AN EYE SAVED IS AN EYE GAINED

VISUAL DISORDER REPORT

GROUP MEMBERS: BSN 3C
1. Catubuan, Francin Marie 2. Ismael, Ma. Krizia Sharette 3. Jaena, Jesahlee 4. Marfil, Ma. Romela Nicolasa 5. Mestosamente, Liezel 6. Morit, Caryl 7. Octavio, Adrian Paul 8. Parra, Karissa 9. Parra, Nicole 10. Tirador, Florante Jim Acanto

Presented to:

Jerry V. Able, RN, MAN

NCM 104 Lecturer

ANATOMY AND PHYSIOLOGY (see the attached video)

Parts of the Eye

Eye structure

Anterior Segment y y y y y y y Conjunctiva Cornea Anterior Sclera Aqueous Humor Irish Lens Anterior and Posterior Chambers

Posterior Segment y y y y y Vitreous Retina Choroid Posterior Sclera Optic Nerve

EXTERNAL STRUCTURES OF THE EYE EYELIDS (PALPEBRAL) & EYELASHES Protect the eye from foreign particles

CONJUNCTIVA a) PALPEBRAL CONJUNCTIVA Pink; lines inner surface of eyelids

b) BULBAR CONJUNTIVA White with small blood vessels, covers anterior sclera

LACRIMAL APPARATUS (LACRIMAL GLAND & ITS DUCTS AND PASSAGES) Produces tears to lubricate the eye & moisten the cornea Tears drain into nasolacrimal duct which empties into nasal cavity

INTERNAL STRUCTURES OF THE EYE 1. EYEBALL THREE LAYERS OF THE EYEBALL A. OUTER LAYER - fibrous coat that supports the eye 1. SCLERAE - Tough, white connective tissue white of the eye - located anteriorly & posteriorly 2. CORNEA - Transparent tissue through which light enters the eye. - Located anteriorly B. MIDDLE LAYER - second layer of the eyeball

- vascular & highly pigmented A. CHOROID - a dark brown membrane located between the sclera & the retina - lines most of the sclera & is attached to the retina but can easily detach from the sclera - contains blood vessels that nourishes the retina - located posteriorly B. CILIARY BODY - connects the choroid with the iris - secretes aqueous humor that helps give the eye its shape C. IRIS - the colored portion of the eye - located in front of the lens - it has a central opening called the pupil INTERNAL STRUCTURES OF THE EYE C. INNER LAYER (RETINA) - a thin, delicate structure in which the fibers of the optic nerve are distributed - bordered externally by the choroid & sclera and internally by the vitreous - contains blood vessels & photoreceptors (cones & rods) - light sensitive layer CONTAINS THE FOLLOWING STRUCTURES 1. CONES - Specialized for fine discrimination, central vision & color vision - Functions at bright levels of illumination 2. RODS

- More sensitive to light than cones - Aid in peripheral vision - Functions at reduced levels of illumination

FLUIDS OF THE EYE A. AQUEOUS HUMOR - Clear, watery fluid that fills the anterior & posterior chambers of the eye - produced by the ciliary processes, & the fluid drains in the Canal of Sclemm - The anterior chamber lies between the cornea & iris - the posterior chamber lies between the iris & lens - serves as refracting medium & provides nutrients to lens & cornea - contributes to maintenance of IOP B. VITREOUS HUMOR - Clear, gelatinous/jell-like material that fill the posterior cavity of the eye - Maintains the form & shape of the eye - Provides additional physical support to the eye - It is produced by the vitreous body 3. VITREOUS BODY - contains a gelatinous substance that occupies the vitreous chamber which is the space between the lens & retina. - transmits light & gives shape to the posterior eye 4. OPTIC DISK - a creamy pink to white depressed area in the retina

