Nurs 421 exam 3/eye and vision disorders guide 2022
update
• Corneal Abrasions: results in an opening that allows for potential of bacteria, protozoal,
or fungal infections.
o Scratch or scrape of the cornea
o Painful
o Provides a portal entry for potential infection
o Risk for corneal ulceration
▪ Emergency!!! The cornea doesn’t have a separate blood supply and can’t
defend itself from infection and has the potential for permanent vision
loss
o Nursing Interventions:
▪ Provide instructions for instillation of prescribed eye drops for anti-
infective therapy
▪ Wash hands before instilling eye drops
▪ Complete medications as prescribed
▪ Do not wear contact lenses until cleared by physician
▪ ***Women: no make-up around the eye***
▪ Keep all follow-up appointments
• Cataracts: An opacity of the lens that distorts the image projected onto the retina.
o Common causes:
▪ Age: drying of the lens due to water loss
▪ Trauma: blunt or penetrating injury or foreign body; exposure to radiation or
UV light
▪ Toxic: long term use of corticosteroids, phenothiazine derivatives, beta
blockers, or miotic medications
▪ Associated with other disease processes: DM, hypoparathyroidism,
down syndrome, chronic sunlight exposure
▪ Complication related to other eye disorders
o Clinical Manifestations:
▪ Progressive and painless loss of vision
▪ Decreased visual acuity
▪ Glare and light sensitivity
▪ Blurred vision
▪ Visible opacity
▪ Absent red reflex
▪ Diplopia (double vision)
o Nursing Interventions:
▪ Check visual acuity using Snellen chart
▪ Examine internal and external eye structures with ophthalmoscope
▪ Determine the client’s functional capacity due to decreased vision
▪ Increase the amount of light in a room
▪ Provide adaptive devices that accommodate for reduced vision: magnifying
lens and large print books, talking devices such as clocks
o Medical Management:
▪ Surgery is the only cure for cataracts
,Nurs 421 exam 3/eye and vision disorders guide 2022
update
• Anticholinergic agents (Atropine 1% ophthalmic solution):
medication prevents pupil constriction for prolonged periods of time
and relaxes muscles in the eye. It is used to dilate the eye preoperatively
and
for visualization of the eye’s internal structures.
• Surgery is an outpatient same day surgery.
o Assess how the vision deficit affects ADLs.
▪ Surgery often delayed until reduced vision impacts activity of daily living
▪ Implement interventions to protect patient from injury and
maintain independence
• Stress that care after surgery requires the instillation of different types
of eyedrops several times a day for 2 to 4 weeks.
o Careful assessment of eye appearance is needed.
o Nursing Management: Provide education:
▪ Discharged home within one hour after surgery
▪ Instruct patient to wear dark glasses outdoors or in brightly lit environments
until the pupil responds to light
▪ What to expect:
• Itching & ‘bloodshot appearance’
• Some discomfort in sight
▪ Best vision is not expected until 4-6 weeks following surgery.
▪ Medication information:
• Assist patient and family in developing a medication schedule for
the timing and the order of eyedrops administration.
▪ Monitor for complications & infection:
• Complications to report immediately:
o Sharp, sudden pain in the eye
o Bleeding or increased discharge
o Lid swelling
o Decreased vision
o Flashes of light or floating shapes
• Signs of infection to report: yellow or green drainage, increased
redness or pain, reduction in visual acuity, increased tear production, and
photophobia.
▪ Prevent increased IOP: avoid bending at the waist, sneezing, blowing nose,
coughing, straining, head hyperflexion, restrictive clothing, sexual
intercourse
▪ Follow-up appointments
• Glaucoma: Intraocular pressure (IOP) is the fluid pressure within an eye.
o Increased IOP on blood vessels in the eye and prevents blood flow, resulting in poorly
oxygenated photoreceptors. These sensitive nerve tissues become ischemic and die.
