 pupillary dilation

 relaxation of ciliary muscles

 pupillary constriction
 contraction of ciliary muscles
 PUPILLARY CONSTRICTION PUPILLARY DILATION
 contraction of Circular muscles  contraction of Radial muscles

 ↑ light intensity  ↓ light intensity

 Parasympathetic stimulation (CN III)  Sympathetic stimulation

 Pressure within the eyeball
 Normal: 10-20mmHg
 measures the client’s
distance & near vision
 simple tool to record
visual acuity
 Normal: 20/20
 numerator

 distance from chart

 denominator
 distance at which a

can read
 “patient himself”
 If 20/200
 the patient needs a distance
of 20 feet to read letters that
a person with normal acuity
could read at 200 feet

 “Legally blind”
 performed to examine
visual fields or peripheral
vision
 tests muscle function of the eyes
 tests 6 cardinal positions of gaze (“large capital-H”)
 Client’s right

 Upward & right

 Down & right

 Client’s left

 Upward & left

 Down & left

 Extrinsic Eye Muscles
Name Cranial Nerve Action

Lateral rectus Moves eye laterally

Medial rectus Moves eye medially
Superior rectus Elevates eye
Inferior rectus Depresses eye
Elevates eye
Inferior oblique
Turns eye laterally
Depresses eye
Superior oblique
Turns eye laterally
 tests for color vision which
involve picking numbers. or
letters out of a complex &
colorful picture
 tests for color vision which
involve picking numbers. or
letters out of a complex &
colorful picture
 Normal: round and equal size
 light causes pupillary constriction

 light causes pupillary dilation

 Client is asked to look straight ahead while the examiner quickly
brings a beam of light (penlight) in from the side and directs it
onto the side
 of the pupil in response to the light shining
into the eye

of the pupil in the eye

 detailed imaging &
recording of
after administration of the
dye
 allows examination of the
under microscopic
magnification

 the client leans on a chin rest to

stabilize the head while a narrow
beam of light is aimed so that it
illuminates only a narrow segment
of the eye
 a beam of x-ray scans the skull & orbits of the eye

 a cross-sectional image is formed by the use of a computer

 contrast material is not usually administered

 installation of a topical dye into the conjunctival sac to outline
the that are not easily
visible

 the eye is viewed through a blue filter

 (+) bright green color :
indicates areas of non-
intact corneal epithelium
 used to assess for an
increase in and
potential glaucoma

 each eye is anesthesized

then a flattened cone is
brought in contact with the
cornea
 client is asked to stare
forward at a point above
the examiner’s ear

 the amount of pressure

needed to flattened the
cornea is measured
 uses an ophthalmoscope
 an instrument used to

examine the retina and

vitreous chamber

 requires dilating the pupils

 examines internal and
external eye structures
 instillation of eye drops
the name, strength, & expiration date of the medication

; put on gloves (if applicable)

 Instruct the client to tilt the , open the eyes &

 instillation of eye drops
 Pull the

 Hold the bottle, gently rest

the

 Squeeze the bottle gently to

allow the drop to
 instillation of eye drops
 Instruct the client to close
the eyes gently & not to
squeeze the eyes shut

 Wait minutes before

instilling another drop, if
more than 1 is prescribed
 instillation of eye drops
 Don’t allow the medication
bottle, dropper, or
applicator to come in
contact with the eyeball
 instillation of eye ointment
 Hold the ointment tube
near, but not touching, the
eye or eyelashes

 Squeeze a thin ribbon of

ointment along the lining of
sac
from the
 instillation of eye ointment
 Instruct the client to
gently

