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1. Care of Patient With Infections of
Eye and Cataract
Kiran Qaisar Ali
Sr. Instructor, AKUSoNaM
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2. Objectives
By the end of the session, learners will be able to:
 Review anatomy and physiology of eye
 Discuss different infections of eye and cataract
 Differentiate the causes and sign & symptoms of different
eye disorders
 Describe medical & surgical management of patients with
the infections of eye & cataract
 Apply nursing interventions while caring for patients with
the infections of eye & cataract
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3. Anatomy & Physiology of the Eye
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4. 4
INFECTIONS OF
EYE

5. Blepharitis
 It is an inflammatory condition of the lid margins.
 It can be an acute or a chronic condition.
 It is usually bilateral.
 Its prominent feature is scales along the eye lashes.
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6. Causes and S/S of Blepharitis
Causes:
• Staphylococcal
• Seborrhoeic
• Associated with dandruff,
poor hygiene, eczema or
allergy to make-up or drugs
• Chronic conjuctivitis
• Chronic nasal infection
Signs & symptoms:
• Red, swollen lid margins
• Scales on lashes
• Eyelid irritation
• Burning sensation
• Itching
• Loss of eyelashes
• photophobia
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7. Treatment of Blepharitis
 Hot compression
 Massage
 Lid scrub
 Antibiotic and Steroid ointments
 Doxocycline or tetracycline pills
 Omega-3 dietary supplementation
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8. Nursing interventions for Blepharitis
 Instruct patient on the treatment:
 Use of clean, warm face cloth over eyelids
 Dandruff-use anti-dandruff shampoo
 Make-up-stop using make-up or change the brand
 Eczema-use steroid ointment
 Drugs-stop offending drugs
 Improve hygienic practices
 Relief of itching and soreness-place clean, warm face cloth
on close eyelid
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9. Glands of Eye
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10. Hordeolum
 It is an inflammation of a gland of Zeis that opens into the
lash follicle.
 It is also known as “Stye” or “External Hordeolum”.
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11. Causes and S/S of Hordeolum
Causes:
• Staphylococcal infections
Risk factors:
• Eye strain &
habitual rubbing
• Chronic blepharitis
• Diabetes mellitus
Sign & symptoms:
• Painful swelling on the eyelid
• Small red bump near
the eyelashes
• Frequent watering in
the affected eye
• Foreign body sensation
• Increased light sensitivity
• Eye pain
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12. Treatment of Hordeolum
 Most Stye heal within a few days on their own or with
warm water compressions.
 Hold a clean washcloth soaked in hot water against the
closed lid for 5 to 10 minutes, 4 to 5 times a day.
 Evacuation of pus. (Incision & drainage)
 Antibiotic eye drops 3 – 4 times/day.
 Eye ointment before going to bed.
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13. Nursing interventions for Hordeolum
 Instruct patient to give steam/hot bathing to the eye.
 Instruct patient to keep eyelids clean by, twice a day using
warm water to wash off any crust or discharge.
 Instruct patient to consult if swelling does not subsides, as a
simple procedure of incision & currettage can be performed
followed by topical application of antibiotics.
 Removal of the affected lash can be done to drain the
abscess but the action is very painful.
 If stye recur, the patient should be investigated for DM.
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14. Chalazion
 It is a swelling of one of the oil producing (Meimobian)
gland due to blockage of its ducts.
 It can affect either upper or lower eyelid.
 It may become infected, then it is called as “internal
Hordeolum.”
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15. Causes and S/S of Chalazion
Causes:
• Staphylococcal infections
Risk factors:
• Eye strain &
habitual rubbing
• Chronic blepharitis
• Diabetes mellitus
Sign & symptoms:
• Painful swelling on the eyelid
• Pea size lump on eyelid
• Frequent watering in
the affected eye
• Foreign body sensation
• Increased light sensitivity
• Eye pain
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16. Treatment of Chalazion
A chalazion will often disappear on its own. If not, then
treatment may include:
 Self-care–application of hot compresses to the affected
eyelid several times a day.
 Medication–injection of a corticosteroid into the chalazion.
This is done by an ophthalmologist, but is rarely required.
Topical antibiotics can be used if a secondary infection of
the chalazion develops.
 Surgery–surgical excision of a chalazion. Surgery may be
done when the chalazion:
 does not respond to medical treatment.
 is growing very rapidly or very large.
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17. Nursing interventions for Chalazion
 Instruct patient to apply steam/hot bathing to the eye.
 Instruct patient to keep eyelids clean by, twice a day using
warm water to wash off any crust or discharge.
 Instruct patient to consult if swelling does not subsides, as
a simple procedure of incision & currettage can be
performed followed by topical application of antibiotics.
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18. Orbital Cellulitis
