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JOFRED M. MARTINEZ, RN
On completion of this chapter, the learner will be able to:
1. Identify significant eye structures and describe their
functions.
2. Identify diagnostic tests for assessment of vision and
evaluation of visual disabilities.
3. Discuss clinical features, diagnostic assessment and
examinations, medical or surgical management, and
nursing management of ocular disorders.
4. Describe therapeutic effects of ophthalmic medications.
On completion of this chapter, the learner will be able to:
5. Define low vision and blindness and differentiate between
functional and visual impairment.
6. List and describe assessment and management strategies
for low vision.
7. Demonstrate orientation and mobility techniques for
patients with low vision in a hospital setting.
8. Demonstrate instillation of eye drops and ointment.
On completion of this chapter, the learner will be able to:
9. Discuss general discharge instructions for patients after
ocular surgery.
10. Discuss strategies for patient safety in ophthalmology.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
Retina
Optic nerve
Optic chiasm
Optic tracks
Lateral geniculate bodies
Optic radiations
Visual cortex area of the brain
 Decrease or loss of accommodation (presbyopia)
 Lens yellow with age
 Senile miosis
 Increased light scatter in the eye causing glare
 Decrease in lens transparency (cataract)
 Dryness or scratchiness of the eyes
 Distorted or blurred image (astigmatism)
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 If the patient is wearing contact lenses, have him
remove them before the test, unless the test is being
performed to evaluate the fit of the contact lenses.
 When instilling dilating drops, tell the patient that his
near vision will be blurred for 40 minutes to 2 hours.
 Advise him to wear dark glasses in bright sunlight until
his pupils return to normal diameter.
 Don’t administer dilating eyedrops to the patient who
has angle closure glaucoma, is hypersensitive to
mydriatics, or has an intraocular lens implant.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Tell the patient that a small transducer will be placed on
his
 closed eyelid and that the transducer will transmit high-
frequency sound waves that will reflect off the structures
in the eye.
 Inform him that he may be asked to move his eyes or
change his gaze during the procedure; explain that his
cooperation will help to ensure accurate results.
 After the test, remove the water-soluble jelly that was
placed on the patient’s eyelids.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Check the patient’s history for an intraocular lens implant,
glaucoma, and hypersensitivity reactions, especially
reactions to contrast media and dilating eye drops.
 If miotic eye drops are ordered, tell the patient with
glaucoma not to use them on the day of the test.
 Explain to the patient that eye drops will be instilled to
dilate his pupils and that a dye will be injected into his
arm. Remind him to maintain his gaze position and
fixation as the dye is injected. Tell him that he may briefly
experience nausea and a feeling of warmth.
 Observe the patient for hypersensitivity reactions to the
dye, such as vomiting, dry mouth, metallic taste, sudden
increased salivation, sneezing, light-headedness, fainting,
and hives.
 Remind the patient that his skin and urine will be a yellow
color for 24 to 48 hours after the test and that his near
vision will be blurred for up to 12 hours.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Because an anesthetic is instilled before the test, tell the
patient not to rub his eyes for at least 20 minutes after the
test, to prevent corneal abrasion.
 If the patient wears contact lenses, tell him not to reinsert
them for at least 30 minutes after the test.
 If the tonometer moved across the cornea during the test,
tell the patient that he may feel a slight scratching
sensation in the eye when the anesthetic wears off.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Regular ocular and physical examinations
 Avoid dangerous items
 Early identification and treatment of strabismus in children
 Early treatment when eye symptoms occur
 Routine instillation of appropriate drops of every newborn
 Blood test during pregnancy to identify syphilis
 Inoculation against rubella
 Regulation of oxygen concentrations in premature infants
 Avoid habitual rubbing of eyes
 Adequate lighting when reading
 Periodically rest eyes during prolonged periods of close
eye work
 Reduce glare and wear protective glasses
 Keep eye glasses clean, protected from scratching,
breakage and properly aligned
 Do not use eye medications unless prescribed by a doctor
 Never use soiled wash cloth around eyes
 Use care when using aerosol sprays
 Maintain a state of good health and eat a well – balanced
diet with adequate vitamins A, B and C
 Use care when using solvents, lye solutions, ammonia,
caustic solutions to avoid splashing or spilling into eyes
MS Eye and Vision Disorders
 Orient the client to the staff and physical environment if
both eyes will be covered after surgery.
