A cataract is a clouding of the lens in the eye that leads to decreased vision. It is the leading cause of blindness worldwide and the most common eye surgery performed, with over 1 million cataract operations annually in the United States. Cataracts usually form due to aging but can be acquired due to diseases like diabetes, injuries, or medications. Surgical removal of the clouded lens and replacement with an artificial lens is currently the only effective treatment for restoring vision impaired by cataracts.

1. CATARACT

2. INTRODUCTION:
• A cataract is a clouding of the lens in the eye
leading to a decrease in vision. It can affect one or
both eyes. Some degree of cataract formation is to
be expected in most people more than 70 year of
age. Worldwide, cataract is the primary cause of
reduced vision and blindness. More than 1 million
cataract operations are now being performed
annually in the united states. A person with a
normal life span is more likely to undergo a
cataract operation then any other major surgical
procedure.

3. • If cataract present in both eyes, one cataract ,
one cataract may affect the patient’s vision
more then the other. Cataracts are the third
leading cause of preventable blindness and the
most common cause of self-declared visual
disability in the united state. The incidence
increases to approximately 70%. Cataract
removal is the most common surgical
procedure for Americans older than 65 years.

4. • The most common cataract is the age-related
or senile type. Senile cataract usually begin
around the age of 50 year and consist of
cortical, nuclear, or posterior subcapsular
opacities, which may coexist in various
combinations. In cortal cataract, spoke-like
opacifications are found in the periphery of the
lens. They progress slowly, infrequently
involve the visual axis, and often do not cause
severe loss of vision.

6. DEFINITION:
 ‘A cataract is opacity of the lens.’ (in Joyce M.
Black)
 ‘A cataract is an opacity within the lens.’ (in
Lewis)
 It is an opacity of the crystalline lens or its
capsule causing visual impairment. (Internet)

8. ANATOMY OF EYE
• External structure
• Eye ball
• Eyelids
• Lacrimal gland

9. • Internal structure – The internal structure
composed of
• conjunctiva,
• cornea,
• sclera,
• the uveal tract(iris, ciliary body, choroid) lens,
• and vitreous chamber

11. PHYSIOLOGY OF EYE:
• Transmission of light
• Visual receptor of the Retina: Cones and
Rods
• Image Processing and the visual cortex

12. RISK FACTORS
• Aging
 Loss of lens transparency
 Clumping or aggregation of lens protein (which leads to
light scattering)
 Accumulation of a yellow-brown pigment due to the
breakdown of lens protein
 Decreased oxygen uptake
 Increase in sodium and calcium
 Decrease in levels of vitamin C, protein, and glutathione
(an antioxidant)

13. • Associated Ocular Conditions
 Retinitis pigmentosa
 Myopia
 Retinal detachment and retinal surgery
 Infection (eg, herpes zoster, uveitis)

14. • Nutritional Factors
 Reduced levels of antioxidants
 Poor nutrition
 Obesity

15. • Physical Factors
 Dehydration associated with chronic diarrhea,
use of purgatives in anorexia nervosa, and use
of hyperbaric oxygenation
 Blunt trauma, perforation of the lens with a
sharp object or foreign body, electric shock
 Ultraviolet radiation in sunlight and x-ray

16. • Systemic Diseases and Syndromes
 Diabetes mellitus
 Down syndrome
 Disorders related to lipid metabolism
 Renal disorders
 Musculoskeletal disorders

17. • Toxic Factors
 Corticosteroids, especially at high doses and in long-
term use
 Alkaline chemical eye burns, poisoning
 Cigarette smoking.
 Calcium, copper, iron, gold, silver, and mercury, which
tend to deposit in the pupillary area of the lens

18. • Congenital cause
 Maternal rubella
 Familiar congenital cataract.
 Galactosemia

19. TYPES OF CATARACT
1.Congenital cataract - A congenital cataract is
clouding of the lens of eyes, that is present at
birth.
2.Acquired cataract – Are caused by diseases or
medications. Diseases that are linked with the
development of cataracts include Glaucoma and
Diabetes. Medication like the use of steroid
(prednisone) and other medication can sometime
lead to cataracts.
3.Sanile cataract – sanile cataract is a age related,
vision-impairing disease characterized by gradual
progressive thickening of the lens of the eye.

