SGH department of ophthalmic nursing.pptx

an overview of ophthalmic nursing

1. OPHTHALMIC NURSING: IMPORTANCE AND CHALLENGES DR.CHIKONDE

2. INTRODUCTION & BACKGROUND Today is a new era in nursing care. Nurses are now active both in; Hospital-based healthcare & Community health initiatives The focus is on specialization in a subspecialties A nurse play a crucial part in the subspecialty area of diagnosis & management

3. INTRODUCTION & BACKGROUND The main objective of specialized nursing educational processes is to; Train nurses to be quick, logical thinkers, even under pressure and during emergency situations

4. OPHTHALMOLOGY NURSING Is considered a specialty in nursing globally & emphasis is to train and develop competent & independent nurse practitioners A specialized ophthalmic nurse should be able to; make clinical decisions based on modern medicine and technology considering patient welfare

5. OPHTHALMIC NURSE A nursing professional that focuses on; assessing and treating patients with a variety of eye diseases and injuries They also have a huge part to play in; Preventive ophthalmology 🡪 saves money & time Screening & Early Diagnose 🡪 better visual outcomes & might  prevent vision impairment Achieving Universal Eye Health .

6. BURDEN OF OPHTHALMIC PROBLEMS According to statistics, world-wide around; 285 million people suffer from vision impairment, 39 million of this population are completely blind & the remaining have some degree of vision impairment from moderate to severe. > 80% of all these cases could have been prevented or treated if action had been taken at the onset of these conditions 

7. THE DOMAINS OF OPHTHALMIC NURSING The domains of ophthalmic nursing are: Eye health Visual impairment Learning disabilities Paediatric care Ageing population Primary care

8. Functional Areas Each domain has been further sub-divided into five fundamental key areas: Social and economic Professional and legal Psychological Educational Environmental & physical

9. THE ROLE OF OPHTHALMIC NURSES Ophthalmic Surgical Assistance : Carrying out pre & post management of eye surgeries. Nursing Care : Apply medical & nursing interventions to fulfill visual care requirements Assess a patient’s visual potential and his or her capability to function independently Help patients overcome psychological obstacles Provide necessary assistance to increase patient independence Helps patients adapt to new and persistent lifestyle-altering conditions  Pretreatment Assessment . consideration of the patient's physical, social, emotional and occupational needs.

10. THE ROLE OF OPHTHALMIC NURSES Eye Health Education : Educating the public and other health workers on; Primary eye care , including health promotion and prevention of avoidable ophthalmic diseases. Awareness of public resources & available services for the visually impaired    Counseling : able to counsel and refer patients who are irreversibly blind for rehabilitation. Outreach : Organize and run school health and community outreach programmes.  Manage ocular emergencies

11. CHALLENGES TO OPHTHALMIC NURSING Clinical Competency 🡪 diagnostic, prognostic or therapeutic decisions Lack of research-awareness 🡪 there is an increasing body of ophthalmic nursing research Shall be involved in clinical research 🡪 Quality of nursing Education🡪 need to enhance training to degree level Community and policy maker’s trust

12. FUTURE FOCUS Visibility of this career path 🡪 would attract more candidates & result in a higher level of patient trust Role strengthening 🡪 To expand roles in response to the changing demands of the service Outreach 🡪 To play role in health education & health promotion Research and Innovation 🡪

13. CONCLUSION The future is depends on the cultural, social, and financial background Nurses Commit is required to dedicating themselves to; Continued learning, Develop and maintain the highest standard of care Involved in multidisciplinary group care

14. ‹#› EYE INFECTIONS D R . CHIKONDE

15. ‹#› Lid Infections Stye (External Hordeolum)‏ - Suppurative inflammation of lash follicle and its associated gland of Zeis or Moll. - Caused by Coagulase Positive Staphylococcus. 🡪 Clinical features: - Acute pain in the lid margin - Tender inflamed swelling over the lid margin with pus pointing anteriorly through the skin

16. Stye

17. ‹#› Stye- Treatment Warm compress. Antibiotics (systemic/ local). Surgical Incision & Curettage.