When too many have died, sight is lost and the vision is permanently lost.
o Left untreated, glaucoma can result in blindness.
o Characterized by optic nerve damage
▪ S/S: commonly painless, and the pt may be unaware of a gradual reduction
in vision.
o Risk factors: age, infection, tumors, DM, genetic predisposition, hypertension,
eye trauma, severe myopia, retinal detachment
,Nurs 421 exam 3/eye and vision disorders guide 2022
update
o Classifications:
▪ Open-angle glaucoma: angle between the iris and sclera, gradual
• S/S: HA, mild eye pain, loss of peripheral vision,
decreased accommodation, halos seen around lights,
elevated IOP
▪ Angle-closure glaucoma: angle between the iris and sclera, sudden
• S/S: rapid onset of elevated IOP, decreased or blurred vision,
colored halos seen around lights, pupils nonreactive to light, severe
pain and
nausea, photophobia
▪ Congenital glaucoma
▪ Glaucoma associated with other conditions
o Glaucoma is a frequent cause of blindness.
▪ Early diagnosis and treatment essential
• Annual eye exams, education about disease process, and early
indication are essential.
o Medical Management: Blindness from glaucoma can be prevented by early
detection, lifelong treatment, and a regimen of close monitoring and follow-up care.
▪ Nonsurgical: Drug therapy focuses on reducing IOP
• Eyedrops drugs are the mainstay of control for glaucoma. They do
not improve lost vision, but prevent further damage.
▪ Surgical: is recommended when the drug therapy is not effective in
controlling IOP
• Laser trabeculoplasty
• Filtering microsurgery
o Nursing Management:
▪ Patient education:
• Benefits of drug therapy:
o Educate the patient that the greatest benefit of drug therapy
compliance is preserving eye vision…discontinuing or
non- compliance can result in permanent vision loss.
o Stress the benefit of drug therapy is achieved only when the
drugs are used on the prescribed schedule, usually q12
hrs
• Proper instillation technique:
o Instilling the drops on time and not skipping doses
o When more than one drug is prescribed, wait 10 to 15 minutes
b/t drug instillation to prevent one drug from ‘washing out’ or
diluting another drug.
• Importance of adherence to drug therapy
• Punctual occlusion: placing pressure on the corner of the eye near
the nose immediately after eyedrop instillation to prevent systemic
absorption of the drug
• Strict handwashing!!!
• Sterility of eyedrop container
o Do not contaminate eyedrop container tips.
o Do not touch the dropper container to any part of the eye
o
, Nurs 421 exam 3/eye and vision disorders guide 2022
update
o
o Medications:
▪ Cholinergic agents: Allows for improved circulation and outflow of aqueous
humor
▪ Adrenergic agonists: Reduce intraocular pressure by limiting production
of aqueous humor, dilates the pupils to improve fluid flow
▪ ***Beta blockers: First line drug therapy***
• Decrease IOP by reducing aqueous humor production
▪ Carbonic anhydrase inhibitors: Decrease IOP by reducing aqueous
humor production
▪ Prostaglandin analogs: Increase outflow by dilating blood vessels in
the trabecular mesh where aqueous humor is collected
• Macular Degeneration: deterioration of the macula (the area of central vision) and can
be atrophic (age related) or exudative.
o Risk factors: smoking, HTN, female, short body stature, family history, diet
lacking carotene and vitamin E
o Types:
▪ The most common type is dry (AMD), caused gradual blockage of
retinal capillaries, allowing retinal cells in the macula to become ischemic
and necrotic
• S/S: Central vision declines, and mild blurring and distortion at first.
Eventually loses all central vision.
▪ Wet AMD: growth of new blood vessels in the macula, which have thin walls
and leak blood and fluid (wet AMD).
o Manifestations: lack of depth perception, objects appear distorted, blurred vision, loss
of central vision, blindness
o Treatment Goal: maintain remaining vision, slowing the process, and identify further
deterioration.
▪ Dietary treatment to reduce risk or slow progression: intake of
antioxidants and the carotemoids luten and zeaxanthin
▪ Laser therapy to seal leaking blood vessels
▪ Ocular injections to inhibit blood vessel growth
• Retinal Detachment: separation of the retina from the epithelium. Detachments are classified
by the nature of their development.
o The onset of retinal detachment is usually sudden and painless because no pain fibers
are located in the retina.
▪ Patients may suddenly see bright flashes of light (photopsia) OR floating dark
spots in the affected eye.
o During the initial phase of the detachment or if the detachment is partial, the patient
may describe the sensation of a curtain being pulled over part of the vision field. The
vision field loss corresponds to the area of detachment
o Treatment: Surgical intervention is indicated to repair the detachment
o Nursing Care:
▪ Post-surgical care is dependent upon the type of procedure performed.
