align
extraocular
muscles


Types: concomitant and
nonconcomitant

8. INFECTION OR
INFLAMMATION OF THE
EYE
Predisposing Factors
 Congenital, age
 Have diabetes



Predisposing Factors
 Have dry skin
 Are experiencing hormonal changes
 Have blepharitis
 Have certain skin conditions
 Lack of Handwashing

STY
An internal sty results from
inflammation of
a meibomian gland, one of
the modified sebaceous
glands that lie close to the
eyeball along the margin of
the eyelids. It may be
caused by an infectious (i.e.,
staphylococcal) or
noninfectious process.

a painless, chronic swelling
of the meibomian gland will
then occur

Infected part of the eye
begins with a reddened
color on the infected part of
the eye

Diagnostic Tests
 Your doctor will usually diagnose
a sty just by looking at your eyelid.

Symptoms
 Burning sensation in the eye
 Crusting of the eyelid margins
 Droopiness of the eyelids
 Itchiness on the eyeball
 Sensitivity to light
 Tearing
 A feeling that something is stuck in
the eye
 Discomfort when blinking

Treatment
Most styes go away on their
own without any treatment,
as soon as the stye ruptures
symptoms tend to improve
rapidly
Inflammation of the eyelid associated with a small
collection of pus and is caused mostly by the
staphylococcus bacteria

Nursing Intervention
 DO NOT burst stye by
yourself
 Apply warm
compress
o held against
the eye 5 to
10 minutes, 3
to 4 times
each day
o to also
encourage
the pus to
drain away
 Pain relievers
o ibuprofen or
acetaminoph
en

9. CONJUNCTIVITIS
Pink eye (conjunctivitis) is an inflammation or
infection of the transparent membrane
(conjunctiva) that lines your eyelid and covers the
white part of your eyeball.

Bacterial conjunctivitis
Bacterial conjunctivitis is
caused by bacteria such as
staphylococci, streptococci
or haemophilus
Small blood vessels in the
conjunctiva become
inflamed causing the whites
of your eyes to appear
reddish or pink

Viral conjunctivitis
Viral conjunctivitis is usually
occurs after a cold or a sore
throat and it is highly
contagious.

Diagnostic Tests
 Slit-lamp
exam
 Cultures
Allergic conjunctivitis
Allergic conjunctivitis is
often caused by dust mites,
pollen and cosmetics and is
common in people who
have hay fever, asthma and
eczema.
Signs/Symptoms
 The pink eye effect is
one of the first signs
of conjunctivitis. In
severe cases, the eyes
may be glued shut on
waking.
 Dryness and itchiness
of the infected eye
occurs
 Redness present at,
discharge may also be
present

Treatment
Topical antibiotic
treatment will
relieve symptoms
and shorten the
length of the
illness. Treatment
with antibiotic
drops/ointment
will also prevent
the risk of more
widespread
extraocular
disease.
(Chloramphenicol
or Fusidic acid)
Nursing Diagnosis
1. Acute Pain related to inflammation of the conjunctiva
2. Anxiety related to lack of knowledge about the
disease process
3. Self-concept disturbance related to a change in the
eyelid (swelling / edema).

Inflammation or infection of
the transparent membrane

10. CHALAZION
a small, usually painless, lump or
swelling that appears on the eyelid.

Granulomatous
inflammatory response
happens

A chalazion forms and may
enlarge and break through
the tarsal plate to the
external portion of the lid

Edema due to blockage of
Meibomian glands occur
Lipid breakdown products
from bacterial enzymes or
sebaceous secretions leak
into surrounding tissue

Signs and symptoms:
 redness in the
eyelid
 tenderness
 swelling

Nursing Management
 Do patient teaching about gentle but firm
massages to promote drainage of
obstructed gland
 Apply warm compresses to help melt
viscous lipids
 Encourage nutritional supplementation
with essential fatty acids

Nursing Diagnosis
 Risk for injury r/t frequent touching of lump in
eyelid
 Risk for infection r/t improper care of eyelid
secretions

Medical management:
 Antibiotic eye ointment or antibiotic pills
 Injection of steroid medicine if it gets
worse

11. TRAUMATIC INJURY OF THE
EYE

Predisposing Factors
 Congenital, age
 Have diabetes



Predisposing Factors
 Have dry skin
 Are experiencing hormonal changes
 Have blepharitis
 Have certain skin conditions
 Lack of Handwashing

