Cataract is a clouding of the lens inside the eye that causes vision loss. It develops slowly over time and can affect one or both eyes. The main causes are aging, exposure to UV radiation, smoking, genetic factors, and various medical conditions. Cataract surgery involves removing the clouded lens and sometimes replacing it with an artificial lens to restore vision. Nurses educate patients on post-operative care including eye drops, limitations on activities, use of protective eyewear, and signs of complications to watch for.

1. CATARACT
Submitted to:-
Mrs. mamta toppo
Subject coordinator
Medical surgical nursing
Rimscon,ranchi.
Presented by:-
Nisha kumari
Roll:-14
Session:-2017-2021
Basic b.sc. Nursing-3rd year
Rimscon,rranchi.

2. CONTENTS
Introduction to cataract
Definition
Epidemiology
Causes of cataract
Risk factors
Pathophysiology of cataract
Clinical manifestation
Classification of cataract
Diagnostic evaluations
Management of cataract
Nursing diagnosis and interventions
Prevention and complications of cataract
A checklist
New reserches recently
Summary
References and bibliography

3. INTRODUCTION
Cataract is the clouding of lens
inside the eye , causing vision loss
that cannot be corrected with
glasses , contact lenses or
cornealrefractive surgery like
LASIK.
Cataract is derived from a Greek
word CATRA – meaning running water
or flowing water .

4. It develops slowly and eventually
interferes with the vision . It might
end up in both the eyes , but they
usually does not forms at the
same time .

5. DEFINITION-
A cataract is an opacification of
the lens of the eye which leads
to a decrease in vision.
A clouding of the eye lens or its
surrounding transparent
membrane that obstructs the
passage of light.
A cataract begins when proteins in
the eye forms clumps that prevents
the lens from sending clear images to
the ratina .

6. EPIDEMIOLOGY-
Cataract remains the leading cause of
blindness.
Age related cataract is responsible for 48% of
the world blindness , which repesents the
about18 million people .
Cataract is also an important cause of low
vision in both developed and developing
countries.
Cataract is more commonly found in older
Americans .

8. Infact , according to NEI 68% of the American
aging 80 or older has been found with
cataract in 2010.
Roughly , 24.4 million Americans had
cataracts and that in number is estimated to
grow to 50.2 million by the year 2050 ,
according to NEI.
Thankfully , modern cataract is one of the
most safest and most effective surgical
procedures today .
About 3 million surgeries are performed every
year .

9. CAUSES / ETIOLOGY-
Several underlying causes of cataract are :-
Overproductions of oxidants .
Smoking.
UV radiations.
Congenital genetic malformations.
Diabetic ratinopathy.
Ocular trauma .
Long term use of corticosteroids.
Other medicines usage like phototoxic 8-
phenothiazines , thiazides , tranquilizers ,
contraceptives

10. RISK FACTORS
•Age :- above 65 years
•Heridity :- due to anomaly in the
chromosomal pattern .
•People living in high altitudes .
•Chronic exposure to heat .
•Glass blowers and welders .
•IOP:- rhinitis pigmentosa , uveitis ,
myopia , glaucoma , retinal detachment .

11. PATHOPHYSIOLOGY-

13. CLINICAL MANIFESTATIONS-
 Blurry vision or distorted images .
 Trouble seeing at night .
 increased sensitivity to glare .
 seeing colours as faded .
 halos surrounding light .
 double vision in the affected eye .
 a need to frequent change in prescription
glasses .
 gradual painless burning .
 loss of vision due to lens opacity .
 decreased colour perception .
 decreased visual acuity .

14.  Poor vision at night .
Photophobia .
Light scattering .
 leukokoria or white pupil .
 reduced light transmission .
 contrast sensitivity is also lost

15. CLASSIFICATION -
Classification of
cataract
Etiological
cataract
Congenital
cataract
Aquired cataract .
1. Senile cataract
2. Traumatic cataract
3. Complicated cataract
4. Metabolic cataract
5. Radiation cataract
6. Electric cataract
7. Dermatogenic cataract
8. Toxic cataract
Morphological
cataract
1. Capsular cataract
2. Sub-capsular cataract
3. Cortical cataract
4. Supranuclear cataract
5. Nuclear cataract
6. Polar cataract

16. A. ETIOLOGICAL CTARACT
1. CONGENITAL CATRACT :- It include
genetic factor malnutrion , infection ,
disease during 1st trimester pregnancy
( German measles , mumps , chicken
pox , hepatitis , radiation and drug
ingestion – thalidomide.)
Birth traumas , metabolic disorders or
infectious disease of the infant .