20. 1.Traumatic cataract – traumatic cataract
develop after an injury to the eye, but it can
take several years for this to happen.
2.Radiation cataract- radiation cataracts can
form after a person undergoes radiation
treatment for cancer.

21. PATHOPHYSIOLOGY

23. CINICAL MENIFESTATION:
 Pain less, Blurred vision(loss of sharpness of
eyesight).
 The patient perceives that surroundings are
dimmer, as if glasses need cleaning.
 Light scattering is common, and the individual
experiences reduced contrast sensitivity,
sensitivity to glare, and reduced visual acuity.
 Abnormal color perception.
 Photophobia(light sensitivity).

24. Nystagmus(involuntary eye movement ).
Gradual loss of Vision.
Pupil Dilates.
Increased intraocular pressure.
 The pupil which is normally black become
gray milky white.

25.  Loss of ability to discriminate between hues and
cloudy white opacity on the pupil.
 Other effects include myopic shift, astigmatism,
monocular diplopia (ie, double vision), color
shift (ie, the aging lens becomes progressively
more absorbent at the blue end of the spectrum),
brunescens (ie, color values shift to yellow-
brown) and reduced light transmission.

26. DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• Slit lamp Microscopy
• Opthalmoscopy - Direct opthalmoscopy &
Indirect opthalmoscopy
• Visual field perimetry
• Glare testing

27. COMPLICATION
 Postoperative infection
 Bleeding
 Macular edema
 Wound leaks
• Complete Vision loss

28. MANAGEMENT

29. MEDICAL MANAGEMENT
 No nonsurgical treatment cures cataracts.
 In the early stages of cataract development, glasses, contact
lenses, strong bifocals, or magnifying lenses may improve
vision.
 Reducing glare with proper light and appropriate lighting
can facilitate reading.
 Mydriatics can be used as short-term treatment to dilate the
pupil and allow more light to reach the retina, although this
increases glare(cause difficult to drive at night).
 Lifestyle adjustment.
 Reassurance

30.  Preoperative Medications- Eye drops may include
the dilating agent such as tropicamide
(mydriacyl) to facilitate the surgery.
• A cycloplegic cyclopentolate (cyclogyl) may
also be administered to paralyze the ciliary
muscles.
• Cataract surgery is performed under tropical
anesthesia using eye drops or regional anesthesia
(retrobulbar injection of local anesthetic
solution).
• The client is often given an intravenous sedative
in addition.

31. SURGICAL MANAGEMENT
• Intracapsular Cataract Extraction(ICCE) –
Intracapsular cataract surgery is removal of both
the lenses and the thin capsule that surround the
lens and left the eye aphakic(without a lens). This
type of surgery was common before 1980, but has
since displaced by extracapsular surgery.
Removal of the capsule requires the large incision
and doesn’t allow comfortable intraocular lens
implantation. Thus, people who undergo a
intraocular cataract surgery has long recovery
periods and have to wear very thick glasses.

32. • Extracapsular cataract Surgery (ECCE)– it
is the removal of the lens where the elastic
capsule that cover the lenses are left partially
intact to allow implantation of an intraocular
lens(IOL)

33. • Phacoemulsification –it is a modern cataract
surgery in which the eye’s internal lens is
emulsified with an ultrasonic hand piece and
aspirated from the eye. Aspirated fluids are
replaced with irrigation of balanced salt
solution to maintain the anterior

34. • Lens Replacement – after removal of the
crystalline lens, the patient is referred to a
aphakic(without lens). The lens, which focuses
light on the retina, must be replaced for the
patient to see clearly.

35. NURSING MANAGEMENT
• Preoperative care –
 To reduce the risk for retrobulbar hemorrhage (after
retrobulbar injection), any anticoagulation therapy that
the patient is receiving is withheld, if medically
appropriate.
 Aspirin should be withheld for 5 to 7 days, nonsteroidal
anti-inflammatory medications (NSAIDs) for 3 to 5
days, and warfarin (Coumadin) until the prothrombin
time of 1.5 is almost reached.

