OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

1. GRACIOUS COLLEGE OF NURSING RAIPUR C.G.
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

2. cloudy lens /crystalline lens

3. INTRODUCTION
A cataract is a dense (solid,) , cloudy area that forms in the
lens of the eye. A cataract begins when proteins in the lens
of the eye clump ( accumulation ) together and
obstruct the passage of light. that prevent the lens from
sending clear images to the retina. The retina works by
converting the light that comes through the lens into signals.
It sends the signals to the optic nerve,
It sends the signals to the optic nerve,
which carries them to the brain. A cataract is a progressive,
painless clouding of the lens of the eye. Cataracts occur when
protein builds up on the lenses and blocks some of the light
from passing through, making it difficult to see clear. Over
time, cataracts can cause blindness. They're often related to
growing older, but sometimes they can develop in younger
people.

4. DEFINITION
Cataract is a condition in which the lens of the eye
becomes opaque one or both eyes may be affected.
Acc. To Barbara k.
Clouding or opacity of the crystalline lens that impairs a
vision.
Acc To. Lippincott.

5. “A cataract is a clouding of the lens in the eye
that affects vision.Most cataracts are related to
aging. Cataracts are very common in older
people.
people.
According to levis

6. PATHOGENESIS:
•DEGENERATION ( disturbing )
•OPACIFICATION
•DEPOSITION OF OTHER MATERIAL
•ABNORMALITY OF LENS PROTEIN
•DISORGANISATION OF FIBRES
•DISORGANISATION OF FIBRES

7. INCIDENCE
CATARACT is a common and significant cause of
visual deficit, affecting nearly 20.5 million people over
age 40 in the U.S.
By age 80 nearly half of the population is affected.
Cataract affects slightly more women than men, and
Cataract affects slightly more women than men, and
more white than dark color people.
2.5 million of adult age 40-49 yrs.
More than 2 million people of age 50-59 yrs.
4 million of adult age 60-69 yrs.
6 million adults age 80 & older.

8. CLASSIFICATION
THERE ARE TWO CLASSIFICATION
CONGENITAL OR DEVELOPMENT
CONGENITAL OR DEVELOPMENT
ACQUIRED CATARACT:-

9. 1. CONGENITAL OR DEVELOPMENT:-
Punctate cataract.
Punctate cataract.
Zonular cataract
Coronary cataract
Anterior capsular cataract
Posterior capsular cataract

10. PUNCTATE CATARACT:- It is most
common Varity manifests by multiple,
small opaque, expanded are seen. On
small opaque, expanded are seen. On
slit limp examination they appear as
blue dots hence known as blue dot
cataract. It doesn’t interfere with
vision.

11. ZONULAR CATARACT:-
Most common type of cataract 50% occurs. the
opacity occupies a discrete zone in the lens zone
of foetal nucleus The main mass of the lens
internal and external to the zone of cataract is
clear, except for small linear opacities like spokes
clear, except for small linear opacities like spokes
of a wheel which may be seen towards the equator.
Occasionally two such rings of opacity are seen. It
is usually bilateral and frequently causes severe
visual defects. Dominant hereditary tendency.
Malnutrition and lack of vit.D

12. CORONARY CATARACT:- It commonly occurs at puberty (
adult ) . It situated in deep layers of cortex there are gap of
club shaped opacities ( dot opacities )in the cortex of lens.
ANTERIOR CAPSULAR CATARACT: - it is due to delayed
formation of the anterior chamber. It project forwards into
anterior chamber like pyramid and the cortex may become
opaque anterior lens epithelial cells become necrotic from a
variety of causes including , keratitis,
variety of causes including , keratitis,
POSTERIOR CAPSULAR CATARACT:- it is due to
persistence of posterior part of vascular sheath cause total
cataract. there is opacification in the posterior or back
portion of the crystalline lens.

13. 2 ACQUIRED CATARACT:-

14. 2 ACQUIRED CATARACT:-
Senile – cortical and nuclear cataract
Cataracts that affect the edges of the lens (cortical
cataracts). A cortical cataract begins as whitish, wedge-
shaped opacities or streaks on the outer edge of the lens
cortex. As it slowly progresses, the streaks extend to the
center and interfere with light passing through the center
center and interfere with light passing through the center
of the lens.
Cataract associated ocular disease
Any eye related disease caused the cataract

15. Cataract associated with systemic disease-
diabetic’s parathyroid,.
Cataract has been associated with many systemic
diseases mainly diabetes mellitus, hypertension,
obesity, chronic kidney disease and autoimmune
disease. Cataract is also a hallmark of many metabolic
disorders and syndromes.
disorders and syndromes.
Cataract due to radiation
Cataracts induced by ionizing radiation (e.g., X-rays
and gamma rays) usually are observed in the
posterior region of the lens, often in the form of a
posterior subcapsular cataract. Increasing the dose
of ionizing radiation causes increasing opacification of
the lens,

16. Traumatic cataract
Traumatic cataract is clouding of the lens and
eyes that may occur after either blunt or
penetrating ocular trauma that disrupts and
damages the lens fibers. Most of the traumatic
cataracts lead to eye lens swelling, but the type and
cataracts lead to eye lens swelling, but the type and
clinical course depends on trauma and the
integrity of the capsular bag.

