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.

1. Cataract
Department of Medical Surgical Nursing

2. Introduction
• 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. 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)

5. Risk factors
• Aging
• Associated Ocular Conditions (Retinitis pigmentosa,
Myopia, Retinal detachment and retinal surgery, Infection)
• Nutritional Factors (Reduced levels of antioxidants, Poor
nutrition, Obesity)
• Physical Factors (Dehydration, Blunt trauma, perforation of
the lens, foreign body,)
• Systemic Diseases and Syndromes (Diabetes mellitus, Down
syndrome, Disorders related to lipid metabolism, Renal
disorders)

6. 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.

7. 3. Sanile cataract – sanile cataract is a age related, vision-
impairing disease characterized by gradual progressive
thickening of the lens of the eye.
4. Traumatic cataract – traumatic cataract develop after an
injury to the eye, but it can take several years for this to
happen.
5. Radiation cataract- radiation cataracts can form after a
person undergoes radiation treatment for cancer.

8. Pathophysiology
Due to causes
Reduction in oxygen uptake and a reduction in initial increase
in water content followed by dehydration of the lens .
Sodium and calcium contents are
increased ,Potassium ,ascorbic acid and proteins are decreased

9. The protein in the lens undergoes numerous age related changes .
Yellowing from formation of fluorescent components and
molecular changes .
OPACIFICATION OF THE LENS

10. CLINICAL 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).
• Nystagmus(involuntary eye movement ).

11. • Gradual loss of Vision.
• Pupil Dilates.
• Increased intraocular
pressure.
• The pupil which is normally
black become gray milky
white.
• Loss of ability to
discriminate between hues
and cloudy white opacity on
the pupil.

12. DIAGNOSTIC EVALUATION
• History Collection
• Physical Examination
• Slit Lamp Microscopy
• Opthalmoscopy
• Visual Field Perimetry
• Glare Testing
• blood sugar, blood pressure

13. Complication
• Postoperative infection
• Bleeding
• Macular edema
• Wound leaks
• Complete Vision loss

14. 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).

15. • Lifestyle adjustment.
• Reassurance
• 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.

16. Surgical Management
• Intracapsular Cataract
Extraction(ICCE)
• Extracapsular cataract
Surgery (ECCE)
• Phacoemulsification
• Lens Replacement

17. 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.
• 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.

19. 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.
• 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.

20. • 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.

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