Eye Disorders

Question 1

Cataract

Answer 1

an opacity within the lens in the eye, may be in one or both eyes. If in both eyes, one eye may affect the persons vision more than the other

Question 2

causes of cataracts

Answer 2

· Age
· Blunt or penetrating trauma
· Congenital factors such as maternal rubella
· Radiation exposure or UV light (sunlight) exposure
· Certain drugs such as systemic corticosteroids or long-term corticosteroids
Ocular inflammation

Question 3

clinical manifestations of cataracts

Answer 3

· Decrease in vision
· Abnormal color perception
· Glare (may be significantly worse at night when the pupil dilates)
· Visual decline is gradual, but the rate of cataract development varies from patient to patient.

Question 4

diagnosis of cataracts

Answer 4

based on decreased visual acuity or other visual problems.

Opacity is directly observable by ophthalmoscopic or slit lamp examination

Question 5

nonsurgical management for cataracts

Answer 5

· Change in glasses prescription
· Strong reading glasses or magnifiers
· Increased lighting
· Lifestyle adjustment

Question 6

Preop for cataract surgery

Answer 6

o Mydriatic (used for dilatation), cycloplegic agents (anticholinergic agent)
§ Teach patient to wear dark glasses to minimize photophobia
o NSAIDs (to reduce inflammation)
o Topical antibiotics
o Antianxiety medications

Question 7

surgery for cataracts

Answer 7

o Removal of lens
o Phacoemulsification
o Extracapsular extraction
o Correction of surgical aphakia
o Intraocular lens implantation (most frequent type of correction)
o Contact lenses

Question 8

Phacoemulsification

Answer 8

incision is make in the surface of the eye or near the cornea and ultrasonic vibrations are used to dissolve clouded lens into fragments, then these are suctioned out

Question 9

Extracapsular extraction

Answer 9

cataract is removed in one piece without being fragmented inside the eye, sutures are needed to close the larger wound

Question 10

postop for cataracts

Answer 10

o Topical antibiotic
o Topical corticosteroid or other anti-inflammatory agent
o Mild analgesia if necessary
o Eye patch or shield and activity as prescribed by patient’s surgeon
o Activity restriction: Activities that increase IOP: bending, stooping, coughing, or lifting
· Photophobia is common when receiving pupil dilation so decreasing room lighting is helpful. These medications may produce stinging and burning

Question 11

health promotion for cataracts

Answer 11

Suggest patient to wear sunglasses and avoid unnecessary radiation, and maintain appropriate intake of antioxidant vitamins (C & E)

Question 12

Patient teaching after eye surgery

Answer 12

· Proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wound is not contaminated during eye care
· How to monitor pain, take main medication and report pain not relieved by medication
· Importance of continued follow-up as recommended to maximize potential visual outcomes
· Signs and symptoms of infection and when and how to report these to allow for early recognition and treatment of possible infection
· Importance of complying with postoperative restrictions on head positioning, bending, coughing, and Valsalva maneuver to optimize visual outcomes and prevent increased intraocular pressure
How to instill eye medications using aseptic techniques and adherence with prescribed eye medication routine to prevent infection

Question 13

age-related macular degeneration

Answer 13

most common cause of IRREVERSIBLE CENTRAL VISION LOSS in people over the age of 60 in the US

Question 14

dry (nonexudative) AMD

Answer 14

o Close vision tasks are becoming more difficult
o Macular cells start to atrophy
o Slowly progressive and painless vision loss

Question 15

Wet (Exudative) AMD

Answer 15

o More severe form
o More rapid onset
o Development of abnormal blood vessels in or near the macula

Question 16

clinical manifestations of macular degeneration

Answer 16

· Blurred and darkened vision, scotomas (blind spots in the visual field)
· Distortion of vision (metamorphopsia)

Question 17

diagnostic for macular degeneration

Answer 17

Primary diagnostic procedure is ophthalmoscopy

Question 18

what test may define the involved area of macular degneration

Answer 18

The Amsler grid test

Question 19

treatment for macular degneration

Answer 19

· Limited treatment
· Medications that are injected directly into the vitreous cavity.
· Photodynamic therapy (PDT) uses verteporfin IV and “cold” laser to excite the dye.
· People at risk for developing advanced AMD should consider supplements of vitamins and minerals (in consultation with their health care provider).

