CATARACT

Definition
Cataracts are cloudy areas in the lens inside the eye - which is normally clear. Cataracts can develop in
one or both eyes. If they develop in both eyes, one will be more severely affected than the other.
No.1 disease that causes blindness

Causes
Most cataracts develop when aging or injury changes the tissue that makes up your eye's lens.Some
cataracts are related to inherited genetic disorders that cause other health problems and increase your
risk of cataracts. Cataracts can also be caused by other eye conditions, medical conditions such as
diabetes, trauma or past eye surgery. Long-term use of steroid medications, too, can cause cataracts to
develop.
Signs and symptoms
Clouded, blurred or dim vision
Increasing difficulty with vision at night
Sensitivity to light and glare
Seeing "halos" around lights
Frequent changes in eyeglass or contact lens prescription
Fading or yellowing of colors
Double vision in a single eye

Risk Factors
Increasing age
Diabetes
Drinking excessive amounts of alcohol
Excessive exposure to sunlight
Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy
Family history of cataracts
High blood pressure
Obesity
Previous eye injury or inflammation
Previous eye surgery
Prolonged use of corticosteroid medications
Smoking

Pathophysiology
The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens
focuses light that passes into your eye, producing clear, sharp images on the retina the light-sensitive
membrane on the back inside wall of your eyeball that functions like the film of a camera.
A cataract scatters the light as it passes through the lens, preventing a sharply defined image from
reaching your retina. As a result, your vision becomes blurred.
As you age, the lenses in your eyes become less flexible, less transparent and thicker. Age-related changes
cause tissues within the lens to break down and clump together, clouding small areas within the lens. As
the cataract continues to develop, the clouding becomes denser and involves a greater part of the lens.
Cataracts may develop in only one eye, but they usually develop in both of your eyes. However, the
cataracts usually aren't totally symmetrical, and the cataract in one eye may be more advanced than the
other.

Diagnosis
An eye exam will be given to test how well you can see (remember to bring your glasses or wear your
contacts to the appointment). Your doctor will also dilate your pupil in order to examine the condition of the lens
and other parts of the eye.

Management
Cataract removal can be performed at any stage and no longer requires ripening of the lens. Surgery is
usually 'outpatient' and performed using local anesthesia. Approximately 90% of patients can achieve a corrected
vision of 20/40 or better after surgery. Phacoemulsification is the most widely used cataract surgery today. This
procedure uses ultrasonic energy (U/S) to emulsify the cataract lens. Extracapsular cataract extraction (ECCE),
consists of removing the lens manually, but leaving the majority of the capsule intact. The lens is expressed
through a 1012 mm incision which is closed with sutures at the end of surgery. Extracapsular extraction is less
frequently performed than phacoemulsification but can be useful when dealing with very hard cataracts or other
situations where emulsification is problematic. Manual small incision cataract surgery (MSICS) has evolved from
extracapsular cataract extraction. In MSICS, the lens is removed through a self-sealing scleral tunnel wound in the
sclera which, ideally, is watertight and does not require suturing. Although "small", the incision is still markedly
larger than the portal in phacoemulsion. This surgery is increasingly popular in the developing world where access
to phacoemulsification is still limited.Intracapsular cataract extraction (ICCE) is rarely performed. The lens and
surrounding capsule are removed in one piece through a large incision while pressure is applied to the vitreous
membrane. The surgery has a high rate of complications.

Medications
A small number of adults and children with cataracts may benefit for a short time from eyedrops that
widen (dilate) the pupil. These eyedrops increase the amount of light getting into the eye. They are sometimes
used to help prevent vision loss in very young children who need to wait for surgery to be done

Nursing interventions
Anxiety related to possible vision loss

1. Protect clients from harm
Construct the therapeutic relationship: first thank his will and give clients the support of the fight.
Recommend the reality of pain-related coping mechanisms Do not focus on phobias, rituals or physical complaints.
Feedback on: the behavior of stress, assessment of stressors and coping resources
Reinforce the idea that physical health Dealing with emotional health.
Then begin to limit maladaptive behavior by supporting clients.

