Eye and

Vision
disorders
 Effect of Visual impairments

Vision loss usually has significant effect on all areas of

person’s life. Mild losses may require only some
adaptation. More serious losses affect independence,
mobility, employment, interpersonal relationships,
pleasure in seeing the people and things a person
treasure is lost.

The loss of vision triggers a grief response. Reaction

that are likely to follow loss of vision include shock,
denial, anger, bargaining, and depression.
 Nursing Care of the Visually Impaired Person
To work with visually impaired, you need to to be aware
of their thoughts and feelings about visual handicaps.
Although some visually impaired people are unable to
see at all, many others have partial vision. Therefore it is
more likely to use term such as visual impairment or
visually handicapped rather than blind.

Assume that people with visual impairments can be

independent and productive. Pity has no place in this
situation because it encourage hopelessness and
helplessness. The person needs help with some task but
should still be treated as an adult. The extent of vision
loss determines the types of assistance that might be
needed.
 Intervention
1. When you enter the room announce your presence and introduce yourself to avoid startling
or embarrassing the patient.
2. Speak before touching the patient to avoid starting the patient.
3. Speak in a normal tone.
4. Address the patient in the appropriate manner for his or her age and intellectual ability.
(visual impairments is not associated with mental impairment).
5. Advise the patient what to expect during procedures.
6. Tell the patient when you leave the room.
7. Leave the bed in low position.
8. Place the call bell within reach and be sure the patient knows how to use it.
9. Keep doors either open or closed so that the ambulatory patient does not run into a partially
closed door.
10. Do not rearrange the room after orienting the room.
11. Eliminate meaningless noise from the environment as much as possible.
12. Make sure patient can locate personal items and use bathrooms.
13. Tell the patient if any new equipment or furniture is brought into the room.
14. Keep pathways in the room free from clutter.
15. For patients who are partially sighted, lightning is very important, glare must be
reduced because it interferes with vision. Windows should have adjustable shades, blinds,
or sheers.Floor should not be highly polished.
16. Do not encourage dependence during hospitalization.
Ask the patient what assistance is required instead of assuming the help is needed.
17. To escort the visually mpaired
person, allow the person to grasp
your upper arm. To enter a narrow
passage or doorway, bring your
arm behind your back to alert the
person.
 Disorder affecting the eye or vision

External Eye Infections:

Blepharitis:
Blepharitis is a common eye condition that
involves inflammation of the eyelids. It
usually affects the eyelash follicles and the
glands that produce oil to lubricate the eyes.
Untreated blepharitis could lead to
inflammation of the cornea or hordeolum
(stye).
Sign and symptoms: redness, itching, swelling, and flaking of the eyelids, photopobia, crusting along
the eyelid margins, eyelids are sealed shut by dried crust on awakening.

Treatment:
Topical Antibiotics, Topical Steroids, Oral Antibiotics, Lubricating Eye Drops or Ointments, Anti
inflammatory Medications, Omega-3 Fatty Acid Supplements
Antifungal Medications.

Nursing intervention:
1. Patient Education, Explain the Condition.
2. Demonstrate Eyelid Hygiene
3. Warm Compresses, Instruct on Proper Application
4. Eyelid Massage, Demonstrate Technique:
5. Medication Management, Explain Medication Usage
Hordeolum is commonly called a stye. It is a
common acute staphylococci infection of the
eyelid margin that originates in lash follicle. It
typically appears as a small, red, swollen, tender
bump near the edge of the eyelid, often
resembling a pimple or boil.

The primary treatment is the application of warm

moist compresses several times a day. If a
person has repeated infection, then these may be
related to staphylococcal infections at some
other location on the body.
The physician attempts to locate any other infection
and may order the hordeolum treated with
ophthalmic antibiotic agents.
Chalazion is a non-infectious, painless, and usually
non-cancerous lump or cyst that forms within the
eyelid. It occurs when an oil gland (meibomian
gland) becomes blocked and the oil accumulates,
causing a swelling.

