Care of the clients with eye disorders

mao ni ang gihatag ni maam

1. ASSESSMENT OF VISION:
C.ACUITY – visual acuity tests
measure the client’s distance
and near vision.
= uses snellen chart; rosenbaum
chart
b.CONFRONTATIONAL TEST
= is performed to examine visual
fields or peripheral vision.
C. EXTRAOCULAR MUSCLE
FUNCTION
= SIX cardinal positions of gaze
(®lateral-upward&®, down & ®, (L),
upward & (L), down & (L)

2. D. COLOR VISION
= uses ISHIHARA PLATE –
consists of numbers that are
composed of colored dots
located within a circle of
colored dots.
= the test is sensitive for the
diagnosis of red/green
blindness.
E. PUPILS
= LIGHT = CONSTRICT ; LIGHT
= DILATES.
= CONSTRICTION OF THE EYE IS A
DIRECT RESPONSE TO THE
SHINING LIGHT = NORMAL

3. CONSTRICTION OF THE OPPOSITE EYE IS
KNOWN AS CONSENSUAL RESPONSE .
F. SCLERA AND CORNEA
= NORMAL COLOR = WHITE
= YELLOW = INDICATES JAUNDICE OR
SYSTEMIC PROBLEMS.
= IN DARK SKINNED PERSON, THE
SCLERA MAY NORMALLY APPEAR
YELLOW ; PIGMENTED DOTS MAY BE
PRESENT
= CORNEA is transparent, smooth, shiny
and bright.

4. CLOUDY AREAS OR SPECKS ON THE
CORNEA MAY BE A RESULT OF AN
ACCIDENT OR EYE INJURY.
G. OPHTHALMOSCOPY
= ophthalmoscope is an instrument used to
examine the external structures and the
interior of the eye
= as the instrument is directed at the pupil,
A RED GLARE (RED REFLEX) IS SEEN IN
THE PUPIL.
= ABSENCE OF REFLEX INDICATES
OPACITY OF THE LENS

5. DIAGNOSTIC TESTS:
3.FLOURESCEIN ANGIOGRAPHY
= detailed imaging and recording of
ocular circulation by a series of
photographs after the administration of
a dye.
2. COMPUTED TOMOGRAPHY
= a beam of x-rays scans the skull and
orbits of the eye.

6. 3. SLIT LAMP = allows examination of the
anterior ocular structures under
microscopic magnification
= the client leans on a chin rest to
stabilize the head while the narrow beam
of light is aimed.
4. TONOMETRY
= used primarily to assess for an IOP and
potential glaucoma.
= normal IOP is 10-21 mmHg.

7. GENERAL CARE FOR EYE SURGERIES:
•PREOPERATIVE CARE:
- if both eyes are to be covered after surgery,
the patient needs to be oriented to the staff and
the physical environment, call light must be
placed within reach
- the child should practice having the eyes
covered to decrease postoperative fear.
- instillation of eye drops the day of surgery
may include to DILATE the pupil.

8. •POSTOPERATIVE:
- prevent increase of IOP thru;
= pt must keep the head still, avoid
coughing, vomiting & sneezing.
= should lie on the unoperative site.
= a burning sensation felt after 1 hr
postoperatively means that anesthetic is
wearing off.
= avoid bending and lifting to prevent stress
on suture line.
*ANY SENSATION OF PRESSURE, REDNESS
AND SHARP PAIN = BLEEDING!! MUST BE
REPORTED IMMEDIATELY ASAP TO AP!

9. COMMON DISORDERS OF THE EYE
* EYELID DISORDERS:
1. blepharitis – inflammation of eyelid margins;
=Irritation, burning, itching, ulceration,
eyelashes fall out.
=d/t staphyloccus infxn or seborrheic in origin
2. Chalazion – internal stye. Painless, slow-
growing, hard non-tender mass.
-infection or retention cyst in meibomian glands.
Hordeolum (sty)- infxn of 1 or more sebaceous
glands of the eyelid either in ext. or int. margins
of the eyelid

10. COMMON DISORDERS OF THE EYE
* DISORDERS OF THE CONJUNCTIVA,
SCLERA AND CORNEA:
1. conjunctivitis – inflammation which results
from bacterial/viral infections.
-redness, swelling, lacrimation, pain,
itching, discharges from eye
a. Acute – bacterial, viral, fungal; no pain
b. Trachoma – chronic caused by chlamydia
trachomatis ; blindness; contagious (fomites,
personal contact)

