Glaucoma and Retinal detachment.pptx ..

Glaucoma and Retinal detachment.pptx

1. Retinal Detachment And Glaucoma

2. Retinal detachment

3. Objectives What Is Retinal detachment. Types of Retinal detachment. Epidemiology of Retinal detachment . Etiology and pathophysiology of retinal detachment. Sign and symptoms and diagnosis of retinal detachment. How is Retinal detachment Treated . Medical, Surgical and Nursing Management of Retinal detachment .

4. Definition Retinal detachment is a serious  eye condition that happens when your retina a layer of tissue at the back of your eye that processes light pulls away from the tissue around it.

5. T ypes Retinal Detachment Causes and Types There are three main types of retinal detachment: Rhegmatogenous.  This is the most common kind. It happens because of a retinal tear. Age usually causes it, as the vitreous gel that fills your eyeball pulls away from your retina. You can also have it because of an eye injury, surgery, or nearsightedness.

6. Cont.. Tractional.  This type happens when scar tissue pulls on your retina, usually because diabetes has damaged the blood vessels in the back of your eye. Exudative.  This kind happens when fluid builds up behind your retina, but there’s no tear. The fluid pushes your retina away from the tissue behind it. Common causes include leaking blood vessels and swelling because of conditions such as an injury, inflammation, or age-related macular degeneration.

7. Epidemiology The incidence of retinal detachment in otherwise normal eyes is around 5 new cases in 100,000 persons per year. Detachment is more frequent in middle-aged or elderly populations, with rates of around 20 in 100,000 per year. The lifetime risk in normal individuals is about 1 in 300. Although retinal detachment usually occurs in just one eye, there is a 15% chance of it developing in the other eye

8. Etiology Trauma Advanced diabetes S hrinkage of the jelly-like vitreous that fills the inside of the eye Myopia Degenerative disorders Inflammation and infections Scarring and fibrous material due to retinopathy and hemorrhages Ocular tumors

9. Pathophysiology Due to etiological factors (a torn or break in retina) Vitreous fluid or serous fluid leaks in between the layers of retina or behind the retinal layers Detachment of retinal layer Retina can peel away from the underlying layer of blood vessels Lack of oxygenation in tissues of retina Vision disturbances

10. Sign & Symptoms Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as: The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision Flashes of light in one or both eyes ( photopsia ) Blurred vision Gradually reduced side (peripheral) vision A curtain-like shadow over your visual field

11. D iagnosis Retinal detachment can be examined by: Retinal examination . Ultrasound imaging. Fluorescein Angiography Tonometry Ophthalmoscopy Refraction Test Color Vision Test Visual Acuity Slit-lamp Examination

12. T reatment Your treatment may involve one or more of these procedures : injecting a bubble of gas into your eye to push the retina against the back of your eye (pneumatic retinopexy ). Laser (thermal) or freezing (cryopexy).  Pneumatic retinopexy . Scleral buckle . Vitrectomy.

13. Medical Managements Mydriatic , cycloplegic Photocoagulation of retnial break External beam radiation therapy or brachytherapy with a plaque may be used for choroidal melanoma. Metastatic lesions respond to chemotherapy or localized radiation therapy. Choroidal hemangiomas may respond to laser photocoagulation or plaque brachytherapy. Retinoblastomas may be shrunk with chemotherapy and then treated locally with heat, laser, or cryotherapy.

14. Surgical management Retinal detachment: pneumatic retinopexy scleral buckling vitrectomy

15. Cont.. Pneumatic retinopexy.  This works well for a tear that’s small and easy to close. Your doctor injects a tiny gas bubble into your vitreous gel. It presses against the upper part of your retina, closing the tear. You’ll need to hold your head in a certain position for several days to keep the bubble in the right place. Scleral buckle.  Your doctor sews a silicone band (buckle) around the white of your eye (called the sclera). This pushes it toward the tear or detachment until it heals. This band is invisible and is permanently attached. Vitrectomy.  This surgery repairs large tears or detachment. Your doctor removes the vitreous gel and replaces it with a gas bubble or oil. A Vitrectomy also might require you to hold your head in one position for some time.

16. Nursing Management Nursing Diagnosis: Disturbed sensory perception (visual). Anxiety . Risk for injury.

17. Nursing Management Interventions: Provide emotional support to the patient who may be distraught at the potential loss of vision. Prepare the patient for surgery by cleaning his face and giving him antibiotics and eyedrops, as ordered. Teach the patient about the role of the retina and why floaters, flashes of light, and decreased vision occur. Allow the patient and family to discuss their concerns.

18. C omplications Any surgical procedure has some risks. Surgery for a detached retina can lead to: Infection Bleeding Higher pressure inside your eye (glaucoma) Fogging of the lens in your eye (cataract)

19. P reventions Get to your eye doctor right away if you see new  floaters, flashing lights, or any other changes in your  vision . Use protective eye wear to prevent eye trauma. Control of blood sugar in diabetic patients. Frequent visits to eye specialist.

