CATARACT

Cataract is cloudy patches that develop in the lens of your eye and can cause blurred or misty vision.
The lens is the transparent structure that sits just behind your pupil (the black dot in the centre of your eye). It allows light
to get to the back of your eye (retina).
Cataracts affect nearly 20.5 million American who are 40 years of age or older or about one in six people in this age range.
By 80 year of age, more than half of all Americans have Cataracts.
Word Health Organization, cataract is the leading cause of blindness in the world (Prevent Blindness American, 2008).
Type of Cataract
Senile ( Age related) cataract
- This is by far the most common type and affects older people
- The 3 most common types of age related cataracts are defined by their location in the lens. Nuclear, cortical, and
posterior subcapsular.

Nuclear cataract is caused by central opacity in the lens and has a substantial genetic component. Associated
with myopia, which worsens when the cataract progresses.
Cortical cataract involves the anterior, posterior, or equatorial cortex of the lens.
Posterior subcapsular cataracts occurs in front of the posterior capsule. Associated with prolonged corticosteroid
use, diabetes, or ocular trauma.

Congenital Cataratcs (Present at birth)
- These are uncommon but important to diagnose early. This is because vision and seeing have to be learnt very early in
infancy. A cataract that is present at birth stops the eye from learning to see and cause blindness.
Risk Factor:
Aging
Systematic Disease and Syndromes
- Diabetes Mellitus
Physical Factors
- Blunt Trauma
- Ultraviolent radiation in sunlight and x-tray
Nutritional Factor
- Reduced levels of antioxidants
- Poor Nutrition
- Obesity
Toxic Factors
- Corticosteroid , especially at high doses and in long-term use
- Alkaline chemical eye burns, poisoning
- Cigarette Smoking
Associated Ocular Conditions
- Myopia
- Retinal detachment and retinal surgery
- Infectious
Clinical Manifestation
Painless, blurry vision is characteristic of cataracts.
Perceive that surroundings are dimmer
Light scattering
Reduced contrast sensitivity
Sensitivity to glare
Reduces visual acuity
Monocular diplopia
Brunescens (color values shift to yellow-brown)
Reduced light transmission
Prevention Measures
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract.
If you smoke, stop.
Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green
leafy vegetables, fruit, and other foods with antioxidants.
Early treatment for many eye diseases may save your sight.



Diagnostic
Snellen test: This eye chart test measures how well you see at various distances.
Ophthalmoscopy: is usually part of a routine eye test to screen for eye diseases. It looks at the back of the eye. The back of
the eye is called the fundus. It consists of the: retina,optic disc,blood vessels
Slit-lamp biomicroscopic examination: The slit-lamp examination looks at structures that are at the front of the eye
combined with a high-intensity light source that can be focused to shine in a thin beam.
Nursing Responsibilities
Wash your hands with soap and water/alcohol gel.
Introduce yourself, stating your full name and your role.
Check patients Identity
Explain the procedure and gain consent.
Position the patient sitting up and ask them to remove any glasses or contact lenses. Warn the patient that you will need to
come quite close and will also need to dim the lights.
1% tropicamide is sometimes used to dilate the pupils after examining the pupils and iris. Remember to check for a history of
glaucoma!
Check patient comfort.
Medical Management
No nonsurgical (medications, eye drops, eyeglasses) treatment cures cataracts or prevents ager elated cataracts.
Studies have found no benet from antioxidant supplements, vitamins C and E, betacarotene, and selenium.
Glasses or contact, bifocal, or magnifying lenses may improve vision. Mydriatics can be used short term, but glare is increased.
Surgical Management
Phacoemulsication
Cataract surgery is a procedure in which an ultrasonic device is used to break up and then remove a cloudy lens, or
cataract, from the eye to improve vision. The insertion of an intraocular lens (IOL) usually immediately follows
phacoemulsification.
Lens replacement (aphakic glasses, contact lenses, and intraocular lens implants).
After removal of the crystalline lens, the patient is referred to as aphakic. The lens,which focuses light on the retina, must
be replaced for the patient to see clearly.

Nursing Responsibilities:
Obtain informed consent
Administer dilating drops every 10 minutes for four doses at least 1 hour before surgery. Antibiotic, corticosteroid, and anti
inammatory drops may be administered prophylactically to prevent postoperative infection and inammation.
Withhold any anticoagulants the patient is receiving, to reduce the risk of retrobulbar hemorrhage.
Provide patient verbal and written instructions about how to protect the eye, administer medications, recognize signs of
complications, and obtain emergency care.
Explains that there should be minimal discomfort after surgery, and instruct the patient to take a mild analgesic agent, such
as acetaminophen, as needed.
Antibiotic, anti inammatory, and corticosteroid eye drops or ointments are prescribed postoperatively
Complication
Retrobulbar Hemorrhage: can result from retrobulbar infiltration of anesthetic agents if the short ciliary artery is
located by the injectia.
Rupture of the posterior capsule
Suprachoroidal haemorrhage: profuse bleeding in the suprachoroidal space
Infection is always a possible complication of surgery, and for this reason a prophylactic antibiotic drop will be
prescribed after cataract extraction.
Suture-related problems
Malposition of the IOL
Chronic endophthalmitis
Opacification of the posterior capsule

Source:Bruners and Suddart Text book