TTT

1. Unit 4: Ophthalmic Disorder
Prepared by:
Jamilah Saad Alqahtani
Nurse Lecturer, MSN, TOT, OR Nurse
Specialist, RGN, BSN,

2. Content
•Common eye conditions
•corneal ulcers, glaucoma, cataract, trachoma.
•Retinal disorders- retinal detachment
•Inflammatory conditions dry eyes, conjunctivitis,
uveitis

3. Objectives
• At the end of this chapter the students will be able to:
• Identify significant eye structure and their main functions
• Identify diagnostic tests for assessment of vision
• Defined the following terms of eyes disorders: common eye conditions,
corneal ulcers, glaucoma trachoma cataract, Retinal disorders- retinal
detachment, Inflammatory conditions dry eyes, conjunctivitis, uvetis.
• Identify the etiology of the following disorders: common eye conditions,
corneal ulcers, glaucoma trachoma cataract, Retinal disorders- retinal
detachment, Inflammatory conditions dry eyes, conjunctivitis, uvetis.
• Discuss the nursing care of patient with the following disorders: common
eye conditions, corneal ulcers, glaucoma trachoma cataract, Retinal
disorders- retinal detachment, Inflammatory conditions dry eyes,
conjunctivitis, uvetis.

4. External structures of eyes

5. Cross section of the eye

6. Assessment And
Evaluation Of Vision
• Ocular history
• Visual acuity
• Snellen chart
• Record each eye
• 20/20 means the patient can read the
‘’20’’ line at a distance of 20 feet
• Finger count or hand motion

7. Diagnostic Evaluation
• Ophthalmoscopy
Direct and indirect
Examines the cornea, lens
and retina
• Tonometry
Measures intraocular or
pressure

8. Diagnostic Evaluation cont’
• Examination of the external structures - Note any evidence
of irritation, inflammatory process, discharge …
• Assess eyelids and sclera
• Assess pupils and pupillary response ‘’use darkened room’’
• Assess extraocular movements
• Ptosis: drooping eyelids
• Nystagmus: oscillating movement of eyeball

9. Impaired Vision
Refractive errors
• Can be corrected by lenses which focus light rays on the retina
Myopia: nearsighted
Hyperopia: farsighted
Astigmatism: distortion due to irregularity of the cornea. Due to refractive
error in which light rays are spread over a diffuse area rather than sharply
focused on the retina, a condition caused by differences in the curvature of
the cornea and lens.
1st

10. Impaired Vision

11. Corneal Ulcer
2nd

12. Corneal ulcer
• A corneal ulcer is an open sore or
epithelial defect with underlying
inflammation on the cornea ‘the clear
structure in the front of the eye’. The
cornea overlies the iris which is the
colored part of the eye and separated
from iris by aqueous fluid in the anterior
chamber of the eye.

13. Anatomy of
Corneal ulcer
• A corneal ulcer will often appear
as a gray to white opaque or
translucent area on the normally
clear and transparent cornea.
• Some corneal ulcers may be too
small to see without adequate
magnification and illumination.

14. Causes of Corneal ulcer
It’s usually caused by an infection.
 Even small injuries to the eye or erosion caused by wearing contact
lenses too long can lead to infections.
dry eye,
eye injury,
inflammatory disorders,
 wearing unsterilized contact lenses
vitamin A deficiency.

15. Causes of Corneal ulcer
• Bacterial infections
• Viruses that may cause corneal ulcers include the herpes simplex virus(the
virus that causes cold sores) and the varicella virus (the virus that causes
both chickenpox and shingles) if it involves the upper eyelid and tip of nose
(herpes zoster ophthalmicus).
• fungal infection can cause corneal ulcers and may occur with improper
care of contact lenses or overuse of eyedrops that contain steroids.
• Parasites like acanthamoeba may also cause corneal surface and may
ulcerate if left untreated.
• Dry eyes
• Chemical burns or other caustic(damaging) solutions splashing into the eye
can injure the cornea and lead to cornea and lead to corneal ulceration.

