Iritis and Corneal Ulcer Presentation.pptx

Conditions of the eye- Iritis and Corneal Ulcer

1. Lutheran School of NURSING Medical and Surgical Nursing 1

2. LAYOUT Learning objectives Basic Anatomy of the EYE and Physiology of Iris Introduction of Irits Pathophysiology Clinical Signs and Symptoms Differential Diagnosis Investigation to confirm Diagnosis Complications Management (Medical and Nursing) Health Education and Promotion Reference

3. Learning Objectives By the end of the presentation, we all should be able to; Describe the Anatomy of the eye and function of the Iris Define Iritis, explain its pathophysiology and list its clinical signs and symptoms Describe its complication if left untreated Use Clinical judgement on how to identify, manage and list ways of preventing occurrence. Learning Issues : (Iritis & Corneal Ulcer) 1.Clinical Signs and Symptoms 2. Management- (Standard Rx Book)

4. Basic Anatomy the EYE and Physiology of the IRIS Iris is made up of muscular fibers that controls how much light enters the pupils, the opening in the center, so you can see clearly. Supplied by parasympathetic and sympathetic. Parasympathetic- stimulates constriction of the pupil. Sympathetic- stimulates the dilatation of the pupil. (Waugh and Grant, 2018)

5. What is Iritis (Anterior Uveitis) It is the inflammation of the Iris which can also be known as Anterior Uveitis. Uveitis is the inflammation of the Uvea or Uveal tract that contains the Iris, ciliary body and choroid. The anterior chamber of the uvea is made up of Iris and Ciliary bodies, hence, when inflamed (-itis) known as Anterior Uveitis . The posterior chamber is made up of the Choroid and when inflamed it is called Choroiditis or Posterior Uveitis . The   annual incidence rate is approximately 8 cases per 100,000 population . International, 2018 ( Centres for disease control and prevention, 1978)

6. Pathophysiology (most cases it is Idiopathic) Causes can be categorized into two Infectious Protozoal- toxo plasma gondii (from disease toxoplasmosis) travels in the blood stream and inflame the iris. Entry of protozoa is from eating uncooked contaminated food. Viral ( Herpes zoster)- following a chicken pox infection, virus remains dormant in spinal cord then later migrate onto a sensory nerve and affect other mucus membranes- Iritis Bacterial ( Lyme Disease) - Borrelia burgdorferi bacterium that causes syphilis travel in the blood stream and end up at the iris irritates it to cause inflammation.

7. 2 . Non-infectious a. Immunological Systemic disorder Ankylosing Spondylitis Bahchet disease Psoriasis Reactive arthritis Sarcoidosis Ulcer colitis > This immune diseases cause inflammation that affect many parts of the body. b. Genetic Disorder HLA-B27 protein that alters immune cells to attack themselves c . Blunt force or injury d. Exposure to toxins/ reaction to medication that causes inflammation

8. Clinical Sign & Symptoms Symptoms ( c/o pt ) Reduced vision Eye pain/ headache Light sensitivity/ photophobia Red eye Tearing/ Lacrimation Vision Loss Signs (on examination) Swelling of Iris Redness without mucopurulent/ teary Constricted pupil due to swelling Blurred vision/ Acuity test ( Seltman , 2019)

9. Risk Factors Have a specific genetic disorder Develop a sexually transmitted infection Weakened immune system/ lower immunity level Smoke Have had/ recurrent tuberculosis

10. Differential Diagnosis 1.Conjunctivitis 2.Acute closure Glaucoma 3. Keratitis

11. Investigation Interrogation- Ask if required, of any known diseases or condition if not stated during initial assessment Examination may include: A vision acuity test Pressure reading Penlight and Slit lamp

12. *if Doctor suspects to be secondary, meaning another health problem, may order Blood tests, Imaging tests ( Chest x-ray) Test fluid inside the eye

13. Management Medical Treatment Optimal Rx is dependent on the determination of cause. Iritis or uveitis in general is a potentially blinding condition which requires prompt referral(administer loading dose then refer to Hospital). Admit and treat as inpatient Look for signs for other disease and treat accordingly Dilate the pupil using Atropine 1% eye ointment b.d until improve then use daily optically then pad the eye (if nil discharge) Analgesics / Antihistamine- Aspirin 600mg (2 tabs) q.i.d Antibiotic compound- Chloramphenicol eye ointment q.i.d 5/7 Doctors might order Anti-inflammatory eye ointment- Hydrocortisone q.i.d 10/7 or until improved Should inflammation persist, doctor may run blood works to confirm causative agents. Nursing Care Process

14. Nursing Dx Goal/ Plan Intervention Fear and Anxiety related to reduced vision and red eye. Awareness and acceptance of Condition. Explain to patient the condition and treatment and possible course of disease. Advise on coping strategies- treatment Advise on safety aspects related to reduced vision Pain and photophobia Alleviation of Pain Explain the cause of the pain. Encourage compliance with topical treatment Advise on the use of analgesics Advise on wearing sun glasses Potential complications of acute secondary glaucoma The early recognition and treatment of complication Ensure patient is fully aware pain, further reduction in vision, or in conjunctival injection requires further medical consultation Advise patient to seek urgent medical help if signs of complication appears. Possibility of reoccurrence The recognition and early treatment of reoccurrence 1. Ensure the patient is aware of the signs of reoccurrence and the need for early treatment. 2. Advise on the means of seeking urgent medical consultation should reoccurrence be suspected. 3. Advise not to use old medication prior to seeking medical help.