2. Environmental modifications that can reduce anxiety
Perform a calm manner to the client.
Reduce the environmental stimulation.
Limit patient interaction with others, to minimize the spread of anxiety in others.
Identification and modification of situations that affect anxiety.
Provide measures to support the physical, such as a warm bath, massage.

3. Encourage clients to do the activities that have been scheduled
Support clients to share their activities with activities such as cleaning the room, then take care garden
reinforcement given socially productive behavior.
Give some kind of physical exercise such as gymnastics, relaxation.
Together with the client to create a schedule of activities.
Involve the family or other support systems that allow.

4. Collaboration for the administration of antianxiety drugs to reduce the symptoms of severe anxiety.
Collaboration of antianxiety drugs,
Observe the side effects of drugs.


GLAUCOMA
Definition
No.2 disease that causes blindness
is a term describing a group of ocular disorders with multi-factorial etiology united by a clinically
characteristic intraocular pressure-associated optic neuropathy
Causes
There are four major types of glaucoma:
Open-angle (chronic) glaucoma
Angle-closure (acute) glaucoma
Congenital glaucoma
Secondary glaucoma
The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind
the colored part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the
anterior chamber angle, or simply the angle.
Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This
pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to
the optic nerve.
Open-angle (chronic) glaucoma is the most common type of glaucoma.
The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the
optic nerve.
Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with
open-angle glaucoma. People of African descent are at particularly high risk for this disease.
Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a
quick, severe, and painful rise in the pressure in the eye.
Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which
painlessly and slowly damages vision.
If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your
doctor is likely to recommend preventive treatment.
Dilating eye drops and certain medications may trigger an acute glaucoma attack.
Congenital glaucoma is seen in babies. It often runs in families (is inherited).
It is present at birth.
It is caused by abnormal eye development.
Secondary glaucoma is caused by:
Drugs such as corticosteroids
Eye diseases such as uveitis
Systemic diseases
Trauma.
Signs and symptoms
OPEN-ANGLE GLAUCOMA
Most people have no symptoms
Once vision loss occurs, the damage is already severe
There is a slow loss of side (peripheral) vision (also called tunnel vision)
Advanced glaucoma can lead to blindness
ANGLE-CLOSURE GLAUCOMA
Symptoms may come and go at first, or steadily become worse
Sudden, severe pain in one eye
Decreased or cloudy vision, often called "steamy" vision
Nausea and vomiting
Rainbow-like halos around lights
Red eye
Eye feels swollen
CONGENITAL GLAUCOMA
Symptoms are usually noticed when the child is a few months old
Cloudiness of the front of the eye
Enlargement of one eye or both eyes
Red eye
Sensitivity to light
Tearing

Risk Factors
Elevated internal eye pressure (intraocular pressure). If your internal eye pressure (intraocular pressure) is
higher than normal, you're at increased risk of developing glaucoma, though not everyone with elevated
intraocular pressure develops the disease.
Age. You're at a higher risk of glaucoma if you're older than age 60, particularly if you're Mexican-
American. You may be at higher risk of angle-closure glaucoma if you're older than age 40. For certain
groups such as African-Americans, however, the risk of developing glaucoma is much higher and occurs at
a younger age than that of other groups. If you're African-American, ask your doctor when you should
start having regular comprehensive eye exams.
Ethnic background. African-Americans older than age 40 have much higher risk of developing glaucoma
than do whites (Caucasians). African-Americans also are more likely to experience permanent blindness as
a result of glaucoma. People of Asian descent have an increased risk of developing acute angle-closure
glaucoma. People of Japanese descent may be more likely to have normal-tension glaucoma.
Family history of glaucoma. If you have a family history of glaucoma, you have a greater risk of developing
it. Glaucoma may have a genetic link, meaning there's a defect in one or more genes that may cause
certain individuals to be more susceptible to the disease. A form of juvenile open-angle glaucoma has
been clearly linked to genetic abnormalities.
Medical conditions. Several conditions may increase your risk of developing glaucoma, including diabetes,
heart diseases, high blood pressure and hypothyroidism.
Other eye conditions. Severe eye injuries can cause increased eye pressure. Other eye conditions that
could cause increased risk of glaucoma include eye tumors, retinal detachment, eye inflammation and
lens dislocation. Certain types of eye surgery also may trigger glaucoma. Also, being nearsighted or
farsighted may increase your risk of developing glaucoma.
Long-term corticosteroid use. Using corticosteroid medications, especially eyedrops for a long period of
time may increase your risk of developing secondary glaucoma

