NUR 4110 Final Adult 2 UPDATED
Eye & Vision Disorders
Chapter 63
GLAUCOMA
• Damage to optic nerve related to increased IOP caused by congestion of
aqueous humor
o Aqueous production & drainage are NOT in balance
o Causes irreversible mechanical or ischemic damage CN 2 (optic) – causes
blindness
Risk factors
• African American • Previous eye trauma
• CV disease • Migraine syndromes
• DM • Near sightedness (myopia)
• Family history • Prolonged use of topical or systemic
• Older age corticosteroids
• Thin cornea
Diagnostics
• Tonometry – assess IOP (topical anesthetic applied first)
• Ophthalmoscopy – inspect optic nerve disc
• Perimetry – visual field assessment
Manifestations
• “silent thief” – gradual loss of visual fields may go unnoticed because central vision is
unaffected
• Early signs diminished accommodation & IIOP
• Difficulty adjusting eye to low lighting – difficulty focusing
• Aching or discomfort around eyes
• HA
• Primary open-angle glaucoma (most
Open angle = Over time
common) – silent thief
o Painless
o Vision ∆
o “tunnel vision” – peripheral vision loss
• Primary open-closure glaucoma = emergency!
o Sudden extreme pain
Closing door on finger = painful
o Blurring
o Halos around lights
o Ocular erythema
o N/V
Treatment
• Goal: prevent further optic nerve damage
• Maintain IOP within a range unlikely to cause damage
o Normal IOP: 10-21 mm Hg
• Pharmacologic therapy life long
o Miotics – constrict pupils
o BB – decrease aqueous production & IIOP
o A-2 agonist – decrease aqueous production
o Carbonic anhydrase inhibitors – decrease aqueous production
o Prostaglandins
• Laser procedures – used to open meshwork to widen canal
o Promoting increased outflow
• Angle-closure glaucoma
,NUR 4110 Final Adult 2 UPDATED
o Peripheral iridectomy – allows aqueous humor to flow from posterior to
anterior chamber
Nursing Management
• Med used may cause vision alterations & other side effects
o Explain action & effect to promote compliance
• Avoid anticholinergic meds – will increase IOP (ex: atropine, ipratropium)
• Post-surgery
o Avoid anything that will increase IOP
▪ coughing, sneezing, bending @ waist, N/V, no lifting heavy object, no
Valsalva maneuver (constipation)
o No driving
o Instill eye drops as Rx
o Don’t rub eyes, use contact lenses
o Wear sunglasses when in direct sunlight
o Feel itchy, blurred vision, eye tearing up more frequently = normal
▪ Will decrease over time
CATARACTS
• Opacity or cloudiness of lens – impairs vision
Risk factor
• Age – Increased incidence with age • DM
• Smoking • Obesity
• Long-term use of corticosteroids – especially high • Eye injuries
doses
• Sunlight & ionizing radiation
Types: Traumatic, congenital, Senile cataract (age related)
Diagnostics
• Snellen test – Decreased visual acuity
• Ophthalmoscope, slit lamp, or inspection – opacity of lens
Manifestations
• Early signs
o Blurred vision, painless
o Decreased color perception (brunescens – yellow-brown)
• Surroundings dimmer (as if glasses need cleaning)
• Absent red reflex
• Photosensitivity
• Myopic shift – able to read fine print again
• Diplopia (double vision)
• Reduced light transmission
Management
• Intervention indicated when visual acuity has been reduced to level that PT finds unacceptable
• Surgery – less than 1 hours (outpatient basis)
• Phacoemulsification:
o ECCE that uses ultrasonic device to suction lens out through tube
o Incision is smaller than standard ECCE
• Lens replacement:
o After removal of lenses by ICCE or ECCE – insert intraocular lens implant
o Eliminates need for aphakic lenses
,NUR 4110 Final Adult 2 UPDATED
o PT may still need glasses
• Pre-op Dilate eye (eyedrops)
o Every 10 min for 4 doses at least 1 hour before surgery
• Post-op:
o Call HCP immediately if
▪ Vision changes – Continuous flashing lights appear
▪ Redness, swelling or pain increase
▪ Type & amount of drainage increase
▪ Significant pain is not relieved by Tylenol
o Wear sunglasses
o Measures to prevent or decrease IOP
▪ Avoid lifting anything heavier than 15 lbs
▪ Sneeze with open mouth (decreases pressures)
o Turn client to back or non-operative side
o Position personal belongs to nonoperative side
RETINAL DETACHMENT
• Separation of sensory retina & retinal pigment epithelium
Patho
• Layers of retina separate due to accumulation of fluid between them
• Retinal layers elevate away from choroid – result of tumor
• When detachment becomes complete = blindness
• Rhegmatogenous detachment – most common
Diagnostics
• Visual acuity
• Indirect ophthalmoscope, slit lamp, stereo fundus photography, fluorescein
angiography – retina
• Tomography & ultrasound
Manifestations
• Sensation of shade or curtain coming across vision of 1 eye
• Bright flashing lights
• Sudden onset of floaters or black spots
o Sign of bleeding
• Hairnet like vision = priority
Treatment
• Scleral buckle
o Compresses sclera – choroid & retina together with splint until scar tissue
forms = closing tear
o Post-op care:
▪ Don’t sleep on affect side
▪ Don’t lay prone
▪ Measure to keep not increase IOP (sunglasses, no lifting, coughing etc.)