• Positioning depends upon the type of procedure.
update
• Corneal Abrasions: results in an opening that allows for potential of bacteria, protozoal,
or fungal infections.
o Scratch or scrape of the cornea
o Painful
o Provides a portal entry for potential infection
o Risk for corneal ulceration
▪ Emergency!!! The cornea doesn’t have a separate blood supply and can’t
defend itself from infection and has the potential for permanent vision
loss
o Nursing Interventions:
▪ Provide instructions for instillation of prescribed eye drops for anti-
infective therapy
▪ Wash hands before instilling eye drops
▪ Complete medications as prescribed
▪ Do not wear contact lenses until cleared by physician
▪ ***Women: no make-up around the eye***
▪ Keep all follow-up appointments
• Cataracts: An opacity of the lens that distorts the image projected onto the retina.
o Common causes:
▪ Age: drying of the lens due to water loss
▪ Trauma: blunt or penetrating injury or foreign body; exposure to radiation or
UV light
▪ Toxic: long term use of corticosteroids, phenothiazine derivatives, beta
blockers, or miotic medications
▪ Associated with other disease processes: DM, hypoparathyroidism,
down syndrome, chronic sunlight exposure
▪ Complication related to other eye disorders
o Clinical Manifestations:
▪ Progressive and painless loss of vision
▪ Decreased visual acuity
▪ Glare and light sensitivity
▪ Blurred vision
▪ Visible opacity
▪ Absent red reflex
▪ Diplopia (double vision)
o Nursing Interventions:
▪ Check visual acuity using Snellen chart
▪ Examine internal and external eye structures with ophthalmoscope
▪ Determine the client’s functional capacity due to decreased vision
▪ Increase the amount of light in a room
▪ Provide adaptive devices that accommodate for reduced vision: magnifying
lens and large print books, talking devices such as clocks
o Medical Management:
▪ Surgery is the only cure for cataracts
,Nurs 421 exam 3/eye and vision disorders guide 2022
update
• Anticholinergic agents (Atropine 1% ophthalmic solution):
medication prevents pupil constriction for prolonged periods of time
and relaxes muscles in the eye. It is used to dilate the eye preoperatively
and
for visualization of the eye’s internal structures.
• Surgery is an outpatient same day surgery.
o Assess how the vision deficit affects ADLs.
▪ Surgery often delayed until reduced vision impacts activity of daily living
▪ Implement interventions to protect patient from injury and
maintain independence
• Stress that care after surgery requires the instillation of different types
of eyedrops several times a day for 2 to 4 weeks.
o Careful assessment of eye appearance is needed.
o Nursing Management: Provide education:
▪ Discharged home within one hour after surgery
▪ Instruct patient to wear dark glasses outdoors or in brightly lit environments
until the pupil responds to light
▪ What to expect:
• Itching & ‘bloodshot appearance’
• Some discomfort in sight
▪ Best vision is not expected until 4-6 weeks following surgery.
▪ Medication information:
• Assist patient and family in developing a medication schedule for
the timing and the order of eyedrops administration.
▪ Monitor for complications & infection:
• Complications to report immediately:
o Sharp, sudden pain in the eye
o Bleeding or increased discharge
o Lid swelling
o Decreased vision
o Flashes of light or floating shapes
• Signs of infection to report: yellow or green drainage, increased
redness or pain, reduction in visual acuity, increased tear production, and
photophobia.
▪ Prevent increased IOP: avoid bending at the waist, sneezing, blowing nose,
coughing, straining, head hyperflexion, restrictive clothing, sexual
intercourse
▪ Follow-up appointments
• Glaucoma: Intraocular pressure (IOP) is the fluid pressure within an eye.
o Increased IOP on blood vessels in the eye and prevents blood flow, resulting in poorly
oxygenated photoreceptors. These sensitive nerve tissues become ischemic and die.
