Retinal detachment: Eye disorder

1. Chestha Arora
M sc. Nursing I year
College of Nursing, ILBS

2. Anatomy and Physiology of
Eye
Definition
Epidemiology
Etiology
Pathophysiology
Types of Retinal
Detachment
Clinical Manifestations
Diagnostic Evaluation
Management
Complications
Prevention
Rehabilitation
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3. Vision is by far the most used of the five senses and
is one of the primary means that we use to gather
information from our surroundings.
More than 75% of the information we receive about
the world around us consists of visual information.
Eyes are organs of the visual system.
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4. EXTERNAL STRUCTURES OF
EYE
Orbit:
 Bony eye socket of the skull.
 Formed by the cheekbone, the forehead, the temple,
and the side of the nose.
 In addition to the eyeball itself, the orbit contains the
muscles that move the eye, blood vessels, and
nerves.
 Also contains the lacrimal gland that is located
underneath the outer portion of the upper eyelid.
 The tears drain away from the eye through the
nasolacrimal duct, which is located at the inner corner
of the eye.
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7. INTERNAL STRUCTURES OF EYE
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9. PHYSIOLOGICAL EVENTS OF VISION
Refraction of light entering the eye
Accommodation of lens to focus image
Convergence of image
Photo-chemical activity in retina and
conversion into neural impulse
Processing of image in brain and
perception 9

10.  A 61-year-old male university professor presents with loss of
vision in his left eye that began yesterday morning and has
become progressively worse.
 He describes the sensation that a curtain was coming up over
his affected eye and this curtain is now affecting his center
vision.
 In addition, 7 days ago the patient noticed what he described
as flashing lights on the left and noticed subsequent floaters.
 The patient has no pain, diplopia, halos, metamorphopsia or
other symptoms. The patient reports having cataract surgery
in his left eye 3 weeks ago.
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11. Retinal detachment describes an emergency situation in which a
thin layer of tissue (the retina) at the back of the eye pulls away
from its normal position.
Retinal detachment separates the retinal cells from the layer of
blood vessels that provides oxygen and nourishment.
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12. EPIDEMIOLOGY
 Although 6% of the general population are thought to have retinal
breaks, most of these are asymptomatic benign atrophic holes, which
are without accompanying pathology and do not lead to retinal
detachment.
 The annual incidence is approximately one in 10,000 or about 1 in 300
over a lifetime.
 The age-adjusted incidence of idiopathic retinal detachments is
approximately 12.5 cases per 100,000 per year, or about 28,000 cases
per year in the US.
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13. Aging
Previous retinal detachment
Family history
Extreme nearsightedness
Previous eye surgery
Previous severe eye injury 13