16. Signs of Corneal ulcer
signs of an infection can notice
before Corneal ulcer
• Itchy eye
• Watery eye
• Burning or stinging sensation in the
eye
• Red or pink eye

17. Symptoms of Corneal ulcer
• Eye inflammation
• Sore eye
• Excessive tearing
• Blurred vision
• White spot on cornea
• Swollen eyelids
• Pus or eye discharge
• Sensitivity to light
• Foreign body sensation

18. Diagnoses Of A Corneal Ulcer
• Eye examination
• Fluorescein eye stain
• A slit-lamp

19. Treatment of Corneal ulcer
• ophthalmologist prescribe an antibacterial, antifungal, or antiviral
eye medication to treat the underlying problem of Corneal ulcer . If
the infection is bad, ophthalmologist may put patient on antibacterial
eye drops while they test the ulcer scrapings to find out the cause of
the infection. In addition, if the eye is inflamed and swollen, or may
have to use corticosteroid eye drops.
• During treatment, ophthalmologist will likely ask patient to avoid the
following: wearing contact lenses, wearing makeup, taking other
medications and touching own eye unnecessarily.
• Corneal transplants In severe cases, the corneal ulcer may warrant
a corneal transplant. Which involves the surgical removal of the
corneal tissue and its replacement with donor tissue.

20. Prevention Of Corneal Ulcer
• The best way to prevent corneal ulcers is to seek treatment as soon as
develop any symptom of an eye infection or as soon as the eye is
injured.
• Other helpful preventive measures include can be included in patient
teaching:
• avoiding sleeping while wearing contact lenses
• cleaning and sterilizing your contacts before and after wearing them
• rinsing eyes to remove any foreign objects
• washing own hands before touching own eyes

21. Glaucoma
3rd

22. Glaucoma
• A group of disorders characterized by high
intraocular pressure (IOP) and optic nerve damage
(IOP) = Intra Ocular Pressure

25. Two Forms Of Glaucoma
• Open-angle glaucoma (known as chronic simple or wide angle)
glaucoma begins insidiously and progresses slowly.
• angle- closure (also known as acute narrow-angle) glaucoma occurs
suddenly and can cause permanent vision loss in 48-72 hours.
Insidiously= in a gradual, subtle way, but with harmful effects

26. Pathophysiology of
glaucoma
• In glaucoma, aqueous
production and drainage are not
in balance.
• When aqueous outflow is
blocked, pressure builds up in
the eye.
• Increased IOP causes irreversible
mechanical or ischemic damage
to the optic nerve

27. Risk Factors of Glaucoma
1. Family history of glaucoma
2. Thin cornea
3. African American race
4. Older age
5. DM
6. Cardiovascular disease
7. Migraine syndromes
8. Myopia (nearsightedness)
9. Eye trauma
10. Prolonged use of the topical or
systemic corticosteroids

28. Types Of Glaucoma, clinical manifestations & Treatment Options:
Types Of Glaucoma clinical manifestations Treatment
Open-angle glaucoma
Usually bilateral, but one eye may be more severely affected than other. In all three types of open-angle glaucoma,
the interior chamber angle is open and appear normal.
Primary open-angle glaucoma POAG Optic nerve damage, visual field
defects. IOP >21mmHg
Usually no symptoms but possible
ocular pain, headache and halos.
Decrease IOP 20%to 50% additional
topical and oral agents added as
necessary.
If medical treatment is unsuccessful,
laser trabeculoplasty (LT) can reduce
IOP to 20% glaucoma filtering
surgery if continue optic nerve
damage despites by medication
therapy and LT
Normal tension glaucoma IOP <=21mmHg optic nerve damage
and visual field defects.
Similar to POAG , the goal is to lower
IOP to at last 30%
Ocular hypertension Elevated IOP. Possible ocular pain or
headache.
Decrease IOP by at last 20%.
halos is a disk or circle of light shown surrounding or above the head of a saint or holy person to represent their holiness.

29. halos is a disk or circle of light shown surrounding or above the
head of a saint or holy person to represent their holiness.

