Cataract (eye disease condition)

detailed information about cataract - contain definition, epidemiology, causes, risk factor, pathophysiology, clinical ,manifestations, classification, diagnosis, nursing management, medical management, research, patient teaching, care of eye.

1. cataract Submitted to:- Mrs. mamta toppo Subject coordinator Medical surgical nursing Rimscon,ranch i . Presented by:- Nisha kumari Roll:-14 Session:-2017-2021 Basic b.sc. Nursing-3 rd year Rimscon,rranchi .

2. contents Introduction to cataract Definition Epidemiology Causes of cataract Risk factors Pathophysiology of cataract Clinical manifestation Classification of cataract Diagnostic evaluations Management of cataract Nursing diagnosis and interventions Prevention and complications of cataract A checklist New reserches recently Summary References and bibliography

3. introduction Cataract is the clouding of lens inside the eye , causing vision loss that cannot be corrected with glasses , contact lenses or cornealrefractive surgery like LASIK. Cataract is derived from a Greek word CATRA – meaning running water or flowing water .

4. It develops slowly and eventually interferes with the vision . It might end up in both the eyes , but they usually does not forms at the same time .

5. Definition- A cataract is an opacification of the lens of the eye which leads to a decrease in vision. A clouding of the eye lens or its surrounding transparent membrane that obstructs the passage of light. A cataract begins when proteins in the eye forms clumps that prevents the lens from sending clear images to the ratina .

6. Epidemiology- Cataract remains the leading cause of blindness. Age related cataract is responsible for 48% of the world blindness , which repesents the about18 million people . Cataract is also an important cause of low vision in both developed and developing countries. Cataract is more commonly found in older Americans .

7. Infact , according to NEI 68% of the American aging 80 or older has been found with cataract in 2010. Roughly , 24.4 million Americans had cataracts and that in number is estimated to grow to 50.2 million by the year 2050 , according to NEI. Thankfully , modern cataract is one of the most safest and most effective surgical procedures today . About 3 million surgeries are performed every year .

8. Causes / etiology - Several underlying causes of cataract are :- Overproductions of oxidants . Smoking. UV radiations. Congenital genetic malformations. Diabetic ratinopathy . Ocular trauma . Long term use of corticosteroids. Other medicines usage like phototoxic 8-phenothiazines , thiazides , tranquilizers , contraceptives

9. Risk factors Age :- above 65 years Heridity :- due to anomaly in the chromosomal pattern . People living in high altitudes . Chronic exposure to heat . Glass blowers and welders . IOP:- rhinitis pigmentosa , uveitis , myopia , glaucoma , retinal detachment .

10. Pathophysiology -

11. Clinical manifestations- Blurry vision or distorted images . Trouble seeing at night . increased sensitivity to glare . seeing colours as faded . halos surrounding light . double vision in the affected eye . a need to frequent change in prescription glasses . gradual painless burning . loss of vision due to lens opacity . decreased colour perception . decreased visual acuity .

12. Poor vision at night . Photophobia . Light scattering . leukokoria or white pupil . reduced light transmission . contrast sensitivity is also lost

13. Classification -

14. A. Etiological ctaract CONGENITAL CATRACT :- It include genetic factor malnutrion , infection , disease during 1 st trimester pregnancy ( German measles , mumps , chicken pox , hepatitis , radiation and drug ingestion – thalidomide.) Birth traumas , metabolic disorders or infectious disease of the infant .

15. 2. Aquired cataract:- Here the opacification occurs due to degeneration of the already formed lens fibers . Senile cataract- also called age related cataract . It is characterized by an initial opacity in the lens , subsequent swelling of the lens and final shrinkage with complete loss of transparency . It may occur due to denaturation of the lens proteins and opacification lens fibers .

16. Traumatic cataract:- most commonly due to penetrating or blunt injury to the eye , laceration and foreign body in the eye. COMPLICATED CATARACT:- it refers to the opacity if the lens secondary to the other intraocular diseases .also called secondary cataract. METABOLIC CATARACT:- occurs due to endocrine disorders and biochemical abnormalities .

17. ELECTRIC CATARACT:- it is known to occur after passage of powerful electric current though the body. DERMATOLOGIC CATARCT :- cataract is associated with the skin disease such as atopic dermatitis . TOXIC CATARACT:- medications those are phototoxic such as tetracycline , phenothiazines , thiazides , tranquilizers , oral contraceptives and corticosteroids also cause cataract . RADIATION CATARACT:- exposure to al l type of causes damage to the lens epithilium .

18. b. Morphological cataract :- CAPSULAR CATARACT:- involves capsule ; maybe anterior or posterior capsule . SUB-CAPSULAR CATARACT:- involves superficial part of the cortex (just below the capsule ) includes anterior and posterior sub-capsule . CORTICAL CATARACT:- the lens fibers of the cortex are mainly affected. There is hydration due to accumulation of water droplets in between the fibers and the proteins are first degenerated and then are coagulated forming opacity .

