Retinal detachment types of retinal detachment

Retinal detachment seperation of retina from RPE

1. CONTENT

RETINAL DETACHMENT
TYPE OF RETINAL DETACHMENT
PATHOPHYSIOLOGY
SYMPTOMS

ETIOLOGY

DIAGNOSIS
COMPLICATION
SURGICAL MANAGEMENT
NURSING MANAGEMENT
PRE OPERATIVE CARE
POST OPERATIVE CARE
HOME CARE

NURSIND DIAGNOSIS
NURSING INTERVENTION
NEW REASEARCH
BIBLIOGRAPHY

2. RETINA
* light-sensitive tissue layer
* sends visual messages
through the optic
Retina have 2 layer
* Sensory retina
cones are present
* Retinal pigment
epithelium (RPE)

3. * Retinal detachment is the separation of
the retinal layers (sensory layer from RPE)
due to a break or tear over the retinal
layers

Four types
* Rhegmatogenous
* Traction

* Combined form of rhegmatogenous and
traction

« Fytidative ®

4. Rhegmatogenous detachment —

* Most common one

* A hole or tear develops in the sensory
retina allowing some of the liquid (vitreous)
to seep through the sensory retina and
detach it [lies detachment

5. Traction — a puna force i is Doc

traction to
* Vitreous hi ge, retinopathy can
cause traction j
Exudative - due to production of serous
fluid under the retina. (uveitis,
degenerative disorders)
w

6. 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 disturbanges

7. Vitreous gel

Fluid-filled space

Retina

-— Retinal break

nd
So

Fluid-filed space

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Retinal detachment

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8. SYMPTOMS

- Floaters
* Cobwebs
* Bright light flashes

* shadow or curtain over a portion of visual
field

* blur in vision
* No complain of pain

9. * floaters - bits of debris in field of vision
that look like spots, hairs or strings

10. Etiology
* Trauma
* Advanced diabetes

* shrinkage 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 =

11. Factors that may increase risk of
retinal detachment:

aging - more common in people older than
40

previous retinal detachment in one eye
family history of retinal detachment
extreme nearsightedness

previous eye surgery

previous severe GE injury or trauma

12. complications

© Redness and swelling of the eyelid.

» Temporary pain and discomfort

* Diplopia

» Floaters

+ Glare and sensitivity to light.

+ Mild drop in vision (usually temporary)
+ Haemorrhage & CME (rare)

13. Diagnostic findings

* Visual acuity
* Ophthalmoscopy
* Slit lamp microscopy

> Unltrasound

14. Surgical management

Retinal tears:

laser surgery (photocoagulation) — with the
help of laser rays the tears are being joined
or sutured.

* freezing (cryopexy) = eryoprob will freeze
and join the retinal tears

Retinal detachment:

* pneumatic retinopexy
* scleral buckling

* vitrectomy

15. PHOTOCOAGULATION

EVirehdesign.com Diabetic retinopathy

16. CRYOPEXY

Retina

BAL Cryopexy
Ñ Treatment

Figure 5: Cryopexy

17. Scleral buckling

Compression of Dent the

and bring t ina ers in contact
with each |

High succ

It uses silico ong ber, or semi-

hard plastic for buc
It will provide a traction on the retina and
allow the retinal tear to settle against the
wall of the eyes =

18. SCLERAL BUCKLING

Retinal detachment
medial rectus muscle

nn, sclera
a BS. choroid
\Wa
f W retina
) À we
| \ A vitreous body
UA Pe
À | / RS
| ty

7 retinal detachment
retinal break” =
lateral rectus muscle

© 2008 Encyclopaedia Britannica, Inc.

Scleral buckle

medial rectus muscle

scleral buckle

lateral rectus muscle

19. Vitrectomy

the vitreous gel
ve blood in the

* It is the surgical
from the eye. |
vitreous gel

* Three incisions

* One incision
source

+ Other incision fı n

- The third incision trument to refill
the vitreous substitute (silicone oil)

* Duration is 2 to 3 hgurs

20. VITRECTOMY

21. « This procedure can be used to remove
foreign bodies, vitreous opacities such as
blood

* Traction on the retina can be relieved

22. Pneumatic retinopexy

* Least invasive
+ A gas bubble, sili

cted into the
1 the sensory

the injected bubblet in postition

23. Gas bubble
Detached retina

»

Retinal tear

A gas bubble is injected inte the vitreous.

24. Nursing Management

« Patient teaching

- Eye surgery is most often done as an outpatient
procedure so patient education is vital

- Signs and symptoms of complications, especially
increased IOP and infection

» Promote comfort

» Patient may need to lie in a special position with
pneumatic retinoplexy

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25. re operative managemen

* Assess the visual acuity of the client's non-operative ey
prior to surgery

« Assess the client's support systems and the possible |
effect of impaired vision on lifestyle and ability to perform
ADLs in the post- operative period

« Safety measures such as installing hand rails,especially if
the client has limited vision in the unaffected eye

* Remove all eye makeup and contact lenses or glasses

prior to surgery

« Mydriatic (pupil-dilating) or cycloplegic (ciliary- paralytic)
drops and drops to lower intraocular pressure may be
prescribed preoperatively.

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26. POST - OPERATIVE
MANAGEMENT

Monitor status of the eye dressing following surgery.
Assess dressings for the presence of bleeding or
drainage
Maintain the eye patch or eye shield in place. The eye
patch or shield helps prevent inadvertent injury to the
operative site
Place the client in a semi-Fowler's or Fowler's position ,
having the client lie on the unaffected side. These
positions reduce intraocular pressure in the affected eye.
Assess the client and medicate or assist to avoid
vomiting coughing , sneezing or straining as needed.
These activities increase intraocular pressure

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27. Home care

Adequate lighting
Promote unrestricted ambulation

Removal of hazards like rugs, clutters,
unnecessary furnitures

Provision of hand rails in hallways, bathrooms
Access to radio and television

Voice activated switches

Pill organizers x

Large print newspapers, magazines

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28. 1. High risk of injury related to loss of
viterous , intraocular hemorrhage ,
increased IOP.

2. Impaired sensory perception vision ,
related to impaired sensory reception /

status of sensory organs,a
therapeutic environment is limited .

3. Acute pain related to trauma to the
incision and increased IOP.

4. Anxiety related to lack of knowledge
about the disease and its treatment .

5. Risk of infection related to trauma to
the incision.

29. 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.

30. Thank