Question 20

Use of vitamin supplements for macualr degeneration

Answer 20

· A dietary supplement of vitamin C, vitamin E, beta-carotene, and zinc decreases the progression of advanced AMD but has no effect on people with minimal AMD or those with no evidence of AMD.
· Eating lots of dark green, leafy vegetables containing lutein (e.g., kale and spinach) may help reduce the risk of AMD

Question 21

Retinal detachment

Answer 21

separation of the sensory retinal with fluid accumulation between the two layers
· Retinal break
· Retinal hole
· Retinal tear

Question 22

causes of retinal detachment

Answer 22

· Increasing age
· Severe myopia
· Eye trauma
· Cataract surgery
Family or personal history of retinal detachment

Question 23

clinical manifestations of retinal detachment

Answer 23

· Patients with a detaching retina describe symptoms that include:
· Photopsia (light flashes)
· floaters and a “cobweb,” “hairnet,” or ring in the field of vision.
· Once the retina has detached, the patient describes a painless loss of peripheral or central vision, “like a curtain” coming across the field of vision.

Question 24

medical treatment for retinal detachment

Answer 24

· Laser Photocoagulation & Cryopexy
· Scleral Buckling
· Pneumatic retinopexy
· Vitrectomy

Question 25

Glaucoma

Answer 25

increased intraocular pressure, optic nerve atrophy, resulting in peripheral visual field losses

Question 26

IOP is normally

Answer 26

10 to 21 mmHg

Question 27

In open-angle glaucoma, IOP is usually between

Answer 27

22 and 32 mmHg

Question 28

In acute angle-closure glaucoma, IOP may be over

Answer 28

55mmHg

Question 29

Patho of Glaucoma

Answer 29

A proper balance between the rate of aqueous production (referred to as inflow) and the rate of aqueous reabsorption (referred to as outflow) is essential to maintain the IOP within normal limits. The place where the outflow occurs is called the angle because it is the angle where the iris meets the cornea. When the rate of inflow is greater than the rate of outflow, IOP can rise above the normal limits. If IOP remains elevated, permanent vision loss may occur.

Question 30

Primary open-angle glaucoma (POAG):

Answer 30

The outflow of aqueous humor is decreased in the trabecular meshwork. The drainage channels become clogged, like a clogged kitchen sink. Damage to the optic nerve can then result.

Question 31

Primary angle-closure glaucoma (PACG):

Answer 31

Is due to a reduction in the outflow of aqueous humor that results from angle closure. Usually this is caused by the lens bulging forward as a result of the aging process.

Question 32

Clinical Manifestations of Primary open-angle glaucoma (POAG)

Answer 32

· Develops slowly and without symptoms of pain or pressure.
· Usually does not notice the gradual visual field loss until peripheral vision has been severely compromised.
· Eventually the patient with untreated glaucoma has “tunnel vision” in which only a small center field can be seen, and all peripheral vision is absent.

Question 33

Clinical Manifestations of Acute angle-closure glaucoma

Answer 33

· Sudden, excruciating pain in or around the eye
· Accompanied by nausea and vomiting.
· Visual symptoms include: seeing colored halos around lights, blurred vision, and ocular redness.

Question 34

Clinical Manifestations of subacute or chronic angle-closure glaucoma

Answer 34

· Appear more gradually
May report a history of blurred vision, seeing colored halos around lights, ocular redness, or eye or brow pain

Question 35

Chronic Open-Angle Glaucoma Drug Therapy

Answer 35

· β-Adrenergic blockers
· α-Adrenergic agonists
· Cholinergic agents (miotics)
· Carbonic anhydrase inhibitors

Question 36

Acute Angle-Closure Glaucoma

Answer 36

· Topical cholinergic agent
· Hyperosmotic agent
· Laser peripheral iridotomy
· Surgical iridectomy

Question 37

Eye drop medications

Answer 37

· B-Adrenergic blockers
· A-Adrenergic Agonists

Question 38

Beta-adrenergic contraindications

Answer 38

Contraindicated in patients with bradycardia, cardiogenic shock, or HF