Cataracts are lens opacities that can develop in one or both eyes, influenced by factors such as aging and systemic disorders. They can be classified by morphology (nuclear and cortical) and maturity (immature and mature), with symptoms including clouded vision, glare, and distorted colors. Treatment typically involves glasses or surgical removal, with specific preoperative assessments and potential postoperative complications requiring careful management.

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2. Ms.Towar Shilshi
Asst. Prof
GSON

3. DEFINITION
A cataract is a lens opacity or cloudiness.
Cataracts can develop in one or both eyes and at
any age.

4. ETIOLOGICAL FACTORS
Ageing factors
Systemic disorders.
Diabetes mellitus
Down’s syndrome
Ocular and systemic and congenital disorders.
Trauma radiation
Exposure to infrared light.
Excessive use of corticosteroids.
Infections (German measles, mumps, hepatitis,
chickenpox)

5. 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
(gla
PATHOPHYSIOLOGY

6. Opacification of lens takeplace by 3 biochemical changes.
1. Hydration 2.Denaturation of 3.Slow
lens protein
sclerosis
Abnormalities of lens proteins
&
Disorganisation of lens fibres
Loss of transparency of lens
Cataract

7. CLASSIFICATION ACCORDING TO
MORPHOLOGY

8. 1. Nuclear cataract
• Most common type
• Occur in the center zone of the lens
(nucleus).
• In its early stages, as the lens
changes the way it focuses light,
patient may become more
nearsighted or even experience a
temporary improvement in reading
vision. Some people actually stop
needing their glasses.
• Unfortunately, this so-called 2n
d
sight
disappears as the lens gradually turns
more densely yellow & further
clouds vision.
• As the cataract progresses, the lens
may even turn brown. Advanced
discoloration can lead to difficulty
distinguishing between shades of blue
& purple.

9. 2. Cortical cataract
• Occur on the outer edge of the lens (cortex).
• Begins as whitish, wedge-shaped opacities or streaks.
• It slowly progresses, the streaks extend to the center and
interfere with light passing through the center of the lens.
• Problems with glare are common with this type of cataract.

12. CLASSIFICATION ACCORDING TO
MATURITY

13. 1. Immature Cataract
Lens is partially opaque
Two morphological forms are seen:
1.Cuneiform Cataract:
–
–
Wedge shaped opacities in the peripheral cortex and
progress towards the nucleus.
Vision is worse in low ambient light when the
pupil is dilated.
1.Cupuliform
Cataract:
–
–
A disc or saucer shaped opacities beneath the posterior
capsule.
Vision is worse in bright ambient light when the
pupil is constricted.
• Lens appears grayish white in color.
• Iris shadow can be seen on the opacity.

14. 2. Mature Cataract
• Lens is completely opaque.
• Vision reduced to just perception of light
• Iris shadow is not seen
• Lens appears pearly white
Right eye mature cataract, with obvious white
opacity at the centre of pupil

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

17. • 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.

18. Symptoms
• A cataract usually develops
slowly, so:
–Causes no pain.
–Cloudiness may affect only a
small part of the lens
–People may be unaware of any
vision loss.
• Over time, however, as the
cataract grows larger, it:
–Clouds more the lens
–Distorts the light passing
through the lens.
–Impairs vision
• Reduced visual acuity (near
and distant object)
• Glare in sunshine or with
street/car lights.
• Distortion of lines.
• Monocular diplopia.
• Altered colours ( white
objects appear yellowish)
• Not associated with pain,
discharge or redness of the
eye

19. Signs
•Reduced acuity.
•An abnormally dim red reflex is seen
when the eye is viewed with an
ophthalmoscope.
•Reduced contrast sensitivity can be
measured by the ophthalmologist.
•Only sever dense cataracts causing
severely impaired vision cause a white
pupil.

20. DIAGNOSTIC STUDIES
•History collection and physical examination
• Snellen visual acuity test.
• Ophthalmoscopy.
• Slit-lamp biomicroscopic examination.
• Tonometry
• Scan ultrasound.

21. 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 method.
– Intracapsular method

22. Pre-op assesments
• General health evaluation including blood pressure check
• Assessment of patients’ ability to co-operate with the
procedure and lie reasonably flat during surgery
• Instruction on eye drop instillation
• The eyes should have a normal pressure, or any pre-existing
glaucoma should be adequately controlled on medications.
• An operating microscope is needed, in order to reach the lens,
a small corneal incision is made close to the limbus for the
phaco-probe.
• It is important to appreciate anterior chamber depth and to
keep all instruments away from the corneal endothelium in the
plane of the iris.

23. 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
.

24. Intra-capsularCataract
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
the
capsule) is removed either by emulsification in
place or cutting it out and artificial intraocular lens is
implanted, and fine sutures close incision.

26. Extra-capsular Cataract Extraction (ECCE)

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

29. Complications of cataract surgery
• 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.
•
to serious
and
Suprachoroidal haemorrhage.
– Severe intraoperative bleeding can lead
permanent reduction in vision.

30. • Uveitis
• Ocular perforation.
• Posterior capsular rupture
• Retinal detachment.
• Cystoid macular oedema
• Glaucoma

31. NURSING MANAGEMENT

33. •Provide patient verbal and written instructions
about how to protect the eye, administer
medications, recognize signs of complications, and
obtain emergency care.
•Explains that there should be minimal discomfort
after surgery, and instruct 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