Glaucoma Diseases and Retinal Problems Flashcards
etiology of glaucoma
disorders that involve many different pathologic changes and symptoms but have in common an optic neuropathy that damages the optic disc, causing atrophy and loss of vision
The neuropathy often is caused by
increased intraocular pressure (IOP) (Boyd, 2020)
Which explanation accurately describes the calculation of intraocular pressure
Rate of aqueous humor production and outflow
Which cause of secondary glaucoma would the nurse include when teaching a class about the eye disorder
A history of retinal detachment
What are the danger signals of glaucoma
-Eyeglasses, even new ones, that do not seem to clarify vision
-Blurred or hazy vision that clears up after a while
-Difficulty adjusting to darkened rooms, such as in movie theaters
-Seeing rainbow-colored rings around lights
-Narrowing of vision at the sides of one or both eyes
-Encourage a complete eye examination if any of these signs is present
glaucoma screening
People at normal risk for glaucoma should be screened every 2 to 4 years before age 40, every 1 to 3 years from ages 40 to 54, every 1 to 2 years from ages 55 to 64, and every 6 to 12 months after age 65 (Glaucoma.org, 2017).
People who are at high risk should be screened every 1 to 2 years after age 35.
risk factors for glaucoma
Diabetes
African Americans
Family history of glaucoma
Air Tonometer
-Commonly used screening technique for early detection of glaucoma
-Measures IOP
-A puff of air is directed at the cornea, which causes a momentary indentation while a pressure reading is taken
-Painless
-Nothing but the air touches the eye.
Applanation Tonometer
-A more complex instrument (than the air tonometer)
-Verifies the diagnosis of glaucoma
-The cornea is flattened, and pressure is measured with a slit-lamp biomicroscope.
Glaucoma treatment
- initial treatment of choice for chronic (open-angle) glaucoma is medication rather than surgery
-Drug therapy is intended to enhance aqueous humor outflow or decrease its production so that IOP is decreased
-Miotics:
Cause blurred vision for 1 to 2 hours after use.
Cause difficulty adjusting to dark rooms because of pupil constriction
-Pilocarpine:
An eye medication disk that resembles a contact lens.
Inserted into the conjunctival sac in the lower eyelid.
Can remain for up to 7 days.
Slow release of medication.
Does not prevent the wearing of contact lenses
-Diuretics
goal of glaucoma surgery
-create an opening so that excess fluid can escape
-A laser is used to create evenly spaced openings in the collecting meshwork (trabeculoplasty) to facilitate aqueous humor drainage in open-angle or chronic glaucoma, A tiny shunt may be placed to drain excess aqueous humor if other surgeries do not produce the desired results.
Points to Cover in the Glaucoma Teaching Plan
-Signs of elevated IOP include pain in the eye, redness, tearing, blurred vision, halos around lights, and frequent need for change in eyeglasses.
-Measures to prevent increase in IOP include low-sodium (Furstenberg) diet, little caffeine intake, preventing constipation and Valsalva maneuver, and decreasing stress.
-Taking prescribed medications and refraining from taking over-the-counter or other medications without the health care provider’s knowledge are important. Glaucoma medication must be taken regularly for life.
-Use good aseptic technique when instilling eye medication.
-Wear an ID tag or bracelet stating “glaucoma,” and carry a card in your wallet that states what medications are being taken.
-Keep an extra bottle of eye medication on hand. Carry eye drops.
-Maintain close medical follow-up with the provider.
-Practice safety habits; avoid night driving if possible.
S/S of narrow-angled glaucoma
-Narrow-angle glaucoma can be acute or chronic
-Acute conditions are a medical emergency in which there is severe pain in the eye accompanied by:
The appearance of colored halos around lights
Blurred vision
Pain in and around the eye
Nausea and vomiting
The cause of narrow-angle glaucoma is
the position of the iris, which lies too close to the drainage canal and bulges forward against the cornea, blocking the drainage of aqueous humor.
The IOP rises suddenly, sometimes reaching a pressure of 50 to 70 mm Hg.
Relief of the situation must be prompt or damage to the optic nerve will cause blindness in the affected eye
Diagnosis
Diagnosis is by history, testing of IOP, and slit-lamp eye examination
postop care after eye surgery
Eye drop:
-Pilocarpine
-Timolol
-Apraclonidine
-Intravenous (IV) acetazolamide
Surgery
-Surgery is performed as soon as inflammation subsides to relieve pressure against the optic nerve endings.
