Download Sensory - Eye Lecture 1 9/29/10

Sensory: Eye
Nicole Tinny, MSN, CNS
LSCC – Revised Fall 2010
Lecture 1
Anatomy and Physiology Review
•
•
•
•
•
•
Layers of the eyeball
Refractive structures and media
External structures
Muscles
Nerves
Blood vessels
Refraction
• Emmetropia: the perfect refraction of the eye
• Hyperopia: occurs when the eye does not
refract light enough
• Myopia: occurs when the eye overrefracts or
overbends the light
• Astigmatism: a refractive error caused by
unevenly curved surfaces on or in the eye,
especially of the cornea
Pupillary Constriction
• Miosis is pupillary constriction.
• Mydriasis is pupillary dilation.
• Accommodation is the process of maintaining
a clear visual image when the gaze is shifted
from a distant to a near object.
Age-Related Structural Changes
•
•
•
•
•
•
•
Decreased eye muscle tone
Ectropion and dry eye
Arcus senilis
Corneal changes
Changes in color of sclera
Less ability to dilate pupil
More light needed for reading
Age-Related Functional Changes
•
•
•
•
•
•
Lens yellows
Accommodation is gradually lost
Near point of vision increases (presbyopia)
Far point decreases
Color perception decreases
Intraocular pressure
Physical Assessment
• Inspection: exophthalmos, enophthalmos,
ptosis, scleral and corneal assessment
• Pupillary assessment: anisocoria, consensual
response (brisk, sluggish, nonreactive or fixed)
(Continued)
Physical Assessment (Continued)
• Tests for measurement of vision: acuity, nearvision testing, confrontation test
• Assessment of extraocular muscle function
Diagnostic Tests
• Corneal staining
• Tonometry
• Ophthalmoscopy
Health Promotion
• Safety and preventative measures
• Eye exam schedule
• Eye glasses and contact lenses
Blepharitis
• Inflammation of the eyelid edges
• Itchy, red, and burning eyes
• Seborrhea of the eyebrows and eyelids with
greasy scales and mattering
• Control with eyelid care using warm, moist
compresses followed by gentle scrubbing with
diluted baby shampoo
• Avoidance of rubbing the eyes
Entropion
• Turning inward of the eyelid causing the
lashes to rub against the eye
• Caused by eyelid muscle spasms, or result of
trauma
• Eyelid turned inward; red conjunctiva
• Surgical correction of eyelid position
• Instruction in procedure to instill eyedrops
Ectropion
• Turning outward and sagging of the eyelid
• Caused by relaxation of the orbicular muscle
• Reduced washing action of tears, leading to
corneal drying and ulceration
• Surgery to restore proper lid alignment
Hordeolum
• Stye can be external or internal.
• Treatment is with warm compresses four
times a day and antibacterial ointment, which
may blur vision.
• To remove ointment, close the eye and gently
wipe the closed eyelid from the nasal side of
the eye outward.
Chalazion
• Inflammation of sebaceous gland in eyelid.
• Most protrude on the inside of eyelid.
• Eye fatigue, light sensitivity, and excessive
tears result.
(Continued)
Chalazion (Continued)
• Treatment consists of warm compresses for 15
minutes 4 times per day, followed by
instillation of ophthalmic ointment.
• Surgery is an option.
Keratoconjunctivitis Sicca
• Also called dry eye syndrome, results from
changes in tear composition, lacrimal gland
malfunction, or altered tear distribution
• Artificial tears, lubricating ointment
• Surgery
Corneal Disorders
• Keratoconus is the degeneration of the
cornea, deposits in the cornea, dystrophies,
keratitis, or ulceration of the corneal surface
• Reduce symptoms, restore corneal clarity,
enhance client’s ability to use remaining vision
• Antibiotics, antifungals, antivirals, steroids
Keratoplasty
• Surgical removal of diseased corneal tissue
and replacement with tissue from a human
donor cornea
• Regional anesthesia
• Postoperative care: subconjunctival antibiotic
injection, antibiotic ointment, pressure patch
and protective shield to cover eye
Eye Donation
• Corneal tissue from donors free of infectious
disease or cancer at the time of their deaths.
• Care of potential eye donors at death:
– Raise head of bed 30 degrees.
– Apply antibiotic eyedrops.