18. ‹#› Internal Hordeolum Small Abscess caused by an acute Staphylococcal infection of meibomian gl. Clinical Features: 🡪 Tender inflamed swelling within tarsal plate. 🡪 More painful than stye. 🡪 Lesion enlarge & discharge pus either posteriorly through conjunctiva or anteriorly through skin.

19. By Dr. Banumathi Gurusamy, HPP ‹#› Internal Hordeolum

20. Internal Hordeolum- Treatment Warm Compress. Antibiotics ( Systemic/ Local). Surgical Incision & Curettage.

21. Chalazion (Meibomian Cyst)‏ Chronic inflammatory lipogranulomatous lesion. Clinical Features: - Painless slowly enlarging firm lesion in the tarsal plate - No signs of inflammation Pathology: Low grade infection obstruction of ducts Accumulation of meibomian secretio n

22. ‹#› Chalazion

23. ‹#› Chalazion

24. ‹#› Chalazion - Treatment Incision and Curettage Antibiotic ointment Complications: 🡪 Mechanical ptosis with Astigmatism 🡪 Int. Hordeolum 🡪 Rare – Meibomian Ca.

25. ‹#› Chalazion - Treatment Incision and Curettage

26. ‹#› Blepharitis Chronic inflammation of lid margin: 🡪 Staph. Blepharitis 🡪 Seborrhoeic Blepharitis Clinical features: 🡪 Irritation & burning sensation over lid margin 🡪 Brittle scales clinging to the lashes 🡪 Tiny ulcerated areas (staph. Blepharitis)‏ Treatment: 🡪 Lid hygiene 🡪 Antibiotic ointment 🡪 Topical steroids

27. By Dr. Banumathi Gurusamy, HPP ‹#› Blepharitis

28. By Dr. Banumathi Gurusamy, HPP ‹#› Blepharitis

29. ‹#›

30. ‹#› Orbital & Preseptal Cellulitis (more common in children)‏ Preseptal cellulitis : Infection of eyelids and soft tissue structures anterior to the orbital septum. Clinical features: 🡪 Mild to moderate eyelids swelling 🡪 Preceded by dental or sinus infections 🡪 History of sharp or blunt trauma 🡪 Ocular motility and pupillary reaction- normal. Treatment: Systemic antibiotics

31. ‹#› Preseptal Cellulitis

32. ‹#› Orbital Cellulitis Infection process posterior to the orbital septum that affects the orbital contents. Extension of infection from nasopharynx or paranasal sinuses- esp. Ethmoidal. Age group: Children & young adults Causative organisms- strep. Pneumoniae, Strep. Pyogenes, staph. Aureous, H. Influenzae (< 5 years).

33. ‹#› Orbital Cellulitis (cont)‏ Clinical features: 🡪 Severe pain with marked swelling of the lids 🡪 Conjuctival chemosis and congestion 🡪 Proptosis of the globe 🡪 Limitation of extraocular movements with diplopia 🡪 Impairment of pupillary reaction with decreased vision.

34. Orbital Cellulitis- Complications 1. Cavernous sinus thrombosis. 2. Meningitis 3. Cerebral abscess 4. Central retinal artery occlusion 5. Optic nerve inflammation 🡪 optic atrophy Blind n ess

35. ‹#› Orbital Cellulitis

36. ‹#› Orbital Cellulitis

37. ‹#› Orbital cellulitis- Treatment 1. Investigations: 🡪 ESR, WBC 🡪 X-Ray paranasal sinuses 🡪 CT Scan 2. ENT referral 3. IV antibiotics 4. Drain the orbit as well as the infected sinuses.

