Eye and Vision disorders Flashcards
What is a cataract?
An opacity or cloudiness of the lens.
Cataracts have increased incidence with what?
Aging.
By age ____, more than half of all Americans have ________.
80 years, cataracts
What is a leading cause of disability on the US?
Cataracts
What are the four types of cataracts?
Secondary, traumatic, radiation, and congenital
What are the risk factors for cataracts?
Age, environment (trauma, excessive sun exposure), heredity, DM, smoking and ETOH, drugs
What are the clinical manifestations of cataracts?
- tends to occur bilaterally at different rates.
- decreased acuity; painless blurred vision
- diplopia; sensitivity to glare
- color distortion
What are the diagnostic tests for eye and vision loss?
- visual acuity test
- Absent red reflex
- dilated eye exam
What is the visual acuity test used for the diagnosis of vision loss?
- snellen and Rosenbaum
What is the instrument used in a dilated eye exam?
Opthalmoscope
When is eye surgery indicated?
When vision and ADL’s are affected
Is eye surgery for cataracts typically outpatient with local anesthesia?
Yes
True or false.
Complications are a regular occurrence for cataract eye surgery.
False.
What is red reflex?
A reddish-orange reflection of light from the eye’s retina that is observed when using an opthalmoscope or retinoscope from one foot away.
For the client who has developed cataracts, the nursing process is geared toward what two things?
Treatment and prevention
What is macular degeneration?
Eye disease that causes vision loss.
What other name is macular degeneration referred to as?
Age-related macular degeneration.
What is the most common cause of vision loss in persons older than 60 yrs old?
Macular degeneration
What are the two types of macular degeneration?
Dry or nonexudative and wet type
Which is the most common type of macular degeneration?
Dry, nonexudative
How is dry or nonexudative macular degeneration described?
Slow breakdown of the layers of the retinal with the appearance of drusen
How is the wet type of macular degeneration described?
Proliferation of abnormal blood vessels growing under the retina-choroidal revascularization
True or false:
Wet type of macular degeneration may have an abrupt onset
True.
What does the macula provide?
Sharp central vision.
Explain the characteristics of nonexudative (dry) macular degeneration:
- gradual accumulation of deposits
- pigment epithelium detaches in small areas
- vision loss typically not significant
- vision loss progresses slowly
- risk that disorder will progress to exudative stage
Explain the characteristics of exudative (wet) macular degeneration?
- formation of new weak blood vessels
- new vessels prone to leak
- elevate retina from choroid
- bleeding can occur
- acute vision loss
Who is at lower risk for developing macular degeneration?
Asians, those with darker pigmentation
What are the risk factors of macular degeneration?
- aging
- smoking
- race (white is higher risk)
What are the manifestation of a damaged macula?
- central vision blurred
- peripheral vision intact
What are the manifestations in wet AMD?
Straight lines appear crooked or wavy
What are the diagnostic tests for AMD?
- Vision and retinal examination
- ambler grid
- fluorescein angiogram
Who is involved int eh collaboration for care of AMD?
Ophthalmologist, OT, social worker, adaptive technology
What type of drugs are given for wet AMD?
Antiangiogenic drugs
Where must the antiangiogenic drug be injected for AMD?
Into the eye
What do antiangiogenic drugs do?
Block vascular endothelial growth factor that stimulates angiogenesis
What are three types of antiangiogenic drugs?
- ranibizumab
- bevacizumab
- pegaptanib
In the early stages, what are the nonpharmacological ways that AMD can be slowed?
High-dose antioxidants, zinc
What are some nonpharmacologic ways to help with AMD?
Large-print books, magnifying glasses, lighting
What is glaucoma?
A disturbance of the functional or structural integrity of the optic nerve
What is the leading cause of blindness of adults in the US?
Glaucoma
What does incidence of glaucoma increase with?
Age
What are the different types of glaucoma?
Open angle, angle closure (pupillary), congenital and glaucoma that is secondary to other conditions
What is open angle glaucoma?
Open-angle refers to the angle between the iris and sclera. The aqueous outflow is decreased due to blockages in the eye’s drainage system causing a gradual rise in IOP.
In glaucoma what happens to aqueous production and drainage?
They are not in balance
What happens when aqueous outflow is blocked?
Pressure builds up in the eye
What does increased IOP cause?
Irreversible mechanical or ischemic drainage.
