CATARACTS

Pamela .K. Mwindwa

Definition
A cataract is a clouding that develops in the
crystalline lens of the eye or in its envelope,
varying in degree from slight to complete opacity
and obstructing the passage of light.
Classifications of Cataract

The following is a classification of the various

types of cataracts.
Classified by etiology
1. Age-related cataract called Senile Cataract.
2. Congenital cataract - present at birth
Classified by etiology
3. Secondary cataract (occurring after other eye
diseases e.g. Uveitis).
4. Traumatic cataract this include blunt or
penetrating eye trauma,
Blunt trauma (capsule usually intact)
Penetrating trauma (capsular rupture & leakage
of lens material—calls for an emergency surgery
for extraction of lens and leaked material to
minimize further damage)
Classification according to location

Anterior pole cataract

Posterior pole cataract
Classification according to the degree

Immature cataract: partially opaque lens, disc

view is hazy
Mature cataract: Completely opaque lens, no
disc view
Hypermature cataract: Liquefied cortical matter.
CAUSES/RISK FACORS OF CATARACTS
AGE – aging can lead to denaturation and
degradation of the lens
Trauma – blunt trauma causes swelling, thickening
and whitening of the lens fibers
Radiation – can arise due to the effects of exposure
to ioning radiation which can damage the DNA of the
lens cells
Genetics -due to an anomaly in the chromosomal
pattern of the individual.
CAUSES/RISK FACORS OF CATARACTS
Skin diseases- can lead to cataracts due the same
embryological origin of the skin and lens and
therefore, can affected by similar diseases such as
atopic dermatitis and eczema
Post –op – vitrectomy – this may be due to the native
vitreous humor is different from the solutions used to
replace the vitreous
CAUSES/RISK FACORS OF
CATARACTS
Diabetes Mellitus – can lead to osmotic over-
hydration of the lens.
Glaucoma – can intraocular circulation
compromise as a consequent to the raised pressure
Pathophysiology
The lens is made mostly of water and protein.
Specific proteins within the lens are responsible
for maintaining its clarity.
Over many years, the structures of these lens
proteins are altered, ultimately leading to a gradual
clouding of the lens.
Pathophysiology
These changes affect lens transparency, causing
vision changes.
Cataract usually develops bilaterally, but at
different rate.
Clinical features
Increased glare in bright light resulting from
irregular refraction of rays
Altered colour perception due to the yellowing of
the lens acting as alight filter.
Visible opacity of the lens on ophthalmoscopic
examination
Reduced visual acuity
Leucorrhoea or ‘whitish pupil’ is seen only in
advanced stages of cataract
Clinical features
Uniocular polyopia (i.e., doubling or trebling of
objects): It occurs due to irregular refraction by the
lens owing to variable refractive index as a result
of cataractous process.
Coloured halos. These may be perceived by some
patients owing to breaking of white light into
coloured spectrum due to presence of water
droplets in the lens.
Clinical features
Loss of vision due to cataract
White pupil
 Investigation
Ask client about:
Family history
Nutrition-history of poor feeding e.g in alcoholism
may lead to malnutrition
Bad habits e.g Excess alcohol and smoking
Occupation e.g Welders
Age above 50years
Past medical history I.e. injury to the eye
Drug use e.g corticosteroides for a long time
 INVESTIGATIONS

(i). Ophthalmoscopy
 May show immature cataract, red reflex
occurs or
 May show a mature cataract, no red reflex and
visible fundus
(ii). Slit lamp biomicroscopy
 Shows a degree of cataract formation and
confirms the diagnosis
Cont’d
(iii). Snellen visual acuity test
 This will reveal decreased visual acuity
(iv). Blood test for sugar
 Blood sugar will be above normal (Normal
level is between 3.3-4.4mmol/L-1
Indications for cataract surgery
When the cataract prevents the individual
from performing their daily activities
All mature congenital cataracts, especialy
bilateral to prevent Amblyopia
All hypermature to prevent secondary
glaucoma
Retrolental disorders requiring treament e.g
retinal detachment
EXTRA CAPSULAR CATARACT
EXTRACTION
In extra capsular cataract extraction, the anterior lens
capsule, the cortex and nucleus are removed leaving
the posterior capsule lens in place.
Following this type of surgery cortical matter may
proliferate on the intact posterior capsule, a condition
requiring capsulectomy.

BONIFACE and SANANA PRESENTATION 9/11/06

 EXTRA CAPSULAR
CATARACT EXTRACTION
This type of surgery is performed;
1. When a posterior chamber intra-ocular lens is to be
implanted.
The lens sits in the posterior capsule to keep it in
place.
2. In patients aged less than 50 years because the
vitreous having a degree of adherence to the lens was
removed, thus causing a pupil block glaucoma,
leaving the posterior capsule prevents this occurring
BONIFACE and SANANA PRESENTATION 9/11/06
 INTRACAPSULAR LENS
EXTRACTION
The supporting zonules are dissolved with the enzyme
and -chymostrypsin.
The entire lens plus its capsule is removed from the eye
by forceps or the cryoprobe.
This type of surgery is performed:
1. When the patient is over 65 years of age, for the
vitreous has lost its adherence to the lens so there is less
danger of the vitreous protruding through the pupil
following lens extraction
2. When anterior chamber intra ocular lens is to be
implanted. BONIFACE and SANANA PRESENTATION 9/11/06
PREOPERATIVE CARE
Admit patient to hospital
Give psychological care and reinforce the need for
cataract extraction
Allow patient to sign consent for operation
Prepare patient for general or local anaesthesia
 A night before operation pupils are dilated with
mydriatics e.g. Atropine sulphate
starved 6-8 hours before surgery in case of need
for general anaesthesia.
Cont’d
Patient is bathed
Case notes ready
Patient gowned and taken to theatre
POST –OP CARE
AIMS
To prevent post- operative infection
To help patient adapt to visual changes especially
if its aphakic eye
To impart knowledge on post-operative
management.
POST –OP CARE
Get a detailed report about the patient’s surgery.
Find out whether an Intraocular lens transplant
was done or not, so that an appropriate care plan is
put in place.
Get the latest vital signs reading as these will be
the baseline data.
Quickly, make an inspection of the eye patch for
any bleeding.
MAINTAING A SAFE ENVIRONMENT
The ward should be clean, dust free and free from
injurious objects.
The patient should lie flat in bed without being
disturbed for 8hrs.
Remove all dirty clothing that the patient may lay
his hands on, to prevent infection.
MAINTAING A SAFE ENVIRONMENT
Instruct the patient not to stoop, not to use dirty
cloth to the face, not to touch the eye,
When they are coughing they should open the
mouth to prevent suture burst.
 OBSERVATIONS

If an IOL (intraocular lens) is in situ, its position

must be checked at each dressing to rule out
displacement
Check for any bleeding which will be seen through
the blood stain on the eye patch.
Check the vital signs and compare with the
previous ones to detect any difference.
OBSERVATIONS
The most common problems which arise following
IOL implantation are displacement, corneal
endothelial damage, and the UGH syndrome, i.e.
uveitis +glaucoma+ hyphaema.
Should any of these be present instant action is
required in order to prevent permanent eye
damage.
OBSERVATIONS
Severe pain is an important symptom of raised
intraocular pressure.
Examine the eye to see if there is any visual
problem.
Use a torch to assess light effect on the pupil.
PSYCHOLOGICAL CARE

If the patient does not have IOL implant, his/her

aphakic vision will have to be corrected by either
the use of aphakic glasses or contact lens.
In order to avoid disappointment at the immediate
postoperative results it should be explained to the
patient that there will be a period of adaptation as
the brain adjusts to changes in visual perception.
PSYCHOLOGICAL CARE
During this period the patient can experience a
certain amount of visual distortion resulting in
central field magnification and peripheral blurring.
This will affect distance and depth perception and
the individual should be cautioned to take care on
steps and stairs and to turn his head more to scan
the whole visual field.
Hygiene
The patient should be assisted with bathing.
He should be escorted and guided in his movement
to the toilet or bathroom to prevent falls.
Eye care should be done with normal saline to
prevent eye infection.
Aseptic measures should be observed to prevent eye
infection.
Hygiene

Before each eye examination meticulous eye care

should be performed.
Prescribed eye medication is also instilled to
facilitate healing
NUTRITION
Will need diet modification -foods rich in vitamin
C and A must be included
The client’s food will have to be put in a special
order for him/her to know exactly where each plate
is.
Anorexia resulting from anxiety
Elimination

Patient should avoid constipation as this will cause

straining that may eventually cause burst of the
sutures.
Stool softeners may be prescribed to aid in easy
bowel movement.
Information, Education and
Communication
Report any signs of vertigo, pain from the eyes
immediately to the nearest health facility.
Avoid stooping
Use a clean face towel when washing the face
Emphasis that sutures will be absorbed.
He should avoid touching the eyes with dirty
hands.
NURSING CARE PLAN
PROBLEM 1
Anxiety
NURSING DIAGNOSIS
Anxiety related to unfamiliar hospital environment, lack of
knowledge about the surgical procedure, fear of un desired
outcome evidenced by frequent asking of questions
OBJECTIVE
The client will be relieved of anxiety within 2hours of
nursing intervention.
 Cont’d

INTERVENTIONS
Orient the patient to his environment
 Encourage client and his family members to
express their fears.
Provide necessary information and answer
questions accordingly.
Maintain a calm environment for psychological
rest
If possible allow former cataract patients to visit
the client and share their experiences.
EXPECTED OUT COME
The client is relieved of anxiety as evidenced by
decrease in asking questions

PROBLEM 2
Risk of injury
NURSING DIGNOSIS
Risk of injury due to falls related to poor vision.
Cont’d
OBJECTIVE
The client will be free from injury from admission
until the vision is improved
INTERVENTIONS
Assist the client to walk
Keep all sharps and other objects that can cause
injury away from the client.
Allow client to use walking stick to navigate his
way
Cont’d
Advise client to seek help from the hospital staff
and others when need arises.

EXPECTED OUTCOME
Client is free from injury from admission until the
vision improves.
 COMPLICATIONS

Without surgical intervention, blindness and

glaucoma occurs.
Postoperative posterior capsule opacification
Secondary glaucoma
Post operative infection
 REHABILITATION
Adaptation to restored normal vision is usually
rapid.
Adaptation to limited vision will require more time
based on individual variations.
There will be need to assist the client adjust to new
job if there is need to and also adjust to new roles
in the family.
REFERENCES
 Black, J.M and Jacobs, E.M (1993), Medical Surgical Nursing, W.B
Saunders Company, Philadelphia
 Loeb, S at al, (1993), Diseases, Springhouse Corporation, Pennsylvania
 Robert B et al, (1997) The Merck Manual of Medical information. Home
Editions. Merck and Co., Inc. Whitehouse Station. N.J.
 Ross and Wilson (1996), Anatomy and Physiology in Health and Illness.
Churchill Livingstone New York.
 Stollery R (1987), Ophthalmic Nursing. Blackwell Scientific Publications.
Oxford.