 If the client is a child, practice covering the eyes.
 Administer mydriatics / cycloplegics as prescribed
• Atropine sulfate
• Cyclomydril
• Scopolamine
• Mydriacyl
To prevent or relieve the following:
 Increased intraocular pressure
 Stress on the suture site
 Hemorrhage on the anterior chamber
 Infection
 Pain
 Position the client supine or turned to the unaffected side.
 Burning sensation about one hour after surgery is normal.
 Use eye patch for 5 to 7 days. Use eye shield during the
night for four weeks.
 Instruct the client to avoid the following:
• Rubbing the eyes
• Lifting the head or hips
• Sudden, jerky head movements
• Sneezing and coughing
• Nausea and vomiting
• Straining during defecation
• Bending and stooping
• Heavy lifting
• Reading for few days
• Watching fast moving objects
 Feeling of “something in the eye” 4 to 5 days postop is
normal.
 Sensation of pressure within the eye and sharp pain in the
yes indicates bleeding.
 Administer miotics as prescribed.
• Carbachol
• Pilocarpine HCl
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Corrective eyeglasses
 Surgery
• Advancement, resection and tucking
• Tenotomy
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Assessment
• pain, photophobia, lacrimation, blepharospasm,
decreased vision
 Treatment
• Trifluridine (Viroptic), idoxuridine (IDU), Adenine
Arabinoside (Vira – A)
• Mechanical /chemical debridement
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
IRITIS
IRIDOCYSTITIS
CHOROIDITIS
CHOROIRETINITIS
 Assessment
• Pain radiating to the forehead and temple, blurred
vision, photophobia, redness without purulent
discharge, small pupil, lacrimation
 Treatment
• Mydriatics and steriods
• Dark glasses
• Analgesics
MS Eye and Vision Disorders
 Assessment
• Inflammation of exciting eye followed by the
sympathizing eye, photophobia, blurred vision
 Treatment
• Enucleation
• Steriods
• Atropine
MS Eye and Vision Disorders
 Assessment
• Reduced visual acuity, changes in visual field,
alterations in the shape of objects, discomfort in the
eyes and photophobia
 Treatment
• Rest the eyes
• Protect eyes from light
• Atropine sulfate
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
RHEGMATOGENOUS DETACHMENT
TRACTION DETACHMENT
COMBINATION OF RHEGMATOGENOUS AND TRACTION
EXUDATIVE DETACHMENT
 Assessment
• Floating spots or opacities, flashes of light, progressive
constriction of vision in one area, cloudy vitreous and
portion of retina
 Treatment
• Bed rest and cover eyes
• Dependent position
• Early surgery
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
INITIATING EVENTS
STRUCTURAL ALTERATIONS IN THE AQUEOUS
OUTFLOW SYSTEM
FUNCTIONAL ALTERATIONS
OPTIC NERVE DAMAGE
VISUAL LOSS
MS Eye and Vision Disorders
 Assessment
• Rapid onset of severe pain
• Blurred vision
• Headache
• Rainbows and halos around lights
• Nausea and vomiting
• Inflamed eye
• Fixed dilated pupils
MS Eye and Vision Disorders
 Treatment
• Bed rest in quiet, darkened room, elevate head 30
degrees
• Monitor vital signs
• Miotic eye drops as ordered
• Administer acetazolamide and glycerol
• Provide emotional support
• Assess client’s ability to see
 Treatment
• Assist according to degree of visual impairment
• Prepare for eye examinations as ordered – tonometry
• Avoid mydriatics
ABC atropine, benadryl cogentin
• Administer antiemetics for nausea
• Diet as tolerated
• Prepare for surgery if ordered
MS Eye and Vision Disorders
 Assessment
• Tunnel vision which can progress to blindness
• Insidious onset – generally no discomfort
• Persistent dull eye pain in the morning
• Frequent changes of glasses, difficulty in adjusting to
darkness, failure to detect changes in color accurately.