17. ETIOLOGY
 AGING:-
Loss of lens transparency
Decreased oxygen uptake
Decreased levels of VIT.C, protein ( help maintain connective tissue including
found in cornea of the eye )
Increase in sodium and calcium
 TOXIC FACTORS:-
Cigarette smoking ( releasing chemical into the lungs that
travel through the blood steam in to the eye smoking also
reduce the number of antioxidants in to the eye (
antioxidants fighting some disease )
Long term use of corticosteroids ( na and water
accumulation )
Chemical eye burns, poisoning.

18. .NUTRITINAL FACTORS:-
Poor nutrition
Obesity
Reduced antioxidants
.PHYSICAL FACTORS:-
Trauma, perforation
U.V. radiation and x rays.

19. ASSOCIATED OCULAR CONDITIONS:-
Myopia ( nearsightedness ) not visible distance objects
Infections
Retinal surgery
SYSTEMIC DISEASES AND SYNDROMS:-
D.M.
Down syndrome
Renal disorders
Musculoskeletal disorder.

20. OVERPRODUCTION OF OXYDABTS
An overproduction of oxidants, which are oxygen
molecules that have been chemically altered due to
normal daily life
UV LIGHT
It is a damage lens proteins in a distinct way (called
glycation) that is typically seen in cataract and in cells
damaged by oxidative stress. In other words, UV light
can substitute for oxygen to trigger harmful
oxidative reactions in the lens.

21. RADIATION THERAPY
Uses high-energy particles or waves, such
as x-rays, gamma rays, electron beams,
as x-rays, gamma rays, electron beams,
or protons, to Near side eye tumors and
destroy or damage cancer cells to damage
the part of lens then lead the cataract .

22. THE LONG-TERM USE OF STEROIDS AND
OTHER MEDICATIONS
Steroids can also suppress your
immune system, which can help
control conditions in which your
control conditions in which your
immune system mistakenly attacks its
own tissues,"

23. PATHOPHYSIOLOGY
Causative factor (trauma, radiation ) cataracts develop
when aging or injury changes the tissue that makes
up the eye's lens
↓
Altered metabolic processes with the lens and reduce the
Altered metabolic processes with the lens and reduce the
oxygen uptake
↓
Cause an accumulation of water and protein fibers
↓
Alteration ( changes) in the lens fiber structure
↓

24. Opacity occur when the lens protein crystalline clumps
together
↓
Decrease ability to lens reflect light cause visual acuity
↓
Chemical modification of lens caused it to be thicken and
Chemical modification of lens caused it to be thicken and
harden
↓
These changes affect lens transparency causing vision loss
↓
Then lead the cataract

25. SYMPTOMS:
Blurred vision
Need for frequent changes in your eyeglasses or
contacts
•Trouble in driving at night (Glare)
•Sensitivity to bright light
•Change in color vision (yellow, orange, and red
appear brighter and WHITE appears dull).
•Coloured haloes - Haloes are rainbow-like coloured
rings around lights or bright objects. They usually occur
because there is extra water in the layers of the eye.

26. SYMPTOMS:
Polyopia
it is the visual perception of multiple images even
after removal of an object from the visual field. The
appearance of many of the same images while
appearance of many of the same images while
watching eye.
Monocular diplopia
occurs when two images are viewed by a
single eye

27. Blurred Vision Due To Scattering
Of Light On The Retina
Change In Colour Vision

28. DIAGNOSTIC TEST

29. DIAGNOSTIC TEST
DIAGNOSTIC FINDINGS
History taking
physical examination
Snellen visual acuity test
Snellen visual acuity test
You will keep both eyes open. You will be asked to cover
one eye with the palm of your hand, a piece of paper,
The visual acuity test is used to determine the smallest
letters you can read on a
standardized chart(Snellen chart) or a card held 20 feet (6
meters) away. while you read out loud the smallest line of
letters you can see on the chart. Numbers, lines, or pictures
are used for people who cannot read,

30. Slit lamp test
Your eye doctor may put drops in your eyes to make any
abnormalities on the surface of your cornea more visible.
The drops contain a yellow dye called fluorescein, which
will wash away your tears. Additional drops may also be put
will wash away your tears. Additional drops may also be put
in your eyes to allow your pupils to dilate, or get bigger.
The doctor will use a low-powered microscope, along with
a slit lamp-, which is a high-intensity light. They will look
closely at eyes. The slit lamp has different filters to get
different views of the eyes. Some doctor’s offices may have
devices that capture digital images to track changes in the
eyes over time.