30. Types Of Glaucoma, clinical manifestations & Treatment Options cont’:
Types Of Glaucoma clinical manifestations Treatment
Angle-closure (pupillary block) glaucoma
Obstruction in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of the peripheral iris
the trabecula. the obstruction results in an increased IOP.
Acute angle-closure glaucoma AACG Rapidly progressive visual damage,
periocular pain, conjunctival hyperemia
and congestion. Pain may be associated
with nausea, vomiting, bardycardia, and
profuse sweating.
Reduce central visual acuity, severely
elevated IOP , corneal edema. Pupil is
vertically oval, fixed in semi dilated
position, and unreactive to light and
accommodation.
Ocular emergency; administration of
hyperosmotics , azetazolamide, and topical
ocular hypertensive agents, such as
pilocarpine and beta-blockers(betaxolol).
Possible laser incision in the iris
(iridotomy) to release blocked aqueous and
reduce IOP. Other eye is also treated with
pilocarpine eye drops and /or surgical
management to avoid a similar
spontaneous attack.
Subacute angle-closure glaucoma Transient blurring of vision, halos around
lights; temporal headache and /or ocular
pain; pupil may be semi dilated.
Prophylactic peripheral laser iridotomy .
Can lead to acute or chronic angle-closure
glaucoma if untreated
Chronic angle-closure glaucoma Progression of glaucomatous cupping and
significant visual filed loss; IOP may be
normal or elevated ocular pain and
headache.
Management similar to the that for POAG
includes laser iridotomy and medication

31. Clinical Manifestations
• ‘’Silent thief’’ of vision; unaware of the
condition until there is significant vision
loss;
• peripheral vision loss(Tunnel Vision),
• blurring,
• halos, difficulty focusing difficulty adjusting
eyes to low lighting.
• May also have aching or discomfort around
eyes or headache
• Diagnosis: tonometry to assess IOP

32. TREATMENT
• Goal is to prevent future optic nerve
damage
• Maintain IOP within normal range to
avoid causing optic nerve damage
• Pharmacologic therapy
• Surgery

33. Pharmacologic therapy
• Patient is usually started on the lowest dose of
optical medication and then advanced to increased
concentrations until the desired IOP level is reached
and maintained .
• One eye is treated first, with the other eye used as a
control in determining the efficacy of the medication
• Several types of ocular medications are used to treat
glaucoma, including miotic (medications that cause
pupillary constriction)
• Adrenergic a gonistis (i.e. sympathomimetic agents )
• Carbonic anhydrase inhibitors
• Prostaglandins

34. Surgical Management
• Laser trabeculoplasty or iridotomy indicated when IOP is inadequately
controlled by medications.
• Filtering procedures: an opening or fistula in the trabecular meshwork
‘trabeculectomy is standard technique’.
• drainage implant or shunt surgery may be performed
• Trabectome surgery is reserved for patients in whom pharmacologic
treatment and/or laser trabeculoplasty do not control the IOP
sufficiently

35. Trabectome

36. Nursing Management
• Create a teaching plan regarding the nature of the disease and importance
of strict adherence to the medication regimen to help ensure compliance
• Review the patient’s medication program, particularly the interactions of
glaucoma-control medications with other medications.
• Explain effects of glaucoma-control medications on vision (e.g. miotics and
sympathomimetics result in altered focus).
• Refer patient to services that assist in performing activities of daily living if
needed.
• Referee patient with impaired mobility for low vision and rehabilitation
services
• Provide reassurance and emotional support.
• Encourage family member to undergo examination at last once every 2
years to detect glaucoma early.

37. Nursing Management
• Patient education
• Focus on maintaining the therapeutic regimen for lifelong control of
chronic condition
• Emphasize the need for adhere to therapy and continued care to
prevent future vision loss
• Provide education regarding the action, uses, effects, side effects of
medications to promote compliance
• Provide support and interventions to help patient adjusting to vision
loss or potential vision loss

38. CATARACTS
4th

39. Cataracts
• A cataract is a lens opacity or cloudiness.
• Cataract can develop in both eyes and at any age.
• Cigarette smoking; long term use of corticosteroids, especially at high
doses, sunlight and ionizing radiation, DM, obesity and eye injuries
increase risk of cataract.
• The three most common types senile (age related ) cataracts are
defined by their location in the lens: nuclear, cortical and posterior
subcapsular.
• Visual impairment depends on the size, density, and location in the
lens. More than one type can be present in one eye.

41. Epidemiology of cataract
• WHO assessed that around 95 million people are visually
impaired because of cataracts in 2014. Numerous large-scale
population-based studies have described that the
prevalence of cataract rises with age, from 3·9% at age 55 to
64 years to around 92·6% at age over 80 years.
• Moreover, the presence of cataracts is related with increased
mortality, and this association might be because of the
relationship between cataracts and systemic conditions for
example type 2 diabetes mellitus or smoking .

