On completion of this chapter, the learner will be able to:1. Identify significant eye structures and describe theirfunctions.2. Identify diagnostic tests for assessment of vision andevaluation of visual disabilities.3. Discuss clinical features, diagnostic assessment andexaminations, medical or surgical management, andnursing management of ocular disorders.4. Describe therapeutic effects of ophthalmic medications.
On completion of this chapter, the learner will be able to:5. Define low vision and blindness and differentiate betweenfunctional and visual impairment.6. List and describe assessment and management strategiesfor low vision.7. Demonstrate orientation and mobility techniques forpatients with low vision in a hospital setting.8. Demonstrate instillation of eye drops and ointment.
On completion of this chapter, the learner will be able to:9. Discuss general discharge instructions for patients afterocular surgery.10. Discuss strategies for patient safety in ophthalmology.
RetinaOptic nerveOptic chiasmOptic tracksLateral geniculate bodiesOptic radiationsVisual cortex area of the brain
Decrease or loss of accommodation (presbyopia) Lens yellow with age Senile miosis Increased light scatter in the eye causing glare Decrease in lens transparency (cataract) Dryness or scratchiness of the eyes Distorted or blurred image (astigmatism)
If the patient is wearing contact lenses, have himremove them before the test, unless the test is beingperformed to evaluate the fit of the contact lenses. When instilling dilating drops, tell the patient that hisnear vision will be blurred for 40 minutes to 2 hours. Advise him to wear dark glasses in bright sunlight untilhis pupils return to normal diameter. Don’t administer dilating eyedrops to the patient whohas angle closure glaucoma, is hypersensitive tomydriatics, or has an intraocular lens implant.
Tell the patient that a small transducer will be placed onhis closed eyelid and that the transducer will transmit high-frequency sound waves that will reflect off the structuresin the eye. Inform him that he may be asked to move his eyes orchange his gaze during the procedure; explain that hiscooperation will help to ensure accurate results. After the test, remove the water-soluble jelly that wasplaced on the patient’s eyelids.
Check the patient’s history for an intraocular lens implant,glaucoma, and hypersensitivity reactions, especiallyreactions to contrast media and dilating eye drops. If miotic eye drops are ordered, tell the patient withglaucoma not to use them on the day of the test. Explain to the patient that eye drops will be instilled todilate his pupils and that a dye will be injected into hisarm. Remind him to maintain his gaze position andfixation as the dye is injected. Tell him that he may brieflyexperience nausea and a feeling of warmth.
Observe the patient for hypersensitivity reactions to thedye, such as vomiting, dry mouth, metallic taste, suddenincreased salivation, sneezing, light-headedness, fainting,and hives. Remind the patient that his skin and urine will be a yellowcolor for 24 to 48 hours after the test and that his nearvision will be blurred for up to 12 hours.
Because an anesthetic is instilled before the test, tell thepatient not to rub his eyes for at least 20 minutes after thetest, to prevent corneal abrasion. If the patient wears contact lenses, tell him not to reinsertthem for at least 30 minutes after the test. If the tonometer moved across the cornea during the test,tell the patient that he may feel a slight scratchingsensation in the eye when the anesthetic wears off.
Regular ocular and physical examinations Avoid dangerous items Early identification and treatment of strabismus in children Early treatment when eye symptoms occur Routine instillation of appropriate drops of every newborn Blood test during pregnancy to identify syphilis Inoculation against rubella Regulation of oxygen concentrations in premature infants Avoid habitual rubbing of eyes
Adequate lighting when reading Periodically rest eyes during prolonged periods of closeeye work Reduce glare and wear protective glasses Keep eye glasses clean, protected from scratching,breakage and properly aligned Do not use eye medications unless prescribed by a doctor Never use soiled wash cloth around eyes Use care when using aerosol sprays
Maintain a state of good health and eat a well – balanceddiet with adequate vitamins A, B and C Use care when using solvents, lye solutions, ammonia,caustic solutions to avoid splashing or spilling into eyes
Orient the client to the staff and physical environment ifboth eyes will be covered after surgery. If the client is a child, practice covering the eyes. Administer mydriatics / cycloplegics as prescribed• Atropine sulfate• Cyclomydril• Scopolamine• Mydriacyl
To prevent or relieve the following: Increased intraocular pressure Stress on the suture site Hemorrhage on the anterior chamber Infection Pain
Position the client supine or turned to the unaffected side. Burning sensation about one hour after surgery is normal. Use eye patch for 5 to 7 days. Use eye shield during thenight for four weeks. Instruct the client to avoid the following:• Rubbing the eyes• Lifting the head or hips• Sudden, jerky head movements• Sneezing and coughing
• Nausea and vomiting• Straining during defecation• Bending and stooping• Heavy lifting• Reading for few days• Watching fast moving objects Feeling of “something in the eye” 4 to 5 days postop isnormal. Sensation of pressure within the eye and sharp pain in theyes indicates bleeding.