31. A retinal examination — sometimes called
ophthalmoscopy or funduscopy — allows your doctor
to evaluate the back of your eye, including the retina,
the optic disk and the underlying layer of blood vessels
the optic disk and the underlying layer of blood vessels
that nourish the retina (choroid).

32. Management

33. SPECIFIC MANAGEMENT OF CATARACT
A) NON SURGICAL:
1.GLASSES: Cataract alters the refractive power of the natural
lens so glasses may allow good vision to be maintained. Use
dark glasses also helps in such situations by keeping the
pupil bigger.
PHARMACOLOGICAL MANGEMENT :
To delay progression of cataract:-
Aldose reductase inhibitors- Oral aspirin 50-100 mg/kg
orally that block the breakdown of glucose by a specific
metabolic pathway called the polyol pathway,
Quercetin 200-400 mg/kg. protect the lens from oxidative
damage and prevent the occurrence of cataracts

34. ANTIOXIDANTS:- Antioxidants like vitamin C & E
& Beta-carotene.(Slow cataract progression)
MEMBRANE STABILIZING AGENTS- benzadac and
benzyl alcohol.
benzyl alcohol.
MYDRIATICS can be used as short term treatment to
dilate the pupil & allow more light to reach the retina.
MISCELLANEOUS- Iodides of calcium , potassium.

35. SURGICAL MANAGEMENT
Extra-capsular cataract extraction( ECCE)
(ECCE) surgery consists of removing the lens but leaving
the majority of the lens capsule intact. ECCE refers to the
technique in which a portion of anterior capsule of the
lens is removed, allowing extraction of the lens nucleus
and cortex,
and cortex,
In either extra-capsular surgery or intra-capsular surgery,
the cataractous lens is removed and replaced with a
plastic lens (an intraocular lens implant) which stays in
the eye permanently. Cataract operations are usually
performed using a local anaesthetic and the patient is
allowed to go home the same day.

36. Intra-capsular cataract extraction (ICCE)
(ICCE) surgery involves removing the entire lens of
the eye, including the lens capsule (Capsulotomy
Phacoemulsi-fication in cataract surgery
involves insertion of a tiny, hollowed tip that uses
high frequency (ultrasonic) vibrations to "break up"
the eye's cloudy lens (cataract). The same tip is used
to suction out the lens

37. 4) Lens replacement :-After removal of the
crystalline lens,There are 3 lenses replacement
options :
1) Aphakic eye-glasses
Aphakic contact lenses provide optimum
Aphakic contact lenses provide optimum
optical correction. Adults with cataracts
undergo cataract surgery with intraocular lens
implantation. A synthetic, artificial lens is placed
inside the eye to replaces the focusing power of a
natural lens that is surgically removed.

38. 2) Contact lenses
(Contact lenses provide patients
with almost normal vision)
3) Intraocular lens (IOL) implants
(Insertion of IOLs during cataract
surgery is the usual approach to lens
replacement)

39. COMPLICATIONS
Inflammation
Increased Intra ocular pressure
Subconjunctival hemorrhage with or without edema.
Toxic anterior segment syndrome Toxic anterior
segment syndrome (TASS) is an acute severe
segment syndrome (TASS) is an acute severe
intraocular inflammation accompanied by diffuse
corneal edema within 1-2 days of anterior segment
surgery
Chronic endophthalmitis - Chronic postoperative
endophthalmitis (CPE) is a delayed infectious
intraocular inflammation process that occurs
more than six weeks after ocular surgery

40. Opacification of the posterior capsule.
Retinal detachment
Retinal detachment or a detached retina separates the
retinal cells from the layer of blood vessels that
provides oxygen and nourishment to the eye
provides oxygen and nourishment to the eye

41. NURSING MANAGEMENT
Pre-operative care
Post-operative care
NURSING DIAGNOSIS
Risk of injury related to increased intraocular
Risk of injury related to increased intraocular
pressure, trauma.
Disturbed sensory perception related to surgical
trauma, lens removal, patching.
Acute pain related to tissue trauma.
Anxiety related temporary vision , impairment activity
restrictions.