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1.Congenital Cataracts
Cataract a marked opacity of the lens.
Present at birth or may become apparent on early

childhood. LOCATION OF OPACITY: Anterior surface of lens due to birth injury. Edge of the lens due to nutritional deficiency during intrauterine life.
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Assessment:
PUPILLARY COLOR : white ( leukocoria )
VISION: Child -Blurred

Infant-lack of response to a smile or inability to reach a grasp a nearby object. Retinoblastoma, retinopathy of prematurity Abscess of the posterior chamber

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Management:
Surgical removal of cloudy lens Followed by insertion of an internal

intraocular lens When to do?

3 months

Amblyopia may result if not done before 6

months/ patch the normal eye Avoid crying, vomiting Mydriatics Steroids
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2. Strabismus
Unequally aligned eyes (cross-eye) Normally the resting position is straight Strabismus divergent or convergent Vertical strabismus Monoclunar strabismus

Alternating strabismus

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Assessment:
TROPIA word for deviation of eye TYPES Exotropia eye turning out Esotropia eye turning in Hypertropia eye turning up PHORIA lines of vision is deviated TYPES Exophoria, Esophoria, Hyperphoria deviation when the child is sick and fatigued.
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Extraocular eye muscle

Eye Muscle Superior rectus Medial rectus Action Turns eye up & medially Turns eye inward Innervation Oculomotor (3rd cranial)nerve Oculomotor (3rd cranial)nerve

Inferior rectus

Turns eye down and medially Turns eye out

Turns eye down & laterally Turns eye up & laterally

Oculomotor(3rd cranial)nerve Abducens (6th cranial)nerve Trochlear(4th cranial)nerve Oculomotor (3rd cranial) nerve
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Lateral rectus
Superior oblique Inferior oblique

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Assessment:
Cover test
Hirshberg s test Concomitant & Nonconcomitant test

MANAGEMENT:
Orthoptics (eye exercise)-weak fusion mechanism
Diverging eyes due to farsighted or nearsighted glasses to correct the basic visual defect. Unequal muscle strength- eye muscle surgery
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3. Retinoblastoma A malignant tumor of the retina of the eye. Due to inherited autosomal dominant pattern. (altered chromosome 13)

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Assessment
LOCATION: retina, vitreous fluid, extend

backward to choroid, optic nerve, subarachnoid space. ON EXAMINATION: absence of red reflex, presence of cats eye, strabismus, tumor metastasizes to other eye DIAGNODTICS: CT scan, lumbar puncture, liver and skeletal survey, bone marrow biopsy
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Management

Cryosurgery Photocoagulation Chemotherapy Radiation Enucleation of the eye (large tumor)

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1. Glaucoma
A group of ocular conditions characterized by optic nerve damage. Optic nerve damage is related to the IOP

caused by congestion of aqueous humor in the eye.

Etiology:
Congenital, inherited, related

to previous trauma.
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Risk Factors for Glaucoma:

Family History of Glaucoma African-American race Older age Diabetes mellitus Cardiovascular disease Migraine syndrome Nearsightedness Eye trauma Prolonged use of topical or systemic corticosteriod
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Physiology:
Aqueous humor flows between the iris and the lens.

90% passes to the trabecular meshwork and to the canal of Schlemm 10% exit through ciliary body into suprachoroidal space to venous circulation, choroid and sclera.
Normal angle=45 (iris /cornea) IOP = 10-21 mmHg

Pathophysiology
THEORY 1. Direct mechanical theory high IOP damages the retinal layer as it passes through the optic nerve head.
2. Indirect ischemic theory high IOP

compresses the microcirculation in the optic nerve head, resulting in cell injury and death.
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TYPES OF GLAUCOMA
1. Open-Angle Glaucoma
a. Chronic Open-angle glaucoma (COAG) b. Normal tension glaucoma

c.

Ocular hypertension

2. Angle-Closure (Pupillary Block) Glaucoma

a. Acute angle-closure glaucoma (AACG)

b. Subacute angle closure glaucoma

c.

Chronic angle-closure glaucoma

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Clinical Manifestation
silent thief of sight

blurred vision or halos Difficulty focusing Difficulty adjusting eyes in low lighting Loss of peripheral vision tunnel vision Aching or discomfort around the eyes Headache Reddened eye with excruciating pain Nausea & Vomiting
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Assessment and Diagnostic:

Purpose: Establish the diagnostic category. Assess the optic nerve damage Formulate a treatment plan 4 types of examination 1. Tonometry to measure the IOP 2. Opthalmoscopy to inspect the optic nerve 3. Gonioscopy to examine the filtration angle of the anterior chamber. 4. Perimetry- to assess the visual field
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VISUAL FIELD OF GLAUCOMA

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Management:
MEDICATION:
Cholinergic (Miotics) Beta Blockers