- the optic nerve enters & exits the eyeball in this area - Referred to as the BLIND SPOT - contains only nerve fibers - lack photoreceptors - insensitive to light 5. MACULA LUTEA - Small, oval, yellowish pink area located lateral & temporal to the optic disk - the central depressed part of the macula is the FOVEA CENTRALIS which is an area where acute vision occurs. 6. CANAL OF SCHLEMM - a passageway that extends completely around the eye - permits fluid to drain out of the eye into the systemic circulation so that a constant IOP is maintained 7. LENS - A transparent circular structure behind the iris & in front of the vitreous body - Bends rays of light so that the light falls on the retina 8. PUPILS - Control the amount of light that enters the eye & reaches the retina - Darkness produces dilation while light produces constriction

EYE MUSCLES
- Muscles do not work independently but work in conjunction with the muscle that produces the opposite movement A. RECTUS MUSCLES - Exert their pull when the eye turns temporarily

B. OBLIQUE MUSCLES - Exert their pull when the eye turns nasally

10. NERVES

A. CRANIAL NERVE II - Optic nerve (nerve of sight) B. CRANIAL NERVE III - Oculomotor C. CRANIAL NERVE IV - Trochlear D. CRANIAL NERVE VI - Abducens

11. BLOOD VESSELS A. OPTHALMIC ARTERY

- Major artery supplying the structures in the eye B. OPTHALMIC VEINS - Venous drainage occurs through vision

Eye Accommodation

ASSESSMENT OF VISION (see attached video) VISUAL ACUITY TEST

- measures the client s distance & near vision

SNELLEN CHART
- simple tool to record visual acuity - the client stands 20 ft from the chart & covers 1 eye and uses the other eye to read the line that appears more clearly - this procedure is repeated for the other eye - the findings are recorded as a comparison between what the client can read at 20 ft and the no. of feet normally required by an individual to read the same line EXAMPLE: 20/50 - The client is able to read at 20 ft from the chart what a healthy eye can read at 50 ft.

CONFRONTATIONAL TEST

- Performed to examine visual fields or peripheral vision - The examiner & the client sit facing each other - The test assumes that the examiner has normal peripheral vision EXTRAOCULAR MUSCLE FUNCTION - tests muscle function of the eyes - tests 6 cardinal positions of gaze 1. Client s right (lateral position) 2. Upward & right (temporal position) 3. Down & right 4. Client s left (lateral position) 5. Upward & left (temporal position) 6. Down & left - client holds head still & asked to move eyes & follow a small object - the examiner looks for any parallel movements of the eye or for nystagmus - an involuntary rhythmic rapid twitching of the eyeballs COLOR VISION TEST - Tests for color vision which involve picking nos. or letters out of a complex & colorful picture ISHIHARA CHART - consists of nos. that are composed of colored dots located within a circle of colored dots - client is asked to read the nos. on the chart - each eye is tested separately - the test is sensitive for the diagnosis of red/green blindness but not effective for the detection of the discrimination of blue

PUPILS - Normal: round & of equal size - Increasing light causes pupillary constriction Decreasing light causes pupillary dilation - the client is asked to look straight ahead while the examiner quickly brings a beam of light ( penlight) in from the side & directs it onto the side - Constriction of the eye is a direct response to the light shining into the eye; constriction of the opposite eye is known as CONSENSUAL RESPONSE

DIAGNOSTIC TESTS FOR THE EYE

FLUORESCEIN ANGIOGRAPHY - detailed imaging & recording of ocular circulation by a series of photographs after administration of the dye PRE-OP NURSING CARE Assess for allergies & previous reactions to dyes Obtain informed consent A mydriatic medication is instilled in the eye 1 hr. before the test The dye is injected into the vein of the client s arm Inform client that the dye may cause the skin to appear yellow for several hrs. after the test & this is gradually eliminated through the urine The client may experience N&V, sneezing, paresthesia of the tongue or pain at the injection site If hives appear, oral or IM antihistamines such as Diphenhydramine (Benadryl) are given as prescribed.

COMPUTED TOMOGRAPHY - a beam of x-ray scans the skull & orbits of the eye - a cross-sectional image is formed by the use of a computer - contrast material is not usually administered NURSING CARE No special client preparation or follow-up care required Instruct the client that he or she will be positioned in a confined space & need to keep the head still during the procedure.