Signs and Symptoms:

Swelling on the eyelid, often near the edge.
Tenderness or mild discomfort.
A small, round bump on the eyelid.
Treatment:
Warm Compresses: Apply warm compresses to the affected eye for about 10-15 minutes, several
times a day. This can help soften the oil and encourage drainage.
Topical Antibiotics (if prescribed): In some cases, a healthcare provider may recommend topical
antibiotics to prevent infection.
Steroid Injections: For larger or persistent chalazia, a healthcare provider might inject a steroid to help
reduce inflammation and promote healing.
Surgical Incision and Drainage: If the chalazion doesn't respond to other treatments, a minor surgical
procedure may be performed to open and drain it. This is typically done in an office setting.
Oral Antibiotics (in rare cases): If there's a secondary bacterial infection, oral antibiotics may be
prescribed.
Conjunctivitis, commonly known as pink eye, is
an inflammation of the conjunctiva, the clear
tissue covering the front of the eye and lining
the inside of the eyelids. It can be caused by
viruses, bacteria, allergens, or irritants.
Signs and Symptoms:
Redness in the whites of the eyes itchy or gritty
sensation in the eyes.
Watery or mucous discharge from the eyes.
Swelling of the eyelids.
Sensitivity to light.
Blurred vision (in some cases).
Treatment:
Viral Conjunctivitis: Usually resolves on its own within
a week or two. Cold compresses can help alleviate
discomfort.
Bacterial Conjunctivitis: May require antibiotic eye
drops or ointment prescribed by a healthcare
professional.
Allergic Conjunctivitis: Antihistamine eye drops or oral
antihistamines can be used to alleviate symptoms.
Avoiding allergens is also important.

Nursing Interventions:
Infection Control if it's caused by bacteria or viruses.
Warm Compresses
Educate on Hygiene
Provide Comfort Measures
Keratitis is inflammation or infection, or both, of the
cornea. The structure of the cornea makes it especially
vulnerable to injury. The portion of the cornea in front
of the pupil has no blood vessels because it must
remain transparent. This means that it has no direct
blood supply, making it vulnerable to infections.

Sources of infection include bacteria, viruses, and

fungi. In addition, chemical or mechanical injuries
cause inflammation that may be followed by infection.
If scar tissue forms, then that portion of the cornea
becomes cloudy and vision is impaired. In addition,
the infection can extend to the inner structures of the
eye. Serious lesions can rupture if the eye is rubbed.
Prompt treatment of keratitis therefore is very
important to preserve vision.
Signs and Symptoms:

Eye Redness
Eye Pain or Discomfort
Blurry Vision
Excessive Tearing or Discharge
Foreign Body Sensation
Swelling of the Eyelids

Treatment:
Antibiotic agents
Topical cortico-steroid agents
Systemic antibiotic agents(may be ordered after culture and sensitivity results are obtained) Sometimes the
physician injects antibiotic agents directly into the conjunctiva. Topical anesthetic agents are not used
because the patient might accidentally cause additional injury to the anesthetized cornea. Eye pads are not
used with keratitis because they provide a dark, damp environment for microorganisms to grow.
Interventions
Comfort Measures: Assist with applying warm
compresses or providing pain relief as directed by the
healthcare provider.

Maintaining a Sterile Environment: Ensure a clean

environment to prevent further contamination or spread
of infection.

Educating on Preventive Measures: Provide guidance

on how to prevent future episodes of keratitis, such as
proper contact lens hygiene.
Entropion and Ectropion
Proper closure of the eyelids is important to
protect the eye and keep the cornea moist.

Entropion is a condition in which the lower lid

turns inward. Eye- lashes rub against the eye,
causing pain and possibly scratching the
cornea. Surgical correction usually is
recommended.
Risk Factors: Treatment Options:
1. Aging. The natural aging process can lead to 1. Surgery
weakening of the eyelid muscles and tissues. 2. Botox Injections
2. Previous Eye Surgery or Injury. Prior eye 3. Temporary measures. Lubricating
surgeries or injuries can alter the anatomy of eye drops or ointment can help
the eyelid. provide relief from irritation and
3. Eyelid spasms or Twitches. Conditions like prevent further damage to the eye
blepharospasm, which causes involuntary surface.
eyelid contractions.
4. Scarring. From burns, infection or other eye
conditions can lead to changes in eyelid
structure.
5. Congenital Abnormalities.
Ectropion is a condition in which the
lower lid droops and turns outward. The
eye does not close completely, causing it
to become dry and irritated. The dry
cornea is easily injured. Like entropion,
ectropion requires surgical correction.
Risk Factors:
1. Aging. The natural aging process can lead to
weakening of the eyelid muscles and tissues.
2. Previous Eye Surgery or Injury. Prior eye
surgeries or injuries can alter the anatomy of
the eyelid.
3. Skin Conditions. Dermatitis or skin cancer,
can affect the eyelid’s structure.
4. Facial Paralysis. Bell’s palsy which causes
facial muscle weakness or paralysis.
5. Congenital Abnormalities.
Treatment Options:
1. Surgery
2. Temporary measures. Lubricating
eye drops or ointment can help
provide relief from irritation and
prevent further damage to the eye
surface.
Eye injury
Eye conditions that warrant immediate
attention include presence of foreign bodies,
chemical contact, perforation of the globe, and
eyelid trauma.