• Rainbows or halos resembling street lights around
lights
MS Eye and Vision Disorders
 Treatment
• Miotics
• Acetazolamide (Diamox)
• Avoid fatigue or stress and avoid large quantities of
fluids
• Surgery
Cholinergics (pilocarpine, carbachol)
Adrenergic agonists (dipivefrin, epinephrine)
Beta-blockers (betaxolol, timolol)
Alpha-adrenergic agonists (apraclonidine, brimonidine)
Carbonic anhydrase inhibitors
(acetazolamide, methazolamide, dorzolamide)
Prostaglandin analogs (latanoprost, bimatoprost)
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
SENILE CATARACT
TRAUMATIC CATARACT
CONGENITAL CATARACT
SECONDARY CATARACT
NUCLEAR CATARACT
CORTICAL CATARACT
POSTERIOR SUBCAPSULAR CATARACT
MS Eye and Vision Disorders
IMMATURE CATARACT
MATURE CATARACT
HYPERMATURE CATARACT
TUMESCENT CATARACT
TREATMENT
 Surgery
• Intracapsular Cataract Extraction (ICCE)
• Extracapsular Cataract Extraction (ECCE)
• Cryoextraction
• Iridectomy
• Phacoemulsification
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
TREATMENT
 Enucleation
 Brachytherapy
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
BLOWOUT
ZYGOMATIC OR TRIPOD
MAXILLARY
MIDFACIAL
ORBITAL APEX
ORBITAL ROOF FRACTURES
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
ENUCLEATION
EVISCERATION
EXANTERATION
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Severe injury resulting in prolapse of uveal tissue or loss
of light projection or perception
 An irritated, blind, painful, deformed, or disfigured eye,
usually caused by glaucoma, retinal detachment, or
chronic inflammation
 An eye without useful vision that is producing or has
produced sympathetic ophthalmia in the other eye
 Intraocular tumors that are untreatable by other means
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Refer to available facilities.
 Orient to environment.
 Promote independence – ADL
 May have a guide dog or use cane for direction.
 When approaching, talk before touching.
 When assisting in ambulation, have the patient hold your
forearm so that you are a step ahead of him.
 Talk to the patient frequently.
 Explain nursing procedures and what is to be done next.
MS Eye and Vision Disorders
MS Eye and Vision Disorders
 Do not change the location of the objects in the room
without describing the change.
 Promote safety in the environment.
 Do not rush up and offer help to a blind person unless it is
clear that the person wants help.
 Suggest gifts for a blind person that appeal to senses
other than vision.

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MS Eye and Vision Disorders

  • 2. On completion of this chapter, the learner will be able to: 1. Identify significant eye structures and describe their functions. 2. Identify diagnostic tests for assessment of vision and evaluation of visual disabilities. 3. Discuss clinical features, diagnostic assessment and examinations, medical or surgical management, and nursing management of ocular disorders. 4. Describe therapeutic effects of ophthalmic medications.
  • 3. On completion of this chapter, the learner will be able to: 5. Define low vision and blindness and differentiate between functional and visual impairment. 6. List and describe assessment and management strategies for low vision. 7. Demonstrate orientation and mobility techniques for patients with low vision in a hospital setting. 8. Demonstrate instillation of eye drops and ointment.
  • 4. On completion of this chapter, the learner will be able to: 9. Discuss general discharge instructions for patients after ocular surgery. 10. Discuss strategies for patient safety in ophthalmology.
  • 21. Retina Optic nerve Optic chiasm Optic tracks Lateral geniculate bodies Optic radiations Visual cortex area of the brain
  • 22.  Decrease or loss of accommodation (presbyopia)  Lens yellow with age  Senile miosis  Increased light scatter in the eye causing glare  Decrease in lens transparency (cataract)  Dryness or scratchiness of the eyes  Distorted or blurred image (astigmatism)
  • 30.  If the patient is wearing contact lenses, have him remove them before the test, unless the test is being performed to evaluate the fit of the contact lenses.  When instilling dilating drops, tell the patient that his near vision will be blurred for 40 minutes to 2 hours.  Advise him to wear dark glasses in bright sunlight until his pupils return to normal diameter.  Don’t administer dilating eyedrops to the patient who has angle closure glaucoma, is hypersensitive to mydriatics, or has an intraocular lens implant.