 It is an acute purulent inflammation of the cellular tissue of
the orbit.
 It is an ophthalmic emergency because of optic nerve
compression.
 It is more common in children and is usually unilateral.
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19. Causes and S/S of Orbital Cellulitis
Causes:
• Spread of infection from
neighbouring structure
• Sepsis following
penetrating injuries
• Following septic operations
• Facial erysipelas
• Spread of pyaemia
Sign & symptoms:
• Proptosis of the affected eye
• Red, inflamed lids
• Chemosis of conjunctiva
• Abscess may form
over upper eyelid
• Reduction in visual acuity
• Malaise & fever
• Relative afferent pupil defect
• Possible double vision
• Limitation and painful
ocular movement
• Optic nerve dysfunction
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20. Treatment of Orbital Cellulitis
 Prompt hospitalization
 Fever management
 Antibiotics/antifungal
 Surgical drainage of abscess to prevent visual loss
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21. Nursing interventions for Orbital Cellulitis
 Complete pain assessment and management
 Encourage usual diet and increase fluid intake
 Maintain general hygiene
 Evaluate CT scan findings
 Send blood cultures
 Send swab of discharge
 N/S eye hygiene
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22. Conjunctivitis
 It is an inflammation of the conjunctiva.
 It is one of the most common and treatable eye infection in
children and adults.
 It is also known as “Red Eye” or “Pink Eye”.
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23. Causes & S/S of Conjunctivitis
Causes:
• Bacterial (staphylococcus)
• Viral (adenovirus, herpes virus)
• Fungal (candida albican)
• Parasitic (parasites)
• Chlamydial (chlamydia trachomatis)
• Allergic (hay fever)
• Mechanical
(wind, smoke, dust)
Sign & symptoms
• Redness in eye & eyelid
• Excessive tearing
• Thick yellow discharge
• Itchy & burning eyes
• Blurred vision
• Increased Sensitivity
to light
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24. Treatment of Conjunctivitis
Treatment of conjunctivitis depends upon the causative
agents.
 Antibiotics eye drops & ointments (bacterial)
 Cold compression (viral)
 Antihistamines & cold compression (allergic)
 Use warm water for eye washing
 Lubricating eye drops
 Maintain general hygiene (esp. eye hygiene)
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25. Nursing interventions for Conjunctivitis
 Instruct patient to wear sunglasses for photosensitivity.
 For decreased visual acuity, give orientation to patient.
 Stress the importance of frequent hand washing and of
not touching the affected eye.
 Teach patient proper use of eye drops and ointments.
 Teach patient proper handling of discharge.
 Instruct patient to avoid rubbing eyes.
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26. Keratitis
 It is an inflammation of the cornea.
 It can result from dryness of the cornea.
 It is potentially a dangerous condition if not treated can
lead to ulceration and perforation of the cornea.
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27. Causes & S/S of Keratitis
Causes:
• Bacteria
• Viruses
• Direct trauma to eye
• Fungi
• Parasites
• Over use of contact
Lenses
Vitamin A deficiency
Sign & symptoms:
• Pain and redness in eye
• Photophobia
• Tearing, watery eyes,
or discharge
• Blurry vision
• Foreign body sensation
in the eye
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28. Management of Keratitis
 Antibiotics, antivirals and antifungals medications, eye
drops and ointments to treat the appropriate organism.
 Laser surgery to destroy unhealthy cells.
 Corneal transplant to eliminate severe infections.
 Instruct patient to wear patch over eye to protect the
healing eye from bright light, foreign objects, lid rubbing
against the cornea and other irritants.
 Instruct patient to wear dark glasses.
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29. Corneal Ulcers
 It is an open sore on the cornea.
 It develop as a result of local necrosis of corneal tissue by
bacteria, viruses, fungi or Acanthamoeba.
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30. Causes & S/S of Corneal Ulcers
Causes:
• Bacterial, viral &
fugal infections
• Acanthamoeba
• Photokeratitis
• Sulphur mustard
chemical keratitis
• Eyelid disorders
(Bell’s palsy)
• Dry eye disorders
• Contact lenses
Sign & symptoms:
• Erythema of eyelid
and conjunctiva
• Mucopurulent discharge
from eye
• Foreign body sensation
• Blurred vision
• Light sensitivity
• Pain
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31. Management of Corneal Ulcers
 Immediate consultation of ophthalmologist is required to
initiate treatment promptly.
 If you wear contact lenses, remove them immediately.
 Apply cool compresses to the affected eye.
 Do not touch or rub your eye with your fingers.
 Limit spread of infection by washing your hands often and
drying them with a clean towel.
 Use of topical broad spectrum antibiotics and analgesics.
 If medical treatment is not effective then emergency corneal
transplant is required.
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32. The Lens
 The lens is a biconvex, avascular colorless transparent
structure.
 It is suspended behind the iris by fibrous ligaments and
connected to the ciliary body.
 The sole purpose of the lens is light transmission to the
retina and the ability to perceive images clearly.

