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Chapter 58 Chapter 58
Assessment and Management of
Patients With Eye and Vision Disorders
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External Structures of the Eye
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Cross-Section of the Eye
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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
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Diagnostic EvaluationOphthalmoscopy
Direct and indirectExamines the cornea, lens and retina
TonometryMeasures intraocular pressure
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Impaired VisionRefractive errors
Can be corrected by lenses which focus light rays on the retina
Myopia: nearsightedHyperopia: farsightedAstigmatism: 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
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GlaucomaA 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 ageRisk factors
Family history of glaucomaOlder ageDiabetes mellitusCardiovascular diseaseNearsightedness (myopia)Eye traumaProlonged use of topical or systemic corticosteroids
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Pathophysiology of GlaucomaIn 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
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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
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Treatment
Goal is to prevent further optic nerve damage
Maintain IOP within a range unlikely to cause damage
Pharmacologic therapy
Surgery (nursing care)
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CataractsAn opacity or cloudiness of the lensIncreased incidence with aging; by age 80 more than
half of all Americans have cataractsRisk 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)
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Cataract
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Clinical ManifestationsPainless, blurry vision Sensitivity to glareReduced visual acuityOther 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
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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
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Retinal DetachmentSeparation 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
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Retinal Detachment
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Surgical TreatmentScleral Buckle
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Trauma
Prevention of injury
Patient and public educationEmergency treatment
Flush chemical injuriesDo not remove foreign objectsProtect using metal shield or paper
cup
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Protective Eye Patches