19. SUPRA-NUCLEAR CATARACT:- it involves only the deeper parts of the cortex ( just outside the nucleus ). NUCLEAR CATARACT :- it involves the crystalline lens . The nucleus becomes diffusely cloudy and obstructs the night rays . POLAR CATRACT :- it involves the capsule and superior part of the cortex in the polar region only and may be anterior polar cataract or posterior polar cataract.

20. Diagnostic evaluation:- History of patient Direct ophthalmoscopy Slit lamp biomicroscopy Refraction and retinoscopy Snellen visual acuity test Glare testing Penlight examination of pupil and lens.

21. Management- SURGICAL MANAGEMENT _ Surgery is the definitive treatment for cataract . The most common surgery is performed in the ambulatory surgery centers , few patients require hospitalizations . The most effective and common treatment is to make incision ( capsulotomy ) into the capsule of the cloudy lens in order to surgically remove the lens . 2 types of eye surgeries used _ Extra capsular cataract examination (ECCE ) Intra capsular cataract examination (ICCE)

22. Intracapsular cataract examination(ICCE) Extracapsular cataract examination(ECCE)

23. PHACOEMULSIFIATION A titanium needle vibrating at ultrasonic frequencies (high frequently sound waves )used to disrupt the lens nucleus . The needle vibrates at ultrasonic frequency (40,000hz )and the lens material is emulsified . A 2 nd fine instrument (called cracker or chopper ) maybe used from a side port to facilitate cracking or chopping of the nucleus into smaller pieces. The anterior capsule and the lens particles are removed from eye by irrigation and aspiration through a sleeve around the needle , the posterior capsule is left to support on IOL.

24. Nursing diagnosis:- High risk of injury related to loss of viterous , intraocular hemorrhage , increased IOP. Impaired sensory perception vision , related to impaired sensory reception / status of sensory organs , a therapeutic environment is limited . Acute pain related to trauma to the incision and increased IOP. Anxiety related to lack of knowledge about the disease and its treatment . Risk of infection related to trauma to the incision .

25. Nursing interventions:- Asses the visual acuity of the client’s non-operative eye prior to surgery . Discuss what happens on the condition of post surgery , pain , limitation of activity, performance , bandage the eye. Comfort the patient with semi-fowler’s or tilted to the side , preferable to patient . Ask patient to avoid activities such as vomiting , coughing , sneezing , straining , or bending over . Ambulation with assistance ; give special bathrooms when recovering from anesthesia . Encourage deep breathing / coughing to maintain eye protection as indicated . Encourage use of stress management techniques.

26. 8. Remove all the eye makeup and contact lenses or glasses prior to surgery . 9. Administer antiemetic medications as needed. Orient the client to the environment . Approach from the side that was operated on , talk and touch. Note for dim or blurred vision and eye irritation , which can occur when using eye drops . use correct techniques for administration of eye medications. Remind clients to use cataract glasses . Place the required items / call bells within reach. Administer antibiotics , anti-inflammatory and other systemic and eye medications as prescribed . Encourage the patient to wear dark glasses after eye dressing is removed.

27. Prevention :- Quit smoking Wear sunglasses

28. Complications:- PCO Intraocular lens dislocation Eye inflammation Light sesitivity Photopsia Macular edema Ptosis Ocular hypertension

29. Health teachings- Explain for the care of eye to prevent contamination of the surgical site . Encourage the patient to use eye shield to protect the operated eye from injury while sleeping. Ask patient to wear dark sunglasses to provide comfort to eyes from sunlight. Encourage Patients to take proper antioxidants vitamins ( vit . C and E) and good nutrition. Ask patients to avoid lifting heavy objects , isometric exercises , straining during defecation . Teach the family and the patient , how to instill the opthalmic ointment or drops . If the patient has increased eye discharge , sharp eye pain , or deterioration in vision , intruct to immediately notify the physician.

30. Checklist for the pre-op assessment before cataract surgery : History collection of the patient . If client uses any glasses ; check for the ability to read without glasses . Sonographic examination (in case if cataract is already at an advanced stage ) Dilate the pupil using eye drops and consult the doctor and documentation of the activity performed Take the consent for the procedure signed by the patient and relatives prior to the surgery. laboratory tests and allergies identification data attached to documents all the vital signs assessed and recorded Remove all the jewellery and ask client to void and wear hopital gown and hair cover. Then administer preoperative medication as prescribed checked unchecked Checked unchecked checked unchecked checked unchecked checked unchecked checked unchecked checked unchecked checked unchecked

31. New researches : survey on cataract as cause of blindness in india .

32. Conclusion:- the study shows that client are having inadequate awareness(24.26%) about cataract.

33. summary Cataract is an opacification or clouding of eyes. Common causes are exposure to UV radiations , smoking , congenital malformations , etc. . Higher age group are at high risk . The pathophysiology says that – due to nuclear sclerosis , there is a decrease in transport of water , antioxidants and nutrients causing progressive oxidant damage to the lens , leads to cataract. It can be treated through surgeries, the most frequently used surgery is PHACOEMULCIFICATION.

34. REFERENCES :- BOOKS INTERNET CONSULTATION WITH THE TEACHERS BILIOGRAPHY :- PV , a book of medical – surgical nursing , 11 edition , page – 186 to 193. www.wikipedia.com

35. thank you