Refractive Errors
Establish communication lines & answer
Def: vision is impaired bec. A shortened or elongated
eyeball prevents light rays from focusing sharply on the
retina
Ophthalmic refraction: is the determination of the
refractive errors of the eye for the purpose of vision
correction
TYPES:
Strabismus ( eye deviation)
-may lead to AMBYLOPIA
Test- Corneal Light Reflex
Cover Test
-if uncorrected nay lead to blindness
Myopia- (also referred to as NEARSIGHTEDNESS)
- The refractive ability of the eye is too strong for
the eye length
- Images are bent and fall in front of, not on, the
retina
Hyperopia ( also referred to as farsightedness)
- Images are focused behind the retina
- A shorter length of the eye may contribute to the
development of hyperopia
Presbyopia
- As people age the crystalline lens loses its elasticity
and is less able to alter its shape to focus the eye
for close work
- Images fall behind the retina
- Usually occurs in 30’s or 40’s
Astigmatism
- Occurs when the curve of the cornea is uneven
- -because the light rays are not refracted equally in
all directions
- a focus point on the retina is not achieved
EYE DISORDERS
BLINDNESS
(LEGALY BLIND)
- Vision of <20/200 with the use of corrective lenses
or a visual field of no greater than 30 degrees
- Greatest incidence after age of 65
- Risk factors: glaucoma, cataracts, diabetic
retinopathy
NURSING DIAGNOSIS
1. VISUAL SENSORY OR PERCEPTUAL ALTERTON R/T
BLINDNESS
2. IMPAIRED SOCIAL INTERACTIONS R/T BLINDNESS
3. RISK FOR INJURY R/T VISUAL IMPAIRMENT
4. SELF CARE DEFICIT R/T VISUAL LOSS
NCP/ Implementation
A. Goal: promote independence and provide
emotional support
1. Familiarize w/ surroundings & encourage use
of touch
S AND SX
2.
questions
3. Deal w/ feelings of loss &
overprotectiveness by family members
4. Provide diversional activities ie:
A. Radio
B. Talking books, tapes, records
5. Encourage self-care activities
6. Allow voicing of frustrations when activity is
not done to satisfaction- to decrease anger
and discouragement.
NCP/IMPLEMENTATION
GOAL: Facilitate activities of daily living.
-Eating:
A. Establish routine placement for tableware, ie:
Plates
B. Help person mentally visualize the plates as a
clock/ compass.
C. Take person’s hand and guide the fingertips to
establish spatial relationship
- Walking
1. Having a person hold your forearm and walk
half a step in front
2. Tell the person when approaching stairs, curb
- Talking
1. Speak when approaching the person and tell
them before you touch them
2. Tell them who you are and what you will be
doing
3. Do not avoid using words such as see/
discussing the appearance of things
- Health Teaching
1. Accident prevention at home
2. Community resources
TRAUMA
- Hematoma
- Chemical burns
- Corneal abrasions
- Penetrating/ non-penetrating wounds
- Foreign bodies
Glaucoma
 Acute (closed angle)
 Impaired passage of aqueous humor into the
circular canal of schlemm due to closure of the
angle between the cornea and the iris
MEDICAL EMERGENCY: requires surgery
 B. Chronic (open-angle)
Local obstruction of the aqueous humor
between the anterior chamber and the canal
MOST COMMONLY TREATED W/ FF MEDS:
1. MIOTICS
ACUTE: 2. CARBONIC ANHYDRASE INHIBITORS
 Pain; severe in and around the eye
 Headache Decrease elevated IOP and ocular hypertension
 Rainbow halos around the lights - TIMOLOL MALEATE (TIMOPTIC)
 Blurring of vision Reduces production of aqueous humor
 N AND V GOALS AND IMPLEMENTATION
CHRONIC: - PROVIDE EMOTIONAL SUPPORT
 Corneal Edema 1. Place personal objects within field of vision
 Decreased peripheral vision 2. Assist with Activities
 Increased cupping of optic disc 3.Encourage verbalization of concerns , fears of
 Tonometry pressures 22mmHg blindness, loss of independence
- HEALTH TEACHING
 Pupils dilated
Prevent IOP by
 Redness of the eye
1. avoiding anger, excitement , worry
NURSING DIAGNOSIS
2. constricting clothing
 VISUAL SENSORY / PERCEPTUAL ALTERATIONS R/T
3.heavy lifting
IOP
4. excessive fluid intake
 PAIN R/T SUDDEN INCREASE IN IOP
5. straining of stool
 RISK FOR INJURY R/T BLINDNESS
6. eye strains
 IMPAIRED PHYSICAL MOBILTIY R/T IMPAIRED
7. atropine, or other mydriatics which cause dilation
VISION
Relaxation and Stress Management Techniques
GOALS AND IMPLEMENTATIONS
Prepare for Surgery , if Ordered.