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 narrow beam of light is aimed so that it illuminates only a narrow segment of the eye.

NURSING CARE Explain the procedure to the client. Advise the client about the brightness of the light & the need to look forward at the point over the examiner s ear

CORNEAL STAINING - installation of a topical dye into the conjunctival sac to outline the 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 nonintact corneal epithelium

NURSING CARE If a client wears contact lenses, they must be removed The client is instructed to blink after the dye has been applied to distribute the dye evenly across the cornea

TONOMETRY - the test is primarily used to assess for an increase in IOP and potential glaucoma - NORMAL IOP: 8-21 mm Hg NURSING CARE 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 cone is measured The client is instructed to avoid rubbing the eye following the examination if the eye has been anesthetized - the potential for scratching the cornea exists

ASSESSMENT : SUBJECTIVE DATA

Nursing History:
Pain pain in the eye, although not a common complaint, can be an important symptom that should be evaluated and treated if pain does not improve. Photophobia - painful oversensitivity to light. Blurred vision lack of sharpness of vision with, as a result, the inability to see fine detail. Spots, floaters- Eye floaters are those tiny spots, specks, flecks and "cobwebs" that drift aimlessly around in your field of vision. Dryness- Dry eye syndrome is a chronic lack of sufficient lubrication and moisture on the surface of the eye.

Diplopia - commonly known as double vision, is the simultaneous perception of two images of a single object. Ptosis- drooping of eyelid: a drooping of the upper or lower eyelid, resulting from muscle weakness or an inability to move muscles The drooping may be worse after being awake longer, when the individual's muscles are tired. This condition is sometimes called "lazy eye", but that term normally refers to amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia orastigmatism.

Exophthalmos (also called exophthalmia or proptosis) - is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor). Proptosis - projection of bodily organ: the forward displacement or protrusion of an organ of the body, especially an eyeball Vision loss or visual loss - is the absence of vision where it existed before, which can happen either acutely (i.e. abruptly) or chronically (i.e. over a long period of time). Blindnes - total or partial inability to see because of disease or disorder of the eye, optic nerve, or brain. The term blindness typically refers to vision loss that is not correctable with eyeglasses or contact lenses.

Paris as seen with full visual fields

Paris as seen with bitemporal hemianopsia

Paris as seen with binasal hemianopsia

Paris as seen with left homonymous hemianopsia

Paris as seen with right homonymous hemianopsia

Hyperopia - ls known as farsightedness, longsightedness or hypermetropia, is a defect

of vision caused by an imperfection in the eye (often when the eyeball is too short or the lens cannot become round enough), causing difficulty focusing on near objects, and in extreme cases causing a sufferer to be unable to focus on objects at any distance . As an object moves toward the eye, the eye must increase its optical power to keep the image in focus on the retina. If the power of the cornea and lens is insufficient, as in hyperopia, the image will appear blurred.

Myopia - "nearsightedness" "shortsightedness is a refractive defect of the eye in which collimated light produces image focus in front of the retina when accommodation is relaxed. Eye care professionals most commonly correct myopia through the use of corrective lenses, such as glasses or contact lenses. It may also be corrected by refractive surgery, but this does have many risks and side effects. The corrective lenses have a negative optical power which compensates for the excessive positive diopters of the myopic eye.

Astigmatism is a very common condition of poor eyesight that is characterized bythe cornea of the eye becoming oval or football-shaped, rather than round, which isnormal and required for good eyesight. The word astigmatism itself come from the Greek a, meaning "without," and stigma, meaning "point". In cases of astigmatism, light rays do not form a single point of focus as they enter the eye, causing the eye to focus on two points instead of one.

Presbyopia - is a condition where the eye exhibits a progressively diminished ability to focus on near objects with age. Presbyopia's exact mechanisms are not known with certainty; the research evidence most strongly supports a loss of elasticity of the crystalline lens, although changes in the lens's curvature from continual growth and loss of power of the ciliary muscles (the muscles that bend and straighten the lens) have also been postulated as its cause. Like gray hair and wrinkles, presbyopia is a symptom caused by the natural course of aging. The first signs of presbyopia--eyestrain, difficulty seeing in dim light, problems focusing on small objects and/or fine print--are usually first noticed between the ages of 40-50.