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Pathophysiology

16. PATHOPHYSIOLOGY
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18. TYPES OF RETINAL DETACHMENT
Rhegmatogenous Tractional
Exudative
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20. CLINICAL MANIFESTATIONS
Floater
s Photopsia
Blurred
vision
A curtain-
like
shadow
over visual
field
Heavy
Eyes
Reduced side
peripheral
vision
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25. History Taking
Snellen's Test
Slit Lamp Examination
Tonometery
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27. DIAGNOSTIC EVALUATION
Ophthalmoscope
Ultrasonography
Amsler grid
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31. CLINICAL VIGNETTE
 Past Ocular History: Cataract surgery Left eye, 3 weeks ago; no
other history of surgery, trauma, amblyopia or strabismus.
 Ocular Medications: None
 Past Medical History: Hypertension – well controlled on medication
Osteoarthritis
 Surgical History: Right knee replacement in 2005
 Past Family Ocular History: Mother – AMD. No history of retinal
detachment, glaucoma, blindness
 Social History: Non-smoker
 Medications: Hydrochlorothiazide and Lisinopril
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32. CLINICAL VIGNETTE
 Allergies: None
 ROS: Denies recent illness or any new CNS, heart, lungs, GI, skin or joint symptoms
Ocular Exam
 Visual Acuity (cc):OD: 20/25 OS: Counting fingers at 3 feet
 IOP (tonoapplantation): OD: 16 mmHg ad OS: 11 mmHg
 Pupils: Equal, round and reactive to light, no APD
 Extraocular Movements: Full OU. No nystagmus.
 Confrontational Visual Fields: Full to finger counting R; central, inferior, and
nasal field deficits OS
 External: Normal, both sides
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33. SLIT LAMP
Lids and Lashes Normal OU
Conjunctiva/Sclera Normal OU
Cornea Clear OU
Anterior Chamber Deep and quiet OU
Iris Normal OU
Lens 1+ nuclear sclerotic cataract OU
Anterior Vitreous
Normal OD, Pigmented cells OS (Shafer’s
sign)
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34. DILATED FUNDUS EXAMINATION
OD
Clear view, CDR 0.3 with sharp optic disc margins; flat
macula with normal foveal light reflex; normal vessels and
peripheral retina
OS
Clear view, CDR 0.3 with sharp optic disc margins; large
area of subretinal fluid extending from 10 o’clock to 4
o’clock with fluid under the macula (mac off retinal
detachment). A horseshoe tear is identified at 2 o’clock.
Small amount of vitreous hemorrhage noted at the site of
the tear.
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35. Amsler Grid: OD: Normal and OS: Blurry throughout, with
nasal regions missing completely
Diagnosis: Rhegmatogenous retinal detachment resulting
from a peripheral retinal tear.
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36. MANAGEMENT
Laser surgery (photocoagulation). The surgeon directs a laser beam into
the eye through the pupil. The laser makes burns around the retinal tear,
creating scarring that usually "welds" the retina to underlying tissue.
Freezing (cryopexy). After giving a local anesthetic to numb eye, the
surgeon applies a freezing probe to the outer surface of the eye directly over
the tear. The freezing causes a scar that helps secure the retina to the eye wall.
Retinal tears
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39. RETINAL DETACHMENT
1.Pneumatic retinopexy :
 In this procedure, the surgeon injects a bubble of air or gas
into the center part of the eye (the vitreous cavity).
 If positioned properly, the bubble pushes the area of the
retina containing the hole or holes against the wall of the
eye, stopping the flow of fluid into the space behind the
retina. Doctor also uses cryopexy during the procedure to
repair the retinal break.
 Fluid that had collected under the retina is absorbed by itself,
and the retina can then adhere to the wall of your eye.
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41.  This procedure involves the surgeon sewing (suturing) a
piece of silicone material to the white of your eye
(sclera) over the affected area.
 This procedure indents the wall of the eye and relieves
some of the force caused by the vitreous tugging on the
retina.
 If person have several tears or holes or an extensive
detachment, surgeon may create a scleral buckle that
encircles entire eye like a belt.
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43. 3. VITRECTOMY
The surgeon removes the
vitreous along with any
tissue that is tugging on
the retina. Air, gas or
silicone oil is then injected
into the vitreous space to
help flatten the retina.
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44. Vitrectomy
Pars Plana
Vitrectomy
Transconjunctival
sutureless
vitrectomy
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46. TREATMENT (CLINICAL
VIGNETTE)
Rhegmatogenous detachments are often treated surgically.
Common procedures include scleral buckle, pneumatic
retinopexy and vitrectomy.
The purpose of the surgery is to relieve vitreous traction and
approximate the retina to the underlying choroid.
Overall, the current surgical techniques have an 80-90%
success rate of anatomical reattachment
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47. Nursing Responsibilities
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48. 1.Initially, the patient complains of flashes of light, floating
spots or filaments in the vitreous, or blurred, “sooty” vision.
2.If detachment progresses rapidly, the patient may report a
veil-like curtain or shadow obscuring portions of the visual
field; the patient may initially mistake the obstruction for a
drooping eyelid or elevated cheek.
3.Straight-ahead vision may be unaffected in early stages but,
as detachment progresses, there will be loss of central as
well as peripheral vision.
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49.  Disturbed sensory perception related to
detached retina
 Anxiety related to sudden vision disturbance
 Risk of injury related to impaired sight
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50.  To provide and educate patient related to pre and
post operative care.
 To reduce anxiety level of patient.
To prevent patient from any kind of injury
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51. 1. Prepare the patient for surgery.
2. Take measures to prevent postoperative complications.
3. Encourage ambulation and independence as tolerated.
4. Administer medication for pain, nausea, and vomiting as
directed.
5. Provide quiet diversional activities, such as listening to a
radio or audio books.
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52. 6. Teach proper technique in giving eye medications.
7. Advise patient to avoid rapid eye movements for several weeks as well
as straining or bending the head below the waist.
8. Advise patient that driving is restricted until cleared by
ophthalmologist.
9. Teach the patient to recognize and immediately report symptoms that
indicate recurring detachment, such as floating spots, flashing lights, and
progressive shadows.
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53. COMPLICATIONS
Loss of vision Epiretinal
Membrane
Vitreous
Haemorrhage
Secondary
Glaucoma
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54.  Wearing Safety Goggles Or Other Protective Eye Gear
 Early Treatment Can Help Prevent Permanent Vision Loss.
 It’s Also Important To Get Comprehensive Dilated Eye Exams Regularly.
 If Person Has Diabetes, Control Blood Sugar
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57. Low-vision Devices
Screen Readers That Enlarge The Size Of Text On A Digital
Screen
“Text To Speech” Software
Handheld Magnifiers Or Those That Are Worn On Patient’s
Head
Occupational Therapy
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58.  Cnrn, R. P. J. H. L., PhD Rn, K. C. H., & Overbaugh, K. (2021). Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing (Brunner and Suddarth’s Textbook of Medical-Surgical) (Fifteenth, North American ed.).
LWW.
 Haug, S. J., & Bhisitkul, R. B. (2012). Risk factors for retinal detachment following cataract surgery. Current
opinion in ophthalmology, 23(1), 7–11. https://doi.org/10.1097/ICU.0b013e32834cd653
 Parks. (2016, August 19). Testing and Diagnosis of Retinal Detachment. Pacific Retina Specialists. Retrieved
January 17, 2022, from https://www.socalretina.com/blog/2013/07/10/testing-and-diagnosis-of-retinal-141466
 Patel, H. M. (2018, September 26). Anatomy of the Human Eye. News-Medical.Net. Retrieved January 15,
2022, from https://www.news-medical.net/health/Anatomy-of-the-Human-Eye.aspx
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59.  Retinal detachment - Symptoms and causes. (2020, August 28). Mayo Clinic. Retrieved January 15,
2022, from https://www.mayoclinic.org/diseases-conditions/retinal-detachment/symptoms-causes/syc-
20351344
 Types and Causes of Retinal Detachment | National Eye Institute. (n.d.). National Eye Institute.
Retrieved January 15, 2022, from https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-
diseases/retinal-detachment/types-and-causes-retinal-detachment
 Yan Yu. (2020, July 13). Retinal Detachment: Pathogenesis | Calgary Guide. The Calgary Guide to
Understanding Disease. Retrieved January 30, 2022, from https://calgaryguide.ucalgary.ca/retinal-
detachment-pathogenesis/
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This Photo by Unknown Author is licensed under CC BY