1. REDUCE IOP
- Laser Trabeculoplasty
 ACTIVITY: bedrest
- Trabeculotomy
 POSITION: SEMI-FOWLER’S
Activity Allowed
 MEDS AS ORDERED: - Moderate exercise (walking)
 MIOTICS Safety measures
 CAI - Eye Protection (shield/ glasses)
 ANTICHOLINESTERASE - Medic Alert Band/ Tag
 OPTHALMIC - Avoid Driving 1-2 hours after instilling miotics
1. MIOTICS Medications
-Used to lower the IOP- increased blood flow to the retina - Purpose and dosage and frequency
and decreased retinal damage and loss of vision - Eyedrop instillation
- can cause a contraction of the ciliary muscle and Community Resources as needed
widening of trabecular meshwork EVALUATION/OUTCOME CRITERIA
(PILOCAPINE) A. EYESIGHT PRESERVED, IF POSSIBLE
- Produces miosis and decrease IOP B. IOP LOWERED ( < 22 mm Hg )
2. CARBONIC ANHYDRASE INHIBITORS C. CONTINUES MEDICAL SUPERVISION FOR LIFE --
(ACETAZOLAMIDE) REPORTS REAPPEARANCE OF SYMPTOM IMMEDIATELY
- Interfere with the production of carbonic acid , - CATARACTS
which leads to decreased aqueous humor
 DEVELOPMENT or DEGENERATIVE
formation and decreased IOP
OPACIFICATION OF THE CRYSTALLINE LENs
- Used for long term treatment of open angle
 CATARACTS CAN DEVELOP @ ANY AGE
glaucoma
 THEY MAY BE DUE TO A VARIETY OF CAUSES
- Recommended only after PILOCARPINE, BETA-
 MOST COMMON IN LATER LIFE & ASSOCIATED
BLOCKERS, AND CHOLINESTERASE
WITH AGING
ANTICHOLINESTERASE
- Facilitates outflow of aqueous humor  CAN DEVELOP IN BOTH EYES -- USUALLY ONE
- (short-acting) PHYSOSTIGMIN SALYCILATE EYE IS MORE COMPROMISED
- (long- acting) DEMECARIUM BROMIDE  VISUAL IMPAIRMENT USUALLY PROGRESSES @
OPTHALMIC: BETA- ADRENERGIC BLOCKERS SAME RATE IN BOTH EYES
- (BETAXOLOL) BETOPTIC- used to RISK FACTORS
 ASSOCIATED OCULAR CONDITIONS  AGING (MOST COMMON)
 TRAUMA
  NUTRITIONAL FACTORS  TOXINS
 PHYSICAL FACTORS  CONGENITAL DEFECTS
 DISEASES & SYNDROMES 5. MILD IRITITIS USUALLY OCCURS
ASSESSMENT REDUCE STRESS ON THE SUTURES & PREVENT
SUBJECTIVE DATA HEMORRHAGE
* VISION ( DIMMING ) GOALS & IMPLEMENTATIONS
* BLURRING ( PAINLESS ) POSTOPERATIVE CARE
* LOSS OF ACUITY (SEE BEST IN LOW LIGHT) A. ACTIVITY:
* DISTORTION 1. AMBULATE , AS ORDERED,
* DIPLOPIA SOON AFTER SURGERY
* PHOTOPHOBIA 2. USUALLY DISCHARGED 5-6 HRS AFTER
* SENSITIVITY TO GLARE SURGERY
ASSESSMENT B. POSITION:
OBJECTIVE DATA 1. FLAT or LOW FOWLER’S
*BLINDNESS 2. LIE ON BACK or TURN TO
A. UNILATERAL UNOPERATIVE SIDE
B. BILATERAL ( PARTICULARLY, in CONGENITAL
CATARACTS) GOALS & IMPLEMENTATIONS
* LOSS OF RED REFLEX POSTOPERATIVE CARE
* GRAY OPACITY OF LENS C. AVOID ACTIVITIES THAT > IOP:
* MYOPIC SHIFT & COLOR SHIFT 1. STRAINING @ STOOL
* ASTIGMATISM 2. VOMITING, COUGHING, SHAVING
* REDUCED LIGHT TRANSMISSION 3. BRUSHING TEETH or HAIR
ANALYSIS / NURSING DIAGNOSES 4. LIFTING OBJECTS > 20lb.