Assessment:
After an injury of the eye, inspect the patient’s
eyelid for trauma and the eye itself for redness,
foreign bodies, or penetrating objects. If the eye
has been exposed to an irritant, attempt to
determine what the substance is.
 Interventions for Specific Eye Injuries:
Type of injury: Foreign Bodies
Emergency intervention:
If not embedded: Remove by
irrigation or by gently touching
the object with the corner of a
clean cloth or gauze pad or a
moistened cotton-tipped
applicator.
Embedded foreign bodies should
be removed only by a physician.
 Interventions for Specific Eye Injuries:
Type of injury: Chemical contact Emergency intervention:
Immediately flush the eye for 30
minutes. Sterile normal saline or
clean water is ideal. Direct the
irrigating fluid to flow from inner
canthus to outer cantus of the eye.
Even if the flushing seems to reveal
all symptoms, the patient should be
examined by a physician to assess the
eye for injury.
 Interventions for Specific Eye Injuries:
Type of injury: Perforation of globe
Emergency intervention:
Do not attempt to remove an
object that has perforated the
eye! You could cause additional
harm. Instead, limit movement
of the object and the eye, and
transport the victim for
immediate medical care. Protect
the injured eye by covering it
with shield that does not touch
the object.
 Interventions for Specific Eye Injuries:
Type of injury: Eye trauma Emergency intervention:

Seek medical evaluation because

injury of the globe, as well as the
lid, is always possible. Do not
apply direct pressure to a
bleeding eyelid. If the globe has
been injured, pressure could
cause additional harm. Apply a
loose dressing, and transport the
victim for medical care.
Corneal opacity refers to a condition where the
cornea, the clear front surface of the eye,
becomes cloudy or opaque, caused by infection
or trauma, scar tissue may form. This can
obstruct the passage of light into the eye,
leading to vision impairment.

Signs and Symptoms:

1. Cloudiness or haziness in the cornea.
2. Blurred or distorted vision.
3. Sensitivity to light.
4. Pain or discomfort in the affected eye.
5. Redness or inflammation of the eye.
Treatment:
Corneal Transplant (Keratoplasty): In severe cases, where vision is significantly impaired, a corneal
transplant may be recommended. This involves replacing the damaged cornea with a healthy donor
cornea.
Specialized Contact Lenses: In some cases, specialized contact lenses may be used to improve
vision by masking the opacity or providing a better refractive surface.

Interventions
1. Advise the patient to avoid any activities that increase pressure in the eye, including rubbing the
eye, bending, lifting, straining a stool(administer stool softener), coughing and report and promptly
treat nausea.
2. Instruct patient to wear shield for several weeks while sleeping to prevent accidental trauma.
3. Rejection of corneal grafts is not common, but it can happen, patient should know thay symptoms
of rejection include redness, swelling, decrease vision and pain(corticosteroids drops reduce
inflammation and risk of rejection).
4. The patient should be informed that it takes some time for the grafted eye to achieve clear vision.
They should be reassured that this is a normal part of the recovery process
 Errors of Refraction
Myopia – (Nearsightedness) is a refractive
error in the eye that causes distant objects
to appear blurry while close objects can
be seen clearly. In myopia, the lens is
situated too far from the retina.It is often
recognized in the early school years.
Typically, the conditions slowly progress
until adolescence.
Signs and Symptoms:
1. Blurred vision looking at distant.
2. Difficulty seeing clearly while driving
especially at night.
3. Squinting or straining the eyes to see
distant objects.
4. Frequent headaches, especially after
activities that require focusing on
distant objects.
Treatment Options:
1. Corrective lenses (Glasses or Contact
lenses).
2. Refractive Surgery. LASIK or PRK
reshape the cornea to correct vision.
3. Orthokeratology (Oryho-K) specialized
contact lenses are worn overnight to
reshape the cornea temporarily.
4. Atropine Eye Drops. Used in some
cases especially for child to slow down the
progression of myopia.
Nursing Intervention:
1. Provide information about the condition, treatment
options, and the importance or regular eye check ups.
2. Assisting with corrective devices.
3. Ensure the patient follows their prescribed treatment
plan, including regular follow-up appointments with an
ophthalmologist.
4. Promoting eye health. Educate patient on proper
practice like proper lighting, taking breaks during close
work, maintaining a balanced diet for over all eye
health.
Hyperopia - (Farsightedness) when the lens
is too close to the retina causing light rays
to focus behind the retina rather than on
it. The hyperopic person sees clearly in
distance but has difficulty focusing on
close objects. It can be present from birth
or develop later in life.
Signs and Symptoms:
1. Blurred vision when looking at close
objects.
2. Difficulty with tasks like reading,
writing or using a computer.
3. Eye squinting or discomfort,
especially after prolonged close-up
work.
4. Squinting in an attempt to see more
clearly.
Treatment Options:
1. Corrective lenses (Glasses or Contact
lenses).
2. Refractive Surgery. LASIK or PRK can
be performed to reshape the cornea and
correct vision.
Nursing Intervention:
1. Provide information about the condition, treatment
options, and the importance or regular eye check ups.
2. Assisting with corrective devices.
3. Ensure the patient follows their prescribed treatment
plan, including regular follow-up appointments with an
ophthalmologist.
4. Promoting eye health. Educate patient on proper
practice like proper lighting, taking breaks during close
work, maintaining a balanced diet for over all eye
health.
Astigmatism is a common
refractive error of the eye. It
occurs when the cornea or lens
is irregularly shaped, leading to
blurred or distorted vision at
various distances.
Signs and Symptoms:
1. Blurred or distorted vision.
2. Difficulty seeing clearly at night.
3. Eye strain or discomfort.
4. Headaches, especially after prolonged visual tasks.
5. Squinting to see clearly.

Treatment:
1. Prescription Eyeglasses or Contact Lenses: Corrective lenses are the most common and effective
way to manage astigmatism. They help compensate for the irregular shape of the cornea or lens.
2. Refractive Surgery: Procedures like LASIK or PRK can reshape the cornea to correct astigmatism.
However, not everyone is a candidate for these surgeries.
3. Toric Lenses: These specialized contact lenses are designed for astigmatism correction. They have
different powers in different meridians to address the irregular shape of the eye.
Presbyopia is a common age-related
condition that affects a person's
ability to focus on close objects. It
typically becomes noticeable in the
early to mid-40s.

Signs and Symptoms:

1. Difficulty reading small print or
fine details up close.
2. Needing to hold reading
materials at arm's length to see
them clearly.
3. Eye strain or discomfort when
performing close-up tasks.
4. Blurred vision at a normal
reading distance.
Treatment:
1. Reading Glasses
2. Bifocal or Multifocal Lense
3. Contact Lenses
4. Refractive Surgery

Nursing Responsibilities:
1. Patient Education
2. Assisting with Corrective Devices
3. Monitoring and Reporting
4. Support and Encouragement
5. Educating on Proper Eyecare
6. Assisting with Refractive Surgery Preparations
 Internal Eye Disorders
Cataracts

Cataracts are a vision condition where

the eye's lens became cloudy(opacity),
causing blurred vision, sensitivity to
light, and difficulty with daily tasks.
They're often linked to aging but can also
result from injury or medical conditions.
Treatment involves surgery to replace the
cloudy lens with an artificial one.
 Types:

A P 1. Nuclear Cataracts: These form in the center (nucleus)

of the lens and are typically associated with aging.

2. Cortical Cataracts: These start on the outer edges of

the lens and gradually work their way toward the center
in a spoke-like fashion. They can cause glare and
difficulty with contrast.

3. Posterior Subcapsular Cataracts: These form at the

back of the lens, often progressing faster than other
types. They can cause problems with reading and glare.
4. Congenital Cataracts: These are present at birth or develop during
childhood due to genetic factors, infection, or injury during
pregnancy.

5. Traumatic Cataracts: These can develop after an eye injury and

may not appear until months or years after the incident.
 Signs and Symptoms:
1. Blurred or Hazy Vision
2. Difficulty Seeing in Low Light
3. Sensitivity to Glare and Bright Lights
4. Frequent Changes in Eyeglass Prescription
5. Halos Around Lights
6. Double Vision in One Eye
7. Difficulty with Night Driving
8. Colors Seem Faded or Yellowed
9. Difficulty Reading or Performing Close-Up Work
 Risk factors:
1. Age (5th- 6th decade of life)
2. Family History
3. Certain Diseases and Conditions (diabetes, hypertension, obesity,
previous eye inflammation)
4. Eye Injuries or Surgeries
5. Excessive Sun Exposure
6. Smoking and Alcohol Use
7. Prolonged Use of Corticosteroids
8. Radiation Exposure (cancer treatments)
9. Congenital Factors
 Diagnosis:
Slit-Lamp Examination: An ophthalmologist uses a special
microscope with a bright light to examine the front and back of your
eyes, including the lens.

Glow Test: Using a special instrument, the doctor can observe any
changes in the reflection of light in the eye, which may indicate the
presence of a cataract.

Contrast Sensitivity Test: This assesses your ability to differentiate

between light and dark contrasts, which can be affected by cataracts.

Visual Field Test: This checks your peripheral vision, which can be
impacted by advanced cataracts
 Medication:
Antibiotic Eye Drops: These are used to prevent or treat
any potential bacterial infections that could occur after
surgery.

Anti-Inflammatory Eye Drops: These help reduce

inflammation and promote healing in the eye following
surgery.

Steroid Eye Drops: These are a type of anti-inflammatory

medication that can help control inflammation and reduce
the risk of complications.

Artificial Tears or Lubricating Eye Drops: These help

keep the eye moist and comfortable during the healing
process.
 Surgical treatment:
Phacoemulsification: The primary surgical treatment for cataracts is called
phacoemulsification. This is the most common and widely used method for cataract
removal.
Incision: A small incision (usually less than 3 millimeters) is made on the cornea's
surface.
Ultrasound Emulsification: A tiny ultrasonic probe is inserted into the eye through the
incision. This probe uses high-frequency sound waves to break up the cloudy lens into
small fragments.
Suction and Removal: The emulsified lens fragments are gently suctioned out of the eye.
IOL Implantation: An artificial intraocular lens (IOL) is inserted into the same position
where the natural lens was located. This artificial lens remains in the eye permanently and
helps focus light onto the retina.
Self-Sealing Incision: In most cases, the incision is designed to be self-sealing,
eliminating the need for stitches.
Extracapsular Cataract Extraction
(ECCE):

This technique involves a larger incision and

manual removal of the cloudy lens, leaving
the back portion of the lens capsule intact.
ECCE is less commonly used today due to
advancements in phacoemulsification.
Manual Small Incision Cataract
Surgery (MSICS):

Similar to ECCE, MSICS uses a larger

incision, but it is smaller than in ECCE.
It's often used in regions where access to
high-tech equipment may be limited.
Intervention:
After surgery
1. To prevent accidental rubbing or poking the eye, the patient wears a protective eye patch for
24 hours after surgery.
2. In terms of how long it take to get their best vision, that usually happens around 4 to 6
weeks.
3. Eye drops, use several times a day you need to reinforce the importance of maintaining that
schedule.
4. Wear dark eye sunglasses when they go outside.
5. Avoid activities or things that can an increase in intraocular pressure ( bending, pushing,
sneezing, coughing, blowing their nose, avoiding straining with bowel movements.
6. Always wash hands before touching or cleaning the postoperative eye.
7. Clean postoperative eye with a clean tissue, wipe the closed eye with a single gesture from
the inner canthus outward.
8. Avoid lying on the side of the affected eye the night after surgery.
9. Slight morning discharge, some redness, and a scratchy feeling maybe expected for a few
days.
10. Cataracts surgery increase the risk for retinal detachment, the patient must know to notify
the surgeon if new floaters (dots) in vision, flashing lights, decrease in vision, pain or increase
in redness occurs.
11. Be careful when climbing or descending stairs.
12. Know when to call physician.
 Glaucoma

Glaucoma- is an eye condition or disorder, that are

usually due to intraocular pressure or IPO, which
damages the optic nerve and if left untreated can
lead to vision loss or blindness.
It is one of the leading causes of irreversible
blindness in the world. Glaucoma often develops
slowly and without noticeable symptoms until it
reaches an advanced stage. The most common
types of glaucoma are open-angle glaucoma and
angle-closure glaucoma, and they can have
different signs and symptoms:
 Glaucoma

Within the eye there is actually fluid called aqueous humor, that acts like blood of
the eye it supplies energy and nutrients to the eye.
Aqueous humor is generated inside the eye by the ciliary body, and the ciliary
body constantly generating this fluid.
Glaucoma

The production rate should be equal to drainage

rate, if not there will be an increase pressure in
the eye, which can lead to glaucoma.
The normal eye pressure is 10 – 21 mmHg

Normally in a healthy eye this fluid flow from

ciliary body, posterior chamber of the eye,
pupil, iris, anterior chamber of the eye, and
drains through trabecular meshwork,
schelmm’s canal.
 2 Types of Glaucoma
Open-Angle Glaucoma:
This is the most common form of glaucoma. It
occurs when the drainage angle within the eye
is open but becomes less efficient over time,
leading to increased intraocular pressure.
Symptoms: Often progresses slowly without
noticeable symptoms until advanced stages.
Symptoms may include gradual loss of
peripheral vision, tunnel vision, and difficulty
adapting to low light conditions.
Risk Factors: Family history of glaucoma,
Ethnicity people of African, Afro-Caribbean,
and Asian descent, age (more common in older
individuals, age after 60), certain medical
conditions like pressure, previous eye injuries,
and high intraocular pressure.
Angle-Closure Glaucoma (Acute Glaucoma):
This is less common but can be more severe. It occurs
when the drainage angle in the eye becomes blocked
suddenly, causing a rapid increase in intraocular
pressure.

Symptoms: Often presents suddenly and can be very

painful. Symptoms may include severe eye pain, blurred
vision, halos around lights, sudden onset of headaches,
and redness in the eye.

Risk Factors: Gender women are more common,

family history, can occur at any age, but it is more
commonly seen in older individuals. It often occurs in
people over the age of 40, certain eye anatomical
features also contribute, hyperopia.
 Diagnosis
Tonometry: This measures the pressure inside the eye. Elevated intraocular pressure (IOP) is a common
indicator of glaucoma, although not everyone with high pressure develops the condition.

Ophthalmoscopy: This involves examining the optic nerve at the back of the eye. Changes in the
appearance of the optic nerve, such as cupping or thinning, can be indicative of glaucoma.

Perimetry (Visual Field Test): This test assesses your peripheral vision. It helps detect any loss of
vision, which is a key sign of glaucoma.

Gonioscopy: This examines the drainage angle of the eye to determine if it's open or closed. This
information is crucial in differentiating between different types of glaucoma.
Optical Coherence Tomography (OCT): This is a non-invasive imaging test that
provides detailed images of the optic nerve and the retinal nerve fiber layer. It helps
assess structural changes related to glaucoma.

Corneal Hysteresis Measurement: This measures the cornea's ability to absorb and
return energy, providing additional information about its biomechanical properties.

Angle Assessment: This evaluates the drainage angle of the eye, which is crucial in
diagnosing different types of glaucoma.

Evaluation of Visual Acuity: This assesses how well you can see at various distances
using an eye chart.

Assessment of the Anterior Chamber Angle: This helps determine if the angle where
the iris meets the cornea is open or closed.
 Medication

Prostaglandin Analogs: These eye drops increase the outflow of fluid from the
eye, effectively reducing IOP. Common examples include latanoprost,
bimatoprost, and travoprost.

Beta-Blockers: These eye drops decrease the production of aqueous humor, the
fluid inside the eye. Timolol is a well-known example.

Alpha Agonists: These eye drops both reduce fluid production and increase
drainage. Brimonidine is a common medication in this class.
Carbonic Anhydrase Inhibitors: Available as eye drops or pills, these medications
decrease the production of aqueous humor. Dorzolamide and brinzolamide are
common eye drop forms, while acetazolamide and methazolamide are available as
oral tablets.

Miotics (Cholinergic Agonists): These eye drops work by increasing the outflow of
aqueous humor. Examples include pilocarpine and carbachol.

Rho Kinase Inhibitors: Medications like netarsudil work by increasing the outflow
of aqueous humor.

Combination Medications: Some glaucoma patients may use eye drops that
combine two different types of medications to improve IOP control.
 Surgical treatment:
Trabeculectomy: In this procedure, a small flap is created in the white of the eye (sclera) to
create a drainage channel for aqueous humor to flow out, reducing IOP.

Glaucoma Drainage Implants (Tube Shunt or Seton):

A small tube is implanted in the eye to divert aqueous humor to a reservoir (plate) situated on
the surface of the eye. This helps regulate IOP.

Minimally Invasive Glaucoma Surgery (MIGS):

MIGS procedures are less invasive than traditional surgeries and aim to improve aqueous
outflow. Examples include trabecular micro-bypass stents and endocyclophotocoagulation
(ECP).
Cyclophotocoagulation:
This laser procedure treats the ciliary body, which produces aqueous humor. By reducing its
ability to produce fluid, IOP is lowered.
Laser Peripheral Iridotomy (LPI) or Iridectomy (LPE): These laser procedures create a small opening
in the iris to improve fluid drainage in angle-closure glaucoma.

Cyclocryotherapy: This is a freezing treatment that reduces the production of aqueous humor by
freezing part of the ciliary body.

Trabeculoplasty (Selective or Argon Laser): This laser treatment helps increase fluid outflow by
treating the trabecular meshwork, the eye's drainage system.

Canaloplasty: This procedure uses a microcatheter to dilate the Schlemm's canal, enhancing the eye's
natural drainage system.

Viscocanalostomy: A gel-like substance is used to dilate the Schlemm's canal, allowing better drainage
of aqueous humor.
 Interventions
1. Education and Information
2. Medication Management
3. Assessment of Visual Function
4. Intraocular Pressure Monitoring
5. Assist with Diagnostic Tests
6. Provide Emotional Support
7. Encourage Compliance
8. Stress Promote Lifestyle Modifications
9. Monitor for Side Effects
10. Provide Comfort Measures
11. Preoperative and Postoperative Care (if applicable)
12. Monitor for Signs of Complications
 Retinal Detachment

Retinal detachment
Is a serious eye condition where the retina, a layer at the
back of the eye responsible for processing visual
information, pulls away from its normal position. This can
lead to vision loss if not treated promptly. It's often
described as seeing a "curtain" or "shadow" in your field of
vision. Immediate medical attention is crucial to prevent
further damage. If you suspect you have a retinal
detachment, seek professional help right away.
 Types
1. Rhegmatogenous Retinal Detachment: This is the most common type, occurring when a tear
or hole forms in the retina. This allows fluid to accumulate underneath, leading to detachment.

2. Tractional Retinal Detachment: This type is caused by scar tissue on the retina, which pulls
it away from the underlying layers.

3. Exudative (or Serous) Retinal Detachment: This occurs when fluid collects underneath the
retina without a tear or hole. It's often related to conditions like age-related macular
degeneration or certain inflammatory disorders.

4. Combined Retinal Detachment: This is a combination of both rhegmatogenous and

tractional detachments, where there's a tear or hole along with traction from scar tissue.
 Signs and Symptoms

1. Sudden Floaters or Flashes

2. Shadow or Curtain Effect
3. Blurred Vision
4. Reduced Peripheral Vision
5. Sensation of a Veil or Cobweb
6. Straight Lines Look Wavy
 Risk factors
1. Aging (40+)
2. Previous Retinal Detachment
3. Family History
4. Severe Myopia (Nearsightedness)
5. Eye Surgery or Trauma
6. Thin Retina
7. Certain Eye Conditions
8. Diabetic Retinopathy
9. Eye Tumors
10. Inflammatory Eye Disorders
 Diagnosis
1. Ophthalmoscopy: This involves a thorough examination of the eye's interior
using a specialized instrument called an ophthalmoscope. It allows the doctor to
view the retina and look for signs of detachment.

2. Ultrasound Imaging: This technique uses high-frequency sound waves to

create images of the eye's interior. It can be especially useful if the retina is
difficult to see directly due to bleeding or cloudiness.

3. Optical Coherence Tomography (OCT): This is a non-invasive imaging test

that uses light waves to capture high-resolution cross-sectional images of the
retina. It helps in assessing the thickness and condition of the retina.
4. Visual Field Testing: This evaluates your peripheral vision. A loss in peripheral vision can
be indicative of retinal detachment.

5. Slit-Lamp Biomicroscopy: This involves using a microscope and a bright light to examine
the front and back of the eye. It can provide detailed images of the retina.

6. Fluorescein Angiography: A dye is injected into the bloodstream, and photographs are
taken as the dye circulates in the blood vessels of the retina. This helps in identifying blood
flow and possible abnormalities.

