1. Visual Disorder
Cataract
By
Mr. Ravi Rai Dangi
Assistant Professor
Fellowship in Neonatal Nursing
MSc. Child Health Nursing

2. Congenital Cataract
 A congenital opacity of the crystalline lens. Cloudiness
in the lens of the eye that is present at, or develops
shortly after birth. Congenital cataracts are also the most
frequent cause of leukocoria (white pupil) in children.

3.  Cataract is the development of opacity in the crystalline
lens of eye. As light cannot pass through the opacity,
vision becomes blurred.

4. Incidence
Congenital cataract affects 1/in 250 newborns.

5. Etiology
Bilateral
• Idiopathic (60%)
• Hereditary (30%)
• Intrauterine infection
• Associated with ocular disorders
• Tumor
• Metabolic
• Maternal drug ingestion
• Malnutrition
• Trauma

6. Unilateral
• Idiopathic (80%)
• Intrauterine infection
• Ocular abnormalities
• Trauma

7. Sign & Symptoms
 Blurry vision
 ‘Wobbling’ eyes
 Asquint (both eyes pointing in different directions)

8.  Halo effect: You will see halos around any light
source
 Enhanced brightness: The sun, lamp or headlights
will seem too glaring and bright as compared to
before. On the other hand, brightness of colors will
decrease.
 Night blindness

9. Spotting these signs in infants is not easy, which is why
your baby’s eyes should be routinely examined within 72
hours of birth.
The test should be followed when they are 6-8 weeks
old. It’s possible that cataracts can develop in children
after these screening tests too.
Detecting cataracts in children at early stages is
important to reduce the risk of long-term vision problems.

10. Pathophysiology
The lens capsule is formed during the fourth and fifth week of gestation
It is a clear membrane which allows light to enter the eye and refract the rays for a clear
image on retina
If there is any reason that interferes with lens development
The lens becomes milky white and cloudy
Obscuring light rays and thus vision

11. Diagnostic evaluation
Slit Lamp
A slit lamp is a special type of microscope that magnifies your
eye so doctor can examine the lens to determine the presence
and severity of a cataract.

12. Contrast Sensitivity
Contrast sensitivity testing is similar to visual
acuity testing but places greater emphasis on how
cataracts can decrease image contrast due to light
scattering and glare caused by the cataract.
Eye doctors consider contrast sensitivity testing to
be a more realistic measurement of true quality of vision.

13. The Pelli Robson contrast sensitivity chart tests your
ability to detect letters that are gradually less contrasted
with the white background as your eyes move down the
chart

14. Pupil Dilation
 Pupil dilation is a common test used in diagnosing
cataracts. Clouding of the lens is not noticeable until a
cataract reaches an advanced stage.
 When your eye is dilated, however, the pupil increases in
size, offering a view of your entire lens.
 By thoroughly examining the lens, a
doctor can determine whether or not
a cataract is affecting your quality of
vision.

15. Management
Pharmacologic Therapy
• Dilating drops- Dilating drops are administered every 10
minutes for four doses at least 1hour before surgery.
• Antibiotic drugs- Antibiotic drugs may be administered
prophylactically to prevent postoperative infection and
inflammation.
• Intravenous sedation- Sedation may be used to minimize
anxiety and discomfort before surgery.

16. Surgical Management
 Cataract surgery is the treatment of choice and should be
performed when patients are younger than 17 weeks to
ensure minimal or no visual deprivation.
 Most ophthalmologists opt for surgery much earlier,
ideally when patients are younger than 2 months, to
prevent irreversible amblyopia and sensory nystagmus in
the case of bilateral congenital cataracts.

17. Extracapsular cataract extraction
Extracapsular cataract extraction (ECCE) is a type
of eye surgery in which the lens of the eyes are removed,
leaving the elastic capsule covering the lens which is left
partially attached to allow the implantation of an
intraocular lens (IOL).

18. Intraocular Lens Implant
 An intraocular lens implant is an artificial replacement
for the lens of your eye. It's part of the surgery to fix
cataracts.
 An intraocular lens implant, or IOL, is made of a clear
plastic.
 There are several different types:

19. Monofocal IOL:
This is the most common. Unlike your natural
lens, which can stretch or bend to help your eye focus,
this implant stays focused at one fixed distance. It
focuses at a distance; person might be able to see things
far away but need glasses to read or see close up.

20.  Multifocal implant:
 Like glasses with bifocal or progressive lenses, this
lens has areas that help person see things at different
distances. It could take several months for brain to
adapt so person’s vision seems natural.

21. Accommodating IOL:
This flexible option acts more like natural lens and
focuses at more than one distance. It makes you less
likely to need reading glasses
Toric IOL:
If patient have astigmatism, or a cornea that's more
football-shaped than round. This can make vision
blurry all over, not just close up or far away. This lens
lessens astigmatism so person won't need glasses to
correct it after your surgery.

23. Follow-Up Care
 It'll take about 8 weeks to fully heal. During that time:
 Keep eye covered with a patch or glasses for the first
several days even when you sleep.
 Don't rub or press your eye, even if it's itchy or oozes a bit
of fluid.
 Take the medicated eye drops your doctor prescribes. You'll
use them for several weeks to help your eye heal.
 Avoid most exercise or heavy lifting. The doctor will tell
you when you can do those things again.

24. Nursing Management
Providing preoperative care
o To reduce the risk for retro bulbar hemorrhage (after
retro bulbar injection), any anticoagulation therapy
that the patient is receiving is withheld, if medically
appropriate. Aspirin should be withheld for 5 to 7
days.
o Dilating drops are administered every 10 minutes for
four doses at least 1 hour before surgery.

25.  Additional dilating drops may be administered in the
operating room (immediately before surgery) if the
affected eye is not fully dilated.
 Antibiotic, corticosteroid, and NSAID drops may be
administered prophylactically to prevent
postoperative infection and inflammation.

26. Providing postoperative care
 The nurse also explains that there is minimal discomfort
after surgery and instructs the patient’s relatives to give a
mild analgesic agent, such as acetaminophen, as needed.
 Antibiotic, anti-inflammatory, and corticosteroid eye
drops or ointments are prescribed postoperatively.
 Always wash hands before touching or cleaning the
postoperative eye.

27.  Clean postoperative eye with a clean tissue; wipe the
closed eye with a single gesture from the inner
canthus outward.
 Avoid contact with light.
 Always use aseptic technique while dealing with
child.

28. Teaching Patients Self-Care
 To prevent accidental rubbing of the eye.
 The patient wears a protective eye patch for 24 hours
after surgery, followed by eyeglasses worn during the
day and a metal shield worn at night for 1 to 4 weeks.
The nurse instructs the patient and family in applying
and caring for the eye shield.

29.  Sunglasses should be worn while outdoors during the
day because the eye is sensitive to light. Slight morning
discharge, some redness, and a scratchy feeling may be
expected for a few days.
 A clean, damp washcloth may be used to remove slight
morning eye discharge.