17. 2. AQUIRED CATARACT:-
Here the opacification occurs due to
degeneration of the already formed lens
fibers.
Senile cataract-
also called age related cataract . It is
characterized by an initial opacity in the lens ,
subsequent swelling of the lens and final
shrinkage with complete loss of transparency
. It may occur due to denaturation of the lens
proteins and opacification lens fibers .

18. TRAUMATIC CATARACT:-
most commonly due to penetrating
or blunt injury to the eye , laceration and foreign
body in the eye.
COMPLICATED CATARACT:-
it refers to the opacity if the lens
secondary to the other intraocular diseases
.also called secondary cataract.
METABOLIC CATARACT:-
occurs due to endocrine disorders and
biochemical abnormalities .

19. ELECTRIC CATARACT:-
it is known to occur after passage of
powerful electric current though the body.
DERMATOLOGIC CATARCT :-
cataract is associated with the skin
disease such as atopic dermatitis .
TOXIC CATARACT:-
 medications those are phototoxic such
as tetracycline , phenothiazines , thiazides ,
tranquilizers , oral contraceptives and
corticosteroids also cause cataract .
RADIATION CATARACT:-
exposure to al l type of causes
damage to the lens epithilium .

20. B. MORPHOLOGICAL CATARACT:-
1. CAPSULAR CATARACT:-
involves capsule ; maybe anterior or
posterior capsule .
2. SUB-CAPSULAR CATARACT:-
involves superficial part of the cortex (just
below the capsule ) includes anterior and posterior
sub-capsule .
3. CORTICAL CATARACT:-
the lens fibers of the cortex are mainly
affected. There is hydration due to
accumulation of water droplets in between the
fibers and the proteins are first degenerated and
then are coagulated forming opacity .

21. 4. SUPRA-NUCLEAR CATARACT:-
it involves only the deeper parts of
the cortex ( just outside the nucleus ).
5. NUCLEAR CATARACT :-
it involves the crystalline lens . The
nucleus becomes diffusely cloudy and obstructs
the night rays .
6. POLAR CATRACT :-
it involves the capsule and superior part
of the cortex in the polar region only and may
be anterior polar cataract or posterior polar
cataract.

23. DIAGNOSTIC EVALUATION:-
History of patient
Direct ophthalmoscopy
Slit lamp biomicroscopy
Refraction and retinoscopy
Snellen visual acuity test
Glare testing
Penlight examination of pupil and lens.

24. MANAGEMENT-
SURGICAL MANAGEMENT _
Surgery is the definitive treatment for cataract . The
most common surgery is performed in the
ambulatory surgery centers , few patients require
hospitalizations . The most effective and common
treatment is to make incision (capsulotomy) into the
capsule of the cloudy lens in order to surgically
remove the lens .
2 types of eye surgeries used _
• Extra capsular cataract examination (ECCE )
• Intra capsular cataract examination (ICCE)

25. Intracapsular cataract
examination(ICCE)
Extracapsular cataract
examination(ECCE)

26. PHACOEMULSIFIATION
A titanium needle vibrating at ultrasonic
frequencies (high frequently sound waves )used
to disrupt the lens nucleus . The needle vibrates
at ultrasonic frequency (40,000hz )and the lens
material is emulsified . A 2nd fine instrument
(called cracker or chopper ) maybe used from a
side port to facilitate cracking or chopping of the
nucleus into smaller pieces.
The anterior capsule and the lens particles are
removed from eye by irrigation and aspiration
through a sleeve around the needle , the posterior
capsule is left to support on IOL.

