Sarah Jane B.

Aca-ac
BSN-3

Nov. 4, 2014

CATARACT
Introduction
A cataract is a lens opacity or cloudiness. It can be either localized or generalized. The most
common cataract is related to aging, although cataracts can have a variety of other causes. According to
World Health Organizations (WHO), cataract is the leading cause of blindness in the world.
Cataracts progresses through stages:
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Early Stage - the cataract is not completely cloudy.

Second Stage- the cataract is completely opaque, and vision is significantly reduced
Third Stage- cataract lenses absorbed water and increase in size, resulting in IOP.
Last Stage- the proteins in the lens break down and leak out through the lens capsule.

Types:
1. Nuclear Cataract
-occurs at the back of the lens. People with diabetes or those taking high doses of steroid
medications have a greater risk of developing a subcapsular cataract.
2. Cortical Cataract
-forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are
associated with aging.
3. Posterior Subcapsular Cataract
-is characterized by white, wedge-like opacities that start in the periphery of the lens and
work their way to the center in a spoke-like fashion. This type of cataract occurs in the
lens cortex, which is the part of the lens that surrounds the central nucleus.
Causes

Cigarette smoking
Long term use of corticosteroids
Sunlight and ionizing radiation
Diabetes
Obesity
Eye injuries

Clinical Manifestations
Painless, blurry vision
Reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity
Other effects: Myopic shift, astigmatism, monocular diplopia, color shift, brunescens, and
reduced light transmission
Diagnostic Test
Snellen Visual Acuity Test
Opthalmoscopy
Slit-lamp biomicroscopic examination

Medical/Surgical Management
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Phacoemulsification- a portion of the anterior capsule is removed, allowing extraction of the

lens nucleus and cortex while the posterior capsule and zonular support are left intact.
Lens Replacement- after removal of the crystalline lens, the patient is referred to as aphakic or a
new lens inserted in the posterior chamber of the eye.

Nursing Intervention

Preoperative Care

Dilating drops are adm every 10 minutes for at least 1 hr before surgery
Additional dilating drops may adm in the operating room
Antibiotic, corticosteroid, and anti-inflammatory drops may be adm prophylactically to
prevent postoperative infection and inflammation

Postoperative Care

Adm medications, recognize signs of complications, and obtain emergency care

Explain that there should be minimal discomfort after surgery and instruct patient to take
minimal analgesic agent

Home and Community-Based Care

Instruct patient to wear protective eye patch for 24 hrs after surgery, followed by
eyeglasses worn during the day and metal shield worn at night for 1-4 weeks to prevent
accidental rubbing or poking of the eye.
A clean, damp washcloth maybe used to slight morning eye discharge.
Explain to the patient the importance of notifying the physician if new floaters in vision,
flashing lights, decrease in vision, pain or increase in redness occurs.

PATHOPHYSIOLOGY