CATARACT

A cataract is an opacity of the eye’s normally clear, transparent crystalline lens. It is commonly
associated with aging (senile cataracts) but can develop at any age. It may also be associated
with blunt or penetrating trauma, long-term corticosteroid use, systemic disease such as diabetes
mellitus, hypoparathyroidism, radiation exposure, expose to long hours of bright sunlight
(ultraviolet), or other eye disorders. Vision impairment depends on the size, density, and location
in the lens.
CLINICAL MANIFESTATIONS
· Diminished visual acuity, disabling sensitivity to glare, painless, dimmed or blurred vision with
distortion of images, poor night vision. Other effects include myopic shift, astigmatism,
monocular diplopia (double vision), color shift (aging lens becomes progressively more
absorbent at the blue end of the spectrum), brunescence (color values shift to yellow brown), and
reduced light transmission.
· Yellowish, gray, or white pupil
· Develops gradually over a period of years; as the cataract worsens, stronger glasses no longer
improve sight
· May develop in both eyes, although one is more compromised than the other
ASSESSMENT AND DIAGNOSTIC METHODS
· Degree of visual acuity is directly proportionate to density of the cataract.
· Snellen visual acuity test
· Opthalmoscopy
· Slit-lamp biomicroscopic examination
· A-scan ultrasonography
MEDICAL MANAGEMENT
There is no medical treatment for cataracts, although use of vitamin C and E and beta-carotene is
being investigated. Glasses or contact, bifocal, or magnifying lenses may improve vision
Mydriatics can be used short term, but glare is increased.
SURGICAL MANAGEMENT
Two surgical techniques are available: intracapsular cataract extraction (ICCE) and extracapsular
cataract extraction (ECCE) including phacoemulsification. Less than 15% of people with
cataracts require surgery.
Indications for surgery are loss of vision that interferes with normal activities or a cataract that is
causing glaucoma. Cataracts are removed under local anesthesia on an outpatient basis. Lens
replacement may involve aphakic eyeglasses, contact lens, and intraocular lens (IOL) implants.
When both eyes have cataracts, one eye is surgically treated at a time.
NURSING MANAGEMENT
· Because surgery is performed on an outpatients basis, instruct patient to make arrangements for
transportation home, care that evening, and a follow-up visit to the surgeon the next day.
· Withhold any anticoagulants the patient is receiving, if medically appropriate. Aspirin should
be withheld for 5 to 7 days, nonsteroidal anti-inflammatory drugs (NSAIDs) for 3 to 5 days, and
warfarin (Coumadin) until the prothrombin time of 1.5 is almost reached.
· Administer dilating drops every 10 minutes for four doses at least 1 hour before surgery.
Antibiotic, corticosteroid, and NSAID drops may be administered prophylactically to prevent
postoperative infection and inflammation.
· Instruct patient to wear a protective eye patch for 24 hours after surgery to prevent accidental
rubbing or poking of the eye. After 24 hours, eyeglasses (sunglasses in bright light) should be
worn during the day and a metal shield worn at night for 1 to 4 weeks.
· Provide postoperative discharge teaching concerning eye medications, cleansing and protection,
activity level and restrictions, diet, pain control, positioning, office appointments, expected
postoperative course, and symptoms to report immediately to the surgeon.
· Instruct patient to restrict bending and lifting heavy objects.
· Caution patient that vision may blur for several days to weeks.
· Inform patient that vision gradually improves as the eye heals; IOL implants improve vision
faster than glasses or contact lenses.
· Reinforce that vision correction is usually needed for remaining visual acuity deficit.
Cataracts are the leading cause of preventable blindness among adults in the United States. The
incidence of cataracts in the United States is 1.2 to 6.0 cases per 10,000 people. A cataract is defined as
opacity of the normally transparent lens that distorts the image projected on the retina. The lens opacity
reduces visual acuity. As the eye ages, the lens loses water and increases in size and density, causing
compression of lens fibers. A cataract then forms as oxygen uptake is reduced, water content decreases,
calcium content increases, and soluble protein becomes insoluble. Over time, compression of lens fibers
causes a painless, progressive loss of transparency that is often bilateral. The rate of cataract formation
in each eye is seldom identical. Without surgery, a cataract can lead to blindness.
Cataract a common cause of gradual vision loss is opacity of the lens or the lens capsule of the eye. The
clouded lens blocks light shining through the cornea. This block, in turn, blurs the image cast onto the
retina. As a result, the brain interprets a hazy image. Cataracts commonly affect both eyes, but
each cataract progresses independently. Exceptions are traumatic cataracts, which are usually unilateral,
and congenital cataracts, which may remain stationary. Cataracts are most prevalent in people older than
age 70. Surgery restores vision in about 95% of patients.

