nucleus
. 2. Ciliary muscle •Function: • Constricts ciliary body • Relaxes tension on lens • Lens become spherical,
which increase the refractive power Ciliary process •Attaches to the lenses by suspensory ligament (zonular
fibers) •Secrete the Aqueous humor into the post. chamber
. 3. DEFINITION • A cataract is a clouding or capacity that develops in the crystalline lens of the eye or in its
envelope, varying in degree from slight to capacity and obstructing the passage of light. • The term cataract is
derived from the Greek word cataractos, which describes rapidly running water or falling water.
. 4. Epidemiology 1. Cataracts remain the leading cause of blindness. 2. Age-related cataract is responsible
for 48% of world blindness, which represents about 18 million people. 3. Cataracts are also an important
cause of low vision in both developed and developing countries.
. 5. Causes of cataract • Old age (commonest)>65 Year • Ocular & systemic diseases – DM – Uveitis –
Previous ocular surgery • Systemic medication – Steroids – Phenothiazines • Trauma & intraocular foreign
bodies • Ionizing radiation – X-ray – UV • Congenital – Part of a syndrome – Abnormal galactose metabolism
– Hypoglycemia • Inherited abnormality – Myotonic dystrophy – Marfan’s syndrom – Rubella – High myopia 8
. 6. Any physical or chemical cause ↓ Disturbs the intracellular and extracellular equilbrium of water and
electrolytes ↓ Deranges the colloid system in lens fibres ↓ Aberrant fibres are formed from germinal
epithelium of lens ↓ Epithelial cell necrosis ↓ Focal opacification of lens epithelium (glaucomflecken) ↓
Opacification of lens PATHOMECHANISM
. 7. Opacification of lens takeplace by 3 biochemical changes. 1. Hydration 2.Denaturation of 3.Slow lens
protein sclerosis Abnormalities of lens proteins & Disorganisation of lens fibres Loss of transparency of lens
Cataract
. 8. CLASSIFICATION : BASED ON : •MORPHOLOGY •AGE OF ONSET •MATURITY •ETIOLOGY
. 9. Cataract Divided to : • Acquired cataract Age - related cataract Metabolic cataract Radiation or electric
cataract Traumatic cataract Toxic cataract Secondary cataract
. 10. AGE OF ONSET: 1.CONGENITAL 2.INFANTILE 3.JUVINILE 4.PRE-SENILE 5.SENILE
. 11. CONGENITAL CATARACT
. 12. INFANTILE AND JUVINILE CATARACT
. 13. Age -related cataract It is the Most commonly occurred. Classified according to: Morphological
Classification •Capsular cataract •Sub capsular cataract •Cortical cataract •Supra nuclear cataract •Nuclear
cataract •Polar cataract
. 14. Nuclear cataract • Most common typeMost common type • Age-relatedAge-related • Occur in theOccur
in the centercenter ofof the lens.the lens. • It involves the nucleusIt involves the nucleus of the crystalline
lens.of the crystalline lens. The nucleus becomesThe nucleus becomes diffusely cloudy anddiffusely cloudy
and obstructs the light rays.obstructs the light rays.
. 15. Cortical cataract • Occur on the outer edge of the lens (cortex). • Begins as whitish, wedge-shaped
opacities. • The lens fibers of the cortex are mainly affected. There is hydration due to accumulation of water
droplets in between the fibers and the protein are first denaturated and then are coagulated forming opacity.
. 16. Subcapsular cataract •It involves superficial part of the cortex(just below the capsule) and includes
anterior sub capsule or posterior sub capsule. capsular cataract • It involves the capsule and may be anterior
capsule or posterior capsule.
. 17. MATURITY: 1.IMMATURE CATARCT 2.MATURE CATARACT 3.HYPERMATURE CATARACT
. 18. MATURE AND IMMATURE CATARACT
. 19. Mature Cataract • Lens is completely opaque. • Vision reduced to just perception of light • Iris shadow is
not seen • Lens appears pearly white Right eye mature cataract, with obvious white opacity at the centre of
pupil
. 20. IMMATURE CATARACT
. 21. Hypermature Cataract • Shrunken and wrinkled anterior capsule due to leakage of water out of the lense.
• This may take any of two forms: 1.Liquefactive/Morgagnian Type 2.Sclerotic Cataract
. 22. Liquefactive/Morgagnian Type • Cortex undergoes auto-lytic liquefaction and turns uniformly milky white.
• The nucleus loses support and settles to the bottom.
. 23. Sclerotic Cataract • The fluid from the cortex gets absorbed and the lens becomes shrunken. • There
may be deposition of calcific material on the lens capsule. • Iridodonesis: Anterior chamber deepens and iris
becomes tremulous. • The zonules become weak, increasing the risk of subluxation / dislocation of lens.