42. Epidemiology of cataract
• The prevalence of cataracts in the past two decades has been decreasing
because rates of cataract surgery have been increasing due to the
improved techniques. Nevertheless, cataracts continue to be the leading
cause of blindness in middle-income and low-income countries responsible
for 50% of blindness, while they are accountable for only 5% of blindness in
developed countries.
• It is imperative to device a set of policies to improve the access of effective
ophthalmic facility and screening, and the quality of management
delivered in developing countries .
• Cataract surgery continues to be one of the most cost-effective treatments
and the most frequently used procedure in many countries.
• By 2020, over 30 million people yearly worldwide are predicted to
experience cataract surgery.

43. Pathophysiology
of Cataract
• The clouded lens
blocks light
shining through
the cornea.
• Images cast onto
the retina are
blurred.
• A hazy image is
interpreted by the
brain
Pathophysiology

47. Causes of cataract
Classified according to cause
• Senile cataracts (chemical changes in lens protein in elderly patient).
• Congenital cataracts(genetic causes, inborn error metabolic,
congenital anomaly, maternal rubella infection during 1st trimester).
• Traumatic cataract (foreign body cause aqueous or vitreous humor to
enter lens capsule)
• Complicated cataract (uveitis, glaucoma, retinitis pigmentosa, retina
detachment, DM, hypoparathyroidism, atopic dermatitis, ionizing
radiation or infrared rays)
• Toxic cataract (drugs or chemical toxicity )

48. Clinical Manifestations
• Painless, blurry vision
• Sensitivity to glare
• Reduced visual acuity
• Other effects include astigmatism,
diplopia (double vision) and color
(color value shift to yellow-brown)
• Diagnostic findings include decreased
visual acuity and opacity of the lens by
ophthalmoscope or inspection.

49. Complications
• Complete vision loss
• Possible complications of surgery :
• Loss of vitreous
• Wound dehiscence
• A Hyphema
• Pupillary block glaucoma
• Retina detachment
• Infection
A hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris). The
blood may cover most or all of the iris and the pupil, blocking vision partially or completely. A hyphema is usually painful.

50. Assessment And Diagnostic Methods
 Degree of visual acuity is directly proportionate to density of
cataract.
• History
 Painless, gradual vision loss
 Glare, especially from headlight with night driving
 Poor reading vision
 Better vision in dim light than in bright light (central opacity)
• Physical finding
 Milky-white pupil on inspection with a penlight
 Grayish-white area behind the pupil (advance cataract )
 Absence of red reflex is lost (mature cataract)
• Test result (diagnostic procedures)
 Snellen visual acuity test
 Ophthalmoscopy
 Slit-lamp biomicroscopic examination

51. Treatment of cataract
Include general, diet, Activities, medications and surgery

52. GENERAL
• Before surgery, eyeglass and contact lens that may help to improve
vision.
• Sunglasses provide reflected lighting rather than direct lighting thus
decreasing glare and aiding vision.
DIET
• No restriction
Activity
• Restricted according to vision loss

53. MEDICATIONS
Nonsteroidal anti-inflammatory drugs
Short-acting local anesthetic
Mydriatics
Corticosteroids
Antibiotics
SURGERY
Lens extraction and implantation of intraocular lens
Extracapsular cataract extraction
intracapsular cataract extraction
Phacoemulsification

54. Nursing Consideration
Nursing diagnosis
• Anxiety
• Deficit knowledge (cataract removal)
• Disturbed sensory perception: visual
• Risk for infection
• Risk for injury
Outcomes
• The patient will be ;
• Voice feelings and concerns
• Express understanding the disorder
• Regain visual function
• Remain free of harm or injury
• Remain free from signs and symptoms of infections

55. Nursing Consideration cont’
Nursing intervention
Perform routine postoperative care
Assist with early ambulation
• Apply an eye shield or eye patch post operative as ordered
Monitoring
Vital signs
Visual acuity
Complications of surgery

56. Patient Teaching
• Be sure to cover:
• Need to avoid activities that increase intraocular pressure such as
straining with coughing, bowel movements, or lifting
• Need to abstain from sexual intercourse until physician approval
• Proper instillation of ophthalmic ointment or drops.
Nursing alert:
If the patient has increase eye discharge, sharp eye pain that’s
unrelieved by analgesics, to notify physician immediately .

