Ch. 49 Eye And Vision Problems Flashcards
The external hordeolum is an infection of the sweat glands in the eyelid whereas an internal hordeolum is an infection of what?
The sebaceous glands
A “stye” is also known as what?
A Hordeolum
The most common causative agents of hordeolum are?
Staphylococcus aureus
Staphylococcus epidermis
Streptococcus
Treatment of Hordeolum includes?
Warm compresses 4x a day and an antibacterial ointment
*ointment may cause blurry vision. Instruct patient on driving precautions
An inflammation of a sebaceous gland in the eyelid
Chalazion
The difference between Hordeolum and chalazion is?
After redness/tenderness, a chalazion is followed by gradual painless swelling and usually no inflammatory signs are present.
Treatment for chalazion include?
Warm compresses for 15 minutes 4x a day followed by installation of ophthalmic ointment
Keratoconjunctivitis or dry eye syndrome can occur with the use of some drugs such as?
Antihistamines
Beta-adrenergic blocking agents
Anti cholinergic drugs
Patient with dry eye syndrome may feel?
A foreign body in the eye
Burning or itching eyes
Photophobia
Treatment of keratoconjunctivitis depend on the severity of manifestations which include:
Restasis, cyclosporine ophthalmic emulsion
Artificial tears for daytime
Lubricating ointments at night
Conjunctiva is inflammation of the?
Conjunctiva
Conjunctivitis is caused by?
Exposure to allergens or irritants
Not contagious
Conjunctivitis is contagious when?
Exposed to bacterial or viral infection
Manifestations of conjunctivitis include?
Edema Sensation of burning Engorgement of blood vessels (bloodshot) Excessive tears Itching
Treatment of conjunctivitis include
Instillation of vasoconstrictors
Corticosteroid eyedrops
Bacterial conjunctivitis or pink eye is usually caused by
Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Manifestations of bacterial conjunctivitis include
Blood vessel dilation
Mild conjunctival edema
Tears and discharge (watery then gets thicker with shreds of mucus)
Pink eye treatment is aimed at elim infection with?
Topical antibiotics
Trachoma is the chief cause for preventable blindness and is caused by what
Chlamydia trachomatis
The manifestations for trachoma are similar to bacterial conjunctivitis with the exception that?
As the disease progresses, eyelid scars and turns inward causing lashes to damage the cornea.
Treatment for trachoma include
A 4 week course of oral or topical tetracycline
Erythromycin
Azithromycin once per week for 1-3 weeks
Why is corneal abrasion, ulceration and infection an emergency?
The cornea has no separate blood supply and cant defend itself from infections that may permanently impair vision
Manifestations of corneal disorder include
Pain Reduced vision Photophobia Eye secretions Cloudy or purulent (pus filled) fluid
Fluorescein stain is used and appears as
Green in patchy areas
Treatments for corneal disorders include
Anti-infective therapy
Broad spectrum antiobiotics
Eyedrops Qh for first 24 hrs
Health teaching and compliance on drug regimen
Treatment for corneal disorders are aimed at restoring
Corneal clarity and enhancing ability to use remaining vision
The surgical removal of diseases corneal tissue and replacement with tissue from a donors cornea is what?
Keratoplasty
After keratoplasty, lying on the non operative side reduces what?
IOP
Manifestations of graft rejection include?
Continuous leak of clear fluid, not tears
Excessive bleeding
Decreased vision
Increased redness
Pain
Photophobia
Light flashes “floaters” in field of vision
*report if w/i first 48 hours and persist for more than 6 hours
Activities that increase IOP include
Bending at waist Lifting more than 10lbs Sneezing coughing Nose blowing BM strain Vomiting Intercourse Head in dependent position Tight shirt collars
Opacity of the lens that distorts the image projected onto the retina
Cataracts
Early manifestations of cataract include?
Progresses to?
Slightly blurred vision and decreased color perception
Blurred and diplopia
No pain or eye redness asso. With age related cataracts
Blindness without surgical intervention
Most common nursing dx for cataracts
Disturbed sensory perception (visual) related to altered sensory reception
Fear
Risk for injury
Self care deficit
The only “cure” for cataracts is surgery. What is done before surgery?
Sedative is given with a series of ophthalmic drugs
Pupils will dilate and cause vasoconstriction
Local anesthetic is injected into muscle cone behind eye for paralysis
What is the difference between extracapsular or phacoemulsification lens extraction?
Extracapsular removal is where the front portion of the capsule is opened by a small incision and the lens is removed whole
Phacoemulsification is where a probe is inserted through the casule and high frequency sound waves break the cataractous lens into sm. pieces and suctioned
Postop care for cataracts include
Mild itching, bloodshot eyes, and creamy white dry crusty drainage is NORMAL
pain with nausea and vomiting, yellow or green drainage must be reported
And activity restrictions must be taken
What is the difference between the aqueous and vitreous humor in the eye?