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CATARACT

34. Cataract
 Opacity of the lens
 A cataract is a cloudiness of the crystalline lens inside
the eye, that causes a progressive, painless loss of
vision. As the lens gets cloudier, the vision will
gradually become more blurred.

35. Cataract

36. Cataract

37. Causes
 Aging process
 Exposure to toxic substances
 Eye injury (blunt or penetrating)
 Diabetes
 Medication long term use of cortisone.
 Radiation therapy
 Prolonged exposure to direct sunlight (ultra violate rays)
 Ocular inflammation & infection

38. Types
 AGE RELATED (SENILE CATARACT)
 Most common cause
 Begin around the age of 50 years
 With increasing age, protein in the lens undergoes
numerous changes
 OTHER FORMS OF CATARACT
 Blunt trauma
 Systemic disease (diabetes)
 Chronic use of corticosteroids

39. Signs and Symptoms
1. EARLY:
 Blurred Vision
 Decreased color perception
2. LATE:
 Diplopia
 Reduced visual acuity→ to blindness
 Absence of red reflex
 Presence of white pupil

40. On the left, a normal
lens receives light
and focuses it on the
retina.
How Cataract Affects Vision
On the right, a cataract blocks
some light from reaching the
lens and distorts the light
being focused on the retina.

42. Pathophysiology
Increased density
Compaction of lens fibers
Reduces the lens water content
Causing lens proteins to precipitate & form crystals
Progressive & painless loss of lens transparency
Opacity of the lens

43. Surgical Management
There are two types of surgery that can be used to remove
lenses that have cataract.
1. Extra capsular surgery consists of surgically removing the
lens, but leaving the back half of the capsule (the outer
covering of the lens) intact. High-frequency sound waves
(phacoemulsification) may be used to soften the lens to
facilitate removal through a smaller incision.

44. Surgical Management
2. Intracapsular surgery involves surgically removing the
entire lens, including the capsule. Today this procedure is
done very rarely.
LENS REPLACEMENT:
 People who have cataract surgery are usually fitted with
an artificial lens at the same time. The artificial lens is a
synthetic disc called an intraocular lens. It is usually
placed in the lens capsule inside the eye.
 Other options include contact lenses and cataract glasses.

45. Surgical Management

47. Nursing Process
HISTORY:
 Recent or past trauma to the eye
 Exposure to radiation or X-rays
 Systemic diseases
 Use of certain medications
 Intraocular disease
PHYSICAL ASSESSMENT:
 Blurred vision / Double vision
 Decreased color perception
 Red reflex is absent
 Pupil appears white

48. Nursing Diagnosis
 Altered sensory perception (visual) R/T ocular lens
opacity
 Fear R/T loss of eye sight, surgery or inability to regain
eyesight
 Risk for injury R/T decrease vision
 Social isolation R/T decrease visual acuity
 Self care deficit R/T visual impairment
 Knowledge deficit R/T lack of information of the disease
process

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50. References
 Black, J. M., Hawks, J. H., & Keene, A. M. (2009). Medical surgical
nursing: Clinical management for positive outcomes. (7th ed.).
Philadelphia: Elsevier Saunders.
 Leibowitz, H. M. (2000). The red eye. The New England Journal of
Medicine, 343(5), 345-351.
 Mueller, J. B. & McStay, C. M (2008). Ocular infection and
inflammation. Emergency Medical Clinic of North America, 26, 57-
72.
 Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2008).
Brunner and suddarth’s textbook for medical-surgical nursing. (11th
ed.). Philadelphia: Lippincott William & Wilkins.
 Stollery, R.., Shaw, M. E., & Lee, A. (2005). Ophthalmic Nursing. (3rd
ed.). Blackwell Publishing: Oxford.
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