  • 40.  Tell the patient that a small transducer will be placed on his  closed eyelid and that the transducer will transmit high- frequency sound waves that will reflect off the structures in the eye.  Inform him that he may be asked to move his eyes or change his gaze during the procedure; explain that his cooperation will help to ensure accurate results.  After the test, remove the water-soluble jelly that was placed on the patient’s eyelids.
  • 47.  Check the patient’s history for an intraocular lens implant, glaucoma, and hypersensitivity reactions, especially reactions to contrast media and dilating eye drops.  If miotic eye drops are ordered, tell the patient with glaucoma not to use them on the day of the test.  Explain to the patient that eye drops will be instilled to dilate his pupils and that a dye will be injected into his arm. Remind him to maintain his gaze position and fixation as the dye is injected. Tell him that he may briefly experience nausea and a feeling of warmth.
  • 48.  Observe the patient for hypersensitivity reactions to the dye, such as vomiting, dry mouth, metallic taste, sudden increased salivation, sneezing, light-headedness, fainting, and hives.  Remind the patient that his skin and urine will be a yellow color for 24 to 48 hours after the test and that his near vision will be blurred for up to 12 hours.
  • 53.  Because an anesthetic is instilled before the test, tell the patient not to rub his eyes for at least 20 minutes after the test, to prevent corneal abrasion.  If the patient wears contact lenses, tell him not to reinsert them for at least 30 minutes after the test.  If the tonometer moved across the cornea during the test, tell the patient that he may feel a slight scratching sensation in the eye when the anesthetic wears off.
  • 57.  Regular ocular and physical examinations  Avoid dangerous items  Early identification and treatment of strabismus in children  Early treatment when eye symptoms occur  Routine instillation of appropriate drops of every newborn  Blood test during pregnancy to identify syphilis  Inoculation against rubella  Regulation of oxygen concentrations in premature infants  Avoid habitual rubbing of eyes
  • 58.  Adequate lighting when reading  Periodically rest eyes during prolonged periods of close eye work  Reduce glare and wear protective glasses  Keep eye glasses clean, protected from scratching, breakage and properly aligned  Do not use eye medications unless prescribed by a doctor  Never use soiled wash cloth around eyes  Use care when using aerosol sprays
  • 59.  Maintain a state of good health and eat a well – balanced diet with adequate vitamins A, B and C  Use care when using solvents, lye solutions, ammonia, caustic solutions to avoid splashing or spilling into eyes
  • 61.  Orient the client to the staff and physical environment if both eyes will be covered after surgery.  If the client is a child, practice covering the eyes.  Administer mydriatics / cycloplegics as prescribed • Atropine sulfate • Cyclomydril • Scopolamine • Mydriacyl
  • 62. To prevent or relieve the following:  Increased intraocular pressure  Stress on the suture site  Hemorrhage on the anterior chamber  Infection  Pain
  • 63.  Position the client supine or turned to the unaffected side.  Burning sensation about one hour after surgery is normal.  Use eye patch for 5 to 7 days. Use eye shield during the night for four weeks.  Instruct the client to avoid the following: • Rubbing the eyes • Lifting the head or hips • Sudden, jerky head movements • Sneezing and coughing
  • 64. • Nausea and vomiting • Straining during defecation • Bending and stooping • Heavy lifting • Reading for few days • Watching fast moving objects  Feeling of “something in the eye” 4 to 5 days postop is normal.  Sensation of pressure within the eye and sharp pain in the yes indicates bleeding.
