 Introduction (Cataract)

 Anatomy and Physiology

 Eyeball is also known as the globe, is cradled and protected in a bony cup called the orbit which
is positioned anteriorly in the skull.

 Accessory structures, including the eyebrows, eyelids, eyelashes, and lacrimal apparatus, also
help to protect the eye.

 Introduction

 Functions of Accessory Structures of the eye:

 Eyebrows – help to protect the eye from direct rays of light, as well as from perspiration or
other foreign matter that may fall from the brow or forehead.

 Eyelashes – help screen the eye from dust and other foreign particles.

 Upper and Lower eyelids or palpebrae – cover the eyeball from the medial canthus to the lateral
canthus.

 Introduction

- They spread lubricating solutions over the globe, protect the eyes from excessive light and
foreign objects, cover the eyes during sleep, and keep them moist by preventing evaporation of
secretions.

 The band of connective tissue that gives form to the eyelids is called the tarsal plate.

 Meibomian glands – whose ducts open onto the margin of each eyelid.

 Introduction

- These modified sebaceous glands, secrete an oily substance that helps prevent the lids from
adhering to each other.

- The eyelids are lined with a mucous membrane called the palpebral conjuctiva.

- This membrane continues into the bulbar conjunctiva, which covers the sclera, the visible white
portion of the eye.

 Introduction

 Lacrimal apparatus – consists of the structures involved in the production and drainage of tears.

- Tears are produced by the lacrimal gland, which is located in the upper, outer aspect of each
orbit.
- Tears contain water, salts, mucus, a bactericidal enzyme called lysozyme.

- Tears clean, lubricate, and moisten the eyeball.

 Cataracts

 Introduction

 Cataract – is an opacity of the crystalline lens of the eye.

 Structure of the Eyeball

 Etiology and Pathophysiology

 The most common type of cataract is that associated with old age.

 Normally, the lens, which is composed of 65% water, 35% minerals, is clear and avascular.

 The lens also becomes yellow with age.

 This causes some colors such as blue, green, and violet to appear gray.

 Some evidence of cataracts can be seen in most patients older than 70 years.

 Cataracts can also occur when the integrity of the lens capsule is disturbed by trauma.

 Other causes of cataract formation include toxicity to chemicals and medications such as
corticosteroids, nutritional deficits, or exposure to high-voltage electricity or radiation.

 Cataracts progress more rapidly in diabetics than in nondiabetics.

 Cataract

 Clinical Manifestations

 A gradual, painless blurring of central distance vision is the chief clinical manifestation of a
cataract.

 Other symptoms include glare spots, ghostly images, double vision from light rays being split by
the opacity and falling in two places in the retina, a need for more light for reading or near work,
headaches and irritability.

 Diagnosis

 An advanced cataract can be seen as a white discoloration immediately behind the pupil when
the eye is obliquely illuminated.

 Less advanced cataracts are identified by ophthalmoscopic examination and slit-lamp

biomicroscopy.
 If cataract extraction with insertion of an intraocular lens (IOL) is planned, A-scan
ultrasonographic measurements and keratometry are performed to determine the focusing
power needed.

 Ophthalmic Microscope

 Slit-Lamp Biomicroscopy

 Intraocular Lens (IOL)

 Management

 The only method of curing vision loss as a result of cataracts is surgical removal.

 The decision to remove cataracts, and when to do so, depends on changes in the cataracts over
time in relationship to the patient’s age, health status, visual loss, and impact on activities of
daily living.

 Cataract surgery is usually performed under local anesthesia as ambulatory surgery.

 If both eyes are affected, the more opaque cataract is removed first and the second about a
month later.

 Cont.

 Cataract extraction leaves the patient aphakic (without a lens) and requires lens replacement by
an IOL implant, contact lenses, or cataract glasses.

 The IOL is invisible, permanent, and cannot be felt.

 Patient Preparation for Cataract Surgery

 Before the start of surgery, the periorbital area is injected with local anesthetic.

 The area is cleansed with an antiseptic scrubbing solution and then sterile drapes are placed.

 Procedure

 There are three types of cataract surgery:

 Extracapsular

 Intracapsular

 Phacoemulsification

 Procedure
 In extracapsular cataract extraction (ECCE), a small incision is made at the corneoscleral limbus
under the operating room microscope.

 The eye entered through the anterior chamber, and the anterior lens capsule is removed.

 The retained lens material is then irrigated from the eye and aspirated through an instrument.

 The posterior lens capsule is left in place to protect the retina and to create a supportive
structure for the lens implant.

 Cont.

 Intracapsular cataract extraction (ICCE) surgery is an older and less frequently performed
technique in which a freezing probe is introduced into the eye and affixed to the lens.

 The lens is then removed intact, so no posterior capsule remains.

 If an IOL is to be implanted, it is placed in the anterior chamber, between the cornea and the
iris, or sutured in the posterior chamber leaving the retina and vitreous less protected.

 Cont.

 Phacoemulsification a cataract procedure in which high-frequency sound waves delivered

through an ultrasonic needle inserted into the lens are used to break the cataract into fine
pieces.

 Phacoemulsification is increasingly used because a smaller incision is required, activity

restrictions are needed for a shorter period, and healing time is required.

 Cont.

 After extraction by either ECCE and ICCE procedure, the eye is sutured closed with material finer
than a human hair.

 An antibiotic is injected subconjunctivally, an ophthalmic antibiotic ointment is instilled, and an

eye patch is applied over the patient’s closed eyelid.

 A metal shield is taped in place over the eye patch.

 Complications

 Complications can occur with or after cataract surgery include; crystoid macular edema (CME)(-
is a painless disorder which affects the central retina or macula), vitreous loss, expulsive
hemorrhage, postoperative inflammation or infection, retinal detachment(is a disorder of the
eye in which the retina peels away from its underlying layer of support tissue. Initial detachment
may be localized, but without rapid treatment the entire retina may detach, leading to vision
loss and blindness. It is a medical emergency.)
 Cont.

 Glaucoma(is an eye disease in which the optic nerve is damaged in a characteristic pattern), or
endophthalmitis(is an inflammation of the internal coats of the eye).