Aphakia - is the absence of the lens of the eye, due to surgical removal, a perforating wound or ulcer, or congenital anomaly. It causes a loss of accommodation, hyperopia, and a deep anterior chamber. Complications include detachment of the vitreous or retina, and glaucoma.

Treatment Aphakia could be corrected by wearing glasses, contact lenses or by implant of an artificial lens (pseudophakia). Hordeolum An external stye is an infection of the sebaceous glands of Zeis at the base of the eyelashes, or an infection of the apocrine sweat glands of Moll. External styes form on the outside of the lids and can be seen as small red bumps. Internal styes are infections of the meibomian sebaceous glands lining the inside of the eyelids. They also cause a red bump underneath the lid with only generalized redness and swelling visible on the outside. Styes are similar to chalazia, but tend to be of smaller size and are more painful and usually produce no lasting damage. Styes are characterized by an acute onset and usually short in duration (7 10 days without treatment) compared to chalazia that are chronic and usually do not resolve without intervention.

Uveitis inflammation of the uveal tract and can affect the iris, the ciliary body of the choroid. Retinopathy a long term complication of diabetes in which the microvascular system of the eye is damaged. Conjunctivitis inflammation of the conjunctiva, characterized by a pink appearancebecause of subconjunctival blood vessel congestion. Bacterial keratitis infection of the cornea by staphylococcus aureus, staphylococcus pneumonia and pseudomonas aeuruginosus Strabismus condition in which there is deviation from perfect ocular alignment.

EYE DISORDERS
Risk factors of eye disorders  AGING PROCESS  CONGENITAL  DIABETES MELLITUS  HEREDITARY  MEDICATIONS  TRAUMA

(SEE ATTACHED VIDEO)

LEGALLY BLIND
- a person is legally blind if the best visual acuity with corrective lenses in the better eye is 20/200 or less or a visual field of 20 degrees or less in the better eye. NURSING CARE When speaking to a client who has limited sight or blind, the nurse uses a normal tone of voice Alert the client when approaching Orient the client to the environment Use a focal point & provide further orientation to the environment from the focal point Allow the client to touch objects in the room Use the clock placement of foods on the meal tray to orient the client Promote independence as much as possible Provide radios, TVs, & clocks that give the time orally or provide a Braille watch. When ambulating, allow the client to grasp the nurse s arm at the elbow - the nurse keeps his or her arm close to the body so that the client can detect the direction of movement Instruct the client to remain one step behind the nurse when ambulating Instruct the client in the use of the cane used for the blind client, which is differentiated from other canes by its straight shape & white color with red tip

Instruct the client that the cane is held in the dominant hand several inches off the floor Instruct the client that the cane sweeps the ground where the client s foot will be placed next to determine the presence of obstacles.

CATARACTS
- an opacity of the lens that distorts the image projected onto the retina & that can progress to blindness - Intervention is indicated when visual acuity has been reduced to a level that the client finds to be unacceptable or adversely affecting lifestyle CAUSES  Aging process (Senile cataracts)  Inherited (Congenital cataracts)  Injury (Traumatic cataracts)  Can occur as a result of another eye disease (Secondary cataracts) ASSESSMENT  Opaque or cloudy white pupil  Gradual loss of vision  Blurred vision  Decreased color perception  Vision that is better in dim light with pupil dilation  Photophobia  Absence of red reflex MEDICAL MANAGEMENT - surgical removal of the lens, one eye at a time - a lens implantation may be performed at the time of surgical procedure

EXTRACAPSULAR EXTRACTION

- the lens is lifted out without removing the lens capsule - may be performed with Phacoemulsion PHACOEMULSION - the lens is broken up by ultrasonic vibrations & extracted INTRACAPSULAR EXTRACTION

- the lens is removed within its capsule through a small incision PARTIAL IRIDECTOMY

