Cataract

This is a topic of sensory organ and this is detailed topic and can be refered by all nursing students bsc, msc and gnm which give you overall idea and things related to cataractwhich include definition, anat and physio, risk factor, pathophysiology, clinical menifestation, diagnostic evaluation, and management

1. CATARACT

2. INTRODUCTION: A cataract is a clouding of the lens in the eye leading to a decrease in vision. It can affect one or both eyes. Some degree of cataract formation is to be expected in most people more than 70 year of age. Worldwide, cataract is the primary cause of reduced vision and blindness. More than 1 million cataract operations are now being performed annually in the united states. A person with a normal life span is more likely to undergo a cataract operation then any other major surgical procedure.

3. If cataract present in both eyes, one cataract , one cataract may affect the patient’s vision more then the other. Cataracts are the third leading cause of preventable blindness and the most common cause of self-declared visual disability in the united state. The incidence increases to approximately 70%. Cataract removal is the most common surgical procedure for Americans older than 65 years.

4. The most common cataract is the age-related or senile type. Senile cataract usually begin around the age of 50 year and consist of cortical, nuclear, or posterior subcapsular opacities, which may coexist in various combinations. In cortal cataract, spoke-like opacifications are found in the periphery of the lens. They progress slowly, infrequently involve the visual axis, and often do not cause severe loss of vision.

5. DEFINITION: ‘A cataract is opacity of the lens.’ (in Joyce M. Black) ‘A cataract is an opacity within the lens.’ (in Lewis) It is an opacity of the crystalline lens or its capsule causing visual impairment. (Internet)

6. ANATOMY OF EYE External structure Eye ball Eyelids Lacrimal gland

7. Internal structure – The internal structure composed of conjunctiva, cornea, sclera, the uveal tract(iris, ciliary body, choroid) lens, and vitreous chamber

8. PHYSIOLOGY OF EYE : Transmission of light Visual receptor of the Retina: Cones and Rods Image Processing and the visual cortex

9. RISK FACTORS Aging Loss of lens transparency Clumping or aggregation of lens protein (which leads to light scattering) Accumulation of a yellow-brown pigment due to the breakdown of lens protein Decreased oxygen uptake Increase in sodium and calcium Decrease in levels of vitamin C, protein, and glutathione (an antioxidant)

10. Associated Ocular Conditions Retinitis pigmentosa Myopia Retinal detachment and retinal surgery Infection ( eg , herpes zoster, uveitis )

11. Nutritional Factors Reduced levels of antioxidants Poor nutrition Obesity

12. Physical Factors Dehydration associated with chronic diarrhea, use of purgatives in anorexia nervosa, and use of hyperbaric oxygenation Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock Ultraviolet radiation in sunlight and x-ray

13. Systemic Diseases and Syndromes Diabetes mellitus Down syndrome Disorders related to lipid metabolism Renal disorders Musculoskeletal disorders

14. Toxic Factors Corticosteroids, especially at high doses and in long-term use Alkaline chemical eye burns, poisoning Cigarette smoking. Calcium, copper, iron, gold, silver, and mercury, which tend to deposit in the pupillary area of the lens

15. Congenital cause Maternal rubella Familiar congenital cataract. Galactosemia

16. TYPES OF CATARACT Congenital cataract - A congenital cataract is clouding of the lens of eyes, that is present at birth. Acquired cataract – Are caused by diseases or medications. Diseases that are linked with the development of cataracts include Glaucoma and Diabetes. Medication like the use of steroid (prednisone) and other medication can sometime lead to cataracts.   Sanile cataract – sanile cataract is a age related, vision-impairing disease characterized by gradual progressive thickening of the lens of the eye.

17. Traumatic cataract – traumatic cataract develop after an injury to the eye, but it can take several years for this to happen. Radiation cataract- radiation cataracts can form after a person undergoes radiation treatment for cancer.

18. PATHOPHYSIOLOGY

19. CINICAL MENIFESTATION: Pain less, Blurred vision(loss of sharpness of eyesight). The patient perceives that surroundings are dimmer, as if glasses need cleaning. Light scattering is common, and the individual experiences reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity. Abnormal color perception. Photophobia(light sensitivity).

20. Nystagmus (involuntary eye movement ). Gradual loss of Vision. Pupil Dilates. Increased intraocular pressure. The pupil which is normally black become gray milky white.

21. Loss of ability to discriminate between hues and cloudy white opacity on the pupil. Other effects include myopic shift, astigmatism, monocular diplopia ( ie , double vision), color shift ( ie , the aging lens becomes progressively more absorbent at the blue end of the spectrum), brunescens ( ie , color values shift to yellow-brown) and reduced light transmission.

22. DIAGNOSTIC EVALUATION History collection Physical examination Slit lamp Microscopy Opthalmoscopy - Direct opthalmoscopy & Indirect opthalmoscopy Visual field perimetry Glare testing

23. COMPLICATION Postoperative infection Bleeding Macular edema Wound leaks Complete Vision loss

24. MANAGEMENT

25. MEDICAL MANAGEMENT No nonsurgical treatment cures cataracts. In the early stages of cataract development, glasses, contact lenses, strong bifocals, or magnifying lenses may improve vision. Reducing glare with proper light and appropriate lighting can facilitate reading. Mydriatics can be used as short-term treatment to dilate the pupil and allow more light to reach the retina, although this increases glare(cause difficult to drive at night). Lifestyle adjustment. Reassurance

26. Preoperative Medications- Eye drops may include the dilating agent such as tropicamide ( mydriacyl ) to facilitate the surgery. A cycloplegic cyclopentolate ( cyclogyl ) may also be administered to paralyze the ciliary muscles. Cataract surgery is performed under tropical anesthesia using eye drops or regional anesthesia ( retrobulbar injection of local anesthetic solution). The client is often given an intravenous sedative in addition.