A. VISUAL SENSORY/PERCEPTUAL 5. BENDING or STOOPING
ALTERATIONS R/T OPACITY OF LENS 6. WEAR GLASSES / SHADED LENS DURING
B. RISK FOR INJURY R/T ACCIDENTS DAY
C. SOCIAL ISOLATION R/T IMPAIRED VISION 7. WEAR EYESHIELD @ NIGHT
CATARACT REMOVAL GOALS & IMPLEMENTATIONS
REMOVAL OF OPACIFIED LENS BECAUSE OF LOSS OF POSTOPERATIVE CARE
VISION D. PROVIDE:
A. EXTRACAPSULAR CATARACT EXTRACTION ( ECCE ) 1. MOUTHWASH
FOLLOWED BY INTRAOCULAR LENS ( IOL ) INSERTION 2. HAIR CARE
B.PHACOEMULSION - USES AN ULTRASONIC DEVICE THAT 3. PERSONAL ITEMS WITHIN EASY REACH
LIQUEFIES THE NUCLEUS & CORTEX WHICH ARE THEN 4. “STEP-IN” SLIPPERS
SUCTIONED OUT THROUGH A TUBE
GOALS & IMPLEMENTATIONS PROMOTE PSYCHOLOGICAL WELL-BEING
PREOPERATIVE CARE • FREQUENT CONTACTS TO PREVENT SENSORY
1. ANTIBIOTIC DROPS/OINTMENT, AS ORDERED DEPRIVATION
2. MYDRIATIC EYEDROPS, AS ORDERED (NOTE • ESPECIALLY, THE ELDERLY
DILATATION OF PUPILS) . HEALTH TEACHING
3. AVOID GLARING LIGHTS POST-OP.
4. SURGERY OFTEN DONE UNDER LOCAL ANESTHESIA A. IF PRESCRIPTIVE GLASSES ARE USED,
WITH SEDATION EXPLAIN ABOUT:
. HEALTH TEACHING 1. MAGNIFICATION
PRE-OP. 2. PERCEPTUAL DISTORTION
1. DO NOT RUB , TOUCH, or SQUEEZE EYES SHUT AFTER 3. BLIND AREAS IN PERIPHERAL VISION
SURGERY 4. GUIDE THRU ACTIVITIES WITH GLASSES
2. EYE PATCH WILL BE ON AFFECTED EYE 5. NEED TO LOOK THRU CENTRAL PORTION
3. ASSISTANCE WILL BE GIVEN FOR NEEDS OF LENS
4. OVERNIGHT HOSPITALIZATION NOT REQUIRED, UNLESS 6. TURNING HEAD TO SIDE WHEN LOOKING
COMPLICATIONS OCCUR TO THE SIDE TO PREVENT DISTORTION
B. EYE CARE:
* INSTILLATION OF MYDRIATIC & CARBONIC ANHDRASE 1. EYE SHIELD @ NIGHT x 1 MONTH
INHIBITORS - TO PREVENT GLAUCOMA & ADHESIONS 2. EYE CARE - NO IOL INSERTION
3. EYE CARE - WITH IOL INSERTION ASSESSMENT – OBJECTIVE DATA
* STEROID- ANTIBIOTIC USED\ A. OPHTHALMIC EXAM REVEALS:
C. SIGNS & SYMPTOMS of: 1. RETINA IS GRAYISH IN AREA OF TEAR
1. INFECTION 2. BRIGHT, RED HORSESHOE-TYPE TEAR
2. IRIS PROLAPSE ANALYSIS / NURSING DIAGNOSIS
* BULGING / PEAR SHAPED PUPIL A. VISUAL SENSORY/PERCEPTUAL ALTERATION R/T
3. HEMORRHAGE BLURRED VISION
* SHARP PAIN B. ANXIETY R/T POTENTIAL LOSS OF VISION