. 24. SUBJECTIVE CLASSIFICATION: • GRADE 0: CLEAR LENS • GRADE 1: SWOLLEN FIBRES AND
SUB CAPSULAR OPACITIES • GRADE 2: NUCLEAR CATARACT AND VISIBLE LENS FIBRES • GRADE 3:
STRONG NUCLEAR CATARACT WITH PERINUCLEAR AREA OPACITY • GRADE 4: TOTAL OPACITY
. 25. SUBJECTIVE CLASSIFICATION
. 26. Clinical Manifestations •Gradual painless burning •Loss of vision due to lens opacity •Increased glare in
bright light •Decreased color perception •Decreased visual acuity •Poorvision at night •
Photophobia(lightPhotophobia(light sensitivity)sensitivity) • Blurred or distorted imagesBlurred or distorted
images • Light scatteringLight scattering • Leukokoria or white pupilLeukokoria or white pupil • Reduced light
transmissionReduced light transmission • Contrast sensitivity is alsoContrast sensitivity is also lostlost
. 27. BLURRED VISION DUE TO SCATTERING OF LIGHT ON THE RETINA
. 28. GLARED VIEW(TROUBLE DRIVING AT NIGHT)
. 29. CHANGE IN COLOUR VISION(DIMNESS)
. 30. 1. History collection 2. Visual acuity test 3. Dilated eye exam 4. Tonometry
. 31. Treatment • Glasses: Cataract alters the refractive power of the natural lens so glasses may allow good
vision to be maintained. • Surgical removal: when visual acuity can't be improved with glasses. • Surgical
techniques –Phacoemulsification method. –Extracapsular cataract extraction. –Intra capsular cataract
extraction. –Intraocular lens implantation –cryosurgery
. 32. Phacoemulsification in cataract surgery involves insertion of a tiny, hollowed tip that uses high frequency
(ultrasonic) vibrations to "break up" the eye's cloudy lens (cataract). The same tip is used to suction out the
lens .
. 33. Intra-capsular Cataract Extraction Intracapsular Cataract Extraction. From the late 1800s until the 1970s,
the technique of choice for cataract extraction was intracapsular cataract extraction (ICCE). The entire lens
(ie, nucleus, cortex, and capsule) is removed, and fine sutures close the incision. ICCE is infrequently
performed today; however, it is indicated when there is a need to remove the entire lens, such as with a
subluxated cataract (ie, partially or completely dislocated lens).
. 34. Extra-capsular Cataract Extraction (ECCE) • Extracapsular Surgery. Extracapsular cataract extraction
(ECCE) achieves the intactness of smaller incisional wounds (less trauma to the eye) and maintenance of
the posterior capsule of the lens, reducing postoperative complications, particularly aphakic retinal
detachment and cystoid macular edema.
. 35. Postoperative care after cataract surgery • Steroid drops (inflammation) • Antibiotic drops (infection) •
Avoid • Very strenuous exertion (rise the pressure in the eyeball) • Ocular trauma.
. 36. Complications of cataract surgery • Infective endophthalmitis – Rare but can cause permanent severe
reduction of vision. – Most cases within two weeks of surgery. – Typically patients present with a short history
of a reduction in their vision and a red painful eye. – This is an ophthalmic emergency. – Low grade infection
with pathogen such as Propionibacterium species can lead patients to present several weeks after initial
surgery with a refractory uveitis • Suprachoroidal haemorrhage. – Severe intraoperative bleeding can lead to
serious and permanent reduction in vision.
. 37. • Uveitis • Ocular perforation. • Postoperative refractive error • Posterior capsular rupture and • vitreous
loss
. 38. Retinal detachment. Cystoid macular oedema Glaucoma Posterior capsular opacification
. 39. Nursing diagnosis • Anxiety related to lack of knowledge about post operative care. • Risk for infection
related to surgical incision and self care after surgery. • Risk for injury related to sensory deficit while
operated eye is patched.
1. cataract is an opacity of the lens that distorts image projected onto the
retina and that can progress to blindness.
2. The lens opacity reduces visual acuity. As the eye ages, the lens loses
water and increases in size and density, causing compression of lens fibers.
A cataract then forms as oxygen uptake is reduced, water content
decreases, calcium content increases, and soluble protein becomes insoluble.
3. Intervention is indicated when visual acuity has been reduced to a level
that the client finds to be unacceptable or adversely affects lifestyle.
4. Over time, compression of lens fibers causes a painless, progressive loss
of transparency that is often bilateral. The rate of cataract formation in
each eye is seldom identical.
Causes
Complications
Assessment
1. Opaque or cloudy white pupil
2. Gradual loss of vision
3. Blurred vision
4. Decreased color perception
5. Vision that is better in dim light with pupil dilation
6. Photophobia
7. Absence of the red reflex
Other Diagnoses that may occur in Nursing Care Plans For Cataract
Anxiety
Deficient knowledge (diagnosis and treatment)
Risk for infection
Risk for injury
Diagnostic Evaluation
General Comments: No specific laboratory tests identify cataracts.
Diagnosis is made by history, visual acuity test, and direct ophthalmoscopic
exam.
Ophthalmoscopy or slit lamp examination may reveal a dark area in the
red reflex. Ophthalmoscopy or slit lamp examination is a microscopic
instrument that allows detailed visualization of anterior segment of eye to
identify lens opacities and other eye abnormalities
Medical Management
Surgical Management
Surgical removal of the opacified lens is the only cure for cataracts. The
lens can be removed when the visual deficit is 20/40.
If cataracts occur bilaterally, the more advanced cataract is removed
first.
Extracapsular cataract extraction, the most common procedure,
removes the anterior lens capsule and cortex, leaving the posterior capsule
intact. A posterior chamber intraocular lens is implanted where the
patient’s own lens used to be.
Intracapsular cataract extraction removes the entire lens
within the intact capsule. An intraocular lens is implanted in
either the anterior or the posterior chamber, or the visual
deficit is corrected with contact lenses or cataract glasses.
Extracapsular cataract extraction
Complications may include retinal disorders, pupillary block, adhesions,
acute glaucoma, macular edema, and retinal detachment. Following
extracapsular cataract extraction, the posterior capsule may become
opacified. This condition, called a secondary membrane or after-cataract,
occurs when subcapsular lens epithelial cells regenerate lens fibers, which
obstruct vision. After-cataract is treated by yttrium-aluminum-garnet
(YAG) laser treatment to the affected tissue.
Pharmacologic Highlights
Documentation Guidelines