27. SURGICAL MANAGEMENT Intracapsular Cataract Extraction (ICCE) – Intracapsular cataract surgery is removal of both the lenses and the thin capsule that surround the lens and left the eye aphakic (without a lens). This type of surgery was common before 1980, but has since displaced by extracapsular surgery. Removal of the capsule requires the large incision and doesn’t allow comfortable intraocular lens implantation. Thus, people who undergo a intraocular cataract surgery has long recovery periods and have to wear very thick glasses.

28. Extracapsular cataract Surgery (ECCE)– it is the removal of the lens where the elastic capsule that cover the lenses are left partially intact to allow implantation of an intraocular lens(IOL)

29. Phacoemulsification –it is a modern cataract surgery in which the eye’s internal lens is emulsified with an ultrasonic hand piece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior

30. Lens Replacement – after removal of the crystalline lens, the patient is referred to a aphakic (without lens). The lens, which focuses light on the retina, must be replaced for the patient to see clearly.

31. NURSING MANAGEMENT Preoperative care – To reduce the risk for retrobulbar hemorrhage (after retrobulbar injection), any anticoagulation therapy that the patient is receiving is withheld, if medically appropriate. Aspirin should be withheld for 5 to 7 days, nonsteroidal anti-inflammatory medications (NSAIDs) for 3 to 5 days, and warfarin (Coumadin) until the prothrombin time of 1.5 is almost reached.

32. Dilating drops are administered every 10 minutes for four doses at least 1 hour before surgery. Additional dilating drops may be administered in the operating room (immediately before surgery) if the affected eye is not fully dilated. Antibiotic, corticosteroid,and NSAID drops may be administered prophylactically to prevent postoperative infection and inflammation.

33. Postoperative care After recovery from anesthesia, the patient receives verbal and written instruction regarding how to protect the eye, administer medications, recognize signs of complications, and obtain emergency care. Activities to be avoided are identified in Chart 58-6. The nurse also explains that there is minimal discomfort after surgery and instructs the patient to take a mild analgesic agent, such as acetaminophen,as needed. Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively

34. Position Patient on back or unoperated side to prevent pressure in operated eye. Keep siderails up as necessary for protection. Place call light within reach. The nurse instruct the patient to be careful to prevent so up water from entering the operative eye during face or hair washing. Stress avoidance of action the increases I.O.P.

35. NURSING DIAGNOSIS Disturbed sensory perception(visual) related to lens extraction and replacement and use of eye patch Anxiety related to lack of knowledge Risk for injury related to blurred vision Acute pain related to trauma to the incision and increased IOP

36. Risk for infection related to trauma to the incision.

37. HEALTH EDUCATION Hygiene- Clean the operated eye gently with the starile saline wash and cotton balls given to you Don’t take head bath for few days after surgery. Remove hair tangle gently on the operated side.

38. Diet – Usually given a full diet. Avoid fried food. Avoid tobacco, alcohol, & bittle nut

39. Teaching patient self-care – To prevent accidental rubbing or poking of the eye, the patient wears a protective eye patch for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks. The nurse instructs the patient and family in applying and caring for the eye shield. Sunglasses should be worn while outdoors during the day because the eye is sensitive to light.

40. Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days. A clean, damp washcloth may be used to remove slight morning eye discharge. 5.Because cataract surgery increases the risk for retinal detachment, the patient must know to notify the surgeon if new floaters ( ie , dots) in vision, flashing lights, decrease in vision, pain, or increase in redness occurs.

41. Continuing care The eye patch is removed after the first follow up appointment. Patients may experience blurring of vision for several days to weeks. Sutures left in the eye alter the curvature of the cornea, resulting in temporary blurring and some astigmatism. Vision gradually improves as the eye heals. Patients with IOL implants have visual improvement faster than those waiting for aphakic glasses or contact lenses.

42. Vision is stabilized when then eye is completely healed, usually within 6 to 12 weeks, when final corrective prescription is completed. Visual correction is needed for any remaining nearsightedness or farsightedness (even in patients with IOL implants).

43. CONCLUSION A cataract is a clouding of the lens in the eye leading to a decrease in vision. It can be present one or both eye. If it present in both eye then one eye is affected more then other.A person with a normal life span is more likely to undergo a cataract operation then any other major surgical procedure. A cataract is a treatable blindness in a person.

44. BIBLIOGRAPHY Joyce M. Black, “medical-surgical nursing, clinical management for positive outcome ” Edition – 8 th , volume- 2 nd, chapter- 63 & 65, elsevier publication 2009, New Delhi page no.-1668-1671,1704-1706. Lewis’s, “medical-surgical nursing,assessment and management of clinical problems” Edition -7 th , section-4, chapter-22, Elsevier publication 2007, New Delhi page no.- 425-429.

45. Lippincott , “Manual of nursing practice” Edition – 9 th , Williams and Wilkins publication 2009, New Delhi. Brunner & siddarth’s , “textbook of medical-surgical nursing”, Edition – 12 th , volume – 2 nd , Published by wolter’s kluwer Pvt Ltd, New Delhi

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