- may be performed with lens extraction to prevent acute secondary glaucoma

PRE-OP NURSING CARE Instruct measures to prevent or decrease IOP Administer pre-op eye medications including mydriatics & cycloplegics as prescribed

POST-OP NURSING CARE Elevate the head of the bed 30-45 degrees Turn the client to the back or un-operative side Maintain an eye patch & orient the client to the environment Position the client s personal belongings on the un-operative side Use side rails for safety Assist with ambulation

CLIENT EDUCATION AFTER CATARACT SURGERY Avoid eye straining Avoid rubbing or placing pressure on the eyes

Avoid rapid movements, straining, sneezing, coughing, bending, vomiting, or lifting objects over 5 lbs Teach measures to prevent constipation 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 an eye implant is not performed, the eye cannot accommodate & glasses must be worn at all times Cataract glasses act as magnifying glasses & replace central vision only Cataract glasses magnify, & objects appear closer therefore teach client to judge distance & climb stairs carefully Contact lenses provide sharp visual acuity but dexterity is needed to insert them Contact the MD for any decrease in vision, severe eye pain or increase in eye discharge

GLAUCOMA
- increased IOP as a result of inadequate drainage of aqueous humor from the canal of Schlemm or over production of aqueous humor - the condition damages the optic nerve & can result in blindness TYPES : ACUTE CLOSED-ANGLE/NARROW ANGLE GLAUCOMA - results from obstruction to outflow to aqueous humor CHRONIC CLOSED-ANGLE GLAUCOMA - follows an untreated attack of acute close-angled glaucoma CHRONIC OPEN-ANGLE GLAUCOMA - results from an overproduction or obstruction to the outflow of aqueous humor ACUTE GLAUCOMA - a rapid onset of IOP > 50-70 mm Hg

CHRONIC GLAUCOMA - a slow, progressive, gradual onset of IOP > 30-50 mm Hg

ASSESSMENT  Progressive loss of peripheral vision followed by a loss of central vision  Elevated IOP (Normal pressure is 10-21 mm Hg)  Vision worsening in the evening with difficulty adjusting to dark rooms  Blurred vision  Halos around white lights  Frontal headaches  Photophobia  Increased lacrimation Progressive loss of central vision

NURSING CARE FOR ACUTE GLAUCOMA

Treat as medical emergency Administer medications as prescribed to lower IOP Prepare the client for peripheral iridectomy - allows aqueous humor to flow from the posterior to anterior chamber

NURSING CARE FOR CHRONIC GLAUCOMA Instruct the client the importance of medications

a. MIOTICS: to constrict the pupils b. CARBONIC ANHYDRASE INHIBITORS: to decrease the production of aqueous humor c. BETA-BLOCKERS: to decrease the production of aqueous humor & IOP Instruct the client the need for life-long medication use Instruct the client to wear a Medic-Alert bracelet

NURSING CARE FOR CHRONIC GLAUCOMA Instruct the client to avoid anti-cholinergic medications Instruct the client to report eye pain, halos around eyes & changes of vision to the physician Instruct the client that when maximal medical therapy has failed to halt the progression of visual field loss & optic nerve damage, surgery will be recommended Prepare the client for TRABECULOPLASTY as prescribed - to facilitate aqueous humor drainage Prepare client for TRABECULECTOMY as prescribed - allows drainage of aqueous humor into the conjuctival spaces by the creation of an opening.

RETINAL DETACHEMENT
- occurs when the layers of the retina separate because of accumulation of fluid between them - also occurs when both retinal layers elevate away from the choroid as a result of a tumor

TYPES PARTIAL RETINAL DETACHMENT - becomes complete if left untreated

COMPLETE RETINAL DETACHMENT - when detachment is complete, blindness may occur ASSESSMENT  Flashes of light  Floaters  Increase in blurred vision  Sense of curtain being drawn  Loss of a portion of the visual field

IMMEDIATE NURSING CARE Provide bedrest 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

MEDICAL MANAGEMENT
- 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 adhesions

DIATHERMY - the use of electrode needle & heat through the sclera to stimulate an inflammatory response leading to adhesions