The vitreous humor is in the posterior segment and the gel doesn’t change in volume.
The aqueous humor in the anterior segment is continuously made up if blood plasma.
What is normal IOP?
10-21mmHg
What is glaucoma?
Ocular disease caused by increased IOP
Poorly oxygenated photoreceptors
Nerve tissues become ischemic and die
Commonly painless
What are the types of glaucoma and their corresponding causes?
Primary- aging, heredity, and central retinal vein occlusion
Secondary- uveitis, iritis, neovascular disorders, trauma, ocular tumors, surgery, degenerative disease
Associated- DM, hypertension, severe myopia, retinal detachment
What is the most common form of primary glaucoma and what does it do?
Primary open-angle glaucoma (PAOG) affects both eyes and is asymptomatic in the early stages
Outflow Aq. Humor through he chamber angle is reduced and cannot leave the eye at the same rate it is produced. IOP increases
What is angle-closure glaucoma (closed angle, narrow angle, acute glaucoma)?
Has a sudden onset. Movement of iris against cornea closes chamber angle obstructing outflow of aq. Humor
Late manifestations of glaucoma
Halos around lights
Peripheral vision loss
Decreased visual acuity
Manifestations of acute angle glaucoma include
Sudden severe pain radiating over face Headache or brow pain Colored halos around lights Sudden blurred vision Decreased light perception Reddened sclera Foggy cornea
What is the tonometry reading for PAOG and angle closure glaucoma?
22-32 mmHg
30mmHg or higher
Most common class of drugs to manage glaucoma?
Prostaglandin agonists Adrenergic agonists, beta-adrenergic blockers, cholinergic blockers Carbonic anhydrase inhibitors
What systemic osmotic drugs can be given for angle closure glaucoma?
Oral glycerin(osmoglyn) and IV mannitol (osmitrol)
The two most common surgical procedures for treating glaucoma are?
Laser trabeculoplasty - burns trabecular meshwork causing meshwork fibers to tighten and increases size of spaces between fibers improving outflow of aqueous humor decreasing IOP.
Filtering microsurgery- creates a drainage hole in the iris between pos/ant chambers
*both ambulatory procedures
Conjunctiva is inflammation of the?
Conjunctiva
Conjunctivitis is caused by?
Exposure to allergens or irritants
Not contagious
Conjunctivitis is contagious when?
Exposed to bacterial or viral infection
Manifestations of conjunctivitis include?
Edema Sensation of burning Engorgement of blood vessels (bloodshot) Excessive tears Itching
Treatment of conjunctivitis include
Instillation of vasoconstrictors
Corticosteroid eyedrops
Bacterial conjunctivitis or pink eye is usually caused by
Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Manifestations of bacterial conjunctivitis include
Blood vessel dilation
Mild conjunctival edema
Tears and discharge (watery then gets thicker with shreds of mucus)
Pink eye treatment is aimed at elim infection with?
Topical antibiotics
Trachoma is the chief cause for preventable blindness and is caused by what
Chlamydia trachomatis
The manifestations for trachoma are similar to bacterial conjunctivitis with the exception that?
As the disease progresses, eyelid scars and turns inward causing lashes to damage the cornea.
Treatment for trachoma include
A 4 week course of oral or topical tetracycline
Erythromycin
Azithromycin once per week for 1-3 weeks
Why is corneal abrasion, ulceration and infection an emergency?
The cornea has no separate blood supply and cant defend itself from infections that may permanently impair vision
Manifestations of corneal disorder include
Pain Reduced vision Photophobia Eye secretions Cloudy or purulent (pus filled) fluid
Fluorescein stain is used and appears as
Green in patchy areas
Treatments for corneal disorders include
Anti-infective therapy
Broad spectrum antiobiotics
Eyedrops Qh for first 24 hrs
Health teaching and compliance on drug regimen
Treatment for corneal disorders are aimed at restoring
Corneal clarity and enhancing ability to use remaining vision
The surgical removal of diseases corneal tissue and replacement with tissue from a donors cornea is what?
Keratoplasty
After keratoplasty, lying on the non operative side reduces what?
IOP
Manifestations of graft rejection include?
Continuous leak of clear fluid, not tears
Excessive bleeding
Decreased vision
Increased redness
Pain
Photophobia
Light flashes “floaters” in field of vision
*report if w/i first 48 hours and persist for more than 6 hours
Activities that increase IOP include
Bending at waist Lifting more than 10lbs Sneezing coughing Nose blowing BM strain Vomiting Intercourse Head in dependent position Tight shirt collars
Opacity of the lens that distorts the image projected onto the retina
Cataracts
Early manifestations of cataract include?