CONTUSION
Blunt trauma occurs to eye

Hemorrhage gradually
reabsorbed over time

Hemorrhage around eye
occurs

Nsg Dx: Altered Body Image related to eye
contusion,
Signs and Symptoms
 Hemorrhage around eye
 Pain around eye
 Limited motion of the eye
 Loss of vision
 Maxillary fracture

Treatment:
 Ice pack
 Pain reliever if pain
exists
 Surgery if maxillary
fracture exists

Blunt trauma caused by being hit in the eye by a blunt
object I.e baseball, fist, soccer ball, or car dashboard
resulting to a “black eye”
Assessment:
 Inspect eye globe
 Ask children how
many fingers they
can count from a
distance of 6 feet or
letting them read a
page from a distance
 Ask children if they
have difficulty seeing
 Evaluate extraocular
eye movements for
adequate function

12. EYELID INJURY
Foreign object strikes
eye

If laceration is in the
inner canthus, disrupts
lacrimal drainage
system (dacryostenosis)

Eyelid becomes
damaged or lacerated

Nsg Dx: Pain r/t injury
Signs and Symptoms
 Pain around eye
 Limited motion of the eye
 Loss of vision

Injury that may accompany eye globe injury or may be
present after a foreign body has struck the eye

Assessment:
 Check for lacerations
Treatment
 Go to doctor
(ophthalmologist)

If laceration is deep,
may cause permanent
ptosis

13. INNER EYE CONDITIONS
Predisposing Factors
- Age group of children at 1 year of
age
- Gender, often in girls
- Increasing age
- Genetic predisposition

Precipitating Factors
- Scarring at the canal of Schlemm
- Galactosemia
- Steroid use
- Radiation exposure
- Retinoblastoma
- Retinopathy
- Smoking
- Obesity
- Diabetes

CONGENITAL GLAUCOMA
A developmental anomaly
in the angle of the anterior
chamber prevents proper
drainage into the canal.

After it has increased in size
to the extent that it can, the
pressure in the eye globe
continues to rise,
compressing and ultimately
destroying the optic nerve.

The increased fluid content
that accumulates causes the
globe of the eye to increase
in size.

Diagnostics
 Examination of the front part of the
eye
 Examination of the fundus
 Tonometry

Signs and Symptoms
 Seems painfully sensitive to light
 Tears up a lot
Depending on how far the disease has
worsened, other eye symptoms can include:
 A cloudy cornea (the front layer of
your eye that’s normally clear)
 One or both eyes larger than
normal
 Redness

Treatment
 Goniotomy or
trabeoculotomy
 acetazolamide
(Diamox)
 Laser Therapy

A developmental anomaly in the angle of the
anterior chamber prevents proper drainage into
the canal. Later in life, glaucoma occurs when the
canal becomes blocked.
Nursing Diagnosis
 Disturbed sensory
perception related to
congenital glaucoma

Glaucoma occurs when the
canal becomes blocked

14. CATARACT
A cataract is the gradually
developing opacity of the lens
or lens capsule of the eye.

If the lens becomes less
transparent and obstructs
the passage of light to the
retina, the patient suffers
from a progressive loss of
vision.


Rays of light pass through
this lens to reach the retina,
where images are formed.

Diagnostics
 Visual acuity test.
 Slit-lamp
examination.
 Retinal exam.
A cataract is the loss of
transparency of the
crystalline lens, the eye’s
natural lens located behind
the pupil.

Signs and Symptoms
- White pupil opening
- Blurred vision in children
- Lack of response to a smile or
inability to reach and grasp a
nearby object for infants
- Nystagmus
- Increasing difficulty with vision at
night
- Sensitivity to light and glare
- Need for brighter light for reading
and other activities
- Seeing "halos" around lights
- Frequent changes in eyeglass or
contact lens prescription
- Fading or yellowing of colors
- Double vision in a single eye

Treatment
 Surgical removal of the cloudy lens
 Phacoemulsification: emulsifying the
cataract and aspirating it
 Insertion of an internal intraocular lens
 Myriatic agent

Nursing Diagnosis
- Risk for injury related to loss of vision as
evidenced by cataract