38. By Dr. Banumathi Gurusamy, HPP ‹#› Lacrimal System

39. ‹#› Infection of Lacrimal System Canaliculitis- infection of lacrimal canaliculi 🡪 Chronic- caused by actinomyces israelii 🡪 Acute caused by herpes simplex infection or fungal infection. Eg: Candida 🡪 Treatment: - Remove the obstructive concretions - Treat with penicillin G. solution/ nystatin drops

40. ‹#› Dacryocystitis (infection of lacrimal sac)‏ Congenital- failure of canalisation of nasolacrimal duct. Clinical features: 🡪 Epiphora 🡪 Reflux of purulent materials when pressed over the medial canthus. Treatment: 1. Hydrostatic massage 2. Antibiotics 3. Probing (6 months and 1 year)‏ 4. Surgery- Dacryocystorhinostomy

41. ‹#› Dacryocystitis

42. ‹#› Dacryocystitis - Adult onset Chronic Dacryocystitis 🡪 Middle age 75% female Predisposing factors: 🡪 Extreme deviated nasal septum. 🡪 Nasal polyp. 🡪 Hypertrophied inferior turbinates. 🡪 Trauma

43. ‹#› Dacryocystitis - Adult onset (cont)‏ Clinical features : 🡪 Epiphora 🡪 Regurgitation of mucous materials on pressure over medial canthus. 🡪 Syringing – blocked nasolacrimal duct. Treatment : 🡪 Hydrostatic massage with repeated syringing. 🡪 Surgery- Dacryocystorhinostomy (DCR)‏

44. ‹#› Acute Dacryocystitis Acute exacerbation of chronic Dacryocystitis Clinical features : 🡪 Pain, redness and swelling over lacrimal sac area. 🡪 Purulent discharge from the punctum 🡪 Fever Treatment: 🡪 Hot compress/ systemic antibiotic 🡪 Aspirate the pus with wide bore needle, (no I&D to avoid fistula formation.)‏ 🡪 Plan for DCR.

45. By Dr. Banumathi Gurusamy, HPP ‹#› Acute Dacryocystitis

46. ‹#› Acute Dacryocystitis

47. By Dr. Banumathi Gurusamy, HPP ‹#› Acute Infectious Dacryoadenitis Infection of lacrimal gland. Clinical features : 🡪 Pain, redness, swelling over the outer one third of the upper eye lid. 🡪 Common in young people. 🡪 Caused by acute infection such as Staph. or H. Influenzae 🡪 Chronic infection as TB. 🡪 Viral infection as mumps. Treatment- treat the causative factor.

48. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis Inflamation of conjunctiva. Bacterial: 🡪 Strepto. Pyogenes, pneumoniae. 🡪 Staph aureus. 🡪 H. Influenzae. 🡪 Gonococcus. Viral: Adenovirus, H. Simplex, H. Zoster Trauma: Chemicals, ultraviolet rays Allergic Ophthalmia neonatorum- Neonates

49. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis- Clinical Features Usually bilateral. Conjunctival hyperaemia. Grittiness/ sandy sensation. Discharge with sticky eye lids. Severe cases- swollen eye lids with pseudomembrane formation. In Gonococcus conjuctivitis- swollen eye lids with copious purulent discharge.

50. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis

51. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis

52. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis - Ophthalmia neonatorum

53. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis

54. By Dr. Banumathi Gurusamy, HPP ‹#› Conjunctivitis- Treatment Conjunctival swab for culture. Frequent local antibiotic/ systemic antibiotic. H. simplex- zovirax ointment Sodium cromoglycate drops with mild steroids 🡪 allergic conjunctivitis.

55. By Dr. Banumathi Gurusamy, HPP ‹#› Karatitis- inflamation of the cornea (corneal ulcer)‏ Aetiology: 1. Bacteria: Staph., Strepto., Pseudomonas, Enterobacteriacea 2. Fungus: aspergillus, candida albicans 3. Viral: H. simplex, H. zoster 4. Acanthamoeba: in contact lense users.

