Diabetic retinopathy

1. MEDICAL SURGICAL NURSING- II
UNIT – II
NURSING MANAGEMENT OF PATIENTS WITH
DISORDERS OF EYE
TOPIC : DISORDERS OF RETINA
PRESENTED BY
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)
LECTURER, MSN DEPARTMENT
CON- SRIPMS, COIMBATORE.

2. DISORDERS OF RETINA

3. INTRODUCTION.
Eyes deliver four-fifths of the information that our brain receives. However, when it comes to
eye diseases, one might miss marking any symptoms, since they are not easily detected or
may be painless. There are several common and rare eye conditions which affect vision. A
healthy retina is essential for clear vision. Retinal diseases are common as they can affect
any part of the eye retina. As retinal diseases affect the vital eye tissue, it causes serious
problems, affects vision, some even leading to blindness.

5. Diabetic retinopathy,
It is the disease of the retina caused by
microangiopathy due to long term effect of diabetes
leading to progressive damage of retina & blindness.

6. llustration depicting diabetic retinopathy

7. DIABETIC RETINOPATHY CLASSIFICATION
Non proliferative and proliferative
Non proliferative DR (NPDR) consists of a variable display of nerve-
fiber layer infarcts (cotton wool spots), intra retinal hemorrhages, and
hard exudates and micro vascular abnormalities.
.

8. proliferative diabetic retinopathy.
PDR is characterized by neovascularization of the disc,
neovascularization of the retina, neovascularization of the iris,
neovascularization of the angle, vitreous hemorrhage or tractional
retinal detachment.

9. STAGES OF RETINOPATHY
•Stage 1: Mild non proliferative retinopathy —
micro aneurysms.
Stage 2: Moderate non proliferative retinopathy —
blocked blood vessels.
Stage 3: Severe non proliferative retinopathy — more
blocked blood vessels & a call for help.
Stage 4: Proliferative retinopathy — blood vessels grow on the retina.

11. RISK FACTORS:
 Poor blood glucose control
 Protein in urine
 High blood pressure
 Prolonged diabetes
 Raised fats (triglycerides) in the blood
 Pregnancy

12.  Hyperlipidemia
 Obesity
 Anemia
 Smoking
 Cataract surgery
CONTI..

13. PATHOPHYSIOLOGY

14. symptoms may include:
 Clients may report ‘’Spiders” “webs” or tiny specks floating in their vision
 Spots or dark strings floating in your vision (floaters)
 Blurred vision.
 Fluctuating vision.
 Impaired color vision.
 Dark or empty areas in your vision.
 Vision loss.

15. DIAGNOSTIC EVALUATION:
Diabetic retinopathy is detected during an eye examination that includes:
•Visual acuity test: Uses an eye chart to measure how well a person sees
at various distances (i.e., visual acuity).
•Pupil dilation: The eye care professional places drops into the eye to
dilate the pupil. This allows him or her to see more of the retina and look
for signs of diabetic retinopathy. After the examination, close-up vision
may remain blurred for several hours.

16. Ophthalmoscopy
It is an examination of the retina in which the eye care
professional: (1) looks through a slit lamp biomicroscope with a
special magnifying lens that provides a narrow view of the retina,
Fundus fluorescein angiography (ffa): This is an imaging
technique which relies on the circulation of fluorescein dye to
show staining, leakage, or non-perfusion of the retinal and
choroidal vasculature.

17. Optical coherence tomography (OCT):
This is an optical imaging modality based upon
interference, and analogous to ultrasound. It
produces cross-sectional images of the retina (B-
scans) which can be used to measure the
thickness of the retina and to resolve its major
layers, allowing the observation of swelling.

18. Ultrasound imaging.
This test is used if bleeding has occurred in the eye and making
it difficult to see your retina.
Retinal examination. The doctor may use an instrument with a bright
light and special lenses to examine the back of your eye, including the
retina. This type of device provides a highly detailed view of your
whole eye, allowing the doctor to see any retinal holes, tears or
detachments.

19. .
Management.
There are three major treatments for diabetic retinopathy.
which are very effective in reducing vision loss from this
disease
 Laser surgery,
 Injection of corticosteroids or anti-VEGF agents into
the eye
 vitrectomy.

20. Laser photocoagulation
Laser photocoagulation can be used in two scenarios for the
treatment of diabetic retinopathy. It can be used to treat
macular edema by creating a Modified Grid at the posterior
pole and it can be used for pan retinal coagulation for
controlling neovascularization. It is widely used for early
stages of proliferative retinopathy.

21. Intravitreal anti-VEGF
There are good results from multiple doses of intra vitreal injections
of anti-VEGF drugs such as
Bevacizumab. &
Aflibercept
Ranibizumab,
may have advantages in improving visual outcome,

22. Intravitreal triamcinolone acetonide
Triamcinolone is a long acting steroid preparation. When
injected in the vitreous cavity, it decreases the macular edema
(thickening of the retina at the macula) caused due to diabetic
maculopathy, and results in an increase in visual acuity.

23. vitrectomy

24. A vitrectomy is performed when there is a lot of blood
in the vitreous. It involves removing the cloudy vitreous
and replacing it with a saline solution to improve the
vision.

26. NURSING DIAGNOSIS:
1.Impaired visual perception related to micro vascular destruction
secondary to diabetes mellitus.
2.Risk for injury related to impaired vision secondary to diabetic
mellitus.

27. • Encourage ambulation and independence as tolerated.
• Administer medication for pain, nausea, and vomiting as
directed.
• Provide quiet diversional activities, such as listening to a radio
or audio books.
• Teach proper technique in giving eye medications.
• Advise patient to avoid rapid eye movements for several
weeks as well as straining or bending the head below the
waist.

28. Nursing Diagnosis : Anxiety related to the disease suffered by
the client.
Goal Statement
Anxiety can be resolved soon.
 Assess the level of anxiety, the degree of experience of pain
/ symptoms develop suddenly and the current state of
knowledge.
 Provide information that is accurate and truthful. Discuss
with the family that the supervision and treatment can
prevent vision loss enhancement.

29.  Encourage the patient to acknowledge the problem and
express feelings. Identification of sources / people who
helped.
 To facilitate nursing action plan which will be given later.
Collaboration with the patient's family will accelerate the
healing process

30. SUMMARY:
Diabetic retinopathy occurs when prolonged diabetes
damages the small blood vessels and nerves in the retina. The
retina is like the film of the eye – it captures images and sends
them to the brain to see. The damaged blood vessels may leak
or the retina may grow weak new vessels. If not treated, this
may lead to long term vision loss.