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Keloid

Keloid. NEUROSENSORY. SYSTEM. ANATOMY & PHYSIOLOGY OF EYES. EXTERNAL STRUCTURES EYELIDS CONJUNCTIVA PALBEBRAL BULBAR LACRIMAL APPARATUS LACRIMAL GLAND, DUCTS & PASSAGES 6 EXTRAOCULAR MUSCLES Levator palpebrae muscle. ANATOMY & PHYSIOLOGY EYES. ORBIT EYEBALL : 3 LAYERS: OUTER

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Keloid

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  1. Keloid

  2. NEUROSENSORY SYSTEM

  3. ANATOMY & PHYSIOLOGY OF EYES EXTERNAL STRUCTURES • EYELIDS • CONJUNCTIVA • PALBEBRAL • BULBAR • LACRIMAL APPARATUS • LACRIMAL GLAND, DUCTS & PASSAGES • 6 EXTRAOCULAR MUSCLES • Levatorpalpebrae muscle

  4. ANATOMY & PHYSIOLOGYEYES • ORBIT • EYEBALL : 3 LAYERS: • OUTER • SCLERA • CORNEA • MIDDLE • CHOROID • CILIARY BODY • IRIS • INNER • RODS • SENSITIVE TO LIGHT • PERIPHERAL VISION • CONES • FINE • DESCRIMINATION • COLOR VSION

  5. EYES

  6. ANATOMY & PHYSIOLOGYEYES • LENS – FOCUS IMAGE • FLUIDS OF THE EYE: • AQUEOUS HUMOR • ANTERIOR & POSTERIOR CHAMBERS • ANTERIOR EYE CAVITY • NUTRIENTS TO LENS & CORNEA • INTRAOCULAR PRESSURE MAINTENANCE • 20-25 mmHg • VITREOUS HUMOR • POSTERIOR EYE CAVITY • TRANSPARENCY & FORM OF THE EYE

  7. EYES

  8. VISUAL PATHWAYS RETINA OPTIC NERVE OPTIC CHIASM OPTIC TRACT OCCIPITAL LOBE

  9. Physical Examination-EYE • VISUAL ACUITY : SNELLEN’S CHART • VISUAL FIELDS: PERIMETRY • EXTERNAL STRUCTURES • POSITION & ALIGNMENT OF EYES • PUPILS (PERRLA) • EXTRAOCULAR MOVEMENTS • PARALYSIS • NYSTAGMUS • CORNEAL REFLEX

  10. DIAGNOSTIC TESTS • SNELLEN • OPHTHALMOSCOPE • BIOMICROSCOPE / SLITLAMP • EXAMINE THE ANTERIOR SEGMENT OF THE EYE • TONOMETER • 14-20 mmHg • BJERRUM’S TANGENT SCREEN • CENTRAL FIELD OF VISION • ISHIHARA COLOR PLATE TEST • IDENTIFY 3 PRIMARY COLORS • GONIOSCOPY • ANGLE OF ANTERIOR CHAMBER

  11. PLANNING FOR HEALTH PROMOTION • PERSISTENT REDNESS • CONTINUED DISCOMFORT & PAIN ESP • FOLLOWING INJURY • CHILDREN: CROSSING OF EYES • BLURRED VISION/ SPOTS BEFORE THE EYES • GROWTH ON THE EYE/ OPACITIES • CONTINUAL DISCHARGE, CRUSTING OR • TEARING • PUPIL IRREGULARITIES CARE OF THE EYES • EYEDROPS, DISCOURAGED • PRINTED MATTER: 14 INCHES AWAY • TV: 10-12 FT AWAY • READ WITH ILLUMINATION: 100-150 WATTS • LIGHT FROM BEHIND • TEACH ABOUT DANGER SIGNALS OF VISUAL DISORDER

  12. DISORDERS - EYE • INJURIES & TRAUMA • INFECTIONS • CATARACT • GLAUCOMA • DETACHMENT OF THE RETINA • REFRACTIVE ERRORS

  13. INJURIES & TRAUMA EMERGENCY: • TREAT THE PATIENT, LEAVE THE EYE ALONE, EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT • FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEA

  14. INFECTIONS • HORDEOLUM/ STY -Zeis gland in the follicle • CHALAZION –meibomian glands • CONJUNCTIVITIS – pink eye • bacterial infection, allergy, trauma • UVEITIS - iris • KERATITIS - cornea • PTERYGIUM – triangular fold • From white of the eye to the cornea

  15. Conjunctivitis

  16. Sty

  17. Chalazion

  18. Pterygium

  19. CATARACT • Opacity of the lens & its capsule which interferes with transparency S/SX: • Dimness in visual acuity • Rapid & marked refraction error CLASSIFICATION: • Primary/ senile • Secondary/ traumatic • Congenital

  20. Cataract

  21. Treatment • Replacement of the intra ocular lens • Commonly done by phakoemulsification technique

  22. EYE SURGERY NURSING CARE PRE-OP • Orient to new environment • Teach deep breathing & how to close eyes without squeezing • Eye antibiotics preop • Mydiatrics if ordered

  23. EYE SURGERY NURSING CARE POST-OP • Reorient patient to his surroundings • Prevent increase in IOP & stress on the suture line

  24. Contd…. • ACTIVITIES THAT INCREASE IOP: • Coughing • Vomiting • Bending • Stooping • Promote comfort of the patient: mild analgesic to control pain

  25. EYE SURGERY • COMPLICATIONS: • NAUSEA & VOMITING • Antiemetics • Cold compress • HEMORRHAGE • Sudden pain of the eye • PROLAPSE OF THE IRIS • Most common postop complication • Can precipitate glaucoma NURSING CARE POST-OP • Observe & treat complications • Promote the rehab of the patient • Encourage the patient to become • independent- walk with him when he first • become ambulatory • Health teachings

  26. EYE SURGERY HEALTH TEACHINGS: • 1-4 wks : dark glasses; temporary corrective lenses • 6-8 wks: permanent lenses • It will take time to learn distances & climb stairs • Color slightly changed • Use one eye at a time unless with contact lens • Decreased peripheral vision

  27. GLAUCOMA • INCREASED IOP • PROGRESSIVE LOSS OF PERIPHERAL VISION CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMOR TYPES: • CHRONIC/ SIMPLE/ OPEN-ANGLE • ACUTE ANGLE CLOSURE • Congenital • Secondary – trauma, uveitis, postop • Absolute – uncontrolled- enucleation

  28. EYES OPEN-ANGLE GLAUCOMA CANAL OF SCHLEMM IRIS CILIARY BODY ANTERIOR CHAMBER LENS ZONULES CORNEA

  29. EYES ACUTE-ANGLE CLOSURE GLAUCOMA CANAL OF SCHLEMM IRIS CILIARY BODY ANTERIOR CHAMBER LENS ZONULES CORNEA

  30. OPEN ANGLE GLAUCOMA S/SX: • Loss of peripheral vision (tunnel) • Difficulty in adjusting to darkness • Failure to detect changes in color • Headache, pain behind the eyeball • Halos • Nausea & vomiting

  31. OPEN ANGLE GLAUCOMA MANAGEMENT: Conservative : • Miotics : pupillary constriction draw iris smooth muscle away from the canal • Acetazolamide : decrease aqueous production • Fluid restriction

  32. Definitive management • Principle: improve drainage of aqueous • Iridocleisis-anterior chamber & subconjunctival space • Corneoscleral trephening – junction of cornea & sclera • Trabeculotomy • Laser therapy to meshwork

  33. Acute Angle Glaucoma CAUSE: • Pupillary dilation by mydiatrics • Abnormal anterior displacement of iris S/SX: • Severe eye pain • Nausea & vomiting • Blurred vision • Colored halos around lights • Dilated pupils • Increased IOP

  34. MANAGEMENT: • Miotics • Azetazolamide • Osmotic agents – glycerol • Surgery - iridectomy

  35. GLAUCOMA NURSING CARE – SURGERY PRE-OP • Explain that vision lost cannot be restored, but further loss can be prevented POST-OP • Flat 24H- prevent iris prolapse • Narotics or sedatives • Liquid diet until 1st dressing • Turn to unoperative site

  36. LONG TERM CARE: • No restriction on the use of the eyes • No fluid restriction; exercise permitted • Medical follow up needed for life

  37. CHOROID RETINA SCLERA OPTIC NERVE RETINAL DETACHMENT

  38. RETINAL DETACHMENT • Fluid accumulation • Tumor CAUSE: • Myopic degeneration • Trauma • Aphakia S/SX: • Floating spots or opacities before the eye • Casts shadows on the retina • BrightFlashes of light • Progressive constriction of vision in 1 eye

  39. Management • Conservative : • Quiet in bed with eyes covered • Head: positioned so that retinal holes lower • Photocoagulation – small burn to retina • Cryotherapy – cold probe to freeze retina • Surgical: • Scleral buckling- sealing break & reattaching

  40. RETINAL DETACHMENT POST-OP NURSING CARE: • Cover eyes • Area of detachment, dependent • Mydiatrics • Discharge instructions: • No strenuous exercises & acivity x 6mos • Contact sports restricted • No sudden jarring head motion • No restriction with use of eyes

  41. REFRACTIVE ERRORS REFRACTION – bending of light rays ACCOMMODATION – ability to adjust from near to far vision ADAPTATION – ability to see light from darkness COMMON ERRORS: • Myopia • Hyperopia • Presbyopia • Astigmatism • Blindness

  42. myopia NEAR-SIGHTED • Long A-P dimension of the eyeball • Light rays focus infront of the retina • Good vision for near distances • Concave lenses

  43. Myopia

  44. hyperopia FAR-SIGHTED • Eyeball A-P dimension too short • Light rays focus behind the retina • Good vision for far distances • Convex lenses

  45. Hyperopia

  46. presbyopia FARSIGHTEDNESS OF OLD AGE • Gradual loss of accommodation • Loss of lens elasticity • Inability to read without holding the material more than 13 ft from the eye • Bifocal lenses

  47. ASTIGMATISM • Asymmetry or irregular curvature of the cornea • Cylindrical lenses BLINDNESS • Vision: 20/200

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