• Vitrectomy
o Intraocular procedure
o Gas bubble, silicon oil, perfluorocarbon & liquids – injected into vitreous cavity
▪ Float against retina to hold it in place until healing occurs
o Post-op care:
▪ Position – prone
Intervention
• Provide bed rest
• Cover both eyes with patch = prevent further detachment
, NUR 4110 Final Adult 2 UPDATED
• Speak to PT before approaching
• FOLLOW-UP danger of recurrence in other eye
• Avoid jerky head movements
• Post-op:
o Monitor for hemorrhage
o Notify HCP if –
▪ sudden, sharp eye pain
▪ new vision loss
o Deep breathing – NOT COUGHING
o Avoid measures that increase IOP
▪ Avoid squinting
▪ Sunglasses during day
▪ Eye patch during night
▪ Avoid rubbing/ scratching eye
▪ Avoid straining activities – ex: reading, TV, computer etc.
AGE-RELATED MACULAR DEGENERATION
• Deterioration of macula decline in central vision!
• No cure!
Types
• Dry or nonexudative – most common (age-related)
o Slow breakdown of layers of retina with appearance of drusen
o Gradual blocking of retinal capillaries leading to an ischemic & necrotic
macula
▪ Rod & cone photoreceptors die
• Wet
o Abrupt onset
o Proliferation of abnormal BVs growing under retina-choroidal revascularization
Diagnostics: amsler grid – grid will appear wavy
Manifestation: blurry spot in middle of vision Middle vision = macular
Treatment
• Interventions aimed @ maximizing remaining vision
• Photodynamic therapy – slows progression of Age-related MD
o Light-sensitive verteporfin dye injected into vessels
o Laser then activates dye shutting down vessels without damaging retina
o Result: slow or stabilize vision loss
o Post-procedure care:
▪ Avoid exposure to sunlight or bright light for 5 days after treatment
• Avoid activation of dye in vessels near surface of skin
HEARING & BALANCE DISORDERS
Chapter 64
CONDUCTIVE HEARING LOSS
• Caused by external or middle ear problem
o Any physical obstruction to transmission of
sound waves
Diagnostics
• Rinne test – mastoid bone tuning fork
o Normal: loudest in front vs behind ear
Eye & Vision Disorders
Chapter 63
GLAUCOMA
• Damage to optic nerve related to increased IOP caused by congestion of
aqueous humor
o Aqueous production & drainage are NOT in balance
o Causes irreversible mechanical or ischemic damage CN 2 (optic) – causes
blindness
Risk factors
• African American • Previous eye trauma
• CV disease • Migraine syndromes
• DM • Near sightedness (myopia)
• Family history • Prolonged use of topical or systemic
• Older age corticosteroids
• Thin cornea
Diagnostics
• Tonometry – assess IOP (topical anesthetic applied first)
• Ophthalmoscopy – inspect optic nerve disc
• Perimetry – visual field assessment
Manifestations
• “silent thief” – gradual loss of visual fields may go unnoticed because central vision is
unaffected
• Early signs diminished accommodation & IIOP
• Difficulty adjusting eye to low lighting – difficulty focusing
• Aching or discomfort around eyes
• HA
• Primary open-angle glaucoma (most
Open angle = Over time
common) – silent thief
o Painless
o Vision ∆
o “tunnel vision” – peripheral vision loss
• Primary open-closure glaucoma = emergency!
