1. Eye Disorders
Prepared by :
Bashar Rasheed Mohammed-Ali
M.Sc. Adults Nursing department, Faculty
of Nursing, University of Kufa
Ministry of higher education
and scientific research
University of kufa
Academic Teaching and Training
The ability to see the world clearly can easily . The eye is a
sensitive, highly specialized sense organ subject to various
disorders, many of which lead to impaired vision.
Impaired vision may affect a person’s independence in self-care,
work and lifestyle choices, sense of self-esteem, safety, ability to
interact with society and the environment, and overall quality of
Many of the leading causes of visual impairment are associated
with aging (eg, cataracts and glaucoma).
7. Causes and risk factors
Aging (Decrease in levels of vitamin C, protein, and an
Associated Ocular Conditions (Retinal detachment and retinal
surgery and Infection)
Toxic Factors (Corticosteroids, especially at high doses and in
long-term use and Cigarette smoking)
Nutritional Factors (Reduced levels of antioxidants, Poor
Physical Factors (Blunt trauma, perforation of the lens with a
sharp object or foreign body and Ultraviolet radiation in sunlight)
Systemic Diseases and Syndromes
corticosteroids Sunlight & radiation
start to cloud a small
area of the lens
it clouds more of your lens and
alters the light passing through the
Scattering of focuses light
on the retina
9. Types of cataracts include:
* A nuclear cataract forms deep in the central zone
(nucleus) of the lens. Nuclear cataracts usually are
associated with aging.
* A cortical cataract is characterized by white, that
start in the periphery of the lens and work their way to
* A subcapsular cataract occurs at the back of the lens.
People with diabetes or those taking high doses of
11. Clinical Manifestations:
* Clouded, blurred vision.
* Increasing difficulty with vision at night.
* Sensitivity to light .
* Seeing "halos" around lights.
* Frequent changes in eyeglass or contact lens
* Double vision in a single eye (diplopia).
* Reduced visual acuity .
12. Assessment and Diagnostic Findings
The Snellen visual acuity test .
slit-lamp biomicroscopic examination are
used to establish the degree of cataract
14. Medical Management
* Nonsurgical (medications, eye drops, eyeglasses)
treatment cures cataracts. found no benefit from
antioxidant supplements, vitamins C and E .
* In the early stages of cataract development,
glasses, contact lenses, or magnifying lenses may
15. Surgical Management
In general, if reduced vision from cataract does not
interfere with normal activities, surgery may not be
needed. In deciding when cataract surgery is to be
Furthermore, patients can communicate and cooperate
during surgery. Intravenous (IV) moderate sedation
may be used to minimize anxiety and discomfort.
When both eyes have cataracts, one eye is treated first,
with at least several weeks, preferably months,
separating the two procedures.
In this method of extracapsular cataract surgery, a portion of
the anterior capsule is removed, allowing extraction of the lens
nucleus and cortex while the posterior capsule are left intact.
An ultrasonic device is used to liquefy the nucleus and cortex,
which are then suctioned out through a tube.
After the pupil has been dilated and the surgeon has made a
small incision on the upper edge of the cornea, a viscoelastic
substance (clear gel) is injected into the space between the
cornea and the lens. This prevents the space from collapsing
and facilitates insertion of the IOL.
18. Lens Replacement
After removal of the crystalline lens, the patient is
referred to as aphakic (i.e., without lens). The lens,
which focuses light on the retina, must be replaced for
the patient to see clearly.
There are three lens replacement options:
- Aphakic eyeglasses
- Contact lenses
- IOL implants
20. The patient with cataracts should receive the usual
preoperative care for ambulatory surgical patients
undergoing eye surgery.
The preoperative tests (eg, complete blood count,
electrocardiogram, urinalysis) that were once required
in all cases are prescribed only if they are indicated by
the patient’s medical history.
21. Providing Preoperative Care
* It has been common practice to withhold any
anticoagulant therapy (eg, aspirin, warfarin ) to
reduce the risk of retrobulbar hemorrhage for 5 to 7
days before surgery.
* Dilating drops are administered every 10 minutes
for four doses at least 1 hour before surgery.
Additional dilating drops may be administered in the
operating room (immediately before surgery).
* Antibiotic, corticosteroid, and anti-inflammatory
drops may be administered to prevent postoperative
infection and inflammation.
22. Providing Postoperative Care
* Before discharge, the patient receives verbal and written
instructions about how to protect the eye, administer
medications and recognize signs of complications.
* The nurse also explains that there should be minimal
discomfort after surgery and instructs the patient to take
a mild analgesic agent, such as acetaminophen, as
* Antibiotic, anti-inflammatory, and corticosteroid eye drops
or ointments are prescribed postoperatively .
* Activities to be avoided
23. Activities to be avoided
Always wash hands before touching or cleaning the
Clean postoperative eye with a clean tissue; wipe the closed eye
with a single gesture from the inner canthus outward.
Bathe or shower; shampoo hair carful or seek assistance.
Avoid lying on the side of the affected eye the night after surgery.
Keep activity light (eg, walking, reading, watching television).
Avoid lifting, pushing, or pulling objects heavier than 15 lb.
Avoid bending or stooping for an extended period.
Be careful when climbing or descending stairs.