11. 2.IRITIS/uveitis – idiopathic or
autoimmune; very red eye, painful to
move, photophobia,
- uveal tract is the middle vascular layer of
the eye; choroid, ciliary body & iris
3. KERATITIS – corneal inflammation.
- pain, photophobia, lacrimation,
blepharospasm, decreased vision
f.Ulcerative – inflammation & ulceration
g.Non-ulcerative

12. 4. corneal ulcer – local necrosis d/t infxn,
trauma or misuse of contact lenses
- tearing, severe pain, v.a., blepharospasm
↓
TX: Trifluriding(Viroptic), Idoxuridine
(IDU), Adenine Arabinoside (Vira-A)
•Topical anti infectives
•Anti histamines (conjunctivitis)
•Cortecosteroids (keratitis)
•Immunosuppressive (uveitis)
•analgesics

13. UVEAL TRACT DISORDERS:
2.UVEITIS
* IRITIS – inflammation of the iris.
* Iridocyclitis – inflammation of the iris and
ciliary body
* Choroiditis
* choroidiretinitis – choroid & retina
Causes: local or systemic disease, injury,
unidentified factors
ASSESSMENT := pain in the eyeball radiating to
the forehead and temple

14. = blurred vision, photophobia, redness of the eyes
with purulent discharge, small pupil and
lacrimation
COLLABORATIVE MANAGEMENT :
•Mydiatrics ( AtSO41% or .25%, Scopolamine)
-to dilate pupils, preventing adhesion of iris and
the lens
•Steroids
•Dark glasses
•analgesics

15. RETINAL DETACHMENT
•Separation of the two primitive layers of retina.
•Elevation of both retinal layers away from the
choroid because of the presence of tumor.
CAUSES:- myopic degeneration, trauma, aphakia
(absence of crystalline lens), hemorrhage,
sudden severe physical exertion.
ASSESSMENT:
-peripheral vision is lost*
-flashes of light

16. -blurred vision ; sense of curtain being drawn
-on ophthalmoscopy, vitreous appears cloudy,
portion of retina hanging like gray cloud.
COLLABORATIVE MANAGEMENT :
-keep the pt quiet in bed with the eyes covered
to try to prevent further detachment.
-EARLY SURGERY is required!

17. SURGICAL PROCEDURES:
2.Draining fluid from the sub retinal space so
that the retina can return to the normal
position.
3.Sealing the retinal breaks by
CRYOSURGERY, a cold probe applied to the
sclera, to stimulate inflammatory response
leading to adhesions.
4.DIATHERMY, the use of an electrode needle
and heat through the sclera.
5.SCLERAL BUCKLING, to hold the choroid
and retina together with a splint until scar
tissue forms closing the tear.

18. GLAUCOMA
= increased IOP, results from inadequate
drainage of aqueous humor from the canal
of schlemm or overproduction of aqueous
humor.
= silent thief of vision
= the condition damages the optic nerve and
can result to blindness.

19. ACUTE GLAUCOMA is a rapid ONSET of IOP
greater than 50 to 70mmHg.
CHRONIC GLAUCOMA is a slow, progressive,
gradual onset of IOP greater than 30-50mmHg.

20. TYPES: acute or chronic
ACUTE (narrow/closed angle) = eye disease char
by suddenly impaired vision due to intraocular
tension caused by an imbalance in production
and excretion of aqueous humor.
= it is the result of corneal flattening & an
abnormal displacement of iris against the angle
of the anterior chamber
CHRONIC (NARROW/CLOSED ANGLE)
= follows an untreated attack of acute closed-
angle glaucoma; less common

21. CHRONIC (simple/wide or open); open-angle
= due to actual obstruction in the excretion of
aqueous humor. It develops slowly at first,
symptoms may be absent. Permanent vision
loss may occur before the individual is aware of
having the disease.
-90% ; most common;ant. Chamber bet. Iris &
cornea are N but flow of AH is obstructed
* Vision loss in glaucoma is IRREVERSIBLE!!
Due to neuronal ischemia & compression and
damage to the retina and optic nerve.