Administer miotics as prescribed.• Carbachol• Pilocarpine HCl
Corrective eyeglasses Surgery• Advancement, resection and tucking• Tenotomy
Assessment• Pain radiating to the forehead and temple, blurredvision, photophobia, redness without purulentdischarge, small pupil, lacrimation Treatment• Mydriatics and steriods• Dark glasses• Analgesics
Assessment• Inflammation of exciting eye followed by thesympathizing eye, photophobia, blurred vision Treatment• Enucleation• Steriods• Atropine
Assessment• Reduced visual acuity, changes in visual field,alterations in the shape of objects, discomfort in theeyes and photophobia Treatment• Rest the eyes• Protect eyes from light• Atropine sulfate
RHEGMATOGENOUS DETACHMENTTRACTION DETACHMENTCOMBINATION OF RHEGMATOGENOUS AND TRACTIONEXUDATIVE DETACHMENT
Assessment• Floating spots or opacities, flashes of light, progressiveconstriction of vision in one area, cloudy vitreous andportion of retina Treatment• Bed rest and cover eyes• Dependent position• Early surgery
INITIATING EVENTSSTRUCTURAL ALTERATIONS IN THE AQUEOUSOUTFLOW SYSTEMFUNCTIONAL ALTERATIONSOPTIC NERVE DAMAGEVISUAL LOSS
Assessment• Rapid onset of severe pain• Blurred vision• Headache• Rainbows and halos around lights• Nausea and vomiting• Inflamed eye• Fixed dilated pupils
Treatment• Bed rest in quiet, darkened room, elevate head 30degrees• Monitor vital signs• Miotic eye drops as ordered• Administer acetazolamide and glycerol• Provide emotional support• Assess client’s ability to see
Treatment• Assist according to degree of visual impairment• Prepare for eye examinations as ordered – tonometry• Avoid mydriaticsABC atropine, benadryl cogentin• Administer antiemetics for nausea• Diet as tolerated• Prepare for surgery if ordered
Assessment• Tunnel vision which can progress to blindness• Insidious onset – generally no discomfort• Persistent dull eye pain in the morning• Frequent changes of glasses, difficulty in adjusting todarkness, failure to detect changes in color accurately.• Rainbows or halos resembling street lights aroundlights
Treatment• Miotics• Acetazolamide (Diamox)• Avoid fatigue or stress and avoid large quantities offluids• Surgery
Severe injury resulting in prolapse of uveal tissue or lossof light projection or perception An irritated, blind, painful, deformed, or disfigured eye,usually caused by glaucoma, retinal detachment, orchronic inflammation An eye without useful vision that is producing or hasproduced sympathetic ophthalmia in the other eye Intraocular tumors that are untreatable by other means
Refer to available facilities. Orient to environment. Promote independence – ADL May have a guide dog or use cane for direction. When approaching, talk before touching. When assisting in ambulation, have the patient hold yourforearm so that you are a step ahead of him. Talk to the patient frequently. Explain nursing procedures and what is to be done next.
Do not change the location of the objects in the roomwithout describing the change. Promote safety in the environment. Do not rush up and offer help to a blind person unless it isclear that the person wants help. Suggest gifts for a blind person that appeal to sensesother than vision.