* HALF MOON OF BLOOD C. RISK FOR INJURY R/T BLINDNESS
D. AVOID: NURSING CARE PLAN / IMPLEMENTATION
1. HEAVY LIFTING A. PREOPERATIVE CARE
2. POTENTIAL EYE TRAUMA 1. GOAL: REDUCE ANXIETY & PREVENT FURTHER
EVALUATION/OUTCOME CRITERIA DETACHMENT
A. ENCOURAGE VERBALIZATION OF FEELINGS,
1.VISION RESTORED ANSWER ALL QUESTIONS, & REINFORCE PHYSICIAN’S
2.NO COMPLICATIONS - (ie. Severe eye pain or EXPLANATION OF SURGICAL PROCEDURE
Hemorrhage) B. ACTIVITY:
3.PERFORMS SELF-CARE ACTIVITIES - (ie. Instills own 1. BEDREST
eyedrops) 2. EYES USUALLY COVERED TO PROMOTE
4.RETURNS FOR FOLLOW-UP OPHTHALMOLOGY EYE RELAXATION
CARE 3. SIDERAILS UP
5.RECOGNIZES SYMPTOMS REQUIRING IMMEDIATE A. PREOPERATIVE CARE
ATTENTION 1.GOAL: REDUCE ANXIETY & PREVENT FURTHER
RETINAL DETACHMENT DETACHMENT
DESCRIPTION C. POSITION:
• A RETINAL HOLE IS A BREAK IN THE INTEGRITY OF 1. ACCORDING TO LOCATION OF RETINAL TEAR
THE PERIPHERAL SENSORY RETINA & CAN BE 2. INVOLVED AREA OF EYE SHOULD BE IN
CAUSED BY TRAUMA / CAN OCCUR W/ AGING DEPENDENT POSITION
• A RETINAL TEAR IS A MORE JAGGED & 1. GOAL: REDUCE ANXIETY & PREVENT FURTHER
IRREGULARLY SHAPED BREAK IN THE RETINA – DETACHMENT
WHICH CAN RESULT FROM TRACTION ON THE D. MEDICATIONS:
RETINA 1. ADMINSTER AS ORDERED
• A RETINAL DETACHMENT IS THE SEPARATION OF 2. CYCLOPLEGIC / MYDRIATICS –
THE SENSORY RETINA FROM THE PIGMENTED TO DILATE THE PUPIL WIDELY & DECREASE
EPITHELIUM – A SEPARATION OF RETINA FROM INTRAOCULAR
CHOROID MOVEMENT
RISK FACTORS E. RELAXING DIVERSION:
A. TRAUMA 1. CONVERSATION
B. DEGENERATION 2. MUSIC
ASSESSMENT -- SUBJECTIVE DATA 2. GOAL: HEALTH TEACHING
A. FLASHES OF LIGHT BEFORE EYES A. PREPARE FOR SURGICAL INTERVENTION
B. VISION IS: 1. CRYOTHERAPY - SUPER-COOLED PROBE IS
1. BLURRED APPLIED TO THE SCLERA, CAUSING A SCAR,
2. SOOTY (SUDDEN ONSET) WHICH PULLS THE CHOROID & RETINA
3. SENSATION OF FLOATING PARTICLES TOGETHER
4. BLANK AREAS OF VISION 2. LASER PHOTOCOAGULATION – A BEAM OF
INTENSE LIGHT FROM A CARBON ARC IS
DIRECTED THROUGH THE DILATED PUPIL ONTO
THE RETINA & SEALS HOLE IF RETINA NOT
DETACHED
2. GOAL: HEALTH TEACHING
 A. PREPARE FOR SURGICAL INTERVENTION 3. GOAL: HEALTH TEACHING