 Instruct the client that

by
the ointment
 dilate the pupils (mydriasis)

 relax the ciliary muscles

 dilate the pupils

 block responses of the sphincter muscle in the ciliary body,

producing mydriasis
 replace tears or add moisture to the eyes

 moisten contact lenses or an artificial eye

 protect the eyes during surgery or diagnostic procedures

 used for keratitis, during anesthesia or in a disorder that results

in unconsciousness or decreased blinking
 constrict the pupil & contract the ciliary muscle
  IOP

  blood flow to the retina

  retinal damage & loss of vision

 open the anterior chamber angle

  outflow of aqueous humor

 secreted by the
 then flows between the
lens and the iris (“Angle”),
into the anterior chamber

 drain out of the eye via the

then
into
 Aqueous humor production =
Aqueous humor drainage
 characteristics:

 result of:
 inadequate drainage
of aqueous humor
from the canal of
Schlemm

 over production of
aqueous humor
 characteristics:
 classifications:
or

or

or
 MC

 due to an or
to the outflow
of aqueous humor

 can be hereditary

 bilateral
 insidious, in onset

 usually with

 no early clinical
manifestations present
 “thief of the night”
 medical emergency

 exit of the aqueous

humor fluid is suddenly
blocked
 Dilating eye drops may
trigger an acute glaucoma
attack
 etiology:
 age; degenerative changes

 Hypertension

 CV disease

 DM

 Obesity
 etiology:
 uveitis

 inflammation of the choroid (uvea)

 tumor in the eye or orbit

 chronic use of ophthalmic corticosteroids

 Japanese ancestry
 pathophysiology:

 due to:
of
aqueous humor

to
outflow (drainage) of
aqueous humor
 pathophysiology:

 pressure pushes the

optic nerve and retina at
the back of the eye
 manifestations:

 via Tonometry
 normal: 10 to 20 mmHg

(Close-angle)
 manifestations:
 blurring or loss of vision

 “tunnel vision”

 rainbow halos around

lights
 manifestations:
 blurring or loss of vision

 “tunnel vision”

 rainbow halos around

lights
 manifestations:

 d lacrimation

 corneal cloudiness

 turbid aqueous humor

 frontal headaches
 nursing management
 treat as

 administer as prescribed to lower IOP

 nursing management
 Instruct the client the importance of medications

 to constrict the pupils; to IOP

 to aqueous humor production

 to aqueous humor production

 nursing management
 Instruct the client the need for

 Instruct the client to wear

 Instruct the client to medications

 s IOP

 Instruct the client to report , around eyes &

to the physician
 nursing management
 if medical treatment has
failed, surgery

 allows aqueous
humor to flow from
the posterior to
anterior chamber
 nursing management
 if medical treatment has
failed, surgery

 to facilitate aqueous
humor drainage
 nursing management
 if medical treatment has
failed, surgery

 to facilitate aqueous
humor drainage
 nursing management
 if medical treatment has
failed, surgery

 allows drainage of
aqueous humor into
the conjunctival
spaces by the
creation of an
opening
 nursing management
 if medical treatment has
failed, surgery

 allows drainage of
aqueous humor into
the conjunctival
spaces by the
creation of an
opening
 an
 distorts the image
projected onto the retina

 can progress to blindness

 MC of blurring or loss of vision

 etiologies:
 Aging process ( )

 Inherited / Infection ( )

 Injury ( )

 as a result of another eye disease ( )

 risk factors:
 cumulative exposure to

 people who live in high altitudes

 people who work in bright sunlight (fishermen)

(Rubella)
 risk factors:
 chronic use of
 progression:
 lens is

can be
transmitted
 lens is
 proteins from
and
 proteins are engulfed by
macrophages

 obstruction of aqueous
flow
 glaucoma
 manifestations:

 cloudy/opaque lens

 vision is better in dim

light with pupil dilation
 manifestations:

 cloudy/opaque lens

 vision is better in dim

light with pupil dilation
 manifestations:

 d color perception

 reddish-orange
reflection from the eye's
retina observed when
using an
ophthalmoscope
 surgical management:
 there is
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an
(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 surgical management:

 the lens is broken up by

ultrasonic vibrations &
extracted

 then an introcular lens

(IOL) is inserted
 post-op nursing care:
30 to 45 degrees

 position the client’s personal

 maintain an for 24 hours and orient the client to the

environment

 use for safety

 post-op nursing care:
 instruct client to regularly wear

even at bedtime
 to preventive accidental

injury

 to prevent patient from

rubbing eye
 post-op nursing care:
 avoid rapid movements, straining, sneezing, coughing, bending,
vomiting, or lifting heavy objects (> 5lbs) in the early post-op
period
 s IOP

 prevent constipation

 wipe excess drainage or tearing with a sterile wet cotton ball

from the
 post-op nursing care:

 s IOP

 Take prescribed ( )

 contact the MD for any , or

 *
 layer with blood vessels

 when retina detaches, it is

deprived from blood and
nutrients
 may be due to:

between retina and choroid

 a
 risk factors:
 aging; retinal degeneration

 previous eye operations

 trauma

 severe myopia

 family history
 risk factors:
 DM retinopathy
 manifestations:
or
across the field of
vision
 shadows or black areas

in field of vision

of a portion in
the visual field
 blindess may occur in

large tears
 manifestations:

 bright

or in
field of vision
 sign of bleeding
 nursing management:
 Provide

with patches to prevent further detachment

to the client

the client’s head as prescribed

the client from injury

 nursing management:

the client for surgical procedure as prescribed

 there is no known medical treatment for retinal detachment;
 surgical management:
 draining fluid from the sub-retinal space so that the retina can
return to the normal position
 surgical management:

 burns and seals small

retinal tears before the
detachment occurs
 surgical management:

 uses nitrous oxide to

freeze tissue behind
retinal tear
 stimulates scar tissue

formation that seals

the tear
 surgical management:

 injection of a gas bubble

into the vitreous body
 pushes the tear

against the choroid

 surgical management:

 holds the choroid &

retina together with a
splint until scar tissue
forms
 post-op nursing care:
 maintain and observe for 24 hours

 monitor

 strict

 proper
for several days
 provide pillows to stomach, elbows, or ankles
 post-op nursing care:

 monitor for sudden, sharp (notify the MD stat)

 encourage DBE but

 s IOP

client with ADL

 post-op nursing care:
or anything that increases IOP

 instruct the client to for 3 to 5 weeks

 instruct client to
from the waist
 s IOP

should be worn through out the day

 including during sleep
 post-op nursing care:
 encourage because of the danger of recurrence
or occurrence in the other eye

for several weeks

 gas bubble may expand at high altitudes
 post-op nursing care:
 administer eye medications as prescribed

 s inflammation

 dilate pupils
 relax ciliary muscles
 s discomfort
 Which nursing intervention is not carried out to a post-op patient
from retinal detachment?

 A. TCDB
 B. No air travel
 C. Eye shield
 D. Bed rest
 a person is legally blind if :
 best visual acuity is 20/200 or less with corrective lenses in the
better eye

 visual field is 20 degrees or less in the better eye

 nursing management:
 use a of voice

the client

the client to the environment

 allow the client to in the room

 nursing management:
 promote as much as possible

 provide radios, TVs, and clocks that give the

 when ambulating, allow the client to

 the nurse keeps his or her arm close to the body so that the
client can detect the direction of movement
 nursing management:
 Instruct the client to remain the nurse when
ambulating

 instruct the client in the use of the

 the cane is held in the several inches off the
floor
 the cane sweeps the ground where the client’s foot will be

placed next to determine the presence of obstacles

 MC cause of visual loss in older
individuals

 common among individuals

 but can occur as early as 50

years old

 exact cause in
 may be hereditary
 accelerates the
progression of the disease

visual loss
 management:
 high doses of , , and
 may delay progression of AMD and vision loss

 same as Legally-blind
 eyes are not aligned because of of the
EOMs
 prevents bringing the gaze of each eye to the same point

 normal in young infant but should not be present after about age
4 months
 types:

 eye deviates inwards

(medial)

