Sensory - Visual Disorders

Question 1

retinopathy of prematurity (ROP)

Answer 1

• occurs because the retina is not completely vascularized and is subject to stress & injury
• common in preemies and low birthweight babies: primary incidence > babies <29 weeks; also in 67% of neonates <1251gm
• five stages > stage 4: partial retinal detachment; stage 5: complete retinal detachment
• long-term outcome depends on extent of damage: from full recovery to blindness; 90% recover with no or minimal loss of vision

Question 2

retinopathy of prematurity

Answer 2

• risk factors: prematurity and low birth weight; prolonged hyperoxia; duration of mechanical ventilation
• to decrease risk: continuous pulse oximetry; careful use of oxygen during procedures; oxygen blenders to keep O2 sat 87-94%; avoid bright lights in nursery
• management: ophthalmological exam 4-6 weeks after birth for all infants before 30 weeks or birth weight <1500gm
• aim: reduce risk of blindness
• treatment: can include corrective lenses and eye surgery

Question 3

visual acuity disorders

Answer 3

myopia, hyperopia, astigmatism, presbyopia

• affects 1/3 of persons aged 40+
• manifestations are related to the underlying pathophysiology; the eye shape and corneal focus on objects near and far
• manage with corrective lenses or surgery
• surgical management: radial keratotomy; photorefractive keratectomy (PRK); laser-assisted in situ keratomileusis (LASIK); laser thermal keratoplasty (LTK); conductive keratoplasty

Question 4

cataracts

Answer 4

• an opacity in the lens of an eye that impairs vision
• alteration in the lens proteins occurs as a person ages
• gradual lens clouding secondary to chemical change
• risk factors: exposure to UV light; advanced age; family history: diabetic or other chronic medical conditions; obesity; elevated blood pressure; smoking and alcohol use; environmental factors; congenital cataracts in newborns
• clinical manifestations: clouded, blurred, or dim vision; night vision difficulty; sensitivity to light/glare; halo vision; color fading; double vision in a single eye; nystagmus; strabismus; absence of red reflex

Question 5

cataracts

Answer 5

• effective treatment is surgical removal of the lens
• surgical management: phacoemulsification; extracapsular or intracapsular cataract extraction
• nursing actions: implement safety measures; administer eye drops; elevate head of bed 30-45 degrees; positions patient on back or non-operative side; maintain eye patch as prescribed by practitioner

Question 6

cataracts

Answer 6

• post-op teaching: decrease risk factors; safety concerns; follow-up appointments; community resources; best vision is not expected until 4-6 weeks following the surgery
• first 24-48 hours after cataract surgery: do not rub or apply pressure to eye; avoid sneezing, coughing, bending over, vomiting, or lifting objects heavier than 5lbs; prevent constipation; avoid eye strain; follow provider’s instructions for eye dressing and use of eye shield at bedtime; wipe excess tearing from inner to outer canthus with a clean, soft tissue; contact the provider immediately for severe pain, visual change, or increase in eye discharge

Question 7

glaucoma

Answer 7

• increased intraocular pressure (IOP) and damage to the optic nerve leading to vision loss and possibly blindness
• increased IOP can be caused by inadequate draining or overproduction of aqueous humor
• normal range for IOP: 10-21 mmHg
• early diagnosis is key factor in minimizing or preventing visual loss

Question 8

glaucoma

Answer 8

• 5 types of glaucoma: primary open-angle; angle-closure; normal tension; secondary; pediatric
• clinical manifestations vary by type of glaucoma
• management: best prevention is regular eye exams; medication therapy
• surgeries: laser trabeculoplasty; filtering surgery; placements of drainage implants

Question 9

macular degeneration

Answer 9

• most common age-related eye disease
• gradually destroys sharp, central vision
• two forms: dry and wet
• modifiable risk factors: high blood pressure; high cholesterol; obesity; smoking; decrease in zinc blood levels
• non modifiable risk factors: age (patients over 60 are at greatest risk); family history; gender (women more likely than men); race (most common in Caucasians)

Question 10

macular degeneration

Answer 10

• dry: most common; gradual blurring of central vision > 3 phases; difficulty recognizing faces
• wet: quick loss of central vision; aka advanced macular degeneration
• treatment: dry > no form of treatment can prevent vision loss; wet > photodynamic therapy; anti-vascular endothelial growth factor therapy; laser surgery

Question 11

retinal detachment

Answer 11

• risk factors: pt’s who suffer from extreme myopic refraction disturbances; history of retinal detachment in the other eye; family history of retinal detachment; pt’s who have had cataract surgery; pt’s who have suffered eye injuries; pt’s with other eye diseases or disorders; presence of systemic diseases
• separation occurs by 3 mechanisms: rhegmatogenous; tractional; exudative
• most common and successful treatments: laser photocoagulation; panretinal photocoagulation; cryopexy; pneumatic retinopexy; scleral buckling; vitrectomy

Question 12

eye trauma

Answer 12

• visual loss related to blunt or penetrating trauma > 35% of cases, client under 17
• 5 most common risk factors: male gender; sports participation; occupation; age group 18-45; consumption of alcohol
• pathophysiology: blunt trauma may yield an injury where bleeding occurs between the cornea and iris; penetrating trauma often lack of protective eyewear
• clinical manifestations: eye pain; edema; scleral discoloration; blurred, double, and loss of vision; excessive tearing
• management: rest, eye patching, special eye drops prescribed for blunt trauma; antibiotic eye drops for penetrating eye trauma