3. SCLERAL BUCKLING – THE SCLERA IS A. EYE CARE:
RESECTED / SHORTENED TO ENHANCE THE CONTACT 1. EYE PATCH / SHIELD @ NIGHT
BETWEEN THE CHOROID & RETINA 2. DARK GLASSES
4. BANDING / ENCIRCLEMENT – SILICANE BAND 3. AVOID RUBBING / SQUEEZING EYES
/ STRAP IS PLACED UNDER THE B. MEDICATIONS:
EXTRAOCULAR MUSCLES AROUND THE 1. DRUG TEACHING
GLOBE 2. AVOID OTC MEDICATION
B. POSTOPERATIVE CARE C. LIMITATIONS:
1. GOAL: REDUCE INTRAOCULAR STRESS & PREVENT 1. NO READING FOR 3 WEEKS
HEMORRHAGE 2. NO PHYSICAL EXERTION FOR 6
A. POSITION: WEEKS
1. FLAT / LOW FOWLER’S D. SIGNS OF REDETACHMENT:
2. SANDBAGS MAY BE USED TO POSITION HEAD 1. FLASHES OF LIGHT
3. TURN TO NON-OPERATIVE SIDE, IF ALLOWED 2. INCREASE IN “FLOATERS”
W/ RETINAL TEAR DEPENDENT 3. BLURRED VISION
4. SPECIAL POSITIONS MAY BE:
PRONE TYPES OF OPHTHALMIC DRUGS
SIDE-LYING
SITTING W/ FACE DOWN ON TABLE F. TOPICAL ANESTHETIC
B. ACTIVITY: ACTION -- DECREASES SENSATION (PAIN)
1. BEDREST USES -- SURGERY, TREATMENTS
2. DECREASE INTRAOCULAR PRESSURE 2. EYE INFLAMMATIONS
By NOT: G. TOPICAL ANTIBIOTIC
A. STOOPING ACTION -- ANTI- INFECTIVE
B. BENDING USES -- EYE INFLAMMATIONS
C. ASSUMING PRONE POSITION H. STEROID
C. MEDICATIONS: ACTION -- 1. EYE INFLAMMATIONS
1. MYDRIATICS – REDUCE EYE MOVEMENT USES -- 1. EYE INFLAMMATIONS &
2. ANTI-INFECTIVES – PREVENT INFECTION ALLERGIC REACTIONS
3. CORTICOSTEROIDS - INFLAMMATION
1. GOAL: REDUCE INTRAOCULAR STRESS & PREVENT A. MYDRIATICS
HEMORRHAGE ACTION -- 1. DILATES PUPIL
D. RANGE OF MOTION EXERCISES: USES -- 1. EXAMINATION OF INTERIOR OF
1. ISOMETRIC EYE
2. PASSIVE 2. PREVENTS ADHESIONS OF IRIS
3. ELASTIC STOCKINGS TO PREVENT W/ CORNEA IN EYE INFLAMMATIONS
THROMBUS R/T IMMOBILITY B. CYCOPLEGIC
ACTION -- 1. DILATES PUPIL
2. GOAL: SUPPORT COPING MECHANISMS 2. PARALYZES CILIARY MUSCLE &
A. PLAN ALL CARE W/ PATIENT IRIS
B. ENCOURAGE VERBALIZATION OF FEELINGS, USES -- 1. DECREASES PAIN &
FEARS PHOTOPHOBIA
C. ENCOURAGE FAMILY INTERACTION 2. PROVIDES REST IN:
D. DIVERSIONAL ACTIVITIES A. INFLAMMATIONS OF IRIS &
CILIARY BODY
B. DISEASES OF CORNEA
C. MIOTICS
ACTION -- 1. CONTRACTS PUPIL
2. PERMITS BETTER DRAINAGE OF
INTRAOCULAR FLUID
USES -- 1. GLAUCOMA