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Blindness
- "Visually Impaired"
- Congenital (birth defects)
- Acquired (diabetic retinopahy, glaucoma, cataracts, retinal degeneration, trauma)
- Legally Blind - 20/200 or visual field < 20 degrees
- Loss of peripheral vision, halos, orbital pressure, bulging
- Emotional support, assistive devices, family teaching, safety, ADLs
- ID self when approaching
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Refractory Errors
- Astigmatism: defect in the curvature of the lens - blurred vision
- Strabismus: cross eyes
- --esotropia - in
- --exotropia - out
- Myopia: nearsightedness (cannot see far)
- Hyperopia: farsightedness (cannot see close)
- --presbyopia - due to aging
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Refractory Errors Dx
- Opthalmoscope
- Retinoscopy
- Visual acuity tests
- Refraction tests
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Refractory Errors Treatment
- Glasses, contacts, laser surgery
- Radial Keratotomy: inscisions to flatten cornea
- LASIK: laser correction with corneal flap
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Eye Surgery Nursing Care
- No NSAIDs or aspirin for one week prior
- No contacts 1-2 days prior
- Eye patch til next morning
- Eye drops for comfort/anti-infective
- Follow up appointment 1-2 days
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Ophthalmic Med Administration
- Sterile, eye dropper should never touch eye
- Drops: Look up - drop into conjuntival sac
- Ointment: small line along lower lid
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Ophthalmic Meds - Anti-Infectives
Kill bacteria
- Gentamicin
- Tobrex
- Mycostatin
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Ophthalmic Meds - Anti-inflammatories
- Control inflammation
- Side effects - increased IOP, masking infection
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Ophthalmic Meds - Anesthetics
- For eye exam and minor surgery
- Side effects: temporary burning, loss of lid reflex
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Ophthalmic Meds - Lubricants
- Replace tears, lubricate contacts
- Usually given at night - blurred vision
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Ophthalmic Meds - Beta Blockers
- Decrease IOP by decreasing production of aqueous humor
- Side effects: cardiac - monitor HR and BP
- Timoptic
- Betoptic
- Timolol
- Betagen
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Ophthalmic Meds - Carbonic Anhydrase Inhibitor
- Decrease IOP by decreasing production of aqueous humor
- Side effects: drowsiness, depression, malaise, diuresis, paresthesia
Diamox
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Ophthalmic Meds - Osmotic Diuretics
- Profound diuresis - decreases intraocular pressure
- given IV in emergency (eye trauma)
- Side effects: HA, N&V, thirst, diarhhea, agitation
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Ophthalmic Meds - Cycloplegic Mydriatics
- Pupil dilation, paralyzes accomodation
- Used during eye exam/surgery
- Side effects: increased IOP, photophobia, dry mouth, hypertension
Need sunglasses
Cyclogyl, Mydriacyl, Mydriafair
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Ophthalmic Meds - Miotics
- Constricts the pupil, opens canal of Schlemm, drains aqueous humor, decreases IOP
- Side effects: blurred vision, decreased light into eye (provide more light to see)
Pilocarpine, Isopto, Carpine
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Conjunctivitis
- Pink eye
- Inflammation of conjuntiva (bacterial or sometimes viral)
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Conjunctivitis S/S
- Erythema
- Edema
- Crusting discharge
- Tearing
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Conjunctivitis Nursing Interventions
- Saline eye irrigations
- Cold compresses for itching/edema
- Topical antibiotics/steroids
- Antihistamines/decongestants (if due to allergies)
- Patient teaching - infection control (keep hands out of eye), cross contamination, wash linens separately, no contacts/smoke/fumes
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Cataracts
- Opacity of the lens
- Usually due to age but can be congenital
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Cataracts Risk Factors
- UV light exposure
- Diabetes
- Age
- Steroids
- Nutritional deficiencies
- Alcohol
- Congenital defects
- Trauma
- Intraocular infections
- Smoking
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Cataracts S/S
- Blurred/hazy vision
- Fog/film over objects
- Profound glare (night driving)
- No pain
- Changes in color vision
- Visible white/gray spot behind pupil
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Cataracts Dx
Ophthalmoscope and Silt Lamp
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Cataracts Treatment
- Surgery is only treatment
- Extracapsular extraction
- Phacoemulsification - ultrasound to break up and extract cataract
- Corticosteroids and antibiotics intra/post-op
- Rare complications - Increased IOP, hemorrhage, retinal detachment, macular edema
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Cataracts Nursing Care
- Avoid increased eye pressure: coughing, sneezing, constipation, vomiting, bending, stooping, lifting
- Limited activity for one week
- Sleep with eye sheid
- Do not lay on affected side
- Prescribed eye drops
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Diabetic Retinopathy
- Diabetes causes vascular changes in retina
- Venous capillaries dilate and develop microscopic aneurysms
- Edema and small hemorrhages into retina
- 10 years post diabetes DX
- Increased in poorly controlled diabetes
- 85% of diabetics develop
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Diabetic Retinopathy S/S
- Diabetic history
- Floaters
- Blurred/spotty vision
- Opacities, hemorrhages, lesions visible
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Diabetic Retinopathy Dx
- Ophthalmoscope - dilated vessels, narrow arteries
- Angiography - shows microaneurysms
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Diabetic Retinopathy Treatment
- Evaluate 3-5 years after Dx then annually
- ACE inhibitors: dilate retinal vessels
- Phoocoagulation: destroys new vssels, seals leaking vessels, prevents retinal edema
- Cryotherapy: decrease bleeding by freezing
- Vitrectomy: removal of the vitreous
- Vitrase (ovine hyalurondase): clears bloodied vitreous in 1 month
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Diabetic Retinopathy Nursing Care
Same as other eye surgery
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Macular Degeneration
- Deterioration of the macula (center of the retina)
- Leading cause of visual impairment in US