CAUSES
Cataracts have several causes and may be age-related, present at birth, or formed as a result of trauma
or exposure to a toxic substance, Cataracts are classified by the cause:

 Senile cataracts develop in elderly people

 Congenital cataracts occur in neonates from inborn errors of metabolism or from maternal rubella
infection during the first trimester
 Traumatic cataracts develop after a foreign body injures the lens with sufficient force to allow
aqueous or vitreous humor to enter the lens capsule
 Complicated cataracts occur secondary to uveitis, glaucoma, retinitis pigmentosa, or retinal
detachment
 Toxic cataracts result from drug or chemical toxicity with prednisone, ergot alkaloids,
naphthalene, and phenothiazines.

Genetic Considerations; Epidemiological studies indicate that cataracts have strong genetic components.
Several loci have been identified for an autosomal dominant form of cataracts. Congenital cataracts occur
with galactosemia and these can appear within just a few days of birth. The specific genetic contributions
of the more common age-associated cataracts are still unclear. Ethnicity and race have no known effect
on the risk of cataracts.

Complications

Complications may include retinal disorders, pupillary block, adhesions, acute glaucoma, macular edema,
and retinal detachment. Following extracapsular cataract extraction, the posterior capsule may become
opacified. This condition, called a secondary membrane or after-cataract, occurs when subcapsular lens
epithelial cells regenerate lens fibers, which obstruct vision. After-cataract is treated by yttrium-aluminum-
garnet (YAG) laser treatment to the affected tissue. Without surgery, a cataract eventually causes
complete vision loss.

Assessment Nursing Care Plans For Cataract

Typically, the patient complains of painless, gradual vision loss. He may also report a blinding glare from
headlights when he drives at night, poor reading vision, and an annoying glare and poor vision in bright
sunlight. If he has a central opacity, the patient may report seeing better in dim light than in bright light,
because this cataract is nuclear and, as the pupil dilates, the patient can see around the opacity.
Physical examination. Cataract formation causes blurred vision, a loss measured by Use of the snellen
chart. Color perception of blue, green, and purple is reported as varying Shades of gray. If the cataract is
advanced, shining a penlight on the pupil reveals the white area Behind the pupil. A dark area in the
normally homogeneous red reflex confirms the diagnosis.

Treatment
Surgical lens extraction

Diagnoses that may occur in Nursing Care Plans For Cataract

 Anxiety
 Deficient knowledge (diagnosis and treatment)
 Disturbed sensory perception: Visual
 Risk for infection
 Risk for injury

Key outcomes Nursing Care Plans For Cataract

 patient and his family will voice their feelings and concerns.
 patient will verbalize understanding of the disease and treatment.
 patient will regain normal visual functioning.
 patient will show no signs or symptoms of infection.
 patient will avoid injury
 Body image; Safety behavior: Personal; Safety behavior: Fall prevention; Safety behavior: Home
physical environment; Anxiety control; Neurological status; Rest; Sleep

Interventions Nursing Care Plans For Cataract

 Postoperatively, monitor the patient until he recovers from the effects of the anesthetic. Keep the
side rails of the bed up, monitor vital signs, and assist him with early ambulation.
 Apply an eye shield or eye patch postoperatively as ordered
 Communication enhancement: Visual deficit; Activity therapy; Cognitive stimulation;
Environmental management; Fall prevention; Surveillance: Safety

Nursing Care Plans For Cataract Home Health:

 Caution him to avoid activities that increase intraocular pressure, such as straining with coughing,
bowel movements, or lifting
 Clients fitted with cataract eyeglasses need information about altered spatial perception. The
eyeglasses should be first used when the patient is seated, until the patient adjusts to the
distortion. Instruct the client to look through the center of the corrective lenses and to turn the
head, rather than only the eyes, when looking to the side. Clear vision is possible only through
the center of the lens. Hand-eye coordination movements must be practiced with assistance and
relearned because of the altered spatial perceptions.
 Teach the patient or family member how to instill ophthalmic ointment or drops.
 Driving, sports, and machine operation can be resumed when permission is granted by the eye
surgeon.
 If the patient has increased eye discharge, sharp eye pain , or deterioration in vision, instruct him
to immediately notify the physician.