22. CHRONIC/SIMPLE GALUCOMA
ASSESSMENT:
*TUNNEL VISION- loss of peripheral vision.
Usually begins in one eye, if untreated both eyes
often become affected.
* Persistent dull eye pain in the morning
* frequent changes in glasses, difficulty in
adjusting to darkness, failure to detect in color
accurately.
* Rainbows or halos resembling street lights,
may be seen around the lights.

23. MANAGEMENT:
* Objective: to reduce IOP and keep it in a safe level.
* Miotics – use to constrict the pupil and draw the
smooth muscle of iris away from the canal of
schlemm= draining of a. humor.
* administer Acetazolamide (diamox) & glycerol orally
as ordered = to reduce production of a. humor.
* Limit OFI
* avoid atropine or other mydriatics as these will dilate
the pupil----iris is brought closer---a. humor is
obstructed.
- prepare for surgery as ordered.

24. * SURGERY :
1. TRABECULECTOMY= for CLOSED ANGLE
2. Laser trabeculoplasty –create multiple laser
burns scars cause stretching & opening the
→
meshwork
3. Gonioscopy -
4. Laser iridotomy – creates multiple perforatiion in
the iris

25. Dx tests
•Tonometry
•Fundoscopy – identifies pallor & ↑ size in
optic disk
•Gonioscopy – gonioscope; measures the
depth of the ant. Chamber
•Visual field testing

26. CATARACT
= is a clouding or opacity of the lens that leads to
blurring of vision ad eventual loss of sight. The opacity
is caused by chemical changes in the protein of the
lens because of slow degenerative changes of AGE,
INJURY, POISON or INTROCULAR INFECTION.
Classification:
* SENILE
* SECONDARY – occurs after systemic disease
* TRAUMATIC - injury
* CONGENITAL
Cataract occur so often in the aged. At 80 years of age,
about 85% of all people have some clouding of the
lens.

27. COLLABORATIVE MANAGEMENT:
•Surgery is the only satisfactory treatment.
1. ICCE - IntraCapsular Cataract Extraction;
removal of the entire lens & its capsule.
2. ECCE – ExtraCapsular Cataract Extraction
an opening is made in the capsule and the
lens is lifted without disturbing the membrane.
3. CRYOEXTRACTION – the cataract is lifted from the
eye by a small probe that has been cooled to a temp
below 0.
4. PHACOEMULSIFICATION –1/4 in. incision, uses
sound waves or ultrasonic vibrations to break up the
cloudy lines so it can be removed by suction.

28. POST-OPERATIVE CARE:
* the eye is covered with a dressing, and eye shield to
protect from injury.
* daily change of dressing is done. After 7-10 days, all
dressings are usually removed.
* During the first month, protect the eye with a shield
at night.
* Redness is normal within a few days, but if
accompanied with pain==see the DR. ASAP!!
* avoid bending, lifting of heavy object.
* administer eye drops as ordered.
IOL implant – is an alternative to cataract glasses or
lenses. The lens, w/c is made up of polyethyl
methacrylate is implanted at the time of cataract
extraction. Provides better binocular vision.

29. REFRACTION ERRORS:
* Emmetropia – normal refractive state; N vision
* Ammetropia – sight not in proper measure.
1. Hyperopia – farsightedness; parallel rays of light focus
behind the retina; corrected with convex lens.
2. Myopia – nearsightedness; light focus in front of the
retina; corrected with concave lens or radial
Keratotomy surgery.
3. Presbyopia – “old sight”; occurs due to aging process.
blurring of near object or visual fatigue when
doing close eye work; convex reading glasses
are recommended.
4. Astigmatism – “distorted vision”; caused by variation in
refractive power along different meridians of
the eye.

30. REHABILITATION OF A BLIND PERSON
•Refer blind person to available facilities.
•Orient to the environment
•Promote independence—ADL
•May have guide dog or use cane for direction.
•When approaching, talk before touching.
•During ambulation, have the pt hold your forearm so that your
step ahead of him.
•Do not change the location of objects without describing it.
•Do not rush up and offer help to a blind person unless it is clear
that the person wants help
•If significant others ask advise about gifts for a blind person,
suggest gifts that appeal to senses than vision.. 