7. Indirect Ophthalmoscopy: This is a more detailed examination of the retina, often done by
a retina specialist using a special lens and a bright light.
 Medication
1.Topical Antibiotics: These are used to prevent infection after surgery. They
are applied to the eye's surface.
2. Topical Steroids: These can be prescribed to reduce inflammation in the
eye after surgery.
3. Pain Medications: These may be prescribed to manage any discomfort or
pain following surgery.
4. Dilating Drops: These are used to keep the pupil dilated, which can help
with the post-operative examination and healing process.
5. Anti-inflammatory Drugs: These may be used to control inflammation in
the eye after surgery.
 Surgical treatment:

1. Pneumatic Retinopexy: This involves injecting a gas bubble into the eye, which helps
push the detached retina back into place. Laser or freezing treatment is then used to seal
the tear.

2. Scleral Buckling: A silicone band or sponge is sewn onto the white of the eye (sclera).
This indents the eye slightly and helps the retina reattach.

3. Vitrectomy: This involves removing the vitreous gel from the center of the eye. The
surgeon then either replaces it with a gas bubble or a silicone oil to help the retina
reattach.

4. Laser or Cryopexy: These techniques use either a laser or freezing probe to create
scar tissue around the tear, sealing it and preventing further fluid leakage.
 Interventions

1. Educate the patient about the condition, treatment options.

2. Preoperative and Postoperative Care.
3. Provide emotional support.
4. Pain management
5. Wound care
6. Medication Management
Senile Macular Degeneration
The macula is the part of the retina that is
responsible for central vision.
As people age, change in the eye cause the
macula to degenerate. Both eyes are usually
affected.

The two types of macular degeneration are dry

(strophic) and wet (exudative).
In the wet form, abnormal blood vessels
develop in or near the macula, resulting in loss
of vision in a specific area.
In the dry form, central vision gets gradually
worse. Patients often report difficulty reading or
doing close work. Both types are progressive.
Peripheral vision remains intact. It is usually
adequate to allow mobility in familiar settings.
Dry AMD (Non-Neovascular AMD):

Description: This is the more common type, accounting

for about 85-90% of cases. It occurs when the cells in
the macula gradually break down over time. There's no
cure for dry AMD, but lifestyle changes, dietary
supplements, and regular monitoring are important in
managing the condition.

Progression: It tends to progress slowly, and vision loss

may not be as severe in the early stages. However, it can
still lead to significant vision impairment over time.
Wet AMD (Neovascular AMD):

Description: This is less common but more

severe. It occurs when abnormal blood vessels
grow under the retina, leaking fluid and blood,
which can cause rapid and severe vision loss.
Although there is no cure, there are treatments
available. Anti-VEGF medications can help
slow down the growth of abnormal blood
vessels and preserve vision.

Progression: Wet AMD tends to progress more

rapidly than dry AMD and can lead to
significant vision loss in a shorter period.
Signs and Symptoms:
Blurred or Distorted Vision
Dark Spots
Reduced Color Perception
Difficulty Adapting to Low Light

Treatment Option: there is no cure treatments play a crucial role in managing the
condition and preserving remaining vision and slow down the progression.
Lifestyle Changes
Low Vision Aids

Anti-VEGF injections: These medications are injected directly into the eye to help inhibit
the growth of abnormal blood vessels. This is the most common treatment for wet
AMD.
Photodynamic therapy: This involves a combination of a light-sensitive drug and laser
treatment to target abnormal blood vessels.
Laser therapy: In some cases, laser treatment may be used to seal leaking blood vessels.
Interventions

1. Patient Education
2. Administering Medications
3. Assisting with Lifestyle Modifications
4. Emotional Support
5. Monitoring and Reporting
Enucleation (removal of the eye)

- Some eye conditions are so serious that removal of the

eyeball is the only treatment. Conditions that may result in
enucleation include injury, infection, sympathetic
ophthalmic, and some glaucoma, and malignancies.

During the surgical procedure the eyeball is removed. A

round device is placed in the cavity, these procedure create a
foundation for the future placement of a prosthesis. The
patient returns from surgery with temporary shell called a
conformer in the prosthesis base, which is covered with a
pressure dressing.

- !Observed for excessive bleeding or increasing pain.

Report any temperature elevation. After the pressure
dressing is removed the physician may order wound care
and topical medication.
Approximately 1 month after the
enucleation, an optician can fit a
prosthesis. The patient must learn to
insert, remove, and clean the
prosthesis.
End.