Ch. 39 Flashcards
aging eye characterisitcs
- iris fades
- cornea less sensitive
- pupil shrinks
- lens becomes yellowed, cloudy
four eye functions
- refraction
- pupillary constriction
- accommodation
- convergence
refraction
bends light rays from the outside into the eye through curved surfaces and refractive media and finally to the retina
pupillary constriction
aka miosis
- controls the amount of light that enters the eye
- when the level of light to one or both eyes is increased, both pupils constrict (smaller)
- certain drugs can alter pupillary constriction
accomodation
the process of maintaining a clear visual image when the gaze is shifted from a distant to a near object
- healthy eyes can adjust its focus by changing the curve of the lens
convergence
the ability to turn both eyes inward toward the nose at the same time
- helps to ensure that only a single image of close objects is seen
refractory errors
- myopia- nearsightedness
- hyperopia- farsightedness
- presbyopia- age-related problem which lens loses its elasticity
- astigmatism- curve of the cornea is uneven
myopia
nearsightedness
hyperopia
farsightedness
presbyopia
age-related problem which lens loses its elasticity
astigmatism
curve of the cornea is uneven
non-surgical corrections for refractive errors
- corrective glasses
- contact lenses
surgical corrections for refractive errors
- refractive surgery
- intraocular lens implantation
age-related eye changes
- reduced visual acuity
- reduced visual function
- structural changes: decreased eye muscle tone, ectropion and dry eye, arcus senilis
- functional changes: near point of vision increases (presbyopia), far point of vision decreases
- general color perception decreases
- higher IOP
all adults should be screened _____ for visual acuity
annually
functional age-related eye changes
- near point of vision increases (presbyopia)
- far point of vision decreases
structural age-related eye changes
- decreased eye muscle tone
- ectropion and dry eye
- arcus senilis
reduced vision interventions
- communication regarding use of adaptive devices
- safety in familiar settings
- ambulation assisted with care
- self-care and independence promoted
- support for the difficulty of adapting to loss of sight
health promotion and maintenance
- impairment of vision impacts physical and psychological well-being
- many vision and eye problems can be avoided
- educate about eye protection methods
eye protection methods
- adequate nutrition, vitamins
- regular eye exams
- use of sunglasses
- use of eye and head protection
conjunctivitis: what infections can cause it
- bacterial infections
- chlamydial infections (STD)
- allergic infections
- COVID-19
cataracts: etiology
- may be present at birth
- or develop over time
- most common age related type change
- also may be due to trauma or other health conditions
cataracts: pathophysiology
clouding and blurring of the lens distorts the image and color projected onto the retina
- visual acuity is restricted
cataracts: clinical manifestations
- cloudy lens
- no pain or eye redness is associated with age-related cataracts
- blurry vision
- decreased color perception
cataracts: assessments
- gradual onset
- eye dr follows
- occurs with increased age
- obtain thorough medical hx
- physical assessment: blurred vision, decreased color perception, difficulty seeing at night
- psychosocial assessment (could be depression as a result of losing independence)
cataracts: diagnostic studies
done by MD
cataracts: collaborative care
- nonsurgical therapy
- surgical therapy
nonsurgical therapy of cataracts
- avoid heavy sun or UV light exposure
- wear sunglasses
- wear eye and head protection
- stop smoking
as the cataract matures, ___ makes it difficult to see the retina
opacity
collaborative management of cataracts: preoperative
- educate patient that surgery is done as an outpatient
- ask patients if they are on any blood clotting meds such as aspirin, clopidogrel, or anticoagulants (ie. warfarin)
- educate about use of eye drops several times/day both before and after surgery
- will someone be able to do that for them if they cannot do it by themself
collaborative management of cataracts: education
- discharged 1-2hrs after
- light eye patch, dark glasses
- avoid water in the eye
- eye drops
- next day follow-up appt (need driver)
- s/sx to report (mild itching is normal, blurry vision initially is normal; should not be having any pain, moderate/purulent drainage)
collaborative management of cataracts: postoperative
- antibiotics are given subconjunctivally
- eye is unpatched. discharge usually within 1hr with dark glasses
- instill antibiotic-steroid eyedrops
- mild itching is normal
- pain indicates a complication
- reduce IOP
- prevent infection
- assess for bleeding
cataracts: health teaching
- signs of complications
- avoid activities that might increase IOP
- no heavy lifting
- no bouncing around
- try to sneeze/cough/blow nose gently
- review procedure for use of eyedrops
- wash hands 1st!