LASER THERAPY

- to stimulate an inflammatory response to seal small retinal tears before the detachment occurs SCLERAL BUCKLING - to hold the choroid & retina together with a splint until scar tissue forms closing the tear INSERTION OF A GAS OR SILICONE OIL

- to encourage attachment because these agents have a specific gravity less than vitreous or air & can float against the retina. POST-OP NURSING CARE Maintain eye patches bilaterally as prescribed Monitor hemorrhage as prescribed Prevent N&V and monitor for restlessness which can cause hemorrhage Monitor for sudden, sharp eye pain (notify the MD stat) Encourage DBE but avoid coughing Provide bedrest for 1-2 days as prescribed If gas has been inserted, position as prescribed on the abdomen & turn the head so unaffected eye is down Administer eye medications as prescribed Assist client with ADL Avoid sudden head movements or anything that increases IOP Instruct the client to limit reading for 3-5 weeks Instruct client to avoid squinting, straining & constipation, lifting heavy objects & bending from the waist

Instruct the client to wear dark glasses during the day & an eye patch at night Encourage follow-up care because of the danger of recurrence or occurrence in the other eye

STRABISMUS
- called SQUINT EYE or LAZY EYE - a condition in which the eyes are not aligned because of lack of muscle coordination of the extraocular muscles - most often results from muscle imbalance or paralysis of extraocular muscles, but may also result from conditions such as brain tumor, myasthenia gravis or infection - normal in young infant but should not be present after about age 4 months ASSESSMENT  Amblyopia if not treated early  Permanent loss of vision if not treated early  Loss of binocular vision  Impairment of depth perception  Frequent headaches  Squints or tilts head to see NURSING CARE Corrective lenses as indicated Instruct the parents regarding patching (occlusion therapy) of the good eye - to strengthen the weak eye Prepare for botulinum toxin (Botox) injection into the eye muscle - produces temporary paralysis - allows muscles opposite the paralyzed muscle to strengthen the eye

Inform the parents that the injection of botulinum toxin wears off in about 2 months & if successful, correction will occur Prepare for surgery to realign the weak muscles as Rx if nonsurgical interventions are unsuccessful instruct the need for follow-up visits.

CONJUNCTIVITIS
- also known as PINK EYE - inflammation of the conjunctiva - usually caused by allergy, infection, or trauma TYPES BACTERIAL OR VIRAL CONJUNCTIVITIS - extremely contagious CHLAMYDIAL CONJUNCTIVITIS - is rare in older children & if diagnosed in a child who is not sexually active, the child should be assessed for possible sexual abuse ASSESSMENT  Itching, burning or scratchy eyelids  Redness  Edema  Discharge NURSING CARE Instruct in infection control measures such as good hand washing & not sharing towels & washcloths Administer antibiotic or antiviral eye drops or ointment as Rx if infection is present Administer antihistamines as Rx if an allergy is present

Instruct the parents that the child should be kept home from school or day care until antibiotic eye drops have been administered for 24 hrs Instruct in the use of cool compresses to lessen irritation & in wearing dark glasses for photophobia Instruct the child to avoid rubbing the eye to prevent injury D/C use of contact lenses & to obtain new lenses to eliminate the chance of re-infection Instruct the adolescent that eye make-up should be discarded & replaced

HYPHEMA
- the presence of blood in the anterior chamber - occurs as a result of injury - condition usually resolves in 5-7 days NURSING CARE Encourage rest in semi-Fowler s position Avoid sudden eye movements for 3-5 days to decrease bleeding Administer cycloplegic eye drops as prescribed - to place the eye at rest Instruct in the use of eye shields or eye patches as prescribed Instruct the client to restrict reading & watching TV

CONTUSIONS
- bleeding into the soft tissue as a result of an injury - causes a black eye & the discoloration disappears in approximately 10 days - pain, photophobia, edema & diplopia may occur

NURSING CARE Place ice on the eye immediately Instruct the client to receive an eye examination

FOREIGN BODIES
- an object such as dust that enters the eye NURSING CARE Have the client look upward, expose the lower lid, wet a cotton - tipped applicator with sterile NSS & gently twist the swab over the particle & remove it If the particle cannot be seen, have the client look downward, place a cotton applicator horizontally on the outer surface of the upper eye lid, grasp the lashes, & pull the upper lid outward & over the cotton applicator, if the particle is seen, gently twist over it to remove.

