 THE EYE

 ANATOMY AND PHYSIOLOGY OF THE EYE

 THE EYE

 The eye is 1 inch in diameter.

 The eye is located in the anterior portion of the orbit.

 The orbit is the bony structure on the skull that surrounds the eye and offers protection to the
eye.

 I. PROTECTION

Eyes are protected by:

• Bony orbits and pads of fat surrounding each eye dorsally.

• Eyelids (palpebrae) and eyelashes which close over the eyes.

 I. PROTECTION

• Lacrimal apparatus – lacrimal gland and associated ducts, which produce tears that wash over
the surface of each eye, lubricating and washing off foreign particles.

• Conjunctiva – mucous membrane that lines eyelids and covers exposed sclera surface.

 II. LAYER OF THE EYE

1. EXTERNAL LAYER

2. MIDDLE LAYER

3. INTERNAL LAYER

 EXTERNAL LAYER OF THE EYE

 The external layer is the fibrous coat that supports the eye.

 The external layer contains the SCLERA (the white of the eye), which is an opaque white tissue.

 EXTERNAL LAYER OF THE EYE

 The external layer contains the CORNEA (window of the eye), which is a dense transparent
layer.

 MIDDLE LAYER OF THE EYE

 The middle layer is the second layer of the eyeball.

 The middle layer is vascular and heavily pigmented.

 The middle layer is consists of the choroid, the ciliary body, and the iris.

 MIDDLE LAYER OF THE EYE

 The CHOROID is the dark brown membrane located between the sclera and the retina.

 The choroid lines most of the sclera and is attached to the retina but can detach easily from the
sclera.

 The choroid contains many blood vessel and supplies nutrients to the retina.

 MIDDLE LAYER OF THE EYE

 The CILIARY BODY connects the choroid with the iris and secretes aqueous humor that helps
give the eye its shape.

 MIDDLE LAYER OF THE EYE

 The IRIS is the colored portion of the eye, is located in front of the lens, and has a central
circular opening called the PUPIL.

 INTERNAL LAYER OF THE EYE

 The layer consists of the retina.

 The RETINA is a thin, delicate structure in which the fibers of the optic nerve are distributed.

 The retina is bondered externally by the choroid and sclera and internally by the vitreous.

 INTERNAL LAYER OF THE EYE

 The retina contains blood vessels and photoreceptors called RODS and CONES.

 RODS AND CONES

 RODS are responsible for peripheral vision and function at reduced levels of illumination.

 Receptors for twilight vision and sensitive to dim light.

 RODS AND CONES

 CONES function at bright levels of illumination and are responsible for color vision and central
vision.

 Receptors for daylight

 III. REFRACTING MEDIA

 Cornea

 Vitreous humor

 Lens

 Aqueous humor

 VITREOUS BODY
 The vitreous body contains a gelatinous substance that occupies the vitreous chamber, which is
the space between the lens and the retina.

 The vitreous body transmits light and gives shape to the posterior eye.

 VITREOUS

 Vitreous is a jell like substance that maintains the shape of the eye.

 Vitreous provides additonal physical support to the retina.

 LENS

 The LENS is a transparent circular structure behind the iris and in front of the vitreous body.

 The lens bends rays of light so that the light falls on the retina.

 AQUEOUS HUMOR

 The AQUEOUS HUMOR is a clear watery chamber fluids that fills the anterior and posterior
chambers of the eye.

 The aqueous humor is produced by the ciliary process, and the fluid drains into the canal of
Schlemm.

 The anterior chamber lies between the cornea and the iris.

 the posterior chamber lies between the iris and the lens.

 IV. MUSCLES

 Intrinsic muscles: iris and ciliary body

 Extrinsic body: four straight (rectus) muscles and two oblique muscles

 V. NERVE SUPPLY

 Optic nerve (nerve of sight).

 Trigeminal nerve carries sensory impulses of pain, touch and temperature from eye and
surrounding structures.

 Motor nerves: oculomotor, trochlear, and abducens.

 VI. BLOOD VESSELS

 Ophthalmic artery is the major artery supplying the structures in the eye.

 Ophthalmic veins drain the blood from the eye.

