Nursing management of patients with disorders of cataract and blindness

1. CATARACT
MS. SIBI SAMUEL
ASSISSTANT PROFESSOR
NIGHTINGALE COLLEGE OF
NURSING , NOIDA

2. A cataract is a cloudy
or opaque area in the
normally clear lens of
the eye. Depending
upon its size and
location, it can interfere
with normal vision.

4. EPIDEMOLOGY
 1. Cataracts remain the
leading cause of blindness.
 2. Age-related cataract is
 responsible for 48% of
 world blindness, which
 represents about 18
 million people.
 3. Cataracts are also an
 important cause of low
 vision in both developed
 and developing countries.

5.  Old age (commonest)>65
Year
• Ocular & systemic
diseases
 – DM
 – Uveitis
 – Previous ocular surgery
 • Systemic medication
 – Steroids
 – Phenothiazines
• Trauma & intraocular
foreign
 bodies
 • Ionizing radiation
 – X-ray, UV
Congenital
 – Part of a syndrome
 – Abnormal galactose
 metabolism
 – Hypoglycemia
• Inherited abnormality
 – Myotonic dystrophy
 – Marfan’s syndrom
 – Rubella
 – High myopia

6. PATHOPHYSIOLOGY
Any physical or chemical cause
↓
Disturbs the intracellular and extracellular equilbrium
of water and electrolytes
↓
Deranges the colloid system in lens fibres
↓
Aberrant fibres are formed from germinal
epithelium of lens
↓
Epithelial cell necrosis
↓
Focal opacification of lens epithelium
(glaucomflecken)
↓
Opacification of lens

7. Opacification of lens takeplace by 3
biochemical changes
1. Hydration
2. Denaturation of lens protein
3. Slowsclerosis
 These leads to
Abnormalities of lens proteins &
Disorganisation of lens fibres
Loss of transparency of lens
Cataract

8. TYPES
 Nuclear Cataract
located in the center of the lens. The nucleus tends to darken,
changing from clear to yellow and sometimes brown.
 2.Cortical Cataract
Affects the layer of the lens surrounding the nucleus. The
cataract looks like a wedge or a spoke.
 3. Subcapsular cataract
 It involves superficial part of the cortex(just below the
capsule) and includes anterior sub capsule or posterior sub
capsule.

9. Cortical cataract
Nuclear cataract
Subcapsular cataract

10. 4.Anterior Subcapsular Cataracts
 This type forms just inside the front of lens capsule. An
injury or swelling in eye can lead to one.
5.Congenital Cataracts
 These are cataracts at the time of born or in childhood.
Some are linked to genes, and others are due to an
illness, like rubella, that mother had during pregnancy.
6.Secondary Cataracts
When another condition or a medical treatment leads to a
cataract, it called as a secondary cataract.

11.  Based on maturity:-
1.Immature Catarct
2.Mature Cataract
3.Hypermature Cataract

12. Mature Cataract
 Lens is completely opaque.
 Vision reduced to just perception of light
 Iris shadow is not seen
 Lens appears pearly white

13. IMMATURE CATARACT

14. Hypermature
 Shrunken and wrinkled anterior capsule due to
leakage of water
 out of the lense.
 • This may take any of two forms:
 1.Liquefactive/Morgagnian Type
 2.Sclerotic Cataract

15. Liquefactive/Morgagnian Type
 Cortex undergoes auto-lytic liquefaction and turns
uniformly
 milky white.
 • The nucleus loses support and settles to the
bottom.

16. Sclerotic Cataract
 •The fluid from the cortex gets absorbed and the lens
becomes shrunken.
 There may be deposition of calcific material on the
lens capsule.
 Iridodonesis: Anterior chamber deepens and iris
becomes tremulous.
 The zonules become weak, increasing the risk of
subluxation / dislocation of lens.