– Close the eyelids and apply small ice pack.
– Discuss donation with family and physician.
Vitreous Hemorrhage
• Bleeding into the vitreous cavity
– Aging
– Systemic disease
– Trauma
– Spontaneous
– Reduce visual acuity
• Mild, moderate, severe
• “floaters”, “black streaks”, reduced visual acuity in hand
motion
UVEITIS
• The uveal tract has three related parts the iris
the ciliary body and the choroid. The
common problem is inflammation or uveitis
• Anterior vs Posterior
• S/S
• Treatment
Macular Degeneration
• The macula—the area of central vision —
deteriorates.
• Degeneration can be atrophic age-related
(dry) or exudative (wet).
• Rod and cone photoreceptors die.
• Central vision declines; client describes “mild
blurring” and “distortion.”
Retinal Hole, Tears, and Detachments
• Rhegmatogenous detachments: a hole or tear
in the retina caused by mechanical force
creates an opening for the vitreous to move
under the retina
• Photopsia or floating dark spots in the
affected eye
• Creation of an inflammatory response that
binds the retina and choroid
Postoperative Care
• Eyepatch and shield are applied.
• Monitor vital signs and inspect shield for
drainage.
• Determine if gas or oil used.
• Nausea and pain are common; report sudden
increase in pain or pain occurring with nausea.
• Avoid activities that increase IOP.
Eye Trauma
•
•
•
•
•
Hyphema
Contusion
Foreign bodies
Lacerations
Penetrating injuries
Cataract
• Clouding of the lens, blurring of the lens
distorts the image and color projected onto
the retina.
• As cataract matures, opacity makes it difficult
to see the retina.
• Visual acuity is restricted.
Disturbed Sensory Perception: Visual
• Interventions include:
– Surgery to remove cataract and implant a small,
clear, plastic lens
– Enhanced social interaction
– Safety issues
Postoperative Care—Cataract
• Antibiotics given subconjunctivally.
• Eye is unpatched. Discharge usually occurs
within 1 hr with dark glasses.
• Instill antibiotic-steroid eyedrops. - TobraDex
• Mild itching is normal. *bloodshot eye*
• Pain indicates a complication.
• Reduce IOP - Diamox
• Prevent infection.
• Assess for bleeding. *no ASA*
Health Teaching
• Report to surgeon: sharp, sudden pain in the
eye, bleeding or increased discharge, lid
swelling, decreased vision, or flashes of light
or floating shapes.
• Avoid activities that might increase IOP.
• Review procedure for use of eyedrops.
Glaucoma
• Group of ocular diseases resulting in increased
IOP
• Primary open-angle glaucoma
• Angle-closure glaucoma
Clinical Manifestations
• Cupping and atrophy of the optic disc, disc
wider and deeper and turns white or gray
• Visual field measurement
• (Acute) Headache or brow pain, nausea and
vomiting, colored halos around lights, and
sudden blurred vision with decreased light
perception
Diagnostic Tests
• Tonometry
Comfort Measures – Nonpharm Mgmt
• Eye Pads
• Compresses
• Irigation
Psychosocial Assessment
•
•
•
•
•
Fear of loss of vision
Inability to perform ADLs
Family Support System
Possible Change in Self Esteem
Knowledge of resources
www.ocularmelanoma.org
www.glaucomafoundation.org
www.neih.nih.gov
Specialized Sensory Support
•
•
•
•
Braille and assistive devices
Communication techniques
Environmental safety
Community services/resources
Drug Therapy for Glaucoma
• Goal – reduce IOP
• Eyedrops are the mainstay
• Do not improve lost vision but prevent more
damage
• 5 common categories of drugs
– (pg 1099-1100)
• Some drugs:
- Timolol - Pilocarpine
-Trusopt - Azopt
The Drugs…
•
•
•
•
•
•
•
Miotics
Mydratics
Anti-glaucoma
CAI
Osmotic Diuretics
Antimicrobials
Antiinflammatory
•
•
•
•
•
Anesthetics
Diagnostics
Antiallergic drugs
Systemic Effects
Instillation of meds
Pediatrics
• Most common –
refractive disorders
• Others include
– Astigmatism
– Amblyopia
– Strabismis
–
–
–
–
–
–
–
Organic diseases
Color blindness
Nystagