Nursing Care of Eye and Vision Disorders

1. Chapter 51 Eye and Vision Disorders

2. Learning Objectives • Identify the data to be collected in the nursing assessment of the eye and vision. • Identify the nursing responsibilities for patients having diagnostic tests or procedures to diagnose eye disorders. • List measures to reduce the risk of eye injuries. • Describe the nursing care of patients who require common therapeutic measures for eye disorders: irrigation, application of ophthalmic drugs, and surgery. • Describe the pathophysiology, signs and symptoms, diagnosis, and treatment of selected eye conditions. • Assist in developing a nursing care plan for the patient with an eye disorder.

3. Anatomy and Physiology of the Eye

4. External Structures Eyelids Eyelashes Conjunctiva Cornea Sclera Extraocular muscles

5. Figure 51-1

6. The Eyeball Sclera Choroid Retina Optic nerve Fluid chambers Anterior chamber Posterior chamber Lens

7. Figure 51-2

8. Figure 51-3

9. Visual Pathway Light enters eye, passes through transparent cornea, aqueous humor, lens, and vitreous humor These structures are called refractive media Refract (bend) horizontal and vertical light rays so that the light rays focus on the retina On retina, light rays are reversed and upside down Images carried as impulses through the optic nerve At optic chiasm, fibers from the left field from each eye join to form the left optic tract Fibers from right field of eye join to form right optic tract Images transmitted to the brain by way of the optic tracts

10. Figure 51-4

11. Age-Related Changes in the Eye Skin around the eye becomes wrinkled and loose Eyelids usually have some excess tissue; not important unless it interferes with vision The amount of fat around the eye decreases, permitting the eyeball to sink deeper into the orbit Tear secretion diminishes; cornea less sensitive Grayish ring may be around the outer margin of the iris Pupil smaller and responds more slowly to light Presbyopia: ability to focus is impaired

12. Health History History of present illness Record changes in vision If pain, inquire about location and nature Sensitivity to light (photophobia) Discharge from the eyes Complaints that the eyes feel dry and irritated Past medical history Diabetes, neurologic disorders, thyroid disease, hypertension

13. Health History Family history Any eye diseases as well as a history of arteriosclerosis, diabetes, and thyroid disease Functional assessment Patient’s occupation, roles, usual activities

14. Physical Examination Inspect the external eye, assess response of the pupil to light, and evaluate gross visual acuity If abnormalities suspected, inform physician or advise patient to seek medical evaluation Acuity commonly tested with Snellen chart

15. Figure 51-5

16. Diagnostic Tests and Procedures Ophthalmoscopic examination Refractometry Visual fields Tonometry Measure of electrical potential Fluorescein angiography Corneal staining Imaging procedures CT, ultrasonography, radioisotope scanning, or MRI

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21. Therapeutic Measures Eye irrigation Topical medications Miotics Mydriatics Anesthetics Cycloplegics Antibiotics Anti-inflammatory drugs Eye surgery Surgical incisions, lasers, and cryotherapy

22. Preoperative Nursing Care Assessment Patient’s emotional state, ability to perform self-care, and knowledge of surgical routines and outcomes Be sure the patient understands the preoperative routine Interventions Anxiety Self-Care Deficit

23. Postoperative Nursing Care Assessment Vital signs and level of consciousness Inspect dressing for bleeding or drainage Patient comfort, including pain and nausea If vision impaired, inspect environment for safety hazards Before discharge, determine patient’s understanding of and ability to administer prescribed medications by having the patient demonstrate self-medication

24. Postoperative Nursing Care Interventions Risk for Injury Disturbed Sensory Perception Acute Pain Anxiety Ineffective Therapeutic Regimen Management

25. Protection of the Eyes and Vision Patient teaching Adults younger than 40 years of age should have their eyes examined every 3 to 5 years After the age of 40, examinations every 2 years and should include testing for glaucoma When there are symptoms of eye problems, patients should seek medical advice

26. Protection of the Eyes and Vision Prevention of injuries Teach young children the danger of throwing or poking objects at the faces of playmates Assess toys for safety Adult activities that produce sparks or cause fragments to be dispersed also cause injuries Advise protective eyewear for such potentially dangerous activities

27. Protection of the Eyes and Vision Basic eye care Gently cleanse the eyelids each time the face is washed; use a clean cloth without soap Wash eye from the inner canthus (near the nose) toward the outer canthus