28. NURSING DIAGNOSIS:-
1. High risk of injury related to loss of viterous
, intraocular hemorrhage , increased IOP.
2. Impaired sensory perception vision , related
to impaired sensory reception / status of
sensory organs , a therapeutic
environment is limited .
3. Acute pain related to trauma to the incision
and increased IOP.
4. Anxiety related to lack of knowledge about
the disease and its treatment .
5. Risk of infection related to trauma to the
incision.

29. NURSING INTERVENTIONS:-
1. Asses the visual acuity of the client’s non-operative
eye prior to surgery .
2. Discuss what happens on the condition of post
surgery , pain , limitation of activity, performance ,
bandage the eye.
3. Comfort the patient with semi-fowler’s or tilted to
the side , preferable to patient .
4. Ask patient to avoid activities such as vomiting ,
coughing , sneezing , straining , or bending over .
5. Ambulation with assistance ; give special
bathrooms when recovering from anesthesia .
6. Encourage deep breathing / coughing to maintain
eye protection as indicated .
7. Encourage use of stress management techniques.

30. 8. Remove all the eye makeup and contact lenses or
glasses prior to surgery .
9. Administer antiemetic medications as needed.
10. Orient the client to the environment . Approach
from the side that was operated on , talk and touch.
11. Note for dim or blurred vision and eye irritation ,
which can occur when using eye drops . use
correct techniques for administration of eye
medications.
12. Remind clients to use cataract glasses .
13. Place the required items / call bells within reach.
14. Administer antibiotics , anti-inflammatory and
other systemic and eye medications as prescribed .
15. Encourage the patient to wear dark glasses after
eye dressing is removed.

31. PREVENTION :-
Quit smoking
Wear sunglasses

32. COMPLICATIONS:-
1. PCO
2. Intraocular lens dislocation
3. Eye inflammation
4. Light sesitivity
5. Photopsia
6. Macular edema
7. Ptosis
8. Ocular hypertension

33. HEALTH TEACHINGS-
Explain for the care of eye to prevent contamination of
the surgical site .
Encourage the patient to use eye shield to protect the
operated eye from injury while sleeping.
•Ask patient to wear dark sunglasses to provide
comfort to eyes from sunlight.
•Encourage Patients to take proper antioxidants
vitamins ( vit. C and E) and good nutrition.
•Ask patients to avoid lifting heavy objects , isometric
exercises , straining during defecation .
•Teach the family and the patient , how to instill the
opthalmic ointment or drops .
•If the patient has increased eye discharge , sharp eye
pain , or deterioration in vision , intruct to immediately
notify the physician.

34. CHECKLIST FOR THE PRE-OP ASSESSMENT BEFORE CATARACT
SURGERY :
History collection of the patient .
If client uses any glasses ; check for the ability to
read without glasses .
Sonographic examination (in case if cataract is
already at an advanced stage )
Dilate the pupil using eye drops and consult the
doctor and documentation of the activity performed
Take the consent for the procedure signed by the
patient and relatives prior to the surgery.
laboratory tests and allergies identification data attached
to documents
all the vital signs assessed and recorded
Remove all the jewellery and ask client to void
and wear hopital gown and hair cover. Then
administer preoperative medication as
prescribed
checked unchecked
Checked unchecked
checked unchecked
checked unchecked
checked unchecked
checked unchecked
checked unchecked
checked unchecked

35. NEW RESEARCHES : SURVEY ON CATARACT AS
CAUSE OF BLINDNESS IN INDIA .

36. CONCLUSION:- THE STUDY SHOWS THAT CLIENT
ARE HAVING INADEQUATE AWARENESS(24.26%)
ABOUT CATARACT.

39. SUMMARY
Cataract is an opacification or clouding of eyes.
Common causes are exposure to UV radiations ,
smoking , congenital malformations , etc. .
Higher age group are at high risk .
The pathophysiology says that – due to nuclear
sclerosis , there is a decrease in transport of water ,
antioxidants and nutrients causing progressive
oxidant damage to the lens , leads to cataract.
It can be treated through surgeries, the most
frequently used surgery is PHACOEMULCIFICATION.

40. REFERENCES :-
BOOKS
INTERNET
CONSULTATION WITH THE TEACHERS
BILIOGRAPHY :-
PV , a book of medical – surgical nursing , 11
edition , page – 186 to 193.
www.wikipedia.com