36.  Dilating drops are administered every 10 minutes
for four doses at least 1 hour before surgery.
Additional dilating drops may be administered in
the operating room (immediately before surgery)
if the affected eye is not fully dilated.
 Antibiotic, corticosteroid,and NSAID drops may
be administered prophylactically to prevent
postoperative infection and inflammation.

37. Postoperative care
 After recovery from anesthesia, the patient receives
verbal and written instruction regarding how to protect
the eye, administer medications, recognize signs of
complications, and obtain emergency care.
 Activities to be avoided are identified in Chart 58-6.
 The nurse also explains that there is minimal discomfort
after surgery and instructs the patient to take a mild
analgesic agent, such as acetaminophen,as needed.
 Antibiotic, anti-inflammatory, and corticosteroid eye
drops or ointments are prescribed postoperatively

38.  Position Patient on back or unoperated side to prevent
pressure in operated eye.
 Keep siderails up as necessary for protection.
 Place call light within reach.
 The nurse instruct the patient to be careful to prevent so
up water from entering the operative eye during face or
hair washing.
 Stress avoidance of action the increases I.O.P.

39. NURSING DIAGNOSIS
• Disturbed sensory perception(visual) related
to lens extraction and replacement and use
of eye patch
• Anxiety related to lack of knowledge
• Risk for injury related to blurred vision
• Acute pain related to trauma to the incision
and increased IOP

40. • Risk for infection related to trauma to the
incision.

41. HEALTH EDUCATION
• Hygiene-
 Clean the operated eye gently with the starile
saline wash and cotton balls given to you
 Don’t take head bath for few days after
surgery.
 Remove hair tangle gently on the operated
side.

42. • Diet –
 Usually given a full diet.
 Avoid fried food.
 Avoid tobacco, alcohol, & bittle nut

43. • Teaching patient self-care –
 To prevent accidental rubbing or poking of the
eye, the patient wears a protective eye patch for
24 hours after surgery, followed by eyeglasses
worn during the day and a metal shield worn at
night for 1 to 4 weeks.
 The nurse instructs the patient and family in
applying and caring for the eye shield.
 Sunglasses should be worn while outdoors during
the day because the eye is sensitive to light.

44. • Slight morning discharge, some redness, and a
scratchy feeling may be expected for a few
days. A clean, damp washcloth may be used to
remove slight morning eye discharge.
5.Because cataract surgery increases the risk
for retinal detachment, the patient must know
to notify the surgeon if new floaters (ie, dots)
in vision, flashing lights, decrease in vision,
pain, or increase in redness occurs.

45. Continuing care
 The eye patch is removed after the first follow up
appointment. Patients may experience blurring of
vision for several days to weeks.
 Sutures left in the eye alter the curvature of the cornea,
resulting in temporary blurring and some astigmatism.
 Vision gradually improves as the eye heals. Patients
with IOL implants have visual improvement faster than
those waiting for aphakic glasses or contact lenses.

46.  Vision is stabilized when then eye is
completely healed, usually within 6 to 12
weeks, when final corrective prescription is
completed.
 Visual correction is needed for any remaining
nearsightedness or farsightedness (even in
patients with IOL implants).

47. CONCLUSION
• A cataract is a clouding of the lens in the eye
leading to a decrease in vision. It can be
present one or both eye. If it present in both
eye then one eye is affected more then other.A
person with a normal life span is more likely to
undergo a cataract operation then any other
major surgical procedure. A cataract is a
treatable blindness in a person.

48. BIBLIOGRAPHY
 Joyce M. Black, “medical-surgical nursing, clinical
management for positive outcome ” Edition – 8th,
volume- 2nd, chapter- 63 & 65, elsevier publication
2009, New Delhi page no.-1668-1671,1704-1706.
 Lewis’s, “medical-surgical nursing,assessment and
management of clinical problems” Edition -7th,
section-4, chapter-22, Elsevier publication 2007, New
Delhi page no.- 425-429.

49.  Lippincott , “Manual of nursing practice”
Edition – 9th, Williams and Wilkins publication
2009, New Delhi.
 Brunner & siddarth’s, “textbook of medical-
surgical nursing”, Edition – 12th, volume –
2nd, Published by wolter’s kluwer Pvt Ltd,
New Delhi

50. • THANK YOU