28. Effect of Visual Impairment Mild losses may require only some adaptations Serious losses affect independence, mobility, employment, and interpersonal relationships People grieve for the lost function just as they might grieve after the death of a loved one Factors that affect a person’s response to this loss include personality, usual coping style, effect of vision loss on the person’s life, and the circumstances of the loss

29. Care of the Visually Impaired Patient Be aware of visually impaired person’s thoughts and feelings about handicaps Assume that people with visual impairments can be independent and productive The person needs help with some tasks but should be treated as an adult The extent of vision loss determines the types of assistance needed

30. Care of the Visually Impaired Patient Interventions Disturbed Sensory Perception Ineffective Coping Self-Care Deficit Ineffective Therapeutic Regimen Management

31. Figure 51-11

32. Figure 51-12

33. Disorders Affecting the Eye or Vision: Inflammation and Infection

34. Blepharitis Inflammation of hair follicles along eyelid margin Caused by bacteria, most often by staphylococci Symptoms include itching, burning, and photophobia; scales or crusts on the lid margins Physician may prescribe an antibiotic ointment Be certain that any medication applied to the eye is an ophthalmic preparation Eyelids can be gently cleansed with baby shampoo solution

35. Hordeolum Commonly called a stye Common acute staphylococcal infection of the eyelid margin that originates in a lash follicle Affected area of lid is red, swollen, and tender Apply warm, moist compresses several times a day Repeated infections may be related to staphylococcal infections at some other location on the body Physician may treat with ophthalmic antibiotics

36. Chalazion Inflammation of the glands in the eyelids Swelling prevents fluid from leaving the glands, causing tenderness Warm compresses may bring some relief Physician may order antibiotics if infection Surgical removal of the gland necessary if condition persists

37. Conjunctivitis Inflammation of the conjunctiva caused by microorganisms, allergy, or chemical irritants Bacterial conjunctivitis commonly called pinkeye Red conjunctiva, mild irritation, drainage Warm/cool compresses, topical vasoconstrictors Infected people should practice good hand washing and should avoid sharing washcloths

38. Conjunctivitis Viral conjunctivitis caused by herpes simplex virus type 1, herpes zoster virus, or adenoviruses Characterized by redness and drainage Round, raised white or gray areas on the conjunctiva Infections caused by herpes simplex virus type 1 are treated with ointments or other topical medications

39. Keratitis Inflammation or infection, or both, of the cornea From bacteria, viruses, fungi; chemical or mechanical injuries cause inflammation that may be followed by infection No noticeable drainage, but considerable pain Topical antibiotics and topical corticosteroids Systemic antibiotics after culture and sensitivity Sometimes physician injects antibiotics directly into the conjunctiva

40. Entropion The lower lid turns inward Eyelashes rub against the eye, causing pain and possibly scratching the cornea Surgical correction usually recommended

41. Ectropion 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 Requires surgical correction

42. Foreign Body Blinking/tearing wash small irritants from eye If foreign body remains, evert the upper and lower lids If object is clearly visible and does not appear to be embedded, you may attempt to remove it Use sterile cotton swab to touch object gently If object not embedded, it usually clings to swab and can be removed If object is embedded, it should be removed only by a physician

43. Figure 51-13

44. Corneal Opacity Inflammation and infection When cornea injured by infection or trauma, scar tissue may form If scar tissue prevents light from entering the eye, varying degrees of vision impairment occur Only treatment is keratoplasty (removal of the scarred cornea and replacement with a healthy cornea) During keratoplasty, damaged cornea removed first An identically sized graft then taken from the donor eye and secured to the recipient’s eye with very fine suture

45. Figure 51-14

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47. Care of the Patient Having Keratoplasty After surgery, the keratoplasty patient has an eye pad and a metal shield over the operative eye Corticosteroid eye drops may be ordered to reduce inflammation

48. Care of the Patient Having Keratoplasty Assessment Inspect dressing for drainage and ask if patient has pain or nausea After dressing is removed, inspect for corneal opacity Also evaluate the patient’s visual acuity Interventions Risk for Injury Pain Impaired Sensory Perception Ineffective Therapeutic Regimen Management

49. Disorders Affecting the Eye or Vision: Errors of Refraction

50. Myopia The medical term for nearsightedness The lens is situated too far from the retina Light rays come together to focus in front of the retina People with myopia have difficulty seeing distant images clearly New glasses needed approximately every 2 years