Progresses to?
Slightly blurred vision and decreased color perception
Blurred and diplopia
No pain or eye redness asso. With age related cataracts
Blindness without surgical intervention
Most common nursing dx for cataracts
Disturbed sensory perception (visual) related to altered sensory reception
Fear
Risk for injury
Self care deficit
The only “cure” for cataracts is surgery. What is done before surgery?
Sedative is given with a series of ophthalmic drugs
Pupils will dilate and cause vasoconstriction
Local anesthetic is injected into muscle cone behind eye for paralysis
What is the difference between extracapsular or phacoemulsification lens extraction?
Extracapsular removal is where the front portion of the capsule is opened by a small incision and the lens is removed whole
Phacoemulsification is where a probe is inserted through the casule and high frequency sound waves break the cataractous lens into sm. pieces and suctioned
Postop care for cataracts include
Mild itching, bloodshot eyes, and creamy white dry crusty drainage is NORMAL
pain with nausea and vomiting, yellow or green drainage must be reported
And activity restrictions must be taken
What is the difference between the aqueous and vitreous humor in the eye?
The vitreous humor is in the posterior segment and the gel doesn’t change in volume.
The aqueous humor in the anterior segment is continuously made up if blood plasma.
What is normal IOP?
10-21mmHg
What is glaucoma?
Ocular disease caused by increased IOP
Poorly oxygenated photoreceptors
Nerve tissues become ischemic and die
Commonly painless
What are the types of glaucoma and their corresponding causes?
Primary- aging, heredity, and central retinal vein occlusion
Secondary- uveitis, iritis, neovascular disorders, trauma, ocular tumors, surgery, degenerative disease
Associated- DM, hypertension, severe myopia, retinal detachment
What is the most common form of primary glaucoma and what does it do?
Primary open-angle glaucoma (PAOG) affects both eyes and is asymptomatic in the early stages
Outflow Aq. Humor through he chamber angle is reduced and cannot leave the eye at the same rate it is produced. IOP increases
What is angle-closure glaucoma (closed angle, narrow angle, acute glaucoma)?
Has a sudden onset. Movement of iris against cornea closes chamber angle obstructing outflow of aq. Humor
Late manifestations of glaucoma
Halos around lights
Peripheral vision loss
Decreased visual acuity
Manifestations of acute angle glaucoma include
Sudden severe pain radiating over face Headache or brow pain Colored halos around lights Sudden blurred vision Decreased light perception Reddened sclera Foggy cornea
What is the tonometry reading for PAOG and angle closure glaucoma?
22-32 mmHg
30mmHg or higher
Most common class of drugs to manage glaucoma?
Prostaglandin agonists Adrenergic agonists, beta-adrenergic blockers, cholinergic blockers Carbonic anhydrase inhibitors
What systemic osmotic drugs can be given for angle closure glaucoma?
Oral glycerin(osmoglyn) and IV mannitol (osmitrol)
The two most common surgical procedures for treating glaucoma are?
Laser trabeculoplasty - burns trabecular meshwork causing meshwork fibers to tighten and increases size of spaces between fibers improving outflow of aqueous humor decreasing IOP.
Filtering microsurgery- creates a drainage hole in the iris between pos/ant chambers
*both ambulatory procedures
Prostaglandin agonists do what?
Lower IOP by dilating the blood vessels in the trabecular mesh collecting more aqueous humor and allowing more fluid to leave the eye
- dont use when cornea is intact
- using with a normal IOP May reduce vision
Adrenergic agonists do what?
Bind to receptors inneye to reduce amount of aqueous humor produced by ciliary bodies and dilating the pupil
- increases BP and may cause hypertensive crisis
- pupils remain dilated causing discomfort with light
Beta adrenergic blockers do what?
Blocks Ba receptors and less aqueous humor is produced by ciliary bodies
- if drug absorbs systemically they constrict pulmonary smooth muscle and narrow airways
- drugs induce hypoglycemia
Cholinergic drugs do what?
Decrease amount of aqueous humor produced and cause miosis, making room between iris and lens allowing fluid to flow through pupil better
- can cause headache flushing increased saliva and sweating
- use good lighting because pupils constrict
Carbonic anhydrase inhibitors so what?
Inhibit production of aqueous humor and dont affect flow or absorption of fluid
- sensitivity to sulfonamides
- shake well before applying
- wait 15 minutes to use contacts
Main manifestation of vitreous hemorrhage?
Reduced visual acuity
Mild- red haze or floaters
Moderate- black streaks or tiny black dots
Severe- reduce visual acuity to hand motion
