CATARACT

Sarah Jane B. Aca-ac BSN-3

Page 1770-1773

Introduction
A cataract is a lens opacity or cloudiness. It
can be either localized or generalized. The
most common cataract is related to aging,
although cataracts can have a variety of other
causes. According to World Health
Organizations (WHO), cataract is the leading
cause of blindness in the world.

Types
1. Nuclear Cataract
-occurs at the back of the lens. People with diabetes or those
taking high doses of steroid medications have a greater risk
of developing a subcapsular cataract.
2. Cortical Cataract
-forms deep in the central zone (nucleus) of the lens. Nuclear
cataracts usually are associated with aging.
3. Posterior Subcapsular Cataract
-is characterized by white, wedge-like opacities that start in the
periphery of the lens and work their way to the center in a
spoke-like fashion. This type of cataract occurs in the lens
cortex, which is the part of the lens that surrounds the central
nucleus.

PATHOPHYSIOLOGY
Changes in the lens proteins affect how the lens

refracts light and reduce its clarity, therefore

decreasing visual acuity. Chemical modification of
these lens proteins leads to the change in lens
colour. New cortical fibres are produced
concentrically and lead to thickening and hardening
of the lens in nuclear sclerosis, which often appears
yellow and can increase the focusing power of the
natural lens. Increasing myopia can also be evidence
of a progressing nuclear sclerotic cataract. In an
experimental model, oxidative stress contributed to
cataract formation, causing a decrease in the level of
adenosine triphosphate and glutathione disulfide.

STAGES
Early Stage - the cataract is not completely

cloudy.
Second Stage- the cataract is completely
opaque, and vision is significantly reduced
Third Stage- cataract lenses absorbed water
and increase in size, resulting in IOP.
Last Stage- the proteins in the lens break
down and leak out through the lens capsule.

Risk factors
Age
Cigarette smoking
Long term use of corticosteroids
Sunlight and ionizing radiation
Diabetes
Obesity
Eye injuries

Clinical Manifestations
Painless, blurry vision
Reduced contrast sensitivity, sensitivity to

glare, and reduced visual acuity

Other effects: Myopic shift, astigmatism,
monocular diplopia, color shift, brunescens,
and reduced light transmission

Diagnostic Test
Snellen Visual Acuity Test
Opthalmoscopy
Slit-lamp biomicroscopic examination

Medical/Surgical Management
Phacoemulsification- a portion of the

anterior capsule is removed, allowing

extraction of the lens nucleus and cortex while
the posterior capsule and zonular support are
left intact.
Lens Replacement- after removal of the
crystalline lens, the patient is referred to as
aphakic or a new lens inserted in the posterior
chamber of the eye.

Nursing Intervention
Preoperative Care
Dilating drops are adm every 10 minutes for at least 1
hr before surgery
Additional dilating drops may adm in the operating
room
Antibiotic, corticosteroid, and anti-inflammatory drops
may be adm prophylactically to prevent postoperative
infection and inflammation
Postoperative Care
Adm medications, recognize signs of complications,
and obtain emergency care
Explain that there should be minimal discomfort after
surgery and instruct patient to take minimal analgesic
agent

Home and Community-Based Care

Instruct patient to wear protective eye patch
for 24 hrs after surgery, followed by
eyeglasses worn during the day and metal
shield worn at night for 1-4 weeks to prevent
accidental rubbing or poking of the eye.
A clean, damp washcloth maybe used to
slight morning eye discharge.
Explain to the patient the importance of
notifying the physician if new floaters in
vision, flashing lights, decrease in vision, pain