Carbonic anhydrase inhibitors

SURGERY:
Laser trabeculoplasty

Laser iridotomy
Trabeculectomy

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Laser peripheral iridotomy

Argon Laser Trabeculoplasty

Selective Laser Trabeculoplasty

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2. Macular Degeneration
Characterized by tiny, yellowish spot called drusen

beneath the retina. Central vision is mostly affected, retaining peripheral vision.
TYPES: 1. Dry type 2. Wet type

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Assessment with clinical manifestation:

DRY AMD:
Blurred vision Blind spot in the middle of visual field

WET AMD: Wavy lines in Amsler Grid Lost central vision Small blind spot
Assess for onset, duration, degree of visual impairment Snellens chart Mydriatics Fundus examination

DIAGNOSTIC: Flourescein angiography Indocyanine green angiography

MANAGEMENT: Photodynamic Therapy Nursing management educate the patient

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3. Cataracts
Formation is gradual, progressive opacity of the

lens or lens capsule that leads to visual loss. CAUSE: aging , trauma, drug or chemical toxicity, genetic defects, secondary effects of other diseases.
Pathophysiology Altered nutrient metabolism

within the lens triggers cataract formation. The lens becomes cloudy and has reduced accommodative power. Light rays cannot pass through the opaque lens to the retina, causing vision loss.
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3 Common types of senile cataracts

1. Nuclear Cataracts

Cause: central opacity/genetic component/Myopia/ Management: Prescription eyeglasses Involves the anterior, posterior or equatorial cortex of the lens. Worst vision in very bright light Development: high in sunlight exposure

2. Cortical Cataracts

3. Posterior sub scapular

Occur in front of posterior capsule Develops in younger people Diminished near vision Due to prolonged used of drugs ( steroids, DM, ocular

 ASSESSMENT:
Progressively worsening blurred vision
Cloudy-appearing lens No pain or eye redness

Laboratory and diagnostic:

Opthalmoscopic and slit-lamp examination confirm the

diagnosis.

MANAGEMENT:
SURGICAL

1. Intracapsular cataract extraction 2. Extracapsular cataract extraction 3. Phacoemulsification 4. Lens Replacement

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Preoperative care:
Withhold any anticoagulant therapy
Dilating drops q 10 mins. X 4 doses 1 hour before surgery.

Additional dilating drops at OR

Antibiotic, corticosteroid, anti inflammatory

Postoperative care: Minimal discomfort after surgery Mild analgesic agent Antibiotic, corticosteroid, anti inflammatory

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LENS REPLACEMENT
1. Aphakic Eyeglasses

Rarely used Objects are magnified @ 25%, making it appear closer Provides almost normal vision Aphakic glasses is still needed Done during surgery Most common CI: uveitis, proliferative diabetic retinopathy,neurovascular trauma
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2. Contact Lenses

3. Insertion of IOL

4. Refractive Errors
Myopia or nearsightedness

Hyperopia or farsightedness
Astigmatism Presbyopia

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astigmatism
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 Low vision - Best corrected visual

acuity of 20/70 to 20/200

Blindness (BCVA) range from

20/400 to no light perception

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 eye strain Tearing Redness Headache

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 Visual acuity Keratometry

Refraction

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CONCAVE

CORRECTIVE LENSES
Spectacles/eyeglasses Contact lens
CONVEX

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CYLINDRICAL

 RADIAL KERATOTOMY (RK)

- a procedure used to decrease nearsightedness

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 PHOTOREFRACTIVE KERATECTOMY (PRK)

- a surgical procedure that uses cool ultraviolet light to shape the surface of the cornea - used to treat myopia and hyperopia without astigmatism

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LASer In Situ Keratomileusis

Means using a laser underneath a corneal flap (in situ) to reshape the cornea (keratomileusis)
Utilizes a highly specialized laser (excimer laser)

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1. ORBITAL TRAUMA
Injury to the orbit is usually associated with head injury Soft globe, prolapsing tissue, ruptured globe and hemorrhage

ASSESS FOR: 1. Soft tissue injury 2. Underlying fractures 3. Visual acuity

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2.SOFT TISSUE INJURY & HEMORRHAGE

Tenderness Ecchymosis Lid swelling Proptosis Hemorrhage

Signs and symptoms:

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 Management:
Cold compress followed by warm

compress Aspiration of hematomas Corticosteroid therapy to reduce optic nerve swelling Optic nerve decompression

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 Blow-out fracture
Zygomatic or tripod Maxillary Mid-facial Orbital apex Orbital roof fractures

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Signs:
swelling of the eyelid bruising around the eye pain in the eye double vision decreased movement of the affected eye

Diagnostic test:
X-ray CT Scan

Management:
- surgery
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 Leading cause of blindness among children and young adults Two types: CHEMICAL BURN