 VII. SENSORY PATHWAY FOR VISION

 VIII. REFLEXES

 Light reflex: pupil becomes smaller when light is flashed in the eye.
  Accommodation: pupil becomes smaller when gaze shifts from distant to near objects.

 HOW EYES PRODUCE TEARS?

 FLOW OF AQUEOUS HUMOR

 ASSESSMENT OF VISION

 ACUITY

 Visual acuity tests measure the client’s distance and near vision.

 Snellen’s chart

SNELLEN’S CHART

 The simple chart is a simple tool to record visual acuity.

 The client stands 20 feet from the chart and covers one eye and uses the other eye to read the
line that appears most clearly.

 If the client is able to do this accurately, the clients reads the next lower line.

 This sequence is repeated until the client is unable to identify correctly more than half of the
characters on the line.

 The procedure is repeated for the other eye.

 The findings are recorded as a comparisons between what the client can read at 20 feet and the
number of feet normally required by an individual to read the same line.

 A result of 20/50 means that the client is able to read at 20 feet from the chart what a healthy
eye can read at 50 feet.

 Clients who wear corrective lenses other than for reading should have their vision tested with
the lens in place.

 CONFRONTATIONAL TEST

 The confrontational test is performed to examine visual field or peripheral vision.

 The examiner and the client sit facing each other.

 The client is asked to look directly into to the eye while the client covers his or her left eye.

 The examiner moves a finger from a nonvisible area into the client’s line of vision.

 The examiner and the client should see the object at approximately the same time.

 When the client sees the object coming into the line of vision, the client informs the examiner.

 The procedure is repeated on the opposite eye.

 The test assumes that the examiner has normal peripheral vision.
  EXTRAOCULAR MUSCLE FUNCTION

Six cardinal position of gaze:

 Client’s right (lateral position)

 Upward and right (temporal position)

 Down and right

 Client’s left (lateral position)

 Upward and left ( temporal position)

 Down and left

Extraocular muscle function

 Client hold head still and is asked to move eyes and to follow a smlal object.

 The examiner notes for any parallel movement of the eye or for nystagmus, an involuntary
rhythmic rapid twitching of the eyeballs.

 COLOR VISION

 Test of color vision involve picking numbers or letters out of a complex and colorful picture.

ISHIHARA CHART:

 The ishihara chart consists of numbers that are composed of colored dots located within a circle
of colored dots.

 Clients asked to read the numbers on the chart.

 Each eye is tested separately.

 The test is sensitive for the diagnosis of red/green blindness but not effective for dection of the
discrimination of blue.

 ISHIHARA CHART

 PUPILS

 The pupils are round and of equal size

 Increasing light causes pupillary constriction.

 Decreasing light causes pupilliary dilation.

 Constriction of both pupils is a normal response to direct light.

 The client is asked to look straight ahead while the examiner quickly brings a beam of light in
from the side and directs it onto the eye.
  The constriction of the eye is a direct response to shining of a light into that eye; constriction of
the opposite eye is known as CONSENSUAL RESPONSE.

 SCLERA AND CORNEA

 Normal sclera is white.

 A yellow to the sclera may indicate jaundice or systemic problems.

 In a dark skinned person, the sclera may normally appear yellow, pigmented dots may be
present.

 The cornea is transparent, smooth, shiny and bright.

 Cloudy areas or specks on the cornea may be the result accident or eye injury.

 OPHTHALMOSCOPY

 The ophthalmoscope is an instrument used to examine the external structures and the interior
of the eye.

 Darken the room so that the pupil will dilate.

 Hold the instrument with the right hand when examining the right eye and with the left hand
when examining the left eye.

 ophthalmoscope

 Ask the client to look straight ahead at an object on the wall.

 Approach the client’s eye from about 12 to 15 inches away and 15 degrees lateral to the client’s
line of vision.

 As the instrument is directed at the pupil, a red glare (red reflex) is seen in the pupil.

 The red reflex is the reflection of light on vascular retina.

 Absence of the red reflex may indicate opacity of the lens.

 The retina, optic disk, optic vessels, fundus, and macula can be examined.