57. Trachoma

58. Trachoma Definition
• Is abilateral chronic follicular conjunctivitis of childhood leads to
blindness during adulthood, if left undertreated.
• The onset in children is usually insidious but it can be acute or
subacute in adults.

59. Trachoma
• The initial symptoms include:
• Red inflamed eyes, tearing, photophobia, ocular
pain purulent exudates, preauricular
lymphadenopathy and lid edema initial ocular.
• Signs include follicular and papillary formations.
• At the middle stage of the disease there is acute
inflammation with papillary hypertrophy and
follicular necrosis after which trichiasis (turning
inward of hair follicles) and entropion begin to
develop.

60. Trachoma
• The initial symptoms include:
• The lashes that are that are turned in rub against the
cornea and after
• Prolonged irritation cause corneal erosion and
ulceration. The late stage of the disease is characterized
by scarred conjunctiva, subepithelial keraititis, abnormal
vascularization of cornea (pannus) and residual scars
from the follicles that look like depressions in the
conjunctiva (like, Herbert’s pits)
• Severe corneal ulceration can lead to perforation and
blindness.

61. Retinal disorders-Retinal detachment

62. Retinal Detachment
• Separation of sensory retina and the RPE(Retinal Pigment Epithelium).
• Manifestation: sensation of a shade or curatain coming across the
vision of the one eye, bright flashing lights,sudden onset of the
floaters.
• Diagnostic findings: assess visual acuity, assessment of retina by
indirect opthalmoscope and fluorescein angiography. Tomography
and ultrasound may also be used.

63. Retinal Detachment

64. 1-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.
2-Freezing (cryopexy). After giving patient 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.
• Both of these procedures are done on an outpatient basis. After your
procedure, patient'll likely be advised to avoid activities that might jar
the eyes — such as running — for a couple of weeks
Surgical Treatment

65. Surgical Treatment
scleral buckle
3-a scleral buckling. In this procedure, doctor will suture a
piece of silicone rubber or sponge, called a buckle, to the
sclera. The material sutured to eye will create a slight
indentation in the wall of the eye, thereby relieving some of
the strain at the site of the detachment. In cases where there
are several tears/holes in the retina or when the detachment
is extensive and severe, surgeon may recommend a scleral
buckle that wraps around the entire eyes. In most cases, the
buckle is usually left on the eye permanently. doctor may use
laser or freezing treatment to create scar tissue around the
retina. This will help seal the seal the retinal tear/break to the
wall of the eye, preventing fluid from detaching the retina.

66. Surgical Treatment
4- In a vitrectomy, doctor will remove the vitreous
fluid from inside the eyeball, and will remove any
tissue that may be preventing the retina from
healing. doctor will then fill the eye with air, gas, or
liquid to replace the vitreous, allowing the retina to
reattach and heal.This procedure is the most
commonly-performed type of retinal surgery.
• Over time, the substance (air, gas, or liquid)
doctor injected is absorbed by the eye, and body
will produce fluid that will fill the vitreous cavity.
If doctor used silicone oil, however, he will need
to surgically remove the oil after several months
have passed and the eye has healed

67. 5-Pneumatic retinopexy
After sealing a retinal tear with
cryopexy, a gas bubble is injected
into the vitreous. The bubble
applies gentle pressure, helping a
detached section of the retina to
reattach to the eyeball

68. Eye Trauma
• Prevention of injury
• Patient and public education
• Emergency treatment
• Flush chemical injuries
• Do not remove foreign objects
• Protect using metal shield or
paper cup

69. Protective Eye Patches

70. Inflammatory Condition
Dry eye
Conjunctivitis
Uveitis
Note:
• Inflammation and infections of eye structures are common.
• Eye infection is a leading cause of blindness worldwide.

71. Dry Eye Syndrome (DES)
Dry eye syndrome (DES) or
keratoconjunctivitis sicca (KCS) is a deficiency
in the production of any of the aqueous mucin
or lipid tear film components.
Causes:
1. lid surface abnormalities; or
2. epithelial abnormalities related to systemic diseases (e.g.
thyroid disorders, Parkinson’s disease),
3. infection, injury or
4. complications of medications (e.g. antihistamines, oral
contraceptive, phenothiazines).

