Retinal Disorders Retinal detachment Retinal vascular disorders o Central retinal vein occlusion o Branch retinal vein occlusion

on o Central retinal vein occlusion o Macular degeneration

Post operative positioning is critical.

Nursing Management: Patient teaching o Eye surgery is most often done as an outpatient procedure, so patient education is vital. Teach the s/s of complications especially increased IOP and infection. Promote comfort Patient may need to lie in a special position with pneumotic retinopexy.

RETINAL DETACHMENT Separation of the sensory retina and the retinal pigment epithelium (RPE)

Manifestations: Sensation of a shade or curtain coming across the vision of one eye. Bright flushing lights Sudden onset of floaters

RETINAL VEIN OR ARTERY OCCLUSION Loss of vision can occur from retinal vein or artery occlusion. Occlusions may result from atherosclerosis, cardiac valvular disease, venous stasis. Hypertension and increase blood viscosity Associated risk factors are: o DM o Glaucoma o Aging Patients may report decreased visual acuity or sudden loss of vision.

Diagnostic Finding: Assess visual acuity Assess retina by indirect opthalmoscope Slit lamp Stereo fundus photography Fluorescin angiography Tomography Ultrasound may also be used

Surgical Treatment Sclera buckle Pars plana vitrectomy o Removal of the vitreous, locating the incisions at the pars plana o Frequently used in combination with other procedures. Pneumatic retinopexy o Injected gas bubble, liquid or oil is used to flatten the sensory retina against the RPE. Age related macular degeneration (AMD). Most common cause of vision loss in persons older than age 60.

MACULAR DEGENERATION

Types: Dry or non-exudative type o Most common o 85-90%

Slow breakdown of layers of the retina with the appearance of drusen. Wet type o May have abrupt onset o Proliferation of abnormal blood vessels growing under the retinachoroidal revascularization (CNV)

Potential exist for sympathetic opthalmia, causing blindness in the uninjured eye with some injuries.

INFECTIOUS AND INFLAMMATORY DISORDER Dry eye syndrome Conjunctivitis (pink eye) Classified by cause= bacterial, viral, fungal, parasitic, allergic and toxic. Viral conjunctivitis is contagious Uveitis Orbital cellulitis

Photodynamic therapy for slowing progresion of AMD Light sensitive verteporfin dye is injected into vessels. A laser then activates the dye, shutting down the vessels without damaging the retina. The result is to slow or stabilize vision loss. Patient must avoid exposure to sunlight or bright light for 5 days after treatment to avoid reactivation of dye in vessels near the surface of the skin.

OCULAR CONSEQUENCES OF SYSTEMIC DISEASE Diabetic retinopathy o Diabetes is a leading cause of blindness in people age 20 to 74. o Ophthalmic complications associated with AIDS. o Eye changes associated with hypertension

Nursing Management: Patient teaching Supportive care Safety promotion Recommendations include improving lighting, getting magnification devices and referring patient to vision center to improve or promote function.

OPTHALMIC MEDICATION Ability of the eye to absorb medication is limited. Barriers to absorption include the size of the conjunctival sac. Corneal membrane barriers; blood- ocular barriers and tearing, blinking and drainage. Intraocular injection as systemic medication may be needed to treat some eye structures or to provide high concentration of medications. Topical medications (drops and ointments) are most frequently used because they are at least invasive, have

TRAUMA Prevention of injury Patient and public education Emergency treatment o Flush chemical injuries o Do not remove foreign objects o Protect using metal shield or paper up.

few side effects and permits self administration. TOPICAL ANETHETICS Mydriatrics (dilate) and cycloplegics (paralyze) Contraindicated with narrow angle or shallow anterior chambers and for patientients in monoamine oxidase inhibitors or tricyclic antidepressants. May cause CNS symptoms and increase BP especially in children and the elderly. Anti-infective medication Antibiotic , antifungal and antiviral products.

Blindness: BCVA of 20/400 to no light perception Legal blindness is BCVA that does not exceed 20/200 in better eye, or widest field of vision is 20 degrees or less. Impaired vision according by functional impairment.

ASSESSMENT OF LOW VISION History Examination of distance and near visual acuity , visual fields, contrast sensitivity, glare, color perception and refraction. Special charts may be used for low vision Nursing assessment must include assessment of functional ability and coping and adaptation in emotional, physical and social areas.

MEDICATIONS USED FOR GLAUCOMA Increase aqueous outflow or decrease aqueous production. May constrict the pupil and affects ability to focus the lens of the eye; affects the vision Anti-inflammatory drugs; corticosteroid suspensions. o Side effects of long term topical steroid include glaucoma, cataracts and increase risk of infection; to avoid these effects (oral NSAID) therapy may be used as an alternative to steroid use.

Management: Support coping strategies, grief process and acceptance of vision loss. Strategies for adaptation to the environment o Placement of items in room o Clock method for trays Communication strategies Collaboration with low vision specialist, occupational therapy or other resources. Braille or other methods for reading and communication Use of service animals

LOW VISION AND BLINDNESS Low Vision: Vision impairment that requires devices and strategies in addition to corrective lenses. Best corrected visual acuity (BCVA) of 20/70 to 20/200.

GUIDLEINES FOR INSTILLING EYE MEDICATION Shake the suspensionor milky solutions to obtain the desired medication level.

Wash hands thoroughly before and after the procedure. Ensure adequate lighting Read the label of the eye medication to make sure it is the correct medication. Assume a comfortable position Do not touch the tip of the medication container to any part of eye or face. Hold the lower lid down , do not press on the eye ball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid. Instill eye drops before applying ointments Apply a inch ribbon of ointment to the lower conjunctival sac. Keep the eyelid closed and applu gentle pressure on the inner cantus (punctual occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eye drops. Using a clean tissue, gently put to skin to absorb excess eye drops that run onto cheeks. Wait for 5 to 10 minutes before instilling another eye medication.

Use of eye patch and shield

SAFETY MEASURES AND TEACHING Patient teaching is vital nursing intervention for patient with eye and vision disorders. Prevention of eye injuries; education Provide safety strategies for patient with low vision in the hospital and home setting. Patient teaching after eye surgery or trauma o Potential complications o Loss of binocular vision with patch or vision impairment of one eye; safety