24. Promoting Home and Community-
Teaching Patients Self-Care
* To prevent accidental rubbing of the eye , the patient
wears a protective eye patch for 24 hours after surgery,
followed by eyeglasses worn during the day for 1 to 4
* Sunglasses should be worn while outdoors during the
day because the eye is sensitive to light.
Glaucoma is a group of ocular conditions
characterized by optic nerve damage. The optic
nerve damage is related to the IOP caused by
congestion of aqueous humor in the eye.
29. Risk Factors for Glaucoma
• Family history of glaucoma
• Older age
• Cardiovascular disease
• Nearsightedness (myopia)
• Eye trauma
• Prolonged use of topical or systemic corticosteroids
30. Causative agents
Retention of aqueous humor
Increased aqueous humor formation
Increase in intraocular pressure
damage of optic nerve
32. Classification of Glaucoma
There are several types of glaucoma. The two main types are
1- Open-angle glaucoma : the most common form of glaucoma,
90% of all glaucoma cases:
* Is caused by the slow clogging
of the drainage canals, resulting
in increased eye pressure
* Develops slowly and is a lifelong
* Has symptoms and damage that are
33. 2- Angle-closure glaucoma : a less common form of
* Is caused by blocked drainage
canals, resulting in a sudden rise
in intraocular pressure
* Has a closed angle
between the iris and cornea
* Develops very quickly
* Has symptoms and damage
that are usually very noticeable
* Demands immediate medical
34. Assessment and Diagnostic Findings
The patient’s ocular and medical history must be detailed
to investigate the history of predisposing factors.
* Four major types of examinations are used in glaucoma :
1- tonometry to measure the IOP .
2- ophthalmoscopy to inspect the optic nerve .
3- gonioscopy to examine the filtration angle of the
anterior chamber .
4- perimetry to assess the visual fields.
* The pallor of the optic nerve is caused by a lack of blood
supply that results from cellular destruction.
36. Medical Management
The aim of all glaucoma treatment is prevention of optic
nerve damage. Lifelong therapy is almost always
necessary because glaucoma cannot be cured. The
object is to achieve the greatest benefit at the least risk
to the patient. Although treatment cannot reverse optic
nerve damage, further damage can be controlled. The
goal is to maintain an IOP within a range unlikely to
cause further damage.
37. Pharmacologic Therapy
Medical management of glaucoma relies on systemic and
topical ocular medications that lower IOP. Therapy takes
into account the patient’s health and stage of glaucoma.
The patient is usually started on the lowest dose of topical
medication and then advanced to increased concentrations
until the desired IOP level is reached and maintained.
One eye is treated first, with the other eye used as a
control in determining the efficacy of the medication; once
efficacy has been established, treatment of the other eye is
38. Several types of ocular medications are used to treat
glaucoma including miotics (medications that cause
pupillary constriction), beta-blockers, alpha2-agonists,
and prostaglandins that reduce IOP by increasing
aqueous humor outflow.
39. Surgical Management
In laser trabeculoplasty for glaucoma, laser burns are
applied to the inner surface of the trabecular
meshwork to open or widen the canal of Schlemm,
thereby promoting outflow of aqueous humor and
decreasing IOP. The procedure is indicated when IOP
is inadequately controlled
40. In laser iridotomy for pupillary block glaucoma, an
opening is made in the iris to eliminate the pupillary
block. Laser iridotomy is contraindicated in patients
with corneal edema. Potential complications are burns
to the cornea, lens, or retina; transient elevated IOP.
41. Nursing Management
* administer cycloplegic eye drops in the affected eye only.
* Apply topical corticostroids as ordered to rest the pupil.
* After surgery, protect the affected eye by applying an eye
patch and eye shield.
* Position the patient on his back or unaffected side, and
following general safety measures.
* Administer pain medications as ordered.
* Monitor the patient’s ability to see clearly.
42. * Monitor the patient’s intra-occular pressures.
* Instruct the patient’s family how to modify the
patient’s environment for safety.
* Teach the patient the signs and symptoms that
require immediate medical attention, such as
sudden vision change or eye pain.
Notas del editor
Because cataract surgery is performed to improve visual functioning, the delay for the other eye gives time for the patient and the surgeon to evaluate whether the results from the first surgery are adequate to preclude the need for a second operation. The delay also provides time for the first eye to recover; if there are any complications.
Stages of Glaucoma
1. Initiating events. Precipitating factors include illness, emotional stress, congenital narrow angles, long-term use of corticosteroids, and use of mydriatics (ie, medications causing pupillary dilation). These events may lead to the second stage.
2. Structural alterations in the aqueous outflow system. Tissue and cellular changes caused by factors that affect aqueous humor dynamics lead to structural alterations and may lead to the third stage.
3. Functional alterations. Conditions such as increased intraocular pressure or impaired blood flow create functional changes that may lead to the fourth stage.
4. Optic nerve damage. Atrophy of the optic nerve is characterized by loss of nerve fibers and blood supply. This fourth stage inevitably progresses to the fifth stage.
5. Visual loss. Progressive loss of vision is characterized by visual field defects.
If the IOP is elevated in both eyes, both are treated. When results are not satisfactory, a new medication is substituted. The main markers of the efficacy of the medication in glaucoma control are lowering of the IOP to the target pressure, appearance of the optic nerve head, and the visual field.