Open-angle glaucoma is what percentage of all glaucoma’s?
90%
What are the characteristics of open-angle glaucoma?
It is chronic, gradually progressive and bilateral
What are the characteristics of angle-closure glaucoma?
- Corneal flattening, bulging of iris into anterior chamber
- intraocular pressure rises abruptly
- angle between iris and the sclera suddenly closes, causing a corresponding increase in IOP
What is angle-closure glaucoma often called?
“Silent thief”
When is glaucoma first noticed?
When there is significant vision loss, blurring, halos, difficulty focusing, difficulty focusing in low lighting
May also have aching or discomfort around eyes or headache.
What are the characteristics of angle-closure glaucoma?
- usually unilateral
- less common
What type of med should you avoid if you have angle-closure glaucoma?
Mydriatics.
What do mydriatics cause?
Dilation of pupil
What are the symptoms of angle-closure glaucoma?
Headaches, severe eye pain, n/v, rainbows around lights at night, very blurred vision profuse tearing
What are the three p’s of blindness?
- prevention (i should have seen this coming)
- painless (i didn’t feel a thing)
- permanent (and know I’m blind forever)
What are the risk factors of glaucoma?
- familial
- over age 40
- DM, HTN
- history of ocular problems
- race AA 6-8 x > whites
- Infection, trauma
What types of ophthalmic meds are used for glaucoma?
Anti inflammatory drugs, corticosteroid suspensions
How do the drugs used for glaucoma work?
They increase aqueous outflows or decrease production, may constrict the pupil and affect ability to focus lens of the eye, may produce systemic affects
Side effects of long-term topical steroids include glaucoma, cataracts, and increased ris of infection, what type of therapy may be used instead of steroidS?
NSAID’s
What are the diagnostic tests for glaucoma?
Tonometry, funduscopy, gonioscopy, visual field testing
What does tonometry measure?
IOP. IOP is elevated in glaucoma, especially angle-closure
What does Gonioscopy measure?
The drainage angle of the anterior chamber of the eye
What does perimeter assess?
Vision loss
What is the goal of treatment of glaucoma?
To prevent further optic nerve damage.
What are other forms of treatment of glaucoma?
Maintain IOP within range unlikely to cause damage, pharmacologic therapy, surgery
What is used for pharmacological therapy for glaucoma?
- topical beta-adrenergic blocking agents
- prostaglandin analogs
- adrenergic agonists
- carbonic anhydrase inhibitors
What types of surgeries are for angle-closure glaucoma?
Gonioplasty, Laser iridotomy
What is Timolol?
A Beta-adrenergic drug
What is the action of timolol?
Decrease the production of aqueous humor in the eye.
What should you assess for when taking timolol?
Hypotension, bradycardia, SOB
What type of surgical procedures are for open angle glaucoma?
- laser trabeculoplasty
- trabeculectomy
- photocoagulation, cyclocryotherapy
- drainage implants, or shunts
What are the pharmacological therapies for angle-closure glaucoma?
- IV diuretic
- Fast-acting miotic drugs
What is the fundus of the eye?
The back part of the eyeball.
Why is laser therapy used for wet AMD?
To seal leaking blood vessels
What are ocular injections in wet AMD for ?
To inhibit blood vessel growth
Is there a cure for macular degeneration?
No.
What are the common causes of cataracts?
- age-related
- traumatic
- toxic
- associated
- complicated
What are the age-related causes of cataracts?
Drying of lens due to water loss, increase in lens density due to lens fiber compaction
What are the traumatic causes of cataracts?
Blunt or penetrating injury or foreign body in the eye, exposure to radiation or ultra violet light
What are the toxic causes of cataracts?
Long term use of corticosteroids, phenothiazine derivatives, beta-blockers, or miotic medications
What are the associated causes of cataracts?
DM, hypoparathyroidism, Down syndrome, chronic sunlight exposure
What are the complicated causes of glaucoma?
Intraocular disease such as retinitis pigmentosa, glaucoma, or retinol detachment
What is diplopia?
Double vision
What type of drug is timolol?
Beta-blocker
What type of IV diuretic is commonly used in emergency treatment of or primary angle-closure glaucoma?
IV mannitol
What type of drug is the first line of drug therapy for glaucoma?
Beta blockers
What is a potential consequence of untreated glaucoma?
Blindness.
