Cataract-Ppt.pptx

Nursing management of patients with disorders of cataract and blindness

1. CATARACT MS. SIBI SAMUEL ASSISSTANT PROFESSOR NIGHTINGALE COLLEGE OF NURSING , NOIDA

2. A cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision.

3. EPIDEMOLOGY 1. Cataracts remain the leading cause of blindness . 2. Age-related cataract is responsible for 48% of world blindness, which represents about 18 million people. 3. Cataracts are also an important cause of low vision in both developed and developing countries.

4. Old age (commonest)>65 Year • Ocular & systemic diseases – DM – Uveitis – Previous ocular surgery • Systemic medication – Steroids – Phenothiazines • Trauma & intraocular foreign bodies • Ionizing radiation – X-ray, UV Congenital – Part of a syndrome – Abnormal galactose metabolism – Hypoglycemia • Inherited abnormality – Myotonic dystrophy – Marfan’s syndrom – Rubella – High myopia

5. PATHOPHYSIOLOGY Any physical or chemical cause ↓ Disturbs the intracellular and extracellular equilbrium of water and electrolytes ↓ Deranges the colloid system in lens fibres ↓ Aberrant fibres are formed from germinal epithelium of lens ↓ Epithelial cell necrosis ↓ Focal opacification of lens epithelium ( glaucomflecken ) ↓ Opacification of lens

6. Opacification of lens takeplace by 3 biochemical changes Hydration Denaturation of lens protein Slowsclerosis These leads to Abnormalities of lens proteins & Disorganisation of lens fibres Loss of transparency of lens Cataract

7. TYPES Nuclear Cataract located in the center of the lens. The nucleus tends to darken, changing from clear to yellow and sometimes brown. 2.Cortical Cataract Affects the layer of the lens surrounding the nucleus. The cataract looks like a wedge or a spoke. 3. Subcapsular cataract It involves superficial part of the cortex(just below the capsule) and includes anterior sub capsule or posterior sub capsule.

8. Cortical cataract Nuclear cataract Subcapsular cataract

9. 4.Anterior Subcapsular Cataracts This type forms just inside the front of lens capsule. An injury or swelling in eye can lead to one. 5.Congenital Cataracts These are cataracts at the time of born or in childhood. Some are linked to genes, and others are due to an illness, like rubella, that mother had during pregnancy. 6.Secondary Cataracts When another condition or a medical treatment leads to a cataract, it called as a secondary cataract.

10. Based on maturity:- 1.Immature Catarct 2.Mature Cataract 3.Hypermature Cataract

11. Mature Cataract Lens is completely opaque . Vision reduced to just perception of light Iris shadow is not seen Lens appears pearly white

12. IMMATURE CATARACT

13. Hypermature Shrunken and wrinkled anterior capsule due to leakage of water out of the lense . • This may take any of two forms : 1.Liquefactive / Morgagnian Type 2.Sclerotic Cataract

14. Liquefactive / Morgagnian Type Cortex undergoes auto-lytic liquefaction and turns uniformly milky white. • The nucleus loses support and settles to the bottom.

15. Sclerotic Cataract •The fluid from the cortex gets absorbed and the lens becomes shrunken. There may be deposition of calcific material on the lens capsule. Iridodonesis : Anterior chamber deepens and iris becomes tremulous. The zonules become weak, increasing the risk of subluxation / dislocation of lens.

16. CLINICAL MANIFESTATION

17. Gradual painless burning •Loss of vision due to lens opacity • Increased glare in bright light •Decreased color perception •Decreased visual acuity •Poor vision at night Photophobia(light sensititvity ) Blured or distorted images Light scattering Leukokoria or white pupil Reduced light transmission

18. Blurred vision due to scattering of light

19. DIAGNOSTIC EVALUATION

20. Cont….

21. TREATMENT • Glasses : Cataract alters the refractive power of the natural lens so glasses may allow good vision to be maintained. Surgical removal : when visual acuity can't be improved with glasses. • Surgical techniques –Phacoemulsification method. – Extracapsular cataract extraction. –Intra capsular cataract extraction. –Intraocular lens implantation –cryosurgery

22. PREOPERATIVE PHASE Nonsteroidal Anti-inflammatory Eye Drops Alpha-adrenergic Agonist Drug Anticholinergic Agent Antibiotics Antianxiety Medications

23. SURGICAL MANAGEMENT Phacoemulsification in cataract surgery involves insertion of a tiny, hollowed tip that uses high frequency (ultrasonic) vibrations to "break up" the eye's cloudy lens (cataract). The same tip is used to suction out the lens

24. INTRA-CAPSULAR CATARACT EXTRACTION Intracapsular Cataract Extraction. From the late 1800s until the 1970s, the technique of choice for cataract extraction was intracapsular cataract extraction (ICCE). The entire lens ( ie , nucleus, cortex, and capsule) is removed, and fine sutures close the incision. ICCE is infrequently performed today; however, it is indicated when there is a need to remove the entire lens, such as with a subluxated cataract ( ie , partially or completely dislocated lens).

25. EXTRA CAPSULAR EXTRACTION

26. Postoperative care after cataract surgery Postoperative care after cataract surgery Steroid drops (inflammation) Antibiotic drops (infection) Avoid Very strenuous exertion (rise the pressure in the eyeball) Ocular trauma.

27. INTRAOCULAR LENS IMPLANTATION

28. NURSING MANAGEMENT Assess visual acuity Give accurate information Administer eye medications Elevate the head of the bed 30 to 45 degrees. Notify the surgeon

29. Posterior Capsule Opacity (PCO) Intraocular Lens Dislocation Eye Inflammation Light Sensitivity Macular Edema Ptosis Ocular Hypertension

30. Infective endophthalmitis – Rare but can cause permanent severe reduction of vision. – Most cases within two weeks of surgery. – Typically patients present with a short history of a reduction in their vision and a red painful eye. – This is an ophthalmic emergency . – Low grade infection with pathogen such as Propionibacterium species can lead patients to present several weeks after initial surgery with a refractory uveitis

31. Suprachoroidal haemorrhage . – Severe intraoperative bleeding can lead to serious and permanent reduction in vision.

32. NURSING DIAGNOSIS Acute pain related to trauma to the incision and increased IOP as evidence by patient verbalization. Anxiety related to lack of knowledge as evidenced by verbalization of anxious questions. Self –care deficits related to visual deficit as evidence by decreased vision acuity Risk for infection related to surgical incision and self care after surgery. Risk for injury related to sensory deficit while operated eye is patched .

33. HEALTH EDUCATION Avoid Eye Straining. Avoid Rubbing Avoid Rapid Movement Proper Hygiene And Eye CarTechniques Use Eye Shield At Bedtime. Follow-up As Recommended

34. Cataract surgery is the principal refractive surgical procedure performed in older adults. Technological advances have allowed for improved surgery through smaller incisions, resulting in better outcomes.