- patient look up at ceiling, head tilted back
- pull down conjunctival sac to put drop into corner of eye
- cant give steroid and antibiotic drops back to back- wait 5 minutes (will be diluted if not given time to absorb)
signs of complications post-op cataract surgery
- sudden, sharp pain in eye
- bleeding or increased discharge
- lid swelling
- decreased vision
- flashes of light or floating shapes
cryopexy
the doctor uses a specially designed probe that applies intense cold therapy to the back wall of the eye (sclera/retina) in order to create a scar tissue around the retinal tear
- used to repair retinal tear/detachment
laser photocoagulation
eye surgery using a laser to shrink or destroy abnormal structures in the retina, or to intentionally cause scarring
- used to repair retinal tear/detachment
age-related macular degeneration: etiology
- leading cause of blindness in adults over 65 years
- age related macular degeneration
- two types: dry (more common) and wet
age-related macular degeneration: pathophysiology
- blockage in the retinal capillaries
- blood and oxygen cant get to macula, causing degeneration
age-related macular degeneration: clinical manifestations
- blurry vision
- loss of central vision (cant see directly in front of them, can only see peripherally)
age-related macular degeneration: collaborative care/treatment
- treatment focuses on slowing the process (laser surgery, intraocular injections)
- NO CURE
glaucoma: etiology
- African-Americans over 40 years old
- increased age: any individual over 60 years old (esp. Mexican Americans)
- family history of glaucoma
- adults with high BP
- adults with corneal thinness
- adults with optic nerve abnormality
- gradual onset
- common cause of blindness
glaucoma: pathophysiology
- increased ocular pressure
- cupping and atrophy of optic disc
glaucoma: primary open-angle
- most common
- asymptomatic early stages
- loss of peripheral vision with progression
glaucoma: angle-closure
- sudden visual loss
- pain
- conjunctival erythema
- corneal edema
glaucoma: clinical manifestations/symptoms
- headache or brow pain
- N/V
- colored halos around lights
- sudden blurred vision with decreased light perception
priority collaborative problems for patients with glaucoma
- decreased visual acuity due to glaucoma
- need for health teaching due to treatment regimen of glaucoma
purpose of glaucoma drug therapy
goal is to decrease IOP
- constrict the pupil
- reduce production or increase absorption of aqueous humor
patient teaching plan for glaucoma drug therapy
- how eyedrops work
- how to administer eyedrops
- monitor for side effects (check if on BP med eye drop, that their BP/HR does not drop too low)
- compliance, timely dosing
conjunctivitis treatment options
- antibiotic ointment
- antibiotic eyedrops
how to prevent spread of conjunctivitis
- not sharing things that come in contact with the infected eyes (ie. towels)
retinal holes, tears, and detachments are often caused by ___
often caused by posterior vitreous detachment
retinal holes, tears, and detachments: assessment
- sudden onset in 1 eye
- painless
- bright flashes of light or floating dark spots
retinal holes, tears, and detachments: interventions
- laser photocoagulation & cryopexy
- surgical repair
glaucoma: secondary
results from another health condition
glaucoma: diagnostic methods
- use machine to look at IOP
- look at lens
- look at macula
what would the RX be for a patient diagnosed with glaucoma
lifelong eye drops to reduce IOP
glaucoma drug therapy- table 39.1
- prostaglandin agonists: latanoprost
- adrenergic agonists: bromonidine
- beta-adrenergic blockers: timolol maleate
- cholinergic agonists: pilocarpine
- carbonic anhydrase inhibitors: dorzolamide
what needs to be done before administering a beta blocker (ie timolol)?
BP & HR
-don’t give if BP and HR are low/below normal because the drugs will only decrease HR/BP more
glaucoma: care coordination and transition management
- instill eyedrops regularly
- follow-up every 1-3 months or as directed
- good handwashing
- keep tip of eyedrops clean
- s/sx of choroidal detachment and hemorrhage
- referrals
arcus senilis
- does not affect vision
- has to do with fatty deposits in the eye (ring around outer cornea of eye)
