INTRAOCULAR DISORDER

 Cataract
 Glaucoma
 Retinal detachment
 Diabetic retinopathy
 Age related macular degeneration
 Grave’s disease
 CATARACTS
- an opacity of the lens that distorts the image projected onto the
retina & that can progress to blindness

CAUSES
 Aging process (Senile cataracts)
 Inherited (Congenital cataracts)
 Injury (Traumatic cataracts)
 Can occur as a result of another eye disease (Secondary cataracts)
 CATARACTS
MEDICAL MANAGEMENT
- surgical removal of the lens, one eye at a time
- a lens implantation may be performed at the time of
surgical procedure
• EXTRACAPSULAR EXTRACTION
- the lens is lifted out without removing the lens capsule
- may be performed with Phacoemulsification
PHACOEMULSIfication
- the lens is broken up by ultrasonic vibrations & extracted
 GLAUCOMA
- increased IOP as a result of inadequate drainage of aqueous
humor from the canal of Schlemm or over production of
aqueous
humor
- the condition damages the optic nerve & can result in blindness
TYPES

1. primary/secondary
2. Acute/chronic
3. Open/closed
 GLAUCOMA
ASSESSMENT
 Elevated IOP (Normal pressure is 10-21 mm Hg)
 Blurred vision
 Halos around white lights
 Frontal headaches/pain
 Photophobia
 Increased lacrimation
NURSING CARE FOR CHRONIC GLAUCOMA
• Instruct the client the importance of medications
a. MIOTICS: to constrict the pupils
b. CARBONIC ANHYDRASE INHIBITORS: to
decrease the
production of aqueous humor
c. BETA-BLOCKERS: to decrease the production of
aqueous
humor & IOP
• Instruct the client the need for life-long medication use
NURSING CARE FOR
CHRONIC GLAUCOMA
• Prepare the client for TRABECULOPLASTY as
prescribed
- to facilitate aqueous humor drainage
• Prepare client for TRABECULECTOMY as prescribed
- allows drainage of aqueous humor into the
conjunctival spaces by
the creation of an opening
Iridectomy
cyclocryotheraphy
 RETINAL DETACHMENT
- occurs when the layers of the retina separate because
of
accumulation of fluid between them
- also occurs when both retinal layers elevate away
from the
choroid as a result of a tumor

TYPES
PARTIAL RETINAL DETACHMENT
- becomes complete if left untreated

COMPLETE RETINAL DETACHMENT

- when detachment is complete, blindness may occur
ASSESSMENT
 Flashes of light
 Floaters
 Increase in blurred vision
 Sense of curtain being drawn
 Loss of a portion of the visual field
MEDICAL MANAGEMENT
• SEALING RETINAL BREAKS BY CRYOSURGERY
- a cold probe applied to the sclera to stimulate an inflammatory
response
leading to adhesions
• DIATHERMY
- the use of electrode needle & heat through the sclera to stimulate an
inflammatory response leading to adhesions
• LASER THERAPY
- to stimulate an inflammatory response to seal small retinal tears
before
the detachment occurs
• SCLERAL BUCKLING
- to hold the choroid & retina together with a splint until scar tissue
forms
closing the tear
• INSERTION OF A GAS OR SILICONE OIL
- to encourage attachment because these agents have a specific
gravity less
than vitreous or air & can float against the retina
RETINAL DETACHMENT
SCLERAL BUCKLE
DIABETIC RETINOPATHY
 Progressive damage to retina and the retinal
vessels when it is occluded
 Inadequate blood supply, sections of the
retina deteriorate causing permanent vision
loss
 All diabetic are at risk
 Hypertensive people are also a candidate
DIABETIC RETINOPATHY
 Types

1. Nonproliferative – retinal vessels are hyper

permeable and weak
2. Proliferative – capillaries are leaking
MANIFESTATIONS OF DR
 Spiders or cobwebs floating in vision
 Dark or red streaks blocks the vision
 Vision loss
 Fluctuating vision loss
 Dark spot in the center of the vision
 Poor night vision difficulty adjusting from
bright light to dim
MANAGEMENT
 Photocoagulation – to stop the leakage of
blood and fluid in the retina using high
energy laser beam under local anesthesia
 Vitrectomy – removal of blood filled vitreous
using a cutter piece by piece replaced by NSS
to maintain normal shape of eye
 MACULAR DEGENERATION
• Age-related macular degeneration (AMD)
• The most common cause of vision loss in persons older
than age 60
• Affects the macula leading to central visual deficits
• Cause is unknown or hereditary
• Blue rays accelerate the disease
• Types
– Dry or nonexudative type is most common,
85%-90%
 Slow breakdown of the layers of the retina with the
appearance of drusen
– Wet type
 May have abrupt onset
 Proliferation of abnormal blood vessels growing
MANAGEMENT
 High dose anti oxidant Vit. C and E beta
carotene zinc
 Injecting verteporfin (Visudyne)
 Special sunglass – blocks blue rays
 Argon photocoagulation
 Retinal transplantation
VISION LOSS ASSOCIATED WITH
MACULAR DEGENERATION
RETINA SHOWING DRUSEN AND AMD
RETINOBLASTOMA

 isa malignant tumor on the retina, the light-

sensing part of the eye, and is highly curable if
treated early.
 This type of cancer can be present in one or both
eyes.
SYMPTOMS OF RETINOBLASTOMA INCLUDE:

