Cataract - Preeti sharma

cataract is clouding of the lens inside the eye..
it is very useful topic in medical filed...in this presentation all content is included about cataract like causes, symptoms and treatment...its very useful in your study.

1. CATARACT BY- PREETI SHARMA MSC. NSG. 1 ST YR.

2. INTRODUCTION A cataract is a clouding of the lens inside the eye which leads to a decrease in vision. Cataracts are the most common cause of vision loss in people over age 60 and are the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic retinopathy.

3. DEFINITION “A cataract is a clouding or opacity within the crystalline lens that leads to gradual painless blurring and eventual loss of vision. The patient may have a cataract in one or both eyes. If present in both eyes, one cataract may affect the patient’s vision. The cataracts are third leading cause of preventable blindness.”

4. ANATOMY AND PHYISOLOGY OF EYE

5. TYPES CONGENITAL ACQUIRED SENILE CORTICAL SENILE NUCLEAR TRAUMATIC CATARACT PATHOLO-GICAL CATARACT CLASSIFICATION

6. Congenital Cataract- It present at birth or form during a baby’s first year, are less common than age related cataracts. Acquired Cataract- It is 4 types:  Senile Cortical- Cortical cataracts are wedge shaped and form around the edges of the nucleus. Senile Nuclear- Nuclear cataracts form in the middle of the lens and cause the nucleus, or the centre, to become yellow or brown.

7. CONT... Traumatic cataract- It develops after an injury to the eye, but it can take several years for this to happen. Pathological Cataract- It develops after any disease of the eye

8.   RISK FACTORS Age: The incidence increases dramatically after the age of 6o. Sex: Cataracts are slightly more common in women than men. Ultraviolet light exposure: – More common in persons living in warm sunny climates. Drug effects: Use of corticosteroids, Phenothiazines and selected chemotherapeutic agents. Poorly-controlled diabetes mellitus accumulation of Sorbitol (by product of glucose). Trauma to the eye.

9. ETIOLOGY   Degenerative changes- Senile cataracts develop in elderly patients, probably because of the degenerative changes in the chemical state of lens proteins. Genetic defects- Congenital cataracts occur in neonates genetic defects or as a sequel of maternal infections during the first trimester. Foreign body injury- Traumatic cataracts occur after a foreign body injures the lens with sufficient force to allow aqueous or vitreous humor to enter the lens capsule and also dislocate the lens

10. Secondary effects- Complicated cataracts occur as secondary effects in patients with uveitis , glaucoma, or retinitis pigmentosa , or in the course of a systemic disease, such as diabetes, hypoparathyroidism , or atopic dermatitis. Drug or chemical toxicity- Toxic cataracts result from drug or chemical toxicity with prednisone, ergot alkaloids, dinitrophenol , naphthalene, phenothiazines , or  pilocarpine , or from extended exposure to ultraviolet rays

11. PATHOPHYSIOLOGY Due to etiological factors   Lens consist of 65% of H 2 O & 35% of protein and minerals   Formation of new proteins   Protein amount of lens increase & clumps to old proteins of lens  

12. Clumps compacted into centre of lens Cloudens the lens     Prevents lights from passing clearly leading to blurred vision & blindness

13. CLINICAL MANIFESTATION Blurred vision - Blurred vision is usually the first symptom of cataracts. Glare - Glare refers to the pain felt when the patient looks directly into the light Halos - Halos are formed when the patient looks at a bright light and there is still the vision of the light after looking away. Double vision - Double vision is also one of the early symptoms of cataract. Maternal Malnutrition - Develops congenital cataract.

14. Coagulation of protein- Cause irreversible opacity. UV rays- Due to long term effect. Disease of the eye- Inflammatory disease of eye i.e. Koroditis . Blunt trauma Electric shock

15. DIAGNOSTIC TESTS   History taking Plane Mirror Examination (to find out the opacity) Slit lamp examination ( to magnify the opacity) Direct or indirect Opthalmoscopy (To find out retinal disease) Perimetery ( to check vision) Tonometery ( To check intra ocular pressure)

16. MANAGEMENT Diagnosis of cataract based on decreased visual acuity or other complaints of visual dysfunction.   Medical management Medications administered pre and postoperatively are: Dilating drops- Dilating drops are administered every 10 minutes for four doses at least 1 hour before surgery.

17. Antibiotic drugs- Antibiotic drugs may be administered Prophylactically to prevent postoperative infection and inflammation. Intravenous sedation- Sedation may be used to minimize anxiety and discomfort before surgery. Surgical management   Lens replacement- There are three lens replacement options:

18. Phacoemulsification - A portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex while the posterior capsule and zonular support are left intact. Aphakic glasses.  In aphakic glasses, objects are magnified by 25%, making them appear closer than they actually are. Contact lenses.  Contact lenses provide patients with almost normal vision, but because contact lenses need to be removed occasionally, the patient also needs a pair of aphakic glasses.

19. Extra capsular cataract extraction (ECCE)- ECCE removes the anterior lens and cortex, leaving the posterior capsule intact. Intra capsular cataract extraction- This procedure removes the entire lens within the intact capsule.

20. NUTRITIONAL MANAGEMENT

21. Nursing Management Nursing assessment The nurse should assess: - Recent medication intake - Vital sign - Preoperative tests - Visual acuity test results - Patient’s medical history

22. Nursing diagnosis Disturbed visual sensory perception  related to altered sensory reception or status of sense organs Risk for trauma   related to poor vision and reduces hand-eye coordination. Anxiety   related to threat of permanent loss of vision/independence. Deficient knowledge   regarding ways of coping with altered abilities related to lack of exposure or recall, misinterpretation, or cognitive limitations.

23. Nursing goal Regaining of usual level of cognition. Recognizing awareness of sensory needs. Be free of injury. Intervention Providing preoperative care.   Use of   anticoagulants   is withheld to reduce the risk of retro bulbar haemorrhage . Providing postoperative care.   Before discharge, the patient receives verbal and written instructions about how to protect the eye, medications, recognize signs of complications, and obtain emergency care.

24. HEALTH EDUCATION: 1. Teach patient and family proper hygiene and eye care techniques to ensure that medications dressing, and/or surgical wound are not contaminated during necessary eye care. 2. Teach patient and family about signs and symptoms of infection and how to report those to allow early recognition and treatment of possible infection. 3. Instruct patient to comply with postoperative restrictions on head positioning, to optimize to visual outcomes and prevent increased IOP.

25. CONCLUSION   Cataract is a clouding of the lens in the eye  which leads to a decrease in vision. 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. Improvements in lens implants provide better visual outcomes than were previously possible.

26. ANY QUESTIONS?