56. By Dr. Banumathi Gurusamy, HPP ‹#› Predisposing Factors Dry eye Contact lens wear Chronic infections of ocular adnexa Epi. Defect-Trauma, chemical injury etc Purulent conjunctivitis Neurotrophic/ Exposure Keratopathy Topical steroids, sys.immunosuppresive Trauma

57. By Dr. Banumathi Gurusamy, HPP ‹#› Symptoms & Signs Red eye Mild to severe ocular pain Photophobia Blurred vision Eye discharge Conjunctival injec. Focal white infiltrates of corneal layers & stromal oedema Severe anterior chamber reaction with hypopyon Postr. synechiae

58. By Dr. Banumathi Gurusamy, HPP ‹#› Diagnosis Corneal Scrapping for 1. Gramstain 2. KOH-mount Culture media 1. Blood agar 2. Chocolate agar 3. Sabouraud’s medium

59. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis Staph.aureus and Strep.pneumoniae : Produce oval yellow white densely opaque stromal lesion with surrounding relatively clear cornea Pseudomonas sp . : sharp ulceration with semiopaque ground glass appearance of adjacent stroma Enterobactriacea : shallow ulceration with diffuse stromal opalescence

60. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis Treatment Intensive anti-biotic drops with cycloplegics (to avoid synachieae formation and to relieve ciliary spasm.)‏ Sub conjunctival injection if necessary

61. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis

62. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis

63. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis

64. By Dr. Banumathi Gurusamy, HPP ‹#› Bacterial Keratitis

65. By Dr. Banumathi Gurusamy, HPP ‹#› Fungal Keratitis Corneal lesion - Greyish white lesion with indistinct margin and delicate feathery finger like projections into adjacent stroma Multiple satellite small foci Overlying epithelium is elevated but intact

66. By Dr. Banumathi Gurusamy, HPP ‹#› Fungal Keratitis

67. By Dr. Banumathi Gurusamy, HPP ‹#› Fungal Keratitis

68. By Dr. Banumathi Gurusamy, HPP ‹#› Fungal Keratitis (cont)‏ Filamentous - Fusarium, aspergillus Non Filamentous - Candida albicans Treatment 1. Amphotericin-B eye drops 2. Fluconazole -1% aq. Solution 3. Ketaconazole 4. Iatroconazole Anti-fungal treatment - six weeks

69. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis (HSV)‏ Caused by H.Simplex virus Superficial punctate keratitis Dendritic keratitis (Thin linear branching lesion with teminal bulbs at the end of each branch Geographic ulcer- large amoeba shaped ulcer with dendritic edges Corneal sensitivity- decreased Stained with Rose Bengal dye

70. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis

71. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis (HSV)‏ Treatment : 1. Topical Acyclovir with cycloplegic 2. Gentle debridement of the infected epi.as an adjunct to anti-viral agents ( anti-viral agents continued for seven to fourteen days then tapered over one week)‏

72. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis (HZV)‏ Herpes Zoster virus. Conjunctivits with corneal involvement (multiple micro dendritis with uveitis). Treatment : - oral Acyclovir - preservative free artificial tears and lubricant oint.at night.

73. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis (HZV)‏

74. By Dr. Banumathi Gurusamy, HPP ‹#› Viral Keratitis (HZV)‏

75. By Dr. Banumathi Gurusamy, HPP ‹#› Acanthamoeba Keratitis Extremely painful stromal keratitis usually in a soft contact lens wearer who practices poor CL. hygiene Severe ocular pain, redness and photophobia over a period of several weeks. Early sign- less corneal and anterior segment inflammation than would be expected for the degree of pain

76. By Dr. Banumathi Gurusamy, HPP ‹#› Acanthamoeba Keratitis (cont)‏ Epithelial and sub-epithelial infiltrates Pseudo dendrites on epithelium Late sign-corneal stromal infiltrates in the shape of a ring Negative culture for bacteria & fungus Lack of response for the anti-biotic and anti-fungal therapy

77. By Dr. Banumathi Gurusamy, HPP ‹#›

78. By Dr. Banumathi Gurusamy, HPP ‹#› Acanthamoeba Keratitis (cont)‏ Treatment : 🡪 Neosporin eye drops. 🡪 Brolene 1 %(Propamidine isethionate). 🡪 Chlorhexidine 0.002% eye drops. 🡪 Oral anti-fungal therapy. 🡪 Treatment continued for 6-8 weeks after the resolution of inflmn. which may take 18 months in some cases. 🡪 Resistant cases- Keratoplasty.

