Neurological 9
Less common type of glaucoma: acute closed-angle (shallow, narrow-angle, primary, or congested glaucoma) - iris bulges and blocks trabecular network.
etiology /epidemiology
a medical and nursing emergency iris lies near drainage channel (canal of Schlemm affects more women; usually after age 45
findings
sudden onset of blurred vision, halos or colored rings around white lights, frontal headache sudden severe eye pain, reddening of the eye, nausea, vomiting followed by progression of findings as pressure increases:
profuse lacrimation mildly dilated, nonreactive pupil nausea/vomiting cornea appears hazy
blindness may result in two to five days if left untreated
management
expected outcome: to prevent or minimize the damaging effects of acute closed-angle glaucoma emergency pharmacologic treatment to decrease IOC
intravenous osmotic agents miotic eye drops includes carbonic anhydrase inhibitors systemic analgesics
surgery
nursing interventions
monitor for effectiveness of medications as ordered post-op eyepatch or sunglasses for photophobia tell client that vision will be blurred for one to two days postsurgery stress importance of routine yearly or more frequent eye examinations teach clients to avoid activities that increase IOP
Cataract - maybe unilateral or bilateral Etiology/epidemiology
clouding of lens - one of the most common eye disorders first type: senile cataract - result of aging process second type: traumatic
develops within months of eye trauma painless but progressive loss of sight in one or both eyes
Expected outcome: correction of visual field defect Treatment: only surgical
cataract extraction: removal of cloudy lens
most commonly done as outpatient procedure usually done on one eye at a time types of cataract extraction
extracapsular cataract extraction (ECCE) Phacoemulsification - ultrasound fragments the lens contents intracapsular cataract extraction (ICCE)
removes lens contents and lens capsule eye becomes hypermetropic
intraocular lens implant usually performed at time of extraction peripheral iridectomy usually performed as part of ECCE or ICCE
Potential complications of surgery
hyphema (blood in anterior chamber of the eye)
may require bed rest and patching observe for increased IOP - complaints of severe pain may prescribe miotics or cycloplegics
vitreous prolapse
allows vitreous humor to fall forward into wound may result in pupil block may lead to retinal detachment vitrectomy may be performed
intraocular infection
complaints of throbbing or in eye pain, drainage from eye antibiotics (ophthalmic and/or systemic)
Nursing interventions
teach client to avoid causes of IOP observe client's ability to instill eyedrops correctly; provide referrals if unable to provide written list of complications for the client to report inform clients that an expected feeling after surgery is one that "sand" is in the eye for six to eight weeks afterwards
Retinal detachment ( illustration ) Etiology/epidemiology
holes or breaks (tears) in retina fluid, blood or a mass separates the retina's sensory layer from the pigmented epithelium (pigment cells) common causes are inflammation, trauma, hemorrhage, and tumors retinal detachment often begins in periphery and spreads posteriorly
Findings
a rapid separation gives feeling of a curtain being pulled over eye so that client has partial vision in affected eye slow separation may be asymptomatic ophthalmic exam reveals detached area as gray bulge, ripple or fold
Management
expected outcome: correction of and/or prevention of further vision loss: 90% are successfully repaired laser surgery
photocoagulation: laser beam is directed through dilated pupil effect is to seal localized breaks or rips in retina
cryotherapy: extreme cold freezes rips in retina diathermy: heat applied with ultrasonic probe to repair rips scleral buckle pharmacotherapy:
adrenergic-mydriatic agents cycloplegic agents antibiotics
Nursing interventions
maintain bed or chair rest as ordered post-op eye patch to rest eye (or both eyes) dark glasses for photophobia administer medications as ordered prevent increases in IOP
Visual impairment and blindness Legal blindness: a maximum visual acuity of 20/200 (with optimum correction) and/or a visual field that is reduced to a range of 20 degrees (normal range: 180 degrees) Chief causes: retinal degeneration, glaucoma, cataract, amblyopia , macular degeneration - called "central" loss of vision Nursing interventions
speak to client upon entering room safety measures based on how client accommodates sight loss orient client to new surroundings; use numbers on traditional clock for placement of furniture or food on plate assist with activities of daily living as required for walking, do not take client's arm to lead. offer the client your arm so that the blind person holds the arm at the elbow of the lead person who walks a little in front of the blind person