 eye deviates outwards

(lateral)
 most often results from:

 due to CN lesion

such as:
 brain tumor
 myasthenia gravis
 infection
 manifestations:
or
(3-D)

or to see
 dxtics:

 performed by shining a
light in the person's eyes
and observing where the
light reflects off the
corneas
 dxtics:

 normal:
 the light falls on the
center of the pupil

:
 light falls medial or
lateral to the center
of the pupil
 nursing management:
 Instruct the parents regarding ( ) of
the “good” eye
 to strengthen the weak eye

 ideally done
 delay can cause permanent vision problems
 nursing management:
 Corrective lenses as indicated

 due to  visual acuity

 Prepare for as prescribed

 if nonsurgical interventions are unsuccessful
 medical management:
(Botox) may also be used
 toxin is injected in the stronger muscle

 produces temporary paralysis

 physically similar to Strabismus

 caused by either
through the optic nerve to the for a sustained period
in the brain
 brain is , and develops abnormally
 manifestations, dxtics, and nursing management are similar to
Strabismus
 (‘pinas)

 inflammation of the conjunctiva

 usually caused by:

 viruses (MC)

 bacteria
 usually caused by:

 usually due to:

 contact lenses

 cosmetics

 allergies from other parts of the body (atopic dermatitis

or asthma)
 manifestations:
(allergy) or
(infection or
trauma) on the eyelids

 watery (viral)
 mucopurulent
(bacterial)
 manifestations:

 slight
 nursing management:
 Instruct in infection control measures such as

 do not sharing towels and washcloths

 Instruct the patient to , more so the eye

 to prevent further spread of infection and injury

with others ( )
 especially if it is due to an infection
 nursing management:
 instruct in the use of to lessen irritation

 wearing
 s photophobia

 prevent the patient from touching his eyes

 Avoid the use of contact lenses until infection has cleared

current contact lenses and cosmetics

 to eliminate the chance of re-infection
 nursing management:
 Administer ophthalmic solutions
 the presence of

 occurs as a

 condition usually in
5 to 7 days
 nursing management:
 Encourage rest in position

for 3 to 5 days to decrease

bleeding

 Administer eye drops as prescribed

 to place the eye at rest
 nursing management:
 Instruct in the use of as prescribed

 Instruct the client to

 as
a result of an

 causes a “ ”
 the discoloration disappears

in approximately 10 days

 pain, photophobia, edema &

diplopia may occur
 nursing management:
 Place on the eye

 Instruct the client to receive an

 inflammation of the eyelids

 usually due to:

 bacterial infection

 seborrhea (dandruff) on

the scalp or eyebrows

 and on the lid
margins

or of lid
margins
 bacterial infection of the
of the
eyelid

and on the lid

margins

 sensation of in
the affected eye
 or of the eyelid

 may follow a hordeolum

that was inadequately
treated
 often and

 requires removal because it

slowly increases in size
 management:
 Topical (eye drops or ointment)

with a “no-tears” baby shampoo, water, and

cotton-tipped applicator

 Soaking the lids with

 to remove crusts in Blepharitis
 management:

 for hordeolum and chalazion

 if everything fails,
 an object such as dust that enters the eye
 nursing management:
 have the client look upward, expose the lower lid, wet a cotton-
tipped applicator with sterile NSS and gently twist the swab over
the particle to remove it
 nursing management:
 If the particle cannot be
seen, have the client look
downward, place a cotton
applicator horizontally on
the outer surface of the
upper eye lid, grasp the
lashes, and pull the upper
lid outward and over the
cotton applicator, if the
particle is seen, gently twist
over it to remove
 an eye injury in which a caustic substance enters the eye
 nursing management:
 Treatment should begin STAT

 Flush the eyes with running

water for at least 15 to 20
minutes

 At the site of injury, obtain a

small sample of the chemical
involved
 nursing management:
 At the ER, the eyes are
irrigated with NSS or an
ophthalmic irrigation
solution