15. Complication Cataracts.  Development of a clouding of the lens of your eye (cataract) is a possible complication, especially if you've had a long period of inflammation. An irregular pupil.  Scar tissue can cause the iris to stick to the underlying lens or the cornea, making the pupil irregular in shape and the iris sluggish in its reaction to light. Glaucoma.  Recurrent iritis can result in glaucoma, a serious eye condition characterized by increased pressure inside the eye and possible vision loss. Calcium deposits on the cornea.  This causes degeneration of your cornea and could decrease your vision. Swelling within the retina.  Swelling and fluid-filled cysts that develop in the retina at the back of the eye can blur or decrease your central vision.

16. Health Education and Promotion Apply a warm compress to your eye. Use eye drops as prescribed. With the appropriate treatment strategy, supervised by an ophthalmologist . Wear sunglasses to decrease light sensitivity and discomfort . If your eye is dilated or if you have been given an eye patch, avoid driving and any hazardous activities. know when to go see a doctor Foods observed to reduce or 'turn down ' the inflammatory response are: olive oil, leafy green vegetables, fatty fish, and some fruits, nuts, herbs and spices . ( Natural Eye Care , 1999 )

17. Summary How does the Iris Function? What is Iritis? Who are responsible for the inflammation? List the type of investigation done to confirm medical diagnosis? What are the drugs given to reduce swelling and pain. When should we administer antibiotics And what can be assumed for further testing should inflammation persist? What is the main complication of Iritis What are some ways we can avoid this inflammation?

18. Kagutoki 👌🤞 Any questions👀🤔

19. TOPIC: Corneal Ulcer

20. OUTLINE Learning outcome 12. Therapeutic Management Introduction 13. Nursing Management Epidemiology 14. Summary Etiology(cause) Pathophysiology Risk/ Pre-disposing factors Signs and Symptoms Differential Diagnosis Investigations Provisional Diagnosis Diagram of Corneal Complications

21. LEARNING OUTCOME By the end of this presentation we will be able to : Understand more about Corneal Ulcer, its Cause and its Pathophysiology. Know the contributing factors or risk factors that leads to corneal ulcer. Identify the signs and symptoms (clinical manifestation) of corneal ulcer. Make differential diagnosis based on some possible clinical manifestations of corneal Ulcer. Know and understand the proper different investigations done for accurate diagnosis of corneal ulcer. Know the complications of Corneal Ulcer. Identify the Therapeutic Management and Nursing Management of Corneal Ulcer .

22. INTRODUCTION Corneal ulcer is an open sore in the outer layer of the cornea. The cornea is the transparent circular part of the eyeballs of both the eyes. It is mostly exposed to the external environment and so often suffers injury, inflammation and infections. The inflammation of the cornea is called Keratitis. Keratitis is often result from trauma or mostly infections causing local necrosis of the corneal tissue which leads to corneal ulcer. Basic Anatomy and Physiology of the CORNEA .

23. EPIDEMIOLOGY The magnitude of blindness (all causes) in the countries of the South-East Asia Region varies from 3 000 people per million population in communities with good economy and health care to over 10 000 per million in low-income settings . Corneal ulcer is a common cause of blindness in low-income settings being responsible for 5-20% of all blindness. In warm, humid areas the relative proportion of fungal to bacterial ulcers approaches 50:50, while in cool dry climates most ulcers are due to bacteria . The major bacterial causes are streptococcus; pseudomonas and staphylococcus . The major fungal isolates are fusarium and aspergillus species. Candida is relatively uncommon.

24. AETIOLOGY(CAUSE) Some causative agents which leads of Corneal Ulcer includes; Viruses (herpes simplex, chlamydia) Bacteria ( streptococcus; pseudomonas and staphylococcus .) Fungi ( a spergillus, fusarium) Protozoa (acanthamoeba) Vitamin A deficiency

25. PATHOPHYSIOLOGY Corneal ulcer is the corneal epithelial defect with underlying inflammation usually due to the invasions by Bacteria, Fungi, Viruses or Acanthamoeba. It can be initiated by mechanical trauma, nutritional deficiency and uncontrolled inflammation which can lead to cause corneal necrosis. During the inflammation of the cornea, the inflammatory cells infiltrate the different corneal layers in response to noxious stimuli, either infectious exogenous agents or self antigens. The inflammatory reaction may result in the supperative melting of the corneal epithelium and stroma resulting in the formation of the ulcer.