72. The tear film needs all three layers to
be healthy in order to do its job and
keep the eye comfortable and seeing
well.
The three layers of the tear film are:
•Lipid (oil) Layer: This layer lubricates
and prevents evaporation
•Aqueous (water) Layer: this layer
nourishes and protects the cornea
•Mucin Layer: This layer keeps the tear
film smoothly against the eye
Tears are made up of three layers
The Meibomian Glands create the lipid (oil) layer of the
tear film. A blockage or poor function of these glands can
lead to evaporative dry eye disease.

74. Clinical manifestations of Dry Eye
Syndrome (DES)
• The most common complaint in dry eye syndrome is a scratchy or foreign
body sensation.
Other symptoms including
• Itchy,
• Excessive Mucus Secretion,
• Inability To Produce Tears
• A Burning Sensation,
• Redness,
• Pain, And
• Difficulty Moving The Lids.

75. Assessment and
diagnostic findings
• Slit-lamp examination shows
an absent or interrupted tear
meniscus at lower lid margin
and the conjunctiva is
thickened, edematous,
hyperemic and has lost its
luster. A tear meniscus is the
crescent- shaped edge of the
film in the lower lid margin.
• Chronic dry eyes may result in
chronic conjunctiva and
corneal irritation that can
lead to corneal erosion,
scarring, ulceration, thinning
or perforation that can
seriously threaten vision.
Secondary bacterial infection
can occur.

76. Management of Dry Eye Syndrome
(DES)
• Management of (DES) requires the complete cooperation of the
patient with a regiment that needs to be followed at home for long
period or complete relief of symptoms is likely.
• Instillation of artificial tears during the day and an ointment at night
is the usual regimen to hydrate and lubricate the eye through
stimulating tears and preserving a moist ocular surface.
• Anti-inflammatory medications are also used and moisture
chambers(e.g. moisture chamber spectacles, swim goggles)may
provide additional relief.

77. Surgical Management of DES
• In advanced cases of dry syndrome surgical
treatment that includes: punctal occlusion, grafting
procedures and lateral tarsorrhaphy (e.g. uniting the
edges of the lids) are options.
• Punctal plugs are mode of silicon material for the
temporary or permanent occlusion of the puncta.
• This helps preserve the natural tears and prolongs
the effects of artificial tears. Short-term occlusion is
performed by inserting punctal or silicone rods in all
four puncta.
• If tearing in induced the upper plugs are removed
and remaining lower plugs are removed in another
week.

78. Conjunctivitis

79. Conjunctivitis
• is defined as inflammation of the bulbar and/or palpebral conjunctiva (the
transparent lubricating mucous membrane that covers both the surface of the
eye and lining of the undersurface of the eyelids),
• Common ocular disease worldwide. Only about 30% of primary care patients with
infectious conjunctivitis are confirmed to have bacterial conjunctivitis, although
80% are treated with antibiotics.
• It is characterized by a pink appearance (hence the common term pink eye)
because of subconjunctival blood vessel hemorrhages.

80. Conjunctivitis Etiologies
• Conjunctivitis, has many etiologies, including; (infection from various bacteria, fungi, and
viruses, as well as toxic and allergic insults).
• The bacterial etiology often depends on geography and age, but the most common
include Staphylococcus, Streptococcus, Corynebacterium, Haemophilus, Pseudomonas,
and Moraxella species.
• household dust
• pollen from trees and grass
• mold spores
• animal dander
• chemical scents such as household detergents or perfume

81. Clinical Manifestations
of Conjunctivitis
• General symptoms include
foreign body sensation,
scratching or burring sensation,
itching and photophobia.
• Conjunctivitis may be unilateral
or bilateral but the infection
usually stats in one eye and then
spreads to the other eye by hand
contact.

82. Assessment and Diagnostic Findings of
Conjunctivitis
• The four main clinical features important to evaluate are
1. the type of discharge (e.g. watery, mucoid, purulent or
mucopurulent)
2. type of conjunctival reaction(e.g. follicular or papillary)
3. presence or absence of lymphadenopathy (e.g. Enlargement of the
preauricular and submandibular lymph nodes where the eyelids
drain)
4. pseudomembranous consist of coagulated exudate that adheres to
the surface of the inflamed conjunctiva.