79. By Dr. Banumathi Gurusamy, HPP ‹#› Principles in the management (corneal ulcer)‏ Primary therapy Promotion of re- epithelialisation - Lubrication-Artificial tears - Lid closure-Torsorrhaphy - Bandage soft contact lens Prevention of perforation - Tissue adhesive glue - Conjunctival flap to cover the thinned out cornea

80. By Dr. Banumathi Gurusamy, HPP ‹#› Principles in the management (cont)‏ Ascorbate -in severe alkali burns to promote healing Severe non-responding cases need therapeutic penetrating keratoplasty Restoration of transparency: - Healed corneal ulcer with dense scarring - penetrating kerotoplasty Non responding ulcers- lead to perferation or endophthalmitis/ pan ophthalmitis- which needs evisceration

81. By Dr. Banumathi Gurusamy, HPP ‹#› Endophthalmitis Intraocular inflamation of ocular cavities and their adjacent structures without extending beyond sclera. Panophthalmitis Endophthalmitis + Involvement of sclera and tenons capsule extending into orbital tissues.

82. By Dr. Banumathi Gurusamy, HPP ‹#› Endophthalmitis Causes: Exogenous & Endogenous Exogenous: - Penetrating ocular trauma - Post op. complications (cataract & filtering operations). - Corneal ulcer Endogenous: - Septic emboli- bacterial endocarditis - Severe uveitis- immunocomp. Patients. - Toxoplasma chorioretinitis. - Spread of inf. From adjacent structures

83. By Dr. Banumathi Gurusamy, HPP ‹#› Endophthalmitis Clinical features : 🡪 Ciliary injection. 🡪 Exudation in AC with hypopyon. 🡪 Posterior synachiae. 🡪 Posterior uveitis. 🡪 Vitreous opacities/ choroiditis. Treatment: 🡪 Vitreal tap for C & S and treat with appropriate antibiotics.

84. By Dr. Banumathi Gurusamy, HPP ‹#› Endophthalmitis

85. By Dr. Banumathi Gurusamy, HPP ‹#› Anterior Uveitis (Iridocyclitis) Inflamation of uveal tract Symptoms: - Pain, unilateral red eye, photophobia and blurred vision. Signs: - Circumcorneal congestion. - Hazy anterior chamber with cells. - Severe inflamation 🡪 hypopyon - Keratic precipitates on endothelium. - Constricted pupil with post. synachiae.

86. By Dr. Banumathi Gurusamy, HPP ‹#› Anterior Uveitis (Iridocyclitis) (cont)‏ Aetiology: 🡪 Exogenous- trauma etc. 🡪 Endogenous: - Idiopathic - Inf.- TB, candida, H.Zoster, Toxoplasmosis, Toxocara - Associated with systemic diseases as D.M, ankylosing spondylitis, sarcoidosis.

87. By Dr. Banumathi Gurusamy, HPP ‹#› Anterior Uveitis (Iridocyclitis) (cont)‏ Investigations: 🡪 ESR, RBS, Blood VDRL, Chest X-Ray, X-Ray Sacroiliac joint. Treatment: 🡪 Steroids (local & systemic)‏ 🡪 Mydriatics- to dilate pupil 🡪 Specific treatment to treat the cause

88. By Dr. Banumathi Gurusamy, HPP ‹#› Anterior Uveitis

89. By Dr. Banumathi Gurusamy, HPP ‹#› Anterior Uveitis

90. By Dr. Banumathi Gurusamy, HPP ‹#› Thank You End Of Presentation