eye disorders Flashcards
glaucoma
- increased IOP
- optic nerve atrophy
- peripheral visual field loss
normal IOP
10-21 mmHg
prevention of glaucoma
early detection and treatment
pathophysiology of glaucoma
rate of aqueous production (inflow) is greater than the rate of aqueous reabsorption (outflow)
-IOP rises above the normal limits
primary open angle glaucoma
- most common type
- outflow is decreased in the trabecular meshwork
- drainage channels become clogged
- damage to the optic nerve can result
s/s of primary open angle glaucoma
- develops slowly without symptoms
- tunnel vision
- IOP: 22-32 mmHg
primary closed angle glaucoma
- reduction in outflow
- lens bulging forward d/t aging
causes of acute closed angle glaucoma
- drug induced mydriasis
- emotional excitement
- darkness
- is an ocular emergency
s/s of acute closed angle glaucoma
- sudden excruciating pain in or around the eye
- n/v
- HA
- IOP>50
- colored halos around lights
- blurred vision
- ocular redness
s/s of subacute/chronic closed angle glaucoma
- colored halos around lights
- blurred vision
- ocular redness
- eye or brown pain
collaborative care for chronic open angle glaucoma
- argon laser trabeculoplasty
- trabeculectomy/filtration surgery
argon laser trabeculoplasty
- non surgical tx
- used when meds are not successful
- outpt procedure
- laser stimulates scarring and contraction of trabecular meshwork, which opens outflow channels
- reduces IOP approx 75%
trabeculectomy
- surgery
- removes part of the iris and trabecular meshwork
- closes scleral flaps loosely
- success rate: 75-85%
collaborative care acute closed angle glaucoma
- miotics
- mannitol
- laser peripheral iridotomy
- surgical iridectomy
glaucoma assessment
- pt’s ability and psychological reaction
- visual acuity
- visual fields
- IOP
- fundus changes
glaucoma teaching
- avoid activity that increases IOP: bending, straining, coughing, suctioning
- instillation of eye drops
- wear ID bracelet
- avoid self treatment
gerontological considerations
- additive effects of beta adrenergic blocking glaucoma agents
- contraindications for beta adrenergic blockers: bradycardia, HTN, heart block, bronchospasm
- aspirin and CAI= increased salicyclic toxicity and acidosis
- eye drops and systemic absorption
cataracts
- opacity within the lens
- can be in one of both eyes
- age related
s/s of cataracts
- gradual decreased vision
- abnormal color perception/color blind
- glare worse @ night, when pupils dilate
non surgical treatment for cataracts
- postpones the need for surgery
- change prescription of glasses
- strong reading glasses or magnifiers
- increased lighting
- lifestyle changes: no driving at night
cataract extraction
- when palliative measures no longer provide acceptable visual function
- anterior capsule opened and the lens nucleus and cortex are removed
- capsular bag is intact
- surgery is the only cure
assessment for cataracts
- visual acuity
- impact of visual disability
- level of knowledge
age related macular degeneration (AMD)
- degenerative disease of the central portion of retina
- results in loss of central vision
- most common cause of irreversible central vision loss in 60+
dry AMD
- nonexudative
- macular cells start to atrophy
- leads to a slowly progressive and painless vision loss
- close vision tasks become difficult
wet AMD
- exudative
- more severe
- rapid onset
- development of abnormal blood vessel in or near the macula
- pt with wet had dry first
causes of AMD
- aging
- genetics
- long term exposure to UV light
- hyperopia
- cigarette smoking
- light colored eyes
- nutrition
s/s of macular degeneration
- blurred vision
- darkened vision
- scotomas (blind spots in vision)
- metamorphopsia (distortion of vision)
diagnosing macular degeneration
- visual acuity
- opthalmoscopy
- amsler grid test: finds involved area
- fundus photography
- IV angiograph
treatment for wet AMD
- photodynamic therapy
- meds
- vitamins and minerals
- smoking cessation
photodynamic therapy
destroys abnormal blood vessels without permanent damage to retinal pigment epithelium and photoreceptor cells
treatment for dry AMD
no treatment
retinal detachment
separation of the sensory retina and underlying pigment epithelium, with fluid accumulation between the 2 layers
risk factors for retinal detachment
- increasing age
- severe myopia
- eye trauma
- diabetic retinopathy
- cataract surgery
- family or personal hx
untreated retinal detachment
become blind
retinal holes
atrophic retinal breaks that occur spontaneously
retinal tears
vitreous humor shrinks during again and pulls on the retina
s/s of retinal detachment
- photopsia (light flashes)
- floaters
- cobweb or hairnet vision
- ring int he field of vision
- painless loss of peripheral or central vision
- curtain falling like vision
diagnostic studies for retinal detachment
- visual acuity
- opthalmoscopy
- slit lamp microscopy
- ultrasound
treatment for retinal detachment
- *goal is to seal any retinal breaks
- laser photocoagulation
- cryopexy
- *and to relieve inward traction on the retina
- scleral buckling
- vitrectomy
- pneumatic retinopexy
postop care for retinal detachment
- topical agents: abx, steroids, dilators, analgesics
- position: prone
- activity restriction: no flying d/t high altitude