 DIAGNOSTIC TESTS FOR THE EYE

 FLUORESCEIN ANGIOGRAPHY

 FLUORESCEIN ANGIOGRAPHY

DESCRIPTION:

 Detailed imaging and recording of ocular circulation by a series of photographs after the
administration of a dye.

PREPROCEDURE INTERVENTION:

 Assess the client for allergies and previous reactions to dyes.

  Obtain informed consent.

 A mydriatic medication, which causes pupil dilation, is instilled in the eye 1 hour before the test.

 The dye is injected into a vein of the client’s arm.

 Inform the client that the dye may cause the skin to appear yellow for several hours after the
test and is eliminated gradually through the urine.

 The client may experience nausea, vomiting, sneezing, paresthesia of the tongue, or pain at the
injection site.

 If hives appear, orally or intramuscularly administered antihistamines such as diphenhydramine

(Benadryl) are given as prescribed.

POSTPROCEDURE INTERVENTION:

 Encourage rest.

 Encourage fluid intake to assist in eliminating the dye from the client’s system.

 Remind the client that the yellow skin appearance will disappear.

 Instruct the client that the urine will appear bright green until the dye is excreted.

 Instruct the client to avoid direct sunlight for a few hours after the test.

 Instruct the client that the photophobia will continue until pupil size returns to normal.

 COMPUTED TOMOGRAPHY

 COMPUTED TOMOGRAPHY

DESCRIPTION:

 A beam of x-rays scans the skull and orbits of the ye.

 A cross sectional images is formed by the use of a computer.

 Contrast material usually is not administered.

INTERVENTION:

 No special client preparation or follow-up care is required.

 Instruct the client that he or she will be positioned in a confined space and will need to keep
their heads still during the procedure.

 SLIT LAMP

 SLIT LAMP

DESCRIPTION:
  A slit lamp allows examination of the anterior ocular structures under microscopic
magnification.

 The client leans on a chin rest to stabilize the head while a narrowed beam of light is aimed so
that it illuminates only a narrow segment of the eye.

INTERVENTION:

 Explain the procedure the to the client.

 Advice the client about the brightness of the light and the need to look forward at a point over
the examiner’s ear.

 CORNEAL STAINING

 CORNEAL STAINING

DESCRIPTION:

 A topical dye is instilled into the conjunctival sac to outline irregularities of the corneal surface
that are not easily visible.

 The eye is viewed through a blue filter, and a bright green color indicates areas of a nonintact
corneal epithelium.

INTERVENTION:

 If the client wears contact lenses, the lenses must be removed.

 The client is instructed to blink after the dye has been applied to distribute the dye evenly
across the cornea.

 TONOMETRY

 TONOMETRY

DESCRIPTION:

 The test is used primarily to assess for an increase of intraocular pressure and potential
glaucoma.

 Normal ocular pressure is 10 to 21 mm Hg.

INTERVENTION:

 Each eye is anesthetized.

 The client is asked to stare forward at a point above the examiner’s ear.

 A flattened cone is brought in contact with the cornea.

 The amount of pressure needed to flatten the cornea is measured.

 The client must be instructed to avoid rubbing the eye following the examination if the eye has
been anesthetized because the potential for scratching the cornea exists.
 GENERAL EYE CARE NURSING GUIDELINES

 GENERAL EYE CARE NURSING GUIDELINES

 Wash hands carefully before and after touching eyes. If attending both eyes always care for
the right eye first, unless it ios infected. If infected, treat the uninfected eye first to avoid
accidental cross-contamination. Prevent cross-contamination between the eyes not only by
washing and treating the uninfected eye but also by having separate equipment for use on each
eye.

 GENERAL EYE CARE NURSING GUIDELINES

 Be gentle when giving any eye care. Do not put pressure on the eyeball.

 Do not touch the eyeball, eyelashes, or lids with the tip of an eye dropper, ointment tube,
irrigating syringe, or your fingers. Never direct eye ointment or forceful streams of irrigatig
solutions onto the cornea.

 GENERAL EYE CARE NURSING GUIDELINES

 Open eyelids by pressing against the bony orbit rather than directly against the eyball.

