Eyes Disorder

EYES
DISORDER
LOW VISION AND BLINDNESS
Vision impairment is defined as having central visual acuity of 20/40 or worse in the better eye with the
best possible correction. Low vision describes visual impairment that requires the use of devices and
strategies to perform visual tasks. Blindness is having best possible corrected central visual acuity that
can range from 20/400 to no light perception. Legal Blindness is a condition of impaired vision and is
defined as having central visual acuity of 20/200 or worse in the better eye with the best possible
correction or whose widest visual field diameter is 20 degrees or less.
Pathophysiology:
Low Vision
Obstruction of the central retinal vein ----- Occlusion of a branch retinal vein with hemorrhage and
edema ------ localized macular region of the retina
Blindness
Blocked blood vessels --- damages the optic nerve ---- impaired transmission to brain ----- blindness
S/sx:
 vision is blurred for distant objects, near objects, or both.

 Headaches
 Squinting
 Eye strain
 Eye Pain
 Double Vision
Medical Management:
 Magnification and image enhancement through the use of low-vision aids and strategies
 Medication are prescribed for glaucoma
 Refer to the community agencies, such as Lighthouse Guild for patients with low vision who live
alone and cannot self-administer.
Nursing Intervention:
 Provide adequate lighting for increased visibility.

 Assist family in identifying hazards in the home and modifying them.
 Encourage the patient to see an ophthalmologist at least yearly.
 Instruct patient to wear prescription glasses when out of bed to enhance vision.
 Assess the patients for the degree of visual impairment to see and perform activities.
GLAUCOMA
Glaucoma is group of ocular condition characterized by elevated intraocular pressure that can lead to
irreversible loss of vision. The result of inadequate drainage of aqueous humor from the anterior chamber
of the eye. It is a condition that causes damage to your eye’s optic nerve and gets worse over time.
Pathophysiology:
S/sx:
1. Pain in the eye esp. in the morning

 In Acute glaucoma: onset of pain is sudden
 In Chronic glaucoma: onset of pain is insidious gradual, at times there may be no pain
2. Blurred vision, Headache, N/V
3. Fixed, dilated pupil in acute glaucoma (DISPLACEMENT OF IRIS)
4. Loss of peripheral vision initially (tunnel vision) , then blindness occurs
5. Rainbows or halos around lights
6. Hypovolemic Shock due to massive bleeding
Medical Management:
Pharmacologic Therapy
 Beta-blockers are the preferred initial topical medications because of their efficacy, minimal
dosing and low cost.
 Cholinergics (i.e., miotics) increase the outflow of the aqueous humor by affecting ciliary muscle
contraction and pupil constriction, allowing flor through a larger opening between the iris and
the trabecular meshwork.
 Beta-blockers and carbonic anhydrase inhibitors decresea aqueous production.
 Prostaglandin analogues reduce IOP by increasing aqueous humor outflow.
 Many ocular medications are used to treat glaucoma including; miotics, beta-blockers, alpha-
agonists, carbonic anhydrase inhibitors and prostaglandins.
Surgical Management
Surgery is reserved for patients in whom pharmacologic treatment has not controlled the IOP.
 Trabeculectomy surgery
 Laser trabeculoplasty for glaucoma
 Peripheral iridotomy for pupillary block glaucoma
 Filtering procedure for glaucoma
Nursing Intervention:
Aim of all glaucoma treatment is prevention of optic nerve damage.
 Maintain bed rest in quiet, darkened room, with HOB elevated

 Administer miotics as prescribed (to constrict pupils, draw iris away from the canal, thus draining
of aqueous humor)
 Administer Diamox (acetazolamide), Timoptic eye drop (Timolol Maleate) (to reduce production
of aqueous humor)
 Surgery (e.g. iridectomy, trabeculectomy)
 Avoid Administration of mydriatics (atropine preparations), Benadryl, and Cogentin = DILATE
pupils and iris is brought closer to the angle of outflow of aqueous humor
CATARACT
A cataract is a clouding of the lens of the eye, which is typically clear. For people who have cataracts,
seeing through cloudy lenses is like looking through a frosty or fogged-up window. Clouded vision caused
by cataracts can make it more difficult to read, drive a car at night or see the expression on a friend's
face.
Pathophysiology
S/sx:
 Painless
 Cloudy or blurry vision
 Surroundings are dimmer
 Light Scattering
 Reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity
Medical Management:
No nonsurgical treatment (e.g., medications, eye drops, eyeglasses) cures cataracts or prevents age-
related cataracts.
Surgical Management
 Phacoemulsification
 Lens Replacement
 Toxic Anterior Segment Syndrome (TASS)
Nursing Intervention
 Provide preoperative and postoperative care

 Promote home and community-based care
 Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth.
KERATOCONUS
Keratoconus is the most common type of corneal dystrophy, is characterized by a conical protuberance
of the cornea with progressive thinning on protrusion and irregular astigmatism.
Pathophysiology
S/sx:
 Glare and halos around lights

 Difficulty seeing at night
 Eye irritation or headaches associated with eye pain
 Increased sensitivity to bright light
 Sudden worsening or clouding of vision
Medical Management:
Therapies:
 Corneal cross-linking
Surgical Management
 Intrastromal corneal ring segments (ICRS)
 Cornea transplant
Nursing Intervention
 Assess the history of the patients that include any visual disorder and visual process and ocular
structure.
 Provide preoperative and postoperative care
CONJUNCTIVITIS
Conjunctivitis often referred to casually as “pink eye”, conjunctivitis is the swelling or inflammation of the
conjunctiva, the thin, transparent layer of tissue that lines the inner surface of the eyelid and covers the
white part of the eye. Causes may or may not be infectious.
Pathophysiology:
S/sx:

Eyes Disorder

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EYES

 vision is blurred for distant objects, near objects, or both.

 Provide adequate lighting for increased visibility.

1. Pain in the eye esp. in the morning

 Maintain bed rest in quiet, darkened room, with HOB elevated

 Provide preoperative and postoperative care

 Glare and halos around lights

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