 A pupil that appears white - called

leucocoria,
 The eyes may not move or focus in the same
direction.
 Eye pain.
 The pupil is constantly dilated.
 Red eye(s).
DIAGNOSIS:

 An eye exam and imaging test given

 These tests include ultrasound, MRI scans, CT
scans, bone scans, spinal tap and bone
marrow tests.
 Photocoagulation. A laser is used to kill blood
vessels that feed the tumor.
 Cryotherapy. Extremely low temperatures are
used to kill cancer cells.
 Chemotherapy-
 withbilateral type- treated with a preservation
attempt. Tumor chemoreduction with
carboplatinnand other drugs may reduce the tumor
volume making them amenable to local therapies
[5]
 Laser therapy (Uses infrared laser light to
precisely destroy the blood vessels surrounding
a tumor.)
 Radiation therapy. as a last resort Radiation
may be given externally or internally.
 Enucleation. Treatment of choice.
 Thermotherapy
 Brachytherapy with beta-emitting eye
applicators have also been a successful major
treatment.
 LEGALLY BLIND
- a person is legally blind if the best visual acuity with corrective
lenses in the better eye is 20/200 or less or a visual field of 20
degrees or less in the better eye

NURSING CARE
• When speaking to a client who has limited sight or blind, the nurse
uses a normal tone of voice
• Orient the client to the environment
• Use a focal point & provide further orientation to the environment
from the focal point
• Allow the client to touch objects in the room
• Use the clock placement of foods on the meal tray to orient the
client
• Promote independence as much as possible
 GRAVE’S DISEASE
 An endocrine disorders
 Exist with or without thyroid dysfunction
 Retracted both upper and lower lids
 Staring or frightened expression (stellwag’s
sign)
 Lid lag (graefe’s sign)- lowering of lid when
looking down
 Infrequent blinking
 Fine tremor with lid closure
 Jerky movements on lid opening
 Globes enlarge – increase size of ocular
muscles
 Edema of eye tissues
 Excess orbital fat
 Proptosis
 Double vision
MANAGEMENT
 Control of thyroid abnormalities
 Diuretics
 Steroids
 Radiotherapy
 Lid surgery
 Tarsorrhapy
 Decompression of the orbit
 Ocular muscle surgery
 CONTUSIONS
- bleeding into the soft tissue as a result of an injury
- causes a black eye & the discoloration disappears in
approximately 10 days
- pain, photophobia, edema & diplopia may occur

NURSING CARE
• Place ice on the eye immediately
• Instruct the client to receive an eye examination
 FOREIGN BODIES
- an object such as dust that enters the eye

NURSING CARE
• Have the client look upward, expose the lower lid, wet a cotton-
tipped applicator with sterile NSS & gently twist the swab over
the particle & remove it
• If the particle cannot be seen, have the client look downward,
place a cotton applicator horizontally on the outer surface of
the upper eye lid, grasp the lashes, & pull the upper lid outward
& over the cotton applicator, if the particle is seen, gently twist
over it to remove
 PENETRATING OBJECTS
- an injury that occurs to the eye in which an object
penetrates the eye

NURSING CARE
• Never remove the object because it may be holding
ocular
structures in place, the object must be removed by MD
• Cover the object with a cup
• Don’t allow the client to bend
• Don’t place pressure on the eye
• Client is to be seen by MD stat
 CHEMICAL BURNS

- an eye injury in which a caustic substance enters the eye

NURSING CARE
• Treatment should begin stat
• Flush the eyes at the site of injury with water for at least 15-20
mins
• At the site of injury, obtain a small sample of the chemical involved
• At the ER, the eyes is irrigated with NSS or an opthalmic irrigation
solution
• The solution is directed across the cornea & toward the lateral
canthus
• Prepare for visual acuity assessment
• Apply an antibiotic ointment as prescribed
• Cover the eye with a patch as prescribed
ENUCLEATION
- removal of the entire eyeball

EXENTERATION
- removal of the eyeball & surrounding tissues
• Performed for the removal of ocular tumors
• After the eye is removed, a ball implant is inserted to
provide a firm
base for socket prosthesis & to facilitate the best cosmetic
result
• A prosthesis is fitted approximately 1 month after surgery