20. Objectives What Is Glaucoma . Epidemiology of glaucoma. W hat are the main causes of glaucoma. What Are the Symptoms of Glaucoma. How Is Glaucoma Diagnosed . How Is Glaucoma Treated. Medical Surgical and Nursing Management of Glaucoma.

21. Introduction Definition: Glaucoma is an eye disease that can damage your optic nerve. The optic nerve supplies visual information to your brain from your eyes. It gets worse over time. It's often linked to a buildup of pressure inside your  eye. Glaucoma tends to run in families. You usually don’t get it until later in life .

22. E pidemiology Globally, there are an estimated 60 million people with glaucomatous optic neuropathy and an estimated 8.4 million people who are blind as the result of glaucoma. These numbers are set to increase to 80 million and 11.2 million by 2020. Glaucoma is the second leading cause of blindness globally. The highest prevalence of open-angle glaucoma occurs in Africans, and the highest prevalence of angle-closure glaucoma occurs in the Inuit. Population-based screening for open-angle glaucoma is not recommended. Screening for angle-closure may be feasible

23. E tiology Having high internal eye pressure (intraocular pressure) Being over age 60. Being black, Asian or Hispanic. Having a family history of glaucoma. Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia. Having corneas that are thin in the center.

24. P athophysiology The primary site of damage is the optic nerve leading to loss of vision. In open angle glaucoma, the angle between the cornea and iris is open. In this type the drainage system slowly get clogged overtime and thus gradual increase in pressure on optic nerve, results in dec. of peripheral vision, as the pressure increase even more, continuous damage to optic nerve, which eventually leads to loss of central vision.

25. Cont.. In closed angle glaucoma the angle between the iris and cornea is too small, that means the passage way for aqueous humor outflow is too narrow and this is result of lens been pushed against the iris, result of this leads to blockage of drainage system. This is most serious type of glaucoma in which rapid pressure build up in the eye which can cause onset of eye pain and redness, blurry vision, headache. This may occur due to dilation of lens or pupil which cause the iris pushing forward and close the angle.

26. Clinical Manifestations Glaucoma is typically characterized by: IOP > 21 mmHg Visual field loss Glaucomatous retinal nerve damage Glaucomatous cupping (Increase in IOP pushes the optic disc back forming an cup size ). In close angle glaucoma the pressure lies between 50 to 80 mm Hg. And cause cornea edema. The pupil is vertically oval & un reactive to light and accommodation.

27. Sign & Symptoms The most common type of glaucoma is primary open-angle glaucoma. It has no signs or symptoms except gradual vision loss. For that reason, it’s important that you go to yearly comprehensive eye exams so your ophthalmologist, or eye specialist, can monitor any changes in your vision. Acute-angle closure glaucoma, which is also known as narrow-angle glaucoma, is a medical emergency.it has following sign & symptoms: severe eye pain nausea vomiting redness in your eye sudden vision disturbances seeing colored rings around lights sudden blurred vision

28. Diagnosis Tonometry: measure intraocular pressure. Tonography : measure the outflow of aqueous humor from the eye. Gonioscopy : is used to estimate width of the anterior chamber angle. Perimetry : diagnosis of scotoma (blind spot). Visual field testing Looking for optic nerve damage, glaucomatous cupping by imaging.

29. Treatment The treatment options for early glaucoma have expanded in recent years and fall into three categories : medications laser , and incisional surgery Medications or laser are both considered first-line treatments. It is not imperative that you start with medications and then proceed to laser treatment.

30. Medical Management Most glaucoma medications are administered topically but the absorption may occurs systemically as it passes through the lacrimal drainage system. It can be overcome by applying a digital pressure on the lacrimal sac for three minutes so that to enhance the drug contact time with the eye is prolonged. Glaucoma medications should be avoided in pregnancy if possible, with systemic carbonic anhydrase inhibitors perhaps carrying the greatest risk due to teratogenicity concerns.

31. Major Groups of Drugs Treating Glaucoma Prostaglandin Analogues ß Blockers Carbonic Anhydrase Inhibitors Alpha 2 Agonist Miotics Combined Therapy Osmotic Agents

32. Surgical management Laser surgeries Trabeculotomy and goniotomy Penetrating filtering surgeriestrabeculectomy Non penetrating filtering surgeries Cyclo destructive procedures Artificial drainage implants

33. Nursing Management ASSESSMENT: History or presence of risk factor: positive family history, tumor of eye, hemorrhage, uveitis, trauma etc. Physical examination based on those in general assessment of the eye may indicate: blurred vision, decreased light perception redness cloudy appearance etc.

34. DIAGNOSIS Acute pain related to increased IOP and surgical complications as evidenced by patient verbalization or facial expression of the patient. GOAL: The pain of patient will be reduced.

35. INTERVENTIONS Monitor vital signs of the patient. Monitor the degree of eye pain very 30 min during the acute phase. Monitor visual acuity at any time before hatching ophthalmic agent for glaucoma. Maintain the bed rest in semi- fowler position. Give analgesic prescription and evaluation of its effectiveness.