83. Assessment and Diagnostic
Findings of Conjunctivitis
• True membranes form when the exudate adheres to the
superficial layer of conjunctive and removal results in
bleeding.
• Follicles are multiple, slightly elevated lesion encircled
by tiny blood vessels; they look like grains of rice.
• Papillae are hyperplastic conjunctival epithelium in
numerous projections that are usually seen as a fine
mosaic pattern under slit-lamp examination.
• Diagnosis is based on the distinctive characteristics of
ocular or chronic presentation and identification of any
precipitating events.
• Positive results of swab smear preparations and
cultures confirm the diagnosis.

84. Types of Conjunctivitis
Conjunctivitis is classified according to its cause.
The major causes are:
1. Allergy ,and irritating toxic stimuli .
2. A wide spectrum of exogenous microbes can cause conjunctivitis
including bacteria (e.g. chlamydia), viruses, fungus, and parasites.
3. Conjunctivitis also result from infection of an existing ocular
infection or can be a manifestation of a systemic disease.

85. Management of Conjunctivitis
The management of Conjunctivitis depends on the
types:
Most types of mild and viral Conjunctivitis are self
limiting, benign conditions that may not require
treatment and laboratory procedures.
For more severe cases topical antibiotics, eye drops or
ointment are prescribed.

86. Complications
If left untreated can lead to;
• Corneal perforation
• Blindness
• Meningitis
• Generalized septicemia

88. Anatomy & Physiology of uvea
The uvea is the middle layer of the eye which contains much of the
eye’s blood vessels. This is one way that inflammatory cells can enter
the eye.
Located between the sclera, the eye’s white outer coat, and the inner
layer of the eye, called the retina, the uvea consists of the iris, ciliary
body, and choroid:
Iris: The colored circle at the front of the eye. It defines eye color,
secretes nutrients to keep the lens healthy, and controls the amount of
light that enters the eye by adjusting the size of the pupil.
Ciliary Body: It is located between the iris and the choroid. It helps the
eye focus by controlling the shape of the lens and it provides nutrients
to keep the lens healthy.
Choroid: A thin, spongy network of blood vessels, which primarily
provides nutrients to the retina.
Uveitis disrupts vision by primarily causing problems with the lens,
retina, optic nerve, and vitreous.

90. Uveitis
•Uveitis is a general term describing a group of
inflammatory diseases that produces swelling and
destroys eye tissues. These diseases can slightly reduce
vision or lead to severe vision loss.
•The term “uveitis” is used because the diseases often
affect a part of the eye called the uvea. Nevertheless,
uveitis is not limited to the uvea. These diseases also
affect the lens, retina, optic nerve, and vitreous,
producing reduced vision or blindness.

91. Uveitis
• Uveitis may be caused by problems or diseases occurring in the eye or
it can be part of an inflammatory disease affecting other parts of
the body.
• It can happen at all ages and primarily affects people between 20 to
60 years old.
• Uveitis can last for a short (acute) or a long (chronic) time. The
severest forms of uveitis reoccur many times.

92. types of uveitis
Eye care professionals
may describe the disease
more specifically as:
1. Anterior uveitis
2. Intermediate uveitis
3. Posterior uveitis
4. Pan uveitis uveitis
Eye care professionals
may also describe the
disease as infectious or
noninfectious uveitis.

93. Uveitis

94. Pathophysiology of uveitis
• The most common types of uveitis is the nongraulomatous type
which manifests as acute condition with pain, photophobia and a
pattern of conjunctival injection, especially around the cornea.
• The pupil is small or irregular and vision is burred.
• There may be small, fine precipitates on posterior corneal surface and
cells in the aqueous humor (e.g. cell and flare) if sever, a hypopyon
(e.g. accumulation of pus in the anterior chamber) may occur.

95. Pathophysiology of uveitis
• The condition may be unilateral or bilateral and may be recurrent.
Repeated attacks of nongranulomatous anterior uveitis can cause
anterior synechia(e.g. peripheral iris adheres to the cornea and
impedes outflow of aqueous humor)
• The development of posterior synechia (e.g. adherence of iris and
lens) block aqueous outflow from posterior chamber.
• Secondary glaucoma can result from either anterior or posterior
synechia. Cataract may also occur as a sequela to uveitis.