26. Diagram Of Corneal Ulcer.

27. RISK FACTORS Contact Lenses - wearing contact lenses increases the risk of infectious and non-infectious keratitis. The risk stems from not disinfecting lenses properly, wearing contact lenses while swimming, wearing them longer than recommended & etc. Reduce immunity - when the immune system is compromised due to disease or medications. Warm climate - living in a warm climate and when a plant material gets into the eye. Plant material can scratch the corneal epithelium and the chemical from the plant can cause inflammation which may lead to an infection . Corticosteroids - the use of corticosteroids eye drops to treat eye disorders can increase the risk developing keratitis or worsen the existing keratitis . Eye injury - if one of the cornea has been damaged from an injury in the past, the vulnerability of developing keratitis is high. Vitamin A deficiency - if the body lacks vitamin A, the eyes will be at high risk of developing eye problem and other eye complications.

28. SIGNS AND SYMPTOMS Eye redness Eye pain Excess tears or other discharge from the eyes Difficulty opening the eyelid because of the pain or irritation Blurred vision Decreased or diminished vision Irritation and feeling of discomfort in the eyes Sensitivity to light (Photophobia) A feeling that something is in the eye

29. DIFFERENTIAL DIAGNOSIS The differential diagnosis of includes ; Conjunctivitis Eye trauma/ Eye injury Foreign body in the eye Trachoma

30. DIAGNOSTIC EVALUATION Accurate Diagnosis of Corneal Ulcer are made possible through the following evaluations; Eye exam - The exam will include an effort to determine how well one can see(visual acuity) Penlight exam - This is to examine the eyes using a penlight to check the pupils reaction, size and other factors by applying a stain to help identify the extent and character of surface irregularities and ulcer of the cornea. Fluorescein Dye - To see the extent of the damage.

31. Cont.… Slit-lamp exam - This instrument uses an intense of light, a slit-like beam to illuminate the cornea, iris, lens and space between the iris and the cornea. The light to view these structure with high magnification to detect the character and extent of Keratitis as well the effects it may have on other structures of the eyes . Laboratory Analysis- Taking a sample of the tears or some cells from the cornea for laboratory analysis to determine the cause of Keratitis to help develop treatment and management of the condition.

32. PROVISIONAL DIAGNOSIS Corneal Ulcer

33. Therapeutic & Nursing Management Viral infection (Herpes simplex keratitis) Acyclovir (Zovirax) 3% ointment 5 times a day. Acyclovir 200-400mg ‘o’ Dly 5-10 days Eye irrigation of any discharge particularly with sodium chloride 0.9% or cooled boil water. Symptomatic relief can be provided by: Cool compress and or simple eye lubricants or gel. Bacterial infection Chloramphenicol eye drop 0.5% topical 1 drop dly 3/7 Chloramphenicol ointment 1% topical Nocte 3/7 Analgesic- Paracetamol 1g ‘o’ PRN/QID adult, 125-250mg children Fungal infection Topical 0.2% Fluconazole dly until improvement. Ketoconazole 200mg dly

34. COMPLICATIONS Potential complications of keratitis and corneal ulcer includes ; Chronic corneal inflammation Chronic or recurrent viral infection of the cornea Open sores on the cornea Corneal swelling and scaring Temporary or permanent reduction of vision Possible complete blindness

35. Health education and promotion Avoid eye makeup. DO NOT wear contact lenses at all, especially while asleep. Take pain medicines. Wear protective glasses . Wear sunglasses when you're outside. W earing goggles or safety glasses when dust or other particles could fly into your eye. Carrots contain vitamin A, which helps with night vision and protects the eyes by helping to absorb light. Increased levels of vitamin A mean your eyes can absorb more energy and become more sensitive in dim light.  Eating carrots can also help prevent cataracts , and corneal ulcers .

36. SUMMARY Corneal ulcer is an open sore on the outer layer of the cornea. The underlying defect of epithelial tissue of the cornea being damaged due to inflammation by different causative agents. Corneal ulcer is a secondary condition results from the inflammation of the cornea. The inflammation of the cornea is known as Keratitis Keratitis and corneal ulcer are caused mostly by Bacteria, Virus, Fungi, and at times Protozoa through trauma, eye injury or any foreign body in the eyes. Corneal Ulcers are managed based on its causative agents, and i.e. through Antimicrobial, Antiviral, Antifungal and Antiprotozoal drugs.

37. End Of Presentation

38. Reference  Centers for Disease Control and Prevention, 1978, Principles of Epidemiology: Lesson 3 - Section 2, United States; https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section2.html Grossman . M and Edson. M, (2019), Natural Eye Care: Your Guide to Healthy Vision and Healing, 2019 Accessed: https:// www.naturaleyecare.com/about.asp Perry, J.P and Tullo , A. B, (1995), Care of the ophthalmic patient : a guide for nurses and health professional, (2nd edn .) London: Chapman & Hall. Seltman . W, (2019), Eye health, WebMD editorial contributors: https://www.webmd.com/eye-health/iritis The Mayo Clinic, ( 2019 ), Mayo Clinic Family Health Book , (5th edn .) https:// www.mayoclinic.org/diseases-conditions/iritis/symptoms-causes/syc-20354961 Waugh. A and Grant. A, 2018, Ross and Wilson Anatomy and Physiology in health and illness (13 th edn .) Elsevier.