FOREIGN OBJECT IN THE EYE

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 SPLASH INJURIES

Irrigate with NSS Parenteral, borad-spectrum antibiotics Administration of tetanus antitoxin

FOREIGN BODIES AND CORNEAL ABRASIONS

No attempt to remove the foreign object Removal of foreign body by specialist Administration of antibiotic ointment Eye is patched
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 Hordeolum Acute suppurative infection of the

glands of the eyelids Caused by Staphylococcus aureus May be internal and external type
Warm compress 4x a day/ 1015mins Incision and drainage antibiotics

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 Chronic granulomatous inflammation

of the meibomian glands Can be single granuloma or multiple granulomas in the upper or lower eyelids

Warm compress 3-4x a day/ 10-15 mins Surgical incision Corticosteroid injection
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 Chronic bilateral inflammation of the

eyelid margins

Types: staphylococcal and seborrheic

Warm compresses with lid massage Lid scrub Antibiotic treatment

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 Infection of the cornea by

Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa

Fortified antibiotic eyedrops q30 mins

then q1-2 hr Systemic antibiotics Cycloplegics

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 Keratoconjunctivitis sicca

Deficiency in the production of the aqueous, mucin or lipid tear film components; lid surface abnormalities or epithelial abnormalities related to systemic diseases.
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Itching Burning Irritation Redness Blurred vision that improves with blinking Excessive tearing Increased discomfort after periods of reading, watching TV, or working on a compute
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 Slit-lamp examination absent

tear meniscus at the lower lid margin - conjunctiva is thickened, edematous, and hyperemic
Can result in chronic conjunctival

and corneal irritation

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 Instillation of artificial tear

Anti-inflammatory medications Concurrent treatment of infections

Surgical treatment:
Punctal occlusion Grafting procedures Lateral tarsorrhapy

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 Inflammation of the conjunctiva

pink eye

Foreign body sensation Scratching or burning sensation Itching Photophobia May be unilateral or bilateral
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 Type of discharge
- Watery, mucoid, purulent or mucopurulent

Type of conjunctival reaction

- Follicular or papillary

Presence of pseudomembranes or true membranes

Presence or absence of

lymphadenopathy

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1. Microbial conjunctivitis

Bacterial Viral

2. Allergic conjunctivitis

3. Toxic conjunctivitis

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Bacterial conjunctivitis
Streptococcus pnemoniae Haemophilus influenzae Staphylococcus aureus
Acute Chronic Common causative microorganisms

Acute onset of redness, burning & discharge Papillary formation Conjunctival irritation Exudates
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 Chlamydial conjunctivitis A bilateral chronic follicular conjunctivitis of childhood that leads to blindness during adulthood if left untreated Transmission is by oralgenital sex or hand-to-eye
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Viral conjunctivitis
Can be acute or chronic Common causative agent: ADENOVIRUS

and HERPES SIMPLEX VIRUS Usually preceded by symptoms of URTI

Discharge is watery Follicles are prominent Redness Foreign body sensation Lid edema Ptosis Hyperemia
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Allergic conjunctivitis
Immunologic or allergic conjunctivitis is a highly hypersensitivity reaction that occurs as part of allergic rhinitis Extreme pruritus, epiphora, injection and severe photophobia
VERNAL CONJUNCTIVITIS - Seasonal conjunctivitis

TOXIC CONJUNCTIVITIS
- chemical conjunctivitis
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 Bacterial conjunctivitis
- Antibiotics

Viral conjunctivitis - Cold compress

- Stress hygiene Allergic conjunctivitis

- Corticosteroids - Cold compress

Toxic conjunctivitis - Eye irrigation

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Inflammation of the uveal tract

TYPES: 1. Nongranulomatous
-

Acute condition with pain, photophobia and pattern of conjunctival injection Hypopyon

2. Granulomatous - More insidious onset - vision is markedly adversely affected - Vitreous clouding
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 Admistration of mydriasis: cyclopentolate (Cyclogyl) , atrophine

Local corticosteroid drops : Pred

Forte 1% and Flarex 0.1%

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Inflammation of the tissues surrounding the eye and may result from bacterial, fungal or viral inflammatory conditions of contiguous structures
Administration of high-dose, broad-

spectrum, systemic antibiotics

Cultures-gram-stained smears Monitoring changes in visual acuity,

degree of proptosis, CNS function

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 Refers to the separation of RPE from

the sensory layer.

-Rhematogenous -Traction -Combination of rhematogenous and traction -Exudative

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Manifestations:
Shade or curtain coming across the vision of

one eye
Cobwebs Bright flashing lights Floaters

1. Scleral buckle 2. Pars plana virtrectomy 3. Pneumatic retinopexy

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Scleral buckle

vitrectomy

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Promoting Comfort

Teaching About Complications

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