o Sudden extreme pain
Closing door on finger = painful
o Blurring
o Halos around lights
o Ocular erythema
o N/V
Treatment
• Goal: prevent further optic nerve damage
• Maintain IOP within a range unlikely to cause damage
o Normal IOP: 10-21 mm Hg
• Pharmacologic therapy life long
o Miotics – constrict pupils
o BB – decrease aqueous production & IIOP
o A-2 agonist – decrease aqueous production
o Carbonic anhydrase inhibitors – decrease aqueous production
o Prostaglandins
• Laser procedures – used to open meshwork to widen canal
o Promoting increased outflow
• Angle-closure glaucoma
,NUR 4110 Final Adult 2 UPDATED
o Peripheral iridectomy – allows aqueous humor to flow from posterior to
anterior chamber
Nursing Management
• Med used may cause vision alterations & other side effects
o Explain action & effect to promote compliance
• Avoid anticholinergic meds – will increase IOP (ex: atropine, ipratropium)
• Post-surgery
o Avoid anything that will increase IOP
▪ coughing, sneezing, bending @ waist, N/V, no lifting heavy object, no
Valsalva maneuver (constipation)
o No driving
o Instill eye drops as Rx
o Don’t rub eyes, use contact lenses
o Wear sunglasses when in direct sunlight
o Feel itchy, blurred vision, eye tearing up more frequently = normal
▪ Will decrease over time
CATARACTS
• Opacity or cloudiness of lens – impairs vision
Risk factor
• Age – Increased incidence with age • DM
• Smoking • Obesity
• Long-term use of corticosteroids – especially high • Eye injuries
doses
• Sunlight & ionizing radiation
Types: Traumatic, congenital, Senile cataract (age related)
Diagnostics
• Snellen test – Decreased visual acuity
• Ophthalmoscope, slit lamp, or inspection – opacity of lens
Manifestations
• Early signs
o Blurred vision, painless
o Decreased color perception (brunescens – yellow-brown)
• Surroundings dimmer (as if glasses need cleaning)
• Absent red reflex
• Photosensitivity
• Myopic shift – able to read fine print again
• Diplopia (double vision)
• Reduced light transmission
Management
• Intervention indicated when visual acuity has been reduced to level that PT finds unacceptable
• Surgery – less than 1 hours (outpatient basis)
• Phacoemulsification:
o ECCE that uses ultrasonic device to suction lens out through tube
o Incision is smaller than standard ECCE
• Lens replacement:
o After removal of lenses by ICCE or ECCE – insert intraocular lens implant
o Eliminates need for aphakic lenses
,NUR 4110 Final Adult 2 UPDATED
o PT may still need glasses
• Pre-op Dilate eye (eyedrops)
o Every 10 min for 4 doses at least 1 hour before surgery
• Post-op:
o Call HCP immediately if
▪ Vision changes – Continuous flashing lights appear
▪ Redness, swelling or pain increase
▪ Type & amount of drainage increase
▪ Significant pain is not relieved by Tylenol
o Wear sunglasses
o Measures to prevent or decrease IOP
▪ Avoid lifting anything heavier than 15 lbs
▪ Sneeze with open mouth (decreases pressures)
o Turn client to back or non-operative side
o Position personal belongs to nonoperative side
RETINAL DETACHMENT
• Separation of sensory retina & retinal pigment epithelium
Patho
• Layers of retina separate due to accumulation of fluid between them
• Retinal layers elevate away from choroid – result of tumor
• When detachment becomes complete = blindness
• Rhegmatogenous detachment – most common
Diagnostics
• Visual acuity
• Indirect ophthalmoscope, slit lamp, stereo fundus photography, fluorescein
angiography – retina
• Tomography & ultrasound
Manifestations
• Sensation of shade or curtain coming across vision of 1 eye
• Bright flashing lights
• Sudden onset of floaters or black spots
o Sign of bleeding
• Hairnet like vision = priority
Treatment
• Scleral buckle
o Compresses sclera – choroid & retina together with splint until scar tissue
forms = closing tear
o Post-op care:
▪ Don’t sleep on affect side
▪ Don’t lay prone
▪ Measure to keep not increase IOP (sunglasses, no lifting, coughing etc.)
• Vitrectomy
o Intraocular procedure
o Gas bubble, silicon oil, perfluorocarbon & liquids – injected into vitreous cavity
▪ Float against retina to hold it in place until healing occurs
o Post-op care:
▪ Position – prone
Intervention
• Provide bed rest
• Cover both eyes with patch = prevent further detachment
, NUR 4110 Final Adult 2 UPDATED
• Speak to PT before approaching
• FOLLOW-UP danger of recurrence in other eye
• Avoid jerky head movements
• Post-op:
o Monitor for hemorrhage
o Notify HCP if –
▪ sudden, sharp eye pain
▪ new vision loss
o Deep breathing – NOT COUGHING
o Avoid measures that increase IOP
▪ Avoid squinting
▪ Sunglasses during day
▪ Eye patch during night
▪ Avoid rubbing/ scratching eye
▪ Avoid straining activities – ex: reading, TV, computer etc.
AGE-RELATED MACULAR DEGENERATION
• Deterioration of macula decline in central vision!
• No cure!
Types
• Dry or nonexudative – most common (age-related)
o Slow breakdown of layers of retina with appearance of drusen
o Gradual blocking of retinal capillaries leading to an ischemic & necrotic
macula
▪ Rod & cone photoreceptors die
• Wet
o Abrupt onset
o Proliferation of abnormal BVs growing under retina-choroidal revascularization
Diagnostics: amsler grid – grid will appear wavy
Manifestation: blurry spot in middle of vision Middle vision = macular
Treatment
• Interventions aimed @ maximizing remaining vision
• Photodynamic therapy – slows progression of Age-related MD
o Light-sensitive verteporfin dye injected into vessels
o Laser then activates dye shutting down vessels without damaging retina
o Result: slow or stabilize vision loss
o Post-procedure care:
▪ Avoid exposure to sunlight or bright light for 5 days after treatment
• Avoid activation of dye in vessels near surface of skin
HEARING & BALANCE DISORDERS
Chapter 64
CONDUCTIVE HEARING LOSS
• Caused by external or middle ear problem
o Any physical obstruction to transmission of
sound waves
Diagnostics
• Rinne test – mastoid bone tuning fork
o Normal: loudest in front vs behind ear
