med surg vision Flashcards
anatomy of the eye
pupil: lets light in
lens & cornae : helps w/ accommodation
retina: covers back of eye
visual acuity testing is testing for what
near & far vision
-snellen for far sight
-miniature eye chart/pocket chart for near vision
ophthalmoscopy
-allows view into fundus of the eye
-dark room to dilate pupil
-move in from 12-15in away & to the side of pts line of vision
-routine in physical exam but also used to look for glaucoma (looking for optic disc cupping)
size of optic disc cup in a pt w/ glaucoma
larger than normal
glare testing
quantifies vision loss associated w/ light scatter
used for patients w/ cataracts to assess ability for night driving
slit lamp test
magnifies the anterior eye w/ a low powered microscope
used for people w/ cataracts, retinal detachment, distinguish between the glaucomas, and macular degeneration
what measures IOP
tonometer
important to measure in pts w/ glaucoma
testing guidelines for IOP
-indicated for all pts >40 yr
-if fam hx of glaucoma, once or twice per year
gonioscopy
performed when high IOP is found & determines whether open or closed angle glaucoma is present
allows visualization where iris meets cornea
vision w/ cataracts looks like
everything is fuzzy & will have flood glare d/t light scatter caused by the opacities
what anatomical structure is mainly affected w/ cataracts & what happens
the lens - changes shape as needed to help focus the image
w/ age lens becomes cloudy & stiffer causing decreased visual acuity and decreased accommodation
cataracts treatment
initially: watch & adjust glasses, add light & day driving
advanced or diabetics d/t need to monitor retina: surgery
pre op care for cataract surgery
-mydriatic (dilating) drops -> need to apply punctal occlusion to avoid systemic effects bc can lead to cardiac issues
-cycloplegic drops to paralyze the eyeball
-NSAID drop + possible anti anxiety med
-decrease room lights
-topical abx prophylactically
cataract surgery facts
-outpatient procedure
-need good medical history
-patient is awake
-NPO 6 to 8 hrs prior
post op care for cataract surgery
-topical abx & steroids given
-eye patch & shield until initial post op visit (within 24 hrs)
-eyes drops (abx & corticosteroid), decrease slowly
-possible activity restriction
-nighttime eye patch
-avoid bending, stooping, lifting, coughing (anything that increases IOP)
post op cataract surgery teaching for pt
-directly following cataract surgery pt may experience improved or decreased visual acuity which is normal
-proper hygiene & eye care techniques
-S/s of infection
-use the meds
-follow up
what gets monitored after cataract surgery
-IOP
-visual acuity
-anterior chamber depth
-corneal clarity
what is retinopathy typically caused by
DM & HTN
prevention & treatment directed towards keeping disease in control
vision w/ retinopathy looks like
splotchy haziness (black hazy dots)
what type of situation is a retinal detachment
urgent
clinical presentation of retinal detachment: while detaching
sudden onset of multiple small floaters &/or light flashes
clinical presentation of retinal detachment: once detached
a painless black curtain comes across field of vision
repair of retinal detachment
four major methods
1) laser photocoagulation
2) cryopexy (creates inflammatory reaction that causes adhesion/scarring)
3) scleral buckle procedure
4) pneumatic retinopexy
time matters
scleral buckle procedure
-extraocular procedure
-a buckle is placed around the outside of the eyeball
-silicone patch wrapped around the eye and then indents the eyeball so it moves towards the retina
-outpatient until local anesthesia
scleral buckle post procedure care
-possible bedrest
-keep HOB elevated at all times to keep IOP down
-topical eye ointments: abx, anti inflams, possible dilating agents
-restrict activity (vigorous exercise should be avoided for 3-4 wks)
-avoid constipation so they dont bear down
scleral buckle discharge teaching
-proper hygiene & eye care
-S/s of infection
-importance of complying w/ activity restrictions
-proper instillation of topical meds
-pain control
-follow ups
pneumatic retinopexy
-intraocular procedure
-a gas bubble is injected into the vitreous cavity
-pt needs to be positioned so that the bubble can apply maximal pressure on the retina by the force of gravity (head down & to one side)
seen in position for several days to weeks
retinal detachment surgery outcomes
-successful 90% of the time
-visual prognosis varies based on extent, length & area of detachment
vision w/ AMD looks like
loss of central vision (block or blurred dot in middle of the eye)
periphery is intact
AMD: dry
-close (central) vision tasks become more difficult
-macular cells start to atrophy leading to progressive, painless vision loss
-less threatening to vision loss
-smoking may increase risk of progression
-no proven effective treatment
-can develop into wet
AMD: wet
-more severe form
-accounts for 90% of cases of AMD related blindness
-rapid onset
-characterized by the development of abnormal blood vessels in or near macula
AMD care (both types)
-antioxidant vitamins & zinc may help slow progression
-smoking cessation
vision w/ glaucoma looks like
central vision is intact but peripheral vision is lost
can go unnoticed for long time d/t slow onset
what is glaucoma
an eye disorder that increases IOP and is a major cause of blindness (2nd behind cataracts)
open angle glaucoma
-faulty “pumper station” , blockage of trabecular meshwork which slows drainage
-problem of reabsorption of aqueous humor
-usually asym
closed angle glaucoma
-a structural problem
-narrow angle between cornea and iris prevents aqueous humor from being reabsorbed
-presents as a painful red eye and must be treated w/n 24hrs or blindness may be permanent
emergency
chronic open angle treatment
first line therapy is medications
-meds decrease AH production causing miosis/opening of trabecular meshwork
biggest barrier to open angle treatment
compliance can be an issue d/t asym disease and frequency of drops
treatment if medications do not work for open agnle
argon laser trabeculoplasty
-outpatient
-topical anesthetic
-laser hits damaged trabecular meshwork and opens outflow channels
what is the gold standard to dx closed angle
gonioscopy
treatment for closed angle: unstable
need to get immediate relief
-beta blocker topical agent
-carbonic anhydrase inhibitor PO
-constrict pupil to lower IOP w/ a miotic eye drop
-treat pain & nausea aggressively bc it will increase IOP
-keep calm
-place patch on affect eye
treatment once close angle is stabilized
prepare for iridotomy -> punches holes in the iris
or
iridectomy
creates pathway for AH to escape
glaucoma screening guidelines
-every 3-5 yrs @ 40 to 60 yr
-every 1-2 yrs >60yr
-AA: periodic exam ages 20-39
precautions when given miotic drop
give before turning off lights bc the dark w/ make the eyes dilate
environment for closed angle
-darken room after constriction
-cool compress to the forehead
-quiet/private
-educate