Pathophysiology
The exact pathophysiology contributing to this is not fully understood. It is believed that the raised
pressure on the retina causes the cells and nerve ganglions in the sensitive retina to die off
(retinal ganglion apoptosis) and in addition the small blood vessels of the retina are also compressed
depriving it of nutrients. This results in a clinically progressive loss of peripheral visual field and ultimately
vision.

Diagnosis
A complete eye exam is needed to diagnose glaucoma. You may be given eye drop to widen (dilate) your
pupil. The eye doctor can look at the inside of the eye when the pupil is dilated.
A test called (tonometry) is done to check eye pressure. However, eye pressure always changes. Eye
pressure can be normal in some people with glaucoma. This is called normal-tension glaucoma. Your
doctor will need to run other tests to confirm glaucoma.
Some of the tests your doctor may do can include:
Using a special lens to look at the eye (gonioscopy)
Photographs or laser scanning images of the inside of the eye (optic nerve imaging)
Examination of the retina in the back of the eye
Slit lamp examination
Visual acuity
Visual field measurement

Management
The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that you
have.
If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most
people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than
those used in the past. You may also be given pills to lower pressure in the eye.
Other treatments may involve:
Laser therapy called an iridotomy
Eye surgery if other treatments do not work
Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. If you have
angle-closure glaucoma, you will receive:
Eye drops
Medicines to lower eye pressure, given by mouth and through a vein (by IV)
Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new
pathway in the colored part of the eye. This relieves pressure and prevents another attack.
Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the
patient is asleep and feels no pain.

Medications
Intraocular pressure can be lowered with medication, usually eye drops. Several different classes of
medications are used to treat glaucoma, with several different medications in each class.
Prostaglandin analogs, such as latanoprost (Xalatan), bimatoprost (Lumigan) and travoprost (Travatan), increase
uveoscleral outflow of aqueous humor. Bimatoprost also increases trabecular outflow.
Topical beta-adrenergic receptor antagonists, such as timolol, levobunolol (Betagan), and betaxolol, decrease
aqueous humor production by the ciliary body.
Alpha2-adrenergic agonists, such as brimonidine (Alphagan) and apraclonidine, work by a dual mechanism,
decreasing aqueous humor production and increasing uveoscleral outflow.
Miotic agents (parasympathomimetics), such as pilocarpine, work by contraction of the ciliary muscle,
opening the trabecular meshwork and allowing increased outflow of the aqueous humour. Echothiophate, an
acetylcholinesterase inhibitor, is used in chronic glaucoma.
Carbonic anhydrase inhibitors, such as dorzolamide (Trusopt), brinzolamide (Azopt),
and acetazolamide (Diamox), lower secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary
body.
Physostigmine is also used to treat glaucoma.
Marijuana to reduce pressure in the eyes

Nursing interventions
Disturbed sensory perception related visual impairment

Encourage expression of feelings about loss/possibility of loss of vision.

Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging
furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night
vision

Demonstrate administration of eye drops, e.g., counting drops, adhering to schedule, not missing doses.

Assist with administration of medications as indicated

Edding, Sairileen D.
BSN 3D