 Keep solutions that are unsafe for eyes away from the bedside of a person with an ocular
disorder and away from areawhere ocular medications are stored.

 Assess how well partially sighted people can see and plan appropriate nursing care.

 GENERAL EYE CARE NURSING GUIDELINES

 In health care facilities, post a sign on the bed of a person with an ocular disorder, clearly stating
contraindicated activities.

 Be familiar with agencies providing services for blind and partially sighted people and with other
aspects of the rehabilitation of visually impaired people. Make appropriate referrals.

 GENERAL EYE CARE NURSING GUIDELINES

 Provide appropriate safety measures for blind and partially sighted people, including people
with eye patches (dressing).

 Always provide adequete light when performing ocular procedures. However, avoid di9rect light
unnecessarily into the person’s eye. Keep the room dimly lit if the person is photophobic.

 GENERAL EYE CARE NURSING GUIDELINES

 Use only sterile materials in the eye.

 Know abbreviations used with referen to eye. “OD” (oculus dexter), R or RE refer to right eye.
“OS” (oculus sinister), L or LE means the left eye. “OU” (oculus uterque) means both eyes.

 Clean eye lids from the inner top the outer canthus.

 GENERAL EYE CARE NURSING GUIDELINES

  Teach people self-care of their eye dressings or eye shields so that they can cope at home. Also
teach proper use of contact lenses and eyeglasses.

 Be familiar with ocular procedures, general guidelines about specific ocular medications and
product information about specific eye medications.

 GENERAL EYE CARE NURSING GUIDELINES

 Try to prevent disorientation in people who have both eyes covered or in newly blinded people.

 Identify yourself and the person to whom you are speaking when you enter the environment of
visually impaired person.

 COMMON NURSING INTERVENTION RELATED TO EYES

 COMMON NURSING INTERVENTION RELATED TO EYES

 Eversion of the eyelids – upper eyelid eversion is performed to inspect and assess the palpebral
conjunctiva.

Use the following technique:

1. Ask the person to look down.

2. Ask the person to gently close the eyelids

 COMMON NURSING INTERVENTION RELATED TO EYES

3. Grasp the eyelashes of the upper lid between thumb and forefinger. Hold an applicator stick
horizontally against the outer eyelid and push down and fold the eyelid on itself.

4. As soon as the lid is inverted, appose the fingers and hold the lashes up against the eyebrowsw.

 COMMON NURSING INTERVENTION RELATED TO EYES

 Ocular irrigation – this may be done to remove chemicals or to remove secreations.

 Cleaning eyelids

 Eye drops and ocular ointment instillation

 Warm eye compress – may be applied to clean eye, relieve pain and increase circulation. They
may reduce ocular tension and increase absorption in superficial infections and eye or eyelids
inflammation.

 COMMON NURSING INTERVENTION RELATED TO EYES

 Cold compress – are used to reduce swelling, relieve pain, relieve itchiong, prevent or control
edema and control bleediong.

 Application and care of eye patch – eye patches are applied to protect the eye from light or
injury, cover an eye deformity, eliminate double vision, limit eye movement and prevent eye
use, absorb secretion and blood and apply pressure.
 COMMON NURSING INTERVENTION RELATED TO EYES

 Artificial eyes (prostheses) – are hollow or shell-shaped plastic structures painted to match the
individual’s normal eye.

 COMMON EYE MEDICATION

 COMMON EYE MEDICATION

 LOCAL ANESTHETICS, TOPICAL OR INJECTIBLE - anesthetize the eye

 PARASYNPATHOMIMETIC DRUGS – produce effects resembling those parasympathetic nerves.

Used as miotics to control intraocular pressure in glaucoma by widening filtration angle and
permitting outflow of aqueous humor.

 COMMON EYE MEDICATION

a. Group I: CHOLINERGIC DRUGS

b. Group II: CHOLINESTERACE INHIBITORS

 PARASYMPATHOLYTICS DRUGS (anticholinergic drugs) – produce effects resembling those of

parasympathetic nerve interruption. Used to facilitate opthalmoscopic assessment and
refraction and treat inflammation.

 COMMON EYE MEDICATION

a. MYDRIATICS

b. CYCLOPLEGICS

 SYMPATHOMIMETIC DRUGS (adrenergic drugs) – produce effects similar to those of impulses

carried by adrenergic postganglionic fibers of the synpathetic nervous system. Used in
ophthalmology primarily to produce mydriasis andvasoconstriction.

 COMMON EYE MEDICATION

 DYES – various dyes are used to stain the cornea to identify corneal diaorder.

 IRRIGATING SOLUTION – used on injured eyes must be sterile and are generally for “single
person” use.

 ANTIBIOTICS – may be used locally or systematically, depending upon problem being treated.

 COMMON EYE MEDICATION

 SULFONAMIDES – most commonly used medications to treat conjunctivitis.

 ADRENAL CORTICOSTEROIDS – steroids effectively treat nonpyrogenic inflammation, allergic

reactions and severe ocular injuries.
  CARBONIC ANHYDRASE INHIBITORS – may be administered to reduce formation of aqueous
humor and thus reduce IOP.

 COMMON EYE MEDICATION

 BETA BLOCKERS – used in treatment of glaucoma.

 Other materials:

SILICONE FLUID lubricate eye socket when an artificial eye is worn.

METHYLCELLULOSE (artificial tears) – provides moisture and lubrication to eyes when

normal tear production is impaired or eyelid closure is incomplete.

 DISORDER OF THE EYE

 RISK FACTORS OF EYE DISORDERS

 Aging process

 Congenital

 Diabetes mellitus

 Hereditary

 Medications

 Trauma

 EYE SYMPTOMS AND THEIR SIGNIFICANCE

 BLURRED VISION

 CONJUNCTIVAL DISCHARGE

 DIPLOPIA (double vision): results from imbalance or paralysis of an extraocular muscle

 EXOPTHALMOS (abnormal forward displacement of the eye out of the orbit so that the eye
appears to be “bulging” forward)

 EYESTRAIN AND HEADACHE ARE COMMON

 FOREIGH BODY SENSATION

 HALOS OR RAINBOWS AROUND LIGHTS: due to corneal edema or may indicate acute glaucoma

 NAUSEA AND VOMITING: may be the presenting symptoms of acute glaucoma

 PAIN

 PHOTOPOBIA (abnormal tolerance to light)

 RETINAL HEMORRHAGE
  SCOTOMA ( blind spot or area of loss of vision within visual field): can be due to damage to
optic nerve or retina

 SPOTS OR FLOATERS OR SPOTS BEFORE THE EYES OR FLOATERS IN THE VISUAL FIELD: vitreous
opacities that are generally transient and have no significance

 SUDDEN LOSS OF VISION

 VITREOUS HEMORRHAGE

 GLAUCOMA

DESCRIPTION:

• Increase intraocular pressure results from inadequate drainage of aqueous humor from the
canal of Schlemm or overproduction of aqueous humor.

• The condition damages the optic nerve and result in blindness.

 GLAUCOMA is the second leading cause of blindness in the US

 There is an increased incidence in the elderly population

 Generally asymptomatic, especially in early stage.

 Tends to be diagnosed during routine visual exams.

 Cannot be cured but can be treated with success pharmacologically and surgically.

 TYPES OF GLAUCOMA

1. Adult primary glaucoma:

a. open angle (wide angle, chronic open angle, chronic simple) glaucoma

b. angle closure (narrow angle, closed angle, acute congestive) glaucoma

(1) Acute

(2) Chronic

2. Secondary glaucoma

3. Absolute glaucoma

 OPEN ANGLE GLAUCOMA

 This glaucoma occurs in people who appear to have normal “ope” chamber angles but have a
resistance in the flow of aqueous humor out of the chamber

 OPEN ANGLE GLAUCOMA

 The resistance maybe in the meshwork, in schlemm’s canal or in the aqueous veins.

 ANGLE CLOSURE GLAUCOMA

  There is a forward displacement of the last roll and root of the iris against the cornea.

 This narrows the chamber angle, obstructing aqueous humor outflow.

 GENERAL ASSESSMENT

ASSESSMENT:

1. Early signs include:

a. increase in intraocular pressure, >22 mmHg. (NORMAL: 11-21mmHg)

b. decreased accommodation or ability to focus.

2. Late sings include:

a. loss of peripheral vision.

b. halos around lights.

c. decreased visual acuity, not correctable with glasses.

d. headache or eye pain which may be so severe as to cause nausea and vomiting.

INTERVENTION FOR GLAUCOMA:

• Treat acute glaucoma as a medical emergency.

• Administer medications prescribed to lower intraocular pressure.

• Prepare the client for peripheral iridectomy, which allows aqueous humor to flow from the
posterior to anterior chamber.

INTERVENTIONS FOR CHRONIC GLAUCOMA:

• Instruct the client on the importance of medications (miotics) to construct the pupils, (carbonic
anhydrase inhibitors) to decrease the production of aqueous humor and intraocular pressure.

• Instruct the client on the need for lifelong medication use.

 Instruct the client to wear medic alert bracelet.

 Instruct the client to avoid anticholinergic medications.

 Instruct the client to report eye pain, halos around the eyes, and changes in vision to the
physician.

 Instruct the client that when maximal medical therapy has failed to halt the progression of visual
field loss and optic nerve damage, surgery will be recommended.

 Prepare the client for trabeculoplasty as prescribed to facilitate aqueous humor drainage.

 Prepare the client for trabeculectomy as prescribed, which allows drainage of aqueous humor
into the conjunctival spaces by the creation of an opening.
  CATARACTS

 CATARACTS

DESCRIPTION:

 A cataract is an opacity of the lens that distorts the image projected onto the retina and that can
progress to blindness.

 Causes include the aging process (senile cataracts), inherited (congenital cataracts), and injury (
traumatic cataracts), cataracts also can result from another eye disease (secondary cataracts).

 Intervention is indicated when visual acuity has been reduced to a level that the client finds to
be unacceptable or adversely affects lifestyle.

 2 MAJOR GROUPS OF CATARACTS

1. DEVELOPMENTAL CATARACTS

congenital cataracts

juvenile cataracts

 2 MAJOR GROUPS OF CATARACTS

2. DEGENERATIVE CATARACTS

age-related cataracts (common)

toxic cataracts

radiation, lighting, electric, and heat ray cataracts

 2 MAJOR GROUPS OF CATARACTS

2. DEGENERATIVE CATARACTS

traumatic cataracts

complicated cataracts

cataract associated with systemic disease

 GENERAL ASSESSMENT (CATARACTS)

ASSESSMENT:

1. Early signs include:

a. blurred vision

b. decreased color perception

 2. Late signs include:

a. diplopia

b. reduced visual acuity progressing to blindness

c. clouded pupil progressing to a milky-white appearance

INTERVENTION:

 Surgical removal of the lens, one eye at a time is performed.

 With extracapsular extraction the lens is lifted out without removing the lens capsule; the
procedure maybe performed by phacoemulsification in which the lens is broken up by sonic
vibrations and is extracted.

 With intracapsular extraction the lens is removed within its capsule through a small incision.

 A partial iridectomy may be performed with the lens extraction to prevent acute secondary
glaucoma.

 A lens implantation may be performed at the time of the surgical procedure.

PREOPERATIVE INTERVENTION:

 Instruct the client regarding the postoperative measures to prevent or decrease intraocular
pressure.

 Administer eye medications preoperatively, including mydriatics and cycloplegics as prescribed.

POSTOPERATIVE INTERVENTIONS:

 Elevate the head of the bed 30 to 45 degrees.

 Turn the client to the back or unoperative side.

 Maintain an eye patch; orient the client to environment.

 Position the client’s personal belongings to the unoperative side.

 Use side rails for safety.

 Assist with ambulation.

CLIENT EDUCATION:

 Avoid eye straining.

 Avoid rubbing or placing pressure on the eyes.

 Avoid rapid movements, straining, sneezing, coughing, bending, vomiting, or lifting objects of
more than 5 lbs.

 Take measures to prevent constipation.

  Follow instructions for dressing changes and prescribed eye drops and medications.

 Wipe excess drainage or tearing with a sterile wet cotton ball from the inner to the outward
canthus

 Use an eye shield at bedtime.

 If a lens implant is not performed, the eye cannot accommodate and glasses must be worn at all
times.

 Cataract glasses act as magnifying glasses and replace central vision only.

 Cataract glasses magnify and objects will appear closer, therefore the client needs to
accommodate, judge distance, and climb stairs carefully.

 Contact lenses provide sharp visual acuity but dexterity is needed to insert them.

 Contact the physician for any decrease in vision, severe eye pain, or increase in eye damage.

 RETINAL DETACHMENT

DESCRIPTION:

• Retinal detachment occurs when the layers of the retina separate because of the accumulation
of fluid between them, or when both retinal layer elevate away from the choroids as a result of
a tumor.

• Partial separation becomes complete if untreated.

• When detachment become complete, blindness occurs.

 GENERAL ASSESSMENT (RETINAL DETACHMENT)

ASSESSMENT:

• Flashes of light

• Floaters

• Increase in blurred vision

• Sense of curtain being drawn

• Loss of portion of the visual field

IMMEDIATE INTERVENTION:

• Provide bed rest.

• Cover both eyes with patches to prevent further detachment.

• Speak to the client before approaching.

• Position the client’s head as prescribed.

 • Protect the client from injury.

 Avoid jerky head movements.

 Minimize eye stress.

 Prepare the client for surgical procedure as prescribed.

 SURGICAL PROCEDURES:

• Draining fluid from the subretinal space so that the retina can return to the normal position.

• Sealing retinal breaks by cryosurgery, a cold probe applied to the sclera, to stimulate an
inflammatory response leading to adhesion.

• Diathermy, the use of an electrode needle and heat through the sclera, to stimulate an
inflammatory response.

• Laser therapy, to stimulate an inflammatory response to seal; small retinal tears before the
detachment occurs.

• Scleral buckling, to hold the choroid and retina together with a splint until scar tissue forms
closing the tear.

• Insertion of gas or silicone oil to encourage attachment because these agents have a specific
gravity less than vitreous or air and can float against the retina.

POSTOPERATIVE INTERVENTIONS:

• Maintain eye patches bilaterally as prescribed.

• Monitor for hemorrhage.

• Prevent nausea and vomiting and monitor for restlessness, which can cause hemorrhage.

• Monitor for sudden, sharp eye pain (notify the physician).

• Encourage deep breathing but avoid coughing.

 Provide bed rest for 1 to 2 days as prescribed.

 Position the client as prescribed.

 If gas has been inserted, position client as prescribed on the abdomen and turn the head so
unaffected eye is down.

 Administer eye medication as prescribed.

 Assist the client with activities of daily living.

 Avoid sudden head movements or anything that increases intraocular pressure.

 Instruct the client to limit reading 3 to 5 weeks.

  Instruct the client to avoid squinting, straining and constipation, lifting heavy objects, and
bending from the waist.

 Instruct the client to wear dark glasses during the day and an eye patch at night.

 Encourage follow up care because of the danger of recurrence or occurrence in the other eye.

 REFRACTION ERRORS

 HYPEROPIA (hypermetropia, “farsightedness”) – parallel rays of light focus behind the retina
when accomodative powers are relaxed. It can be corrected with a convex lens, which increases
the angle of incidence of light rays entering the cornea and lens, thus focusing the light rays on
the surface of the retina.

 REFRACTION ERRORS

 MYOPIA (“nearsightednesss”) – parallel rays of light focus in front of the retina, before reaching
the retinal surface. Typically near vision is normal but distant vision is defective. It can be
corrected with concave (minus) lens, which diverge the light rays so they can focus on the
retina.

 REFRACTION ERRORS

 PRESBYOPIA (“old sight”) – lessening the effective powers of accomodation occurs because of
hardening of the lens due to the aging process. It can be corrected with a lens that corrects any
basic refractive error and that also has a convex reading addition for close work.

 REFRACTION ERRORS

 ASTIGMATISM (“distorted vision”) – is vision that is “not in a point.” astigmatism is distorted

vision caused by variation in refractive power along different meridians of the eye. It can be
corrected with cylindric lens.

THANK YOU…