When too many have died, sight is lost and the vision is permanently lost.
o Left untreated, glaucoma can result in blindness.
o Characterized by optic nerve damage
▪ S/S: commonly painless, and the pt may be unaware of a gradual reduction
in vision.
o Risk factors: age, infection, tumors, DM, genetic predisposition, hypertension,
eye trauma, severe myopia, retinal detachment
,Nurs 421 exam 3/eye and vision disorders guide 2022
update
o Classifications:
▪ Open-angle glaucoma: angle between the iris and sclera, gradual
• S/S: HA, mild eye pain, loss of peripheral vision,
decreased accommodation, halos seen around lights,
elevated IOP
▪ Angle-closure glaucoma: angle between the iris and sclera, sudden
• S/S: rapid onset of elevated IOP, decreased or blurred vision,
colored halos seen around lights, pupils nonreactive to light, severe
pain and
nausea, photophobia
▪ Congenital glaucoma
▪ Glaucoma associated with other conditions
o Glaucoma is a frequent cause of blindness.
▪ Early diagnosis and treatment essential
• Annual eye exams, education about disease process, and early
indication are essential.
o Medical Management: Blindness from glaucoma can be prevented by early
detection, lifelong treatment, and a regimen of close monitoring and follow-up care.
▪ Nonsurgical: Drug therapy focuses on reducing IOP
• Eyedrops drugs are the mainstay of control for glaucoma. They do
not improve lost vision, but prevent further damage.
▪ Surgical: is recommended when the drug therapy is not effective in
controlling IOP
• Laser trabeculoplasty
• Filtering microsurgery
o Nursing Management:
▪ Patient education:
• Benefits of drug therapy:
o Educate the patient that the greatest benefit of drug therapy
compliance is preserving eye vision…discontinuing or
non- compliance can result in permanent vision loss.
o Stress the benefit of drug therapy is achieved only when the
drugs are used on the prescribed schedule, usually q12
hrs
• Proper instillation technique:
o Instilling the drops on time and not skipping doses
o When more than one drug is prescribed, wait 10 to 15 minutes
b/t drug instillation to prevent one drug from ‘washing out’ or
diluting another drug.
• Importance of adherence to drug therapy
• Punctual occlusion: placing pressure on the corner of the eye near
the nose immediately after eyedrop instillation to prevent systemic
absorption of the drug
• Strict handwashing!!!
• Sterility of eyedrop container
o Do not contaminate eyedrop container tips.
o Do not touch the dropper container to any part of the eye
o
, Nurs 421 exam 3/eye and vision disorders guide 2022
update
o
o Medications:
▪ Cholinergic agents: Allows for improved circulation and outflow of aqueous
humor
▪ Adrenergic agonists: Reduce intraocular pressure by limiting production
of aqueous humor, dilates the pupils to improve fluid flow
▪ ***Beta blockers: First line drug therapy***
• Decrease IOP by reducing aqueous humor production
▪ Carbonic anhydrase inhibitors: Decrease IOP by reducing aqueous
humor production
▪ Prostaglandin analogs: Increase outflow by dilating blood vessels in
the trabecular mesh where aqueous humor is collected
• Macular Degeneration: deterioration of the macula (the area of central vision) and can
be atrophic (age related) or exudative.
o Risk factors: smoking, HTN, female, short body stature, family history, diet
lacking carotene and vitamin E
o Types:
▪ The most common type is dry (AMD), caused gradual blockage of
retinal capillaries, allowing retinal cells in the macula to become ischemic
and necrotic
• S/S: Central vision declines, and mild blurring and distortion at first.
Eventually loses all central vision.
▪ Wet AMD: growth of new blood vessels in the macula, which have thin walls
and leak blood and fluid (wet AMD).
o Manifestations: lack of depth perception, objects appear distorted, blurred vision, loss
of central vision, blindness
o Treatment Goal: maintain remaining vision, slowing the process, and identify further
deterioration.
▪ Dietary treatment to reduce risk or slow progression: intake of
antioxidants and the carotemoids luten and zeaxanthin
▪ Laser therapy to seal leaking blood vessels
▪ Ocular injections to inhibit blood vessel growth
• Retinal Detachment: separation of the retina from the epithelium. Detachments are classified
by the nature of their development.
o The onset of retinal detachment is usually sudden and painless because no pain fibers
are located in the retina.
▪ Patients may suddenly see bright flashes of light (photopsia) OR floating dark
spots in the affected eye.
o During the initial phase of the detachment or if the detachment is partial, the patient
may describe the sensation of a curtain being pulled over part of the vision field. The
vision field loss corresponds to the area of detachment
o Treatment: Surgical intervention is indicated to repair the detachment
o Nursing Care:
▪ Post-surgical care is dependent upon the type of procedure performed.
• Positioning depends upon the type of procedure.