96. Uveitis etiology
Uveitis is caused by inflammatory responses inside the eye.
Uveitis may be caused by:
o In many cases the cause is unknown.
o An attack from the body’s own immune system (autoimmunity). such as rheumatoid arthritis.
o AIDS/HIV and other diseases that weaken the immune system
o Inflammatory disorders, such as Crohn's disease, ulcerative colitis
o Infections that increase the risk of uveitis include HIV, brucellosis, herpes simplex, herpes zoster, leptospirosis, Lyme
disease, syphilis, toxocariasis, toxoplasmosis, and tuberculosis(TB).
o Infections or tumors occurring within the eye or in other parts of the body.
o Bruises to the eye.
o Toxins that may penetrate the eye.
o The disease will cause symptoms, such as decreased vision, pain, light sensitivity, and increased floaters.
• Uveitis may occur as a normal immune response to fight an infection inside the eye.
• Research suggests that there may be a link between black tattoo ink and uveitis.
https://www.medicalnewstoday.com/articles/166410.php

97. Symptoms of uveitis
• Uveitis can affect one or both eyes.
 Symptoms may develop rapidly and can include:
• Blurred vision
• Dark, floating spots in the vision (floaters)
• Eye pain may be minimal
• Redness of the eye
• Headache
• A small pupil
• Alteration of the color of the iris
• Sensitivity to light (photophobia)
• The keratic precipitate may be large and grayish.
• Vision is markedly and adversely affected.
• Conjunctival injection id diffuse and there may be vitreous clouding.
• In sever posterior uveitis such as chorioretinitis there may be retinal and choroidal hemorrhages.

98. Diagnostic test of uveitis
• This evaluation should be include physical examination complete systems review and
diagnostic tests including:
• . Laboratory tests may be done to rule out an infection or an autoimmune disorder.
Include the following:
• a complete blood cell count CBC,
• erythrocyte sedimentation rate,
• antinuclear antibodies (ANA),
• The Venereal Disease Research Laboratory (VDRL), and
• Lyme disease titer.
• The eye exams used, include:
• An Eye Chart or Visual Acuity Test:
• A Funduscopic Exam: Ocular Pressure:
• A Slit Lamp Exam.
The Venereal Disease Research Laboratory test(VDRL) is a blood test for syphilis that was developed by the eponymous lab. The VDRL test is used to
screen for syphilis (it has high sensitivity), whereas other, more specific tests are used to diagnose the disease

99. Management of uveitis
• Because photophobia is common complaint patients should wear
dark glasses outdoors.
• Cylopentolate (cyclogy) and atropine are commonly used.
• Local corticosteroid drops such as order forte 1% and flarex0.1%
instilled four to six times a day are also used to decrease
inflammation
• In very sever cases systemic corticosteroids as well as intravitreal
corticosteroids may be used in the uveitis is recurrent a medical
workup should be initiated to discover any underlying causes.

100. Nursing considerations:
• Fundamental goals of ophthalmic nursing should include the preservation of the
vision and prevention of further loss vision in those patient who have already
experienced some degree of vision loss.
• Skillful listening and interviewing on the part of the nurse critical tools for the
rehabilitation of the distressed patient.
• The health care provider together with patient should determine which goal are
possible.
• A referral to low-vision center for evaluation may be an appropriate intervention
but for some patients it may be signal that all hope of vision restoration is lost.
• To be effective, the nurse listen to the patient, tires to determine his or her level
of health care needs and makes suggestions and recommendations that can be
value to the patient.
• Lines of communication must be kept open so that the patient is comfortable
exploring all treatment modalities without fear of being ridiculed or patronized.

101. References
• Smelter S.C.,Bare B.G.,(Brunner and suddarths Medical-surgical
Nursing ,.lippencot
• Lewis S.W., Heitkemper M.M., Dirkson S.R., Medical Surgical Nursing
Assessment And Management of clinical problems
• Philadelphia, PA. Lippincott, Williams & Wilkins. 2003(Nurse's 3-
Minute Clinical Reference)
• https://nei.nih.gov/health/uveitis/uveitis
• https://www.healthline.com/health/uveitis
• http://www.hawaiianeye.com/eye-conditions/dry-eye-syndrome/