PENETRATING OBJECTS
- an injury that occurs to the eye in which an object penetrates the eye NURSING CARE Never remove the object because it may be holding ocular structures in place, the object must be removed by MD Cover the object with a cup Don t allow the client to bend Don t place pressure on the eye Client is to be seen by MD stat

CHEMICAL BURNS
- an eye injury in which a caustic substance enters the eye NURSING CARE Treatment should begin stat Flush the eyes at the site of injury with water for at least 15-20 mins At the site of injury, obtain a small sample of the chemical involved At the ER, the eyes is irrigated with NSS or an opthalmic irrigation solution The solution is directed across the cornea & toward the lateral canthus Prepare for visual acuity assessment Apply an antibiotic ointment as prescribed Cover the eye with a patch as prescribed

ENUCLEATION
- removal of the entire eyeball

EXENTERATION
- removal of the eyeball & surrounding tissues Performed for the removal of ocular tumors After the eye is removed, a ball implant is inserted to provide a firm base for socket prosthesis & to facilitate the best cosmetic result A prosthesis is fitted approximately 1 month after surgery

ENUCLEATION AND EXENTERATION PRE-OP NURSING CARE Provide emotional support to the client Encourage the client to verbalize feelings related to loss

POST-OP NURSING CARE Monitor V/S Assess pressure patch or dressing Report changes in V/S or the presence of bright red drainage on the pressure patch or dressing

ORGAN DONATION
Eye :
Obtained from cadavers Must be enucleated soon after death due to rapid endothelial cell death Must be stored in a preserving solution Storage, handling & coordination of donor tissue with surgeons is provided by a network of state eye bank associations across the country

CARE OF THE DECEASED CLIENT AS A POTENTIAL EYE DONOR

Discuss the option of eye donation with MD & family Raise the head of the bed 30 Instill antibiotic eye drops as RX Close the eyes & apply a small ice pack to the closed eyes

PRE-OP CARE OF THE RECIPIENT Recipient may be told of the tissue availability only several hrs to 1 day before surgery

Assist in alleviating client anxiety Assess for signs of eye infection Report the presence of any redness, watery or purulent drainage or edema around the eyes to MD Instill antibiotic drops into the eyes as Rx to reduce the no. of microorganisms present

Administer IV fluids & medications as Rx POST-OP CARE TO THE RECIPIENT Eye is covered with a pressure patch and protective shield that are left in place until the next day Don t remove or change the dressing without the MD s order Monitor V/S, LOC & assess dressing Position the client on unoperative side to reduce IOP Orient the client frequently Monitor for complications of bleeding, wound leakage, infection & graft rejection Instruct the client in how to apply the patch & eye shield Instruct the client to wear the eye shield at night for 1 month & whenever around small children or pets.

GRAFT REJECTION
Can occur at anytime Inform the client of signs of rejection Signs include redness, swelling, decreased vision, & pain (RSDP) Treated with topical steroids

END OF REPORT -

CD (VIDEO) TABLE OF CONTENTS

 Eye Safety Video File  Anatomy & Physiology Folder y Ophthalmology Lecture (Eye Anatomy Part 1, 2 and 3) Video File y How the Eye Functions 1941 (Part 1 and 2) Video File  Assessment & Diagnostic Test Folder y Color Blindness Test Video File y Dynamic Visual Acuity Test Video File y Snellen Chart  Eye Disorders and Management Folder y Cataract Surgery Video File y Glaucoma Surgery Video File y Retinal Detachment Video File y Foreign Bodies Video File y Injuries and Chemical Burns Video File y Enuncleations Indication Procedure and Post Operative Care Video File y Exenteration Eye Video File