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Chapter 58

Chapter 58 . Assessment and Management of Patients With Eye and Vision Disorders . External Structures of the Eye. Cross-Section of the Eye. Assessment and Evaluation of Vision. Ocular history Visual acuity Snellen chart Record each eye

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Chapter 58

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  1. Chapter 58 Assessment and Management of Patients With Eye and Vision Disorders

  2. External Structures of the Eye

  3. Cross-Section of the Eye

  4. Assessment and Evaluation of Vision • Ocular history • Visual acuity • Snellen chart • Record each eye • 20/20 means the patient can read the “20” line at a distance of 20 feet • Finger count or hand motion

  5. Diagnostic Evaluation • Ophthalmoscopy • Direct and indirect • Examines the cornea, lens and retina • Tonometry • Measures intraocular pressure

  6. Impaired Vision • Refractive errors • Can be corrected by lenses which focus light rays on the retina • Myopia: nearsighted • Hyperopia: farsighted • Astigmatism: distortion due to irregularity of the cornea. Due to refractive error in which light rays are spread over a diffuse area rather than sharply focused on the retina, a condition caused by differences in the curvature of the cornea and lens

  7. Glaucoma • A group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure (IOP) caused by congestion of the aqueous humor • The leading cause of blindness in adults in the U.S. • Incidence increases with age • Risk factors • Family history of glaucoma • Older age • Diabetes mellitus • Cardiovascular disease • Nearsightedness (myopia) • Eye trauma • Prolonged use of topical or systemic corticosteroids

  8. Pathophysiology of Glaucoma • In glaucoma, aqueous production and drainage are not in balance. • When aqueous outflow is blocked, pressure builds up in the eye. • Increased IOP causes irreversible mechanical and/or ischemic damage to the optic nerve. • Types of glaucoma: 1. Open-angle 2. Angle-closure (pupillary block) glaucoma 3. Congenital glaucomas 4. glaucoma secondary to other conditions

  9. Clinical Manifestations • “Silent thief” of vision; unaware of the condition until there is significant vision loss; peripheral vision loss, blurring, halos, difficulty focusing, difficulty adjusting eyes to low lighting • May also have aching or discomfort around eyes or headache • Diagnosis: Tonometry to assess IOP

  10. Treatment • Goal is to prevent further optic nerve damage • Maintain IOP within a range unlikely to cause damage • Pharmacologic therapy • Surgery (nursing care)

  11. Cataracts • An opacity or cloudiness of the lens • Increased incidence with aging; by age 80 more than half of all Americans have cataracts • Risk factors • Aging (Clumping or aggregation of lens protein) • Associated Ocular Conditions (Myopia, retenal surgery) • Toxic Factors (Corticosteroids, smoking) • Nutritional Factors (low antioxidants, poor nutrition) • Physical Factors (dehydration, trauma, ultraviolet ray) • Systemic Diseases and Syndromes (DM, MS Renal)

  12. Cataract

  13. Clinical Manifestations • Painless, blurry vision • Sensitivity to glare • Reduced visual acuity • Other effects include astigmatism, diplopia (double vision), and color (color value shift to yellow-brown) • Diagnostic findings include decreased visual acuity and opacity of the lens by ophthalmoscope, or inspection

  14. Surgical Management • If reduced vision does not interfere with normal activities, surgery is not needed. • Removal of the lens and replacing it with an artificial lens

  15. Retinal Detachment • Separation of the sensory retina and the RPE (retinal pigment epithelium) • Manifestations: sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, sudden onset of floaters • Diagnostic findings: assess visual acuity, assessment of retina by indirect ophthalmoscope and fluorescein angiography. Tomography and ultrasound may also be used

  16. Retinal Detachment

  17. Surgical Treatment Scleral Buckle

  18. Trauma • Prevention of injury • Patient and public education • Emergency treatment • Flush chemical injuries • Do not remove foreign objects • Protect using metal shield or paper cup

  19. Protective Eye Patches

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