  • 65.  Administer miotics as prescribed. • Carbachol • Pilocarpine HCl
  • 76.  Corrective eyeglasses  Surgery • Advancement, resection and tucking • Tenotomy
  • 84.  Assessment • pain, photophobia, lacrimation, blepharospasm, decreased vision  Treatment • Trifluridine (Viroptic), idoxuridine (IDU), Adenine Arabinoside (Vira – A) • Mechanical /chemical debridement
  • 92.  Assessment • Pain radiating to the forehead and temple, blurred vision, photophobia, redness without purulent discharge, small pupil, lacrimation  Treatment • Mydriatics and steriods • Dark glasses • Analgesics
  • 94.  Assessment • Inflammation of exciting eye followed by the sympathizing eye, photophobia, blurred vision  Treatment • Enucleation • Steriods • Atropine
  • 96.  Assessment • Reduced visual acuity, changes in visual field, alterations in the shape of objects, discomfort in the eyes and photophobia  Treatment • Rest the eyes • Protect eyes from light • Atropine sulfate
  • 100. RHEGMATOGENOUS DETACHMENT TRACTION DETACHMENT COMBINATION OF RHEGMATOGENOUS AND TRACTION EXUDATIVE DETACHMENT
  • 101.  Assessment • Floating spots or opacities, flashes of light, progressive constriction of vision in one area, cloudy vitreous and portion of retina  Treatment • Bed rest and cover eyes • Dependent position • Early surgery
  • 108. INITIATING EVENTS STRUCTURAL ALTERATIONS IN THE AQUEOUS OUTFLOW SYSTEM FUNCTIONAL ALTERATIONS OPTIC NERVE DAMAGE VISUAL LOSS
  • 110.  Assessment • Rapid onset of severe pain • Blurred vision • Headache • Rainbows and halos around lights • Nausea and vomiting • Inflamed eye • Fixed dilated pupils
  • 112.  Treatment • Bed rest in quiet, darkened room, elevate head 30 degrees • Monitor vital signs • Miotic eye drops as ordered • Administer acetazolamide and glycerol • Provide emotional support • Assess client’s ability to see
  • 113.  Treatment • Assist according to degree of visual impairment • Prepare for eye examinations as ordered – tonometry • Avoid mydriatics ABC atropine, benadryl cogentin • Administer antiemetics for nausea • Diet as tolerated • Prepare for surgery if ordered
  • 115.  Assessment • Tunnel vision which can progress to blindness • Insidious onset – generally no discomfort • Persistent dull eye pain in the morning • Frequent changes of glasses, difficulty in adjusting to darkness, failure to detect changes in color accurately. • Rainbows or halos resembling street lights around lights
  • 117.  Treatment • Miotics • Acetazolamide (Diamox) • Avoid fatigue or stress and avoid large quantities of fluids • Surgery
  • 118. Cholinergics (pilocarpine, carbachol) Adrenergic agonists (dipivefrin, epinephrine) Beta-blockers (betaxolol, timolol) Alpha-adrenergic agonists (apraclonidine, brimonidine) Carbonic anhydrase inhibitors (acetazolamide, methazolamide, dorzolamide) Prostaglandin analogs (latanoprost, bimatoprost)
  • 129. SENILE CATARACT TRAUMATIC CATARACT CONGENITAL CATARACT SECONDARY CATARACT
  • 132. IMMATURE CATARACT MATURE CATARACT HYPERMATURE CATARACT TUMESCENT CATARACT
  • 133. TREATMENT  Surgery • Intracapsular Cataract Extraction (ICCE) • Extracapsular Cataract Extraction (ECCE) • Cryoextraction • Iridectomy • Phacoemulsification
  • 160.  Severe injury resulting in prolapse of uveal tissue or loss of light projection or perception  An irritated, blind, painful, deformed, or disfigured eye, usually caused by glaucoma, retinal detachment, or chronic inflammation  An eye without useful vision that is producing or has produced sympathetic ophthalmia in the other eye  Intraocular tumors that are untreatable by other means
  • 166.  Refer to available facilities.  Orient to environment.  Promote independence – ADL  May have a guide dog or use cane for direction.  When approaching, talk before touching.  When assisting in ambulation, have the patient hold your forearm so that you are a step ahead of him.  Talk to the patient frequently.  Explain nursing procedures and what is to be done next.
  • 169.  Do not change the location of the objects in the room without describing the change.  Promote safety in the environment.  Do not rush up and offer help to a blind person unless it is clear that the person wants help.  Suggest gifts for a blind person that appeal to senses other than vision.