-Procedures that allow filtering of the aqueous humor from the anterior chamber into the subconjunctival space are performed. These include:
Laser iridotomy
Trabeculectomy
Laser trabeculoplasty
Others
-If these procedures fail, sometimes cyclocryotherapy (the application of a freezing tip) may be used on the ciliary body to decrease the aqueous production.
Patient education should include:
Teaching about activity precautions during healing
The schedule for eye drops
Symptoms to report to the surgeon
Aseptic handling of the eye drops and eye shield
Which change in the eyes would the nurse anticipate after instilling miotic eye drops?
Pupil constriction
common causes of retinal detachment
rhegmatogenous detachments where a hole, tear, or break in the neuronal layer allows vitreous humor to seep between layers.
Causes of retinal detachment also include:
Traction or exudative mechanisms
Congenital malformations
Trauma
Metabolic disorder, such as diabetic or hypertensive retinopathy
Risk factors for retinal detachment are:
high degree of myopia
History of cataract surgery
Direct trauma to the eye
Age older than age 40
Occurs most commonly between ages 40 and 70 years
history of retinal detachment in the other eye
15% of people with retinal detachment in one eye develop detachment in the other eye.
pathophysiology of retinal detachment
separation of the sensory layers of the retina from the pigmented epithelial layer, the choroid, causing vitreous fluid to leak under the retina, separating a portion of it from the vascular wall and thereby depriving the retina of its blood supply
S/S of retinal detachment
-Flashes of colored light accompanied by showers of floaters (black spots)
-Feeling as if a curtain has been drawn over a portion of the visual field
-Later, cloudy vision or loss of central vision
In severe cases, complete loss of vision
retinal detachment Diagnosis
-Direct ophthalmoscope
-Stereoscopic indirect ophthalmoscope
-Ultrasound:
Can be used when the eye is clouded by opacity from cataract or hemorrhage
treatment for retinal detachment
Laser therapy
Photocoagulator
Cryotherapy
Scleral Buckling
Closed Vitrectomy
Postoperative Nursing Management: retnial detachment
-Monitor IOP closely for at least 24 hours.
Head positioning:
Prescribed by the surgeon
Position head so that the area repaired is dependent, preventing the pull of gravity from disrupting the surgical site
If oil or a gas bubble was used, the positioning is calculated to apply pressure to the retina.
Postoperative Patient Education: retinal detachment surgery
-Pain: ice packs
-Return of vision: improves gradually over several weeks to months
-Several types of eye drops as well as an antibiotic ointment
-Activity: showering with head back, avoid heavy lifting, straining at stool, and vigorous activity for several weeks
-Flashing lights:
common for the first few weeks, decrease over 2-6 months (if worsen notify surgon)
-Light sensitivity: lessens over a period of 4-6 weeks
-Eye discharge:
moderate amount is not unusual, should be yellowish or pink-tinged
Notify the surgeon if:
The amount increases markedly
The discharge is accompanied by severe pain
The discharge has a foul smell or has a greenish tinge (indicating a potential infection)
-If discharge occurs:
Cleanse the eyelid with a gauze pad or cotton ball moistened with irrigating solution or tap water.
Wipe from the inner to the outer area of the eye.
Use a separate clean pad/cotton ball for each eye.
he two major causes of retinopathy are.
diabetes mellitus (DM) and hypertension.
Contributing factors are:
excessive use of nicotine
excessive use of caffeine
high stress levels
two forms of diabetic retinopathy
proliferative and nonproliferative retinopathy.
proliferative
-Occurs later in the course of DM
-Neovascularization occurs, in which new blood vessels grow from the existing retinal vessels.
The new vessels are thinner and rupture more easily, causing hemorrhage.
-The blood from the hemorrhage causes scarring, which also interferes with vision
Retinal detachment may occur as a result of proliferative retinopathy
Nonproliferative
-Microaneurysms develop on the retinal blood vessels.
-These eventually swell and rupture, causing hemorrhage into the vitreous humor, which interferes with vision.
As the retinopathy progresses, there are alterations in vision such as
Blurring
Missing areas in the field of vision
Seeing red or black lines or spots
retinopathy treated
control of bp
blood glucose control
Which education would the nurse provide to a patient with diabetes to prevent retinopathy?
Avoid drinks containing caffeine.
neovascularization
The growth of new vessels
Which complication is associated with proliferative retinopathy
Retinal detachment