17. CLINICAL MANIFESTATION

18.  Gradual painless
 burning
 •Loss of vision due to
 lens opacity
 • Increased glare in
 bright light
 •Decreased color
 perception
 •Decreased visual
 acuity
 •Poor vision at night
 Photophobia(light
sensititvity)
 Blured or distorted
images
 Light scattering
 Leukokoria or white
pupil
 Reduced light
transmission

19. Blurred vision due to scattering of light

20. DIAGNOSTIC EVALUATION
• History And Physical Examination
• Visual Acuity Measurement
• Slit Lamp Microscopy

21. Cont….
• Ophthalmoscopy
• Glare Testing
• Keratometry and A-Scan
ultrasound

22. TREATMENT
 • Glasses: Cataract alters the refractive power of the
natural lens so glasses may allow good vision to be
maintained.
 Surgical removal: when visual acuity can't be
improved with glasses.
 • Surgical techniques
 –Phacoemulsification method.
 –Extracapsular cataract extraction.
 –Intra capsular cataract extraction.
 –Intraocular lens implantation
 –cryosurgery

23. PREOPERATIVE PHASE
 Nonsteroidal Anti-inflammatory Eye Drops
 Alpha-adrenergic Agonist Drug
 Anticholinergic Agent
 Antibiotics
 Antianxiety Medications

24. SURGICAL MANAGEMENT
 Phacoemulsification 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

26. INTRA-CAPSULAR CATARACT
EXTRACTION
 Intracapsular Cataract Extraction. From the
late 1800s until the 1970s, the technique of
choice for cataract extraction was intracapsular
cataract extraction (ICCE). The entire lens (ie,
nucleus, cortex, and capsule) is removed, and fine
sutures close the incision. ICCE is infrequently
performed today; however, it is indicated when there
is a need to remove the entire lens, such as with a
subluxated cataract (ie, partially or completely
dislocated lens).

27. EXTRA CAPSULAR EXTRACTION

28. Postoperative care after cataract
surgery
 Steroid drops (inflammation)
 Antibiotic drops (infection)
 Avoid Very strenuous exertion (rise the pressure in
the eyeball)
 Ocular trauma.

29. INTRAOCULAR LENS IMPLANTATION

30. NURSING MANAGEMENT
 Assess visual acuity
 Give accurate information
 Administer eye medications
 Elevate the head of the bed 30 to 45 degrees.
 Notify the surgeon

31.  Posterior Capsule Opacity (PCO)
 Intraocular Lens Dislocation
 Eye Inflammation
 Light Sensitivity
 Macular Edema
 Ptosis
 Ocular Hypertension

32.  Infective endophthalmitis
– Rare but can cause permanent severe reduction of vision.
– Most cases within two weeks of surgery.
– Typically patients present with a short history of a
reduction in their vision and a red painful eye.
– This is an ophthalmic emergency.
– Low grade infection with pathogen such as
Propionibacterium species can lead patients to present
several weeks after initial surgery with a refractory uveitis

33.  Suprachoroidal haemorrhage.
 – Severe intraoperative bleeding can lead to serious
and permanent reduction in vision.

34. NURSING DIAGNOSIS
1. Acute pain related to trauma to the incision and increased
IOP as evidence by patient verbalization.
2. Anxiety related to lack of knowledge as evidenced by
verbalization of anxious questions.
3. Self –care deficits related to visual deficit as evidence by
decreased vision acuity
4. Risk for infection related to surgical incision and
self care after surgery.
5. Risk for injury related to sensory deficit while
6. operated eye is patched.

35. HEALTH EDUCATION
 Avoid Eye Straining.
 Avoid Rubbing
 Avoid Rapid Movement
 Proper Hygiene And Eye CarTechniques
 Use Eye Shield At Bedtime.
 Follow-up As Recommended

36.  Cataract surgery is the principal refractive
surgical procedure performed in older
adults. Technological advances have allowed
for improved surgery through smaller
incisions, resulting in better outcomes.