CARE OF CLIENTS WITH PROBLEMS IN NUTRITION AND GASTRO-INTESTINAL METABOLISM

AND ENDOCRINE FUNCTION, PERCEPTION AND COORDINATION-ACUTE AND CHRONIC - LEC

THE EYE AND VISION ASTIGMATISM

VISION
 Occurs when an abnormal curvature of the cornea can
cause two focal points to fall in two different locations
Is the passage of rays of light from an object through the
 Makes both near and far objects appear blurry
cornea, aqueous humor, lens and vitreous humor to the
 Correction: Bifocals (two corrective lenses; one for near
retina, and its appreciation in the cerebral cortex
vision or reading, the other for far vision)

ACCOMODATION PRESBYOPIA
The adjustment of the lens to change the focus of the eye  Is caused when the center of the lens in the eye
hardens so that it is unable to focus up close
OCULAR REFRACTION REFRACTIVE ERROR  This condition generally affects those over the age of
A procedure that reveals Normally, light is refracted 40
the degree to which the or bent by the cornea and
 Correction: Bifocals (two corrective lenses; one for
various light transmitting lens onto the retina at the
near vision or reading, the other for far vision)
portions of the eye, bring back of an eye to create
light rays into correct focus clear images
Corrective Lenses
on the retina
Vision is impaired because a
shortened or elongated
eyeball prevents light rays
from focusing sharply on
the retina

TYPES OF REFRACTIVE ERRORS

EMMETROPIA (NORMAL)

Rays coming from an object at a distance of 6 meters (20 ft)

or more are brought to a focus on the retina by the lens

AMETROPIA (ABNORMAL)

NEARSIGHTEDNESS (MYOPIA)

 Have deeper eyeballs

 Rays of light coming from an object at a distance of 6
meters (20 ft) or more are brought to focus in front or
short of the retina
DIAGNOSTIC FINDINGS
 Correction: Concave lens
FARSIGHTEDNESS (HYPERROPIA) SNELLEN CHART
 Shallow eyeballs
 Rays of light coming from an object at a distance of 6  Measures visual acuity
meters (20 ft) or more are brought to a focus at the
back or beyond of the retina ISHIHARA TEST (COLOR BLINDNESS TEST)
 Correction: Convex Lens
 People who are “color blind” cannot distinguish red
from green or blue from yellow

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  Composed of a series of colored cards on which RISK FACTORS
numbers or lines of equal shade can be read by a
person with normal color vision but not by someone  Aging
with defective color vision  Associated ocular condition such as infection and
myopia
OPHTHALMOSCOPE  Toxic factors
 Nutritional factors
 Ophthalmoscopy requires dilating the pupils with  Physical factors
drops to give the doctor the best view of inside of the  Systemic disease such as DM, Down syndrome,
eye disorder of lipid metabolism, renal disorders
 Purpose: To view the eye’s fundus and to detect  Infections (Measles, Chicken Pox, Herpes Simplex,
changes in the retina due to eye disease Cytomegalovirus, Herpes Zoster, Poliomyelitis,
Influenza, Syphilis, Toxoplasmosis)
COMMON EYE PROBLEMS
CLINICAL MANIFESTATIONS
CATARACT
 Painless, blurry vision
A cataract is an opacity of the normally clear lens which can  Perceives surroundings as dimmer
develop as a result of aging, metabolic disorders, trauma or  Light scattering
heredity  Reduced visual acuity
 Astigmatism
 Diplopia
 Color changes browner in color

DIAGNOSTIC TEST

 Snellen chart
 Ophthalmoscopy
 Slip lamp

MANAGEMENT

ASSESSMENT FINDINGS  Surgical cataract removal

 Followed by placement of an intraocular lens (IOL)
 Patching
 Treatment for any underlying disorder may be
needed

SURGICAL MANAGEMENT

INTRACAPSULAR CATARACT EXTRACTION (ICCE)

Involves removal of the lens, the entire lens capsule and its
attachments from the eye

EXTRACAPSULAR CATARACT EXTRACTION (ECCE)

CONGENITAL CATARACT
 Refers to a surgery in which the entire cataract is
removed through a small hole made in the lens capsule
A congenital cataract involves clouding of the lens of the eye
 The rest of the lens capsule and all its attachments are
that is present at birth
left intact