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Macular Degeneration Risk Factors
- Family history
- Diabetes
- Smoking
- Caucasian
- UV light exposure
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Types of Macular Degenration
- Dry: age related, gradual onset
- Wet: caused by blockage in capillaries, sudden onset
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Macular Degeneration S/S
- No early symptoms
- Loss of color vision
- Blured vision
- Distortion of lines
- Empty spot in central vision
- Appearance of drusen (yellow exudates)
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Macular Degeneration Dx
- Amsler Grid Test
- Ophthalmoscope
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Macular Degeneration Treatment
- Dry: no treatment
- Wet: photocoagulation of new vessels to prevent growth into macula
- No way to restore central vision
- Visual aids - lenses, magnifying glass
- Vitamins C, E, beta-carotene help slow progression
- Early detection critical
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Detached Retina
- Retina detaches from choroid layer, causing hemorrhage or leakage of vitreous
- Caused by degenerative changes or trauma
- Partial detachment: progressive vision loss
- Total detachment: blindness
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Detached Retina S/S
- Sudden change in vision
- Floaters or flashing light
- "Veil" or "curtain" over vision
- No pain (no receptors on retina)
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Detached Retina Dx
- Ophthalmoscope and silt lamp
- Ultrasound
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Detached Retina Treatment
- Laser photocoagulation: burn off tears/breaks
- Cryotherapy: freezes retina
- Diathermy: burns retina via ultrasound
- Scleral Buckling: silicone band around eyeball to seal tears
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Detached Retina Nursing Care
- Eye bandaged post op
- Antibiotic, cycloplegic, and mydriatic drops
- Antianxiety meds
- Limited activities 3-5 weeks (to prevent another detachment)
- Avoid constipation and vomiting
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Detached Retina Prognosis
- Reattachment 90% successful
- Maximum sight within 3 months
- If not reattached, retina dies -> blindness
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Glaucoma
- Increase in pressure in he eye caused by changes in outflow of aqueous humor
- Affects peripheral vision
- One of the leading causes of blindness
- Over age 35
- No cure
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Open Angle Glaucoma
- Chronic
- Elderly
- Risk factors - hypertension, previous eye inury, African-American
- Possibly hereditary
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Closed Angle Glaucoma
- aka Narrow Angle
- Sudden onset
- Eye injury interferes with drainage of aqueous humor, increases pressure
- Medical emergency
- Eye drops, Mannitol, surgery
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Open Angle Glaucoma S/S
- Gradual onset
- Tired eyes
- Headache
- Difficulty focusing
- Peripheral vision loss
- Halos
- Inability to detect colors
- Increased IOP - Optic disk cupping
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Closed Angle Glaucoma S/S
- Rapid onset
- Severe pain
- Decreased vision
- N&V
- Enlarged, fixed pupil
- Colored halos
- Increased IOP - Optic disk cupping
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Glaucoma Dx
- Tonometer
- Visual field studies - decreased peripheral vision
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Glaucoma Medications
- Eye drops - improve flow, decrease production of aqueous humor
- Miotics - constrict pupil, open canal of Schlemm, drain aqueous humor
- Carbonic anhydrase inhibitors, beta blockers - decrease production of aqueous humor
- Osmotics - IV for emergency
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Glaucoma Surgery
- Trabeculoplasty/Trabeculectomy: laser procedure on iris/surrounding tissue to facilitate aqueous humor flow
- Iridotomy: inscion into iris to create opening for aqueous humor
Both increase aqueous humor outflow/decrease IOP
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Glaucoma Nursing Care
- Use eye drops regulary
- Medic alert bracelet
- Regular eye exams (q 2-4 years, q 1-2 years > 65)
- Post-surgical eye precautions
- Patient and family teaching - treatment, care, and compliance
- Patient safety
- No OTC allergy meds
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Corneal Injuries
- Foreign bodies - dust, propellants, eye lashes, contact lenses
- Burns
- Penetrating wounds
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Corneal Injuries S/S
- No bleeding (cornea non-vascular)
- Pain with eye/lid movement
- Tearing
- Redness
- Pruritis
- Vision Loss
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Corneal Injuries Dx
- Visual/ophthalmoscope exam
- Fluorescein staining
- Peripheral vision tests
- Silt lamp exam
- Ultrasound, X-ray, CAT scan
- MRI
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Corneal Injuries Treatment
- Ask about first aid given at scene
- Burns: flush eye 15-20 mins with tap water to prevent scarring -> ER
- Penetrating wounds: do not remove object, cover both eyes -> ER
- Foreign objects:
- -Eye flush - saline
- -Moist q-tip/gauze to remove visible object
- Antibiotic ointment/drops
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Corneal Injuries Nursing Care
- Assist with procedures
- Patient teaching
- Handwashing
- Eye safety
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Keratitis & Corneal Ulcers
- Inflammation of the cornea
- Caused by irritation, bacteria, or virus
- Contact lens wears more succeptible
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Keratitis & Corneal Ulcers S/S
- Severe eye pain, increased with blinking
- Tearing
- Photophobia, photosensitivity
- Visual disturbances
- Untreated - vision loss
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Keratitis & Corneal Ulcers Dx
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Keratitis & Corneal Ulcers Treatment
- Topical antibiotics/steroids (systemic if severe)
- Cycloplegic mydriatic drugs - paralyze ocular muscles, dilate pupil
- Analgesics
- Sunglasses
- Pressure dressings
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Encleation
Surgical removal of the eye (eyeball or eyeball + surrounding structures) due to tumor or trauma
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Enucleation Nursing Care
- Emotional support
- Pain relief
- Pressure dressings to control bleeding
- Routine post op care
- Prosthetic fitting 4 weeks
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