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 KELMAN PHACO EMULSIFICATION

The use of high frequency sound waves to liquefy the

contents of the lens which can then be safely removed from
the eye using suction through a 3 mm incision

NURSING CONSIDERATIONS

PRE-OP POST-OP
- Dilate pupils - Prevent stress on the
- Shave eyelashes suture line
- Face scrub - Prevent increase IOP
- Sedation - Prevent hemorrhage
- Prevent infection
CAUSES
- Correct visual acuity to
20/40 – 20/15
 Do not have a well -misunderstood cause
 Usually begins in infancy and childhood
 Need glasses for farsightedness
HEALTH TEACHINGS
 Seems to develop because the eye muscles are
uncoordinated and do not move the eyes together
 Eye shield at night
 Acquired strabismus can occasionally occur because of
 Avoid heavy lifting
a problem in the brain, an injury to the eye socket, or
 Normal ADL
thyroid eye disease
 No bending below knees
 Sleep on the unoperative side, 3-4 weeks SIGNS AND SYMPTOMS
 Don’t get soap or water in the eyes
 Don’t touch or rub your eyes CHILDREN:
 Don’t squeeze eye shut
 May hold their heads to one side if they can use
Call the doctor if:
their eyes together in that position
 May close or cover one eye when it deviates,
 Decreased vision
especially at first
 Severe and persistent eye pain
 Increase redness in the eye and eyelid ADULTS:
 Increase eye discharge or color change
 Have more symptoms
STRABISMUS
 Double vision (see a second image)
 May lose depth perception
 Refers to misaligned eye
 Can be subtle or obvious TREATMENT
 Intermittent (occurring occasionally) or constant
 It can affect one eye only or shift between the eyes  Patch the good eye and wear glasses before treating
the strabismus
Types:
 Surgery to get the eyes close enough to perfectly
straight that it is hard to see any residual deviation
 Esotropia
 Prisms and botox injections of the eye muscles are
 Exotropia
alternatives to surgery in some cases
 Hyperropia
 Hyporopia GLAUCOMA

 Is a condition where pressure inside the eye rises

to the point of causing damage to the optic nerve
with associated loss of vision

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  It usually affects both eyes, and it is the leading 5. Visual loss: progressive loss of vision is characteri zed by
cause of blindness in the world visual field defects
 Normal IOP is 10-20mmHg
CAUSES

- Hereditary - Poor diet

- Steroids in the eye drops
- Diabetes
- Previous eye injury or
surgery
- Affects people of all ages
- Wearing contact lenses
- Too much reading
- Reading in low light

CLINICAL MANIFESTATIONS

For all glaucoma cases:

PATHOPHYSIOLOGY  “Silent thief of sight”
 Blurred vision
There are two accepted theories regarding how increased IOP
 Eye pain
damages the optic nerve in glaucoma
 Red eye
1. The direct mechanical theory  Dilated pupils
 Severe pain in the head
 Suggests that high IOP damages the retinal layer as it  Seeing halos around lights
passes though the optic never head
DIAGNOSTIC PROCEDURE
2. The indirect ischemic theory

 Suggests that high IOP compresses the microcirculation

TONOMETRY
in the optic nerve head, resulting in cell injury and
death  The doctor first numbs eye and then he takes this tool
and places it on eye
 This tool measures the eye pressure

STAGES

1. Initiating events: precipitating factors include illness,

emotional stress, congenital narrow angles, long-term
use of corticosteroid, and mydriatics (ie, medications
causing pupillary dilation)

2. Structural alterations in the aqueous outflow system: OPHTHALMOSCOPY

tissue and cellular changes caused by factors that affect
aqueous humor dynamics lead to structural alterations Doctors puts eye drops into your eye which dilate the pupil,
and then he can look into your eye and see your optic nerve
3. Functional alterations: condition such as increased IOP
or impaired blood flow create functional cha nges that
lead to the fourth stage

4. Optic nerve damage: atrophy of the optic nerve is

characterized by loss of nerve fiber and blood supply, and
this fourth stage inevitably progresses to the fifth stage

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 3. Pigmentary

 Which occurs when pigment from the iris flakes off and
block the drainage canal

4. Secondary Glaucoma

 Can develop only from specific things like a tumor,

diabetes, and a medical condition most likely having
something to do with your eye

5. Congenital Glaucoma (born with)

PERIMETRY
 Symptoms, which include cloudy eyes, excessive
Which is a visual field test that helps patient with glaucoma tearing, and sensitivity to light
and tests if there is lost vision
TREATMENT
GONIOSCOPY
 No cure for glaucoma yet but it can be controlled with
Doctor numbs eye, then uses a special contact lenses that drugs
magnifies inside the eye  There can be some side effects to the medication, like
mood swings
 Laser surgery

TYPES OF LASER SURGERY

1. Laser Peripheral Iridotomy

 Used for treating acute angle glaucoma

 The procedure makes an opening in the iris, which

lets the fluid drain more
TYPES OF GLAUCOMA
2. Argon Laser Trabeculoplasty
1. Open Angle Glaucoma  Used for the open angle glaucoma and when doctor
do this, they aim the laser at the opening of the
 Most common type and comprises about 90% of all
canal, helping the drainage system work by making
cases of glaucoma
it a little bigger
 No symptoms for this glaucoma
 Chamber is open and appears normal 3. Microsurgery

2. Closure Glaucoma (acute or narrow angle glaucoma)
 The angle of the canal is blocked by part of the iris
 This kind can only be treated with laser surgery to
take it away almost completely, but it is not all the
way gone
 Conventional surgery and it is used for acute,
chronic, congenital, and secondary glaucoma.
Drainage canals intact
4. Selective Laser Trabeculoplasty
 It is a combination of very low frequencies that
treat specific cells and leave the mesh-like drainage
canals intact

5. Laser Cyclophotocoagulation

 Used for severe glaucoma cases that can’t be

treated with minor surgery, that helps decrease the
amount of fluid made

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 NURSING MANAGEMENT 4. Exudative retinal detachments are the result of the
production of a serous fluid under the retina from the
 Explain the importance of continued use of eye choroid
medication
CLINICAL MANIFESTATIONS
 Explain the need for continued medical supervision
 Teach the client to avoid activities that can increase
Subjective Objective
intraocular pressure
 Instruct client to report sever eye or blow pain &  Bright flashes or light  Retinal separation
nausea to the physician noted on
 Cobwebs or sudden ophthalmoscopy
RETINAL DETACHMENT onset of a great
number of Floaters  Assessment of visual
 Separation of the RPE from the neurosensory layer loss
 May result from trauma, aging process, or cataract  Sensation of a veil
surgery; also seen in client with myopia shade or curtain
coming across the
vision of one eye

MANAGEMENT

 Bed rest, with the area of detachment in the

dependent side to promote healing
 Tranquilizers to promote rest & reduce
anxiety
 Surgical interventions

SURGICAL INTERVENTIONS
FOUR TYPES OF RETINAL DETACHMENT
1. Cryosurgery
1. Rhegmatogenous detachment
 Super cooled probe causes retinal scarring & healing of
 Is the most common form the area
 A hole or tear develops in the sensory retina,
allowing some of the liquid vitreous to seep
through the sensory retina and detach it from the
RPE (Retinal Pigment Epithelium)
 People at risk for this type of detachment include
those with high
o Myopia or after cataract surgery
o Trauma

2. Traction Retinal Detachment

 Cause is Tension, or a pulling force

2. Photocoagulation
 Patients with this condition have developed
 Laser beam through the pupil produces retinal burn,
fibrous scar tissue form conditions such as
which causes scarring of the involved area
diabetic retinopathy, vitreous hemorrhage, or the
retinopathy of prematurity

3. A combination of rhegmatogenous and traction

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3. Scleral bucking

 Shortening of the sclera to force the choroid closer to

the retina

NURSING INTERVENTION

 Provide accurate information; alleviate anxiety

 Provide a call bell for the client & answer promptly
 Explain; normal occupational activity will return 3
weeks & to a more active job in 6-8 weeks
 Instruct client to avoid activities that increase IOP
 Keep the client on bed rest in a position as ordered
 Maintain protective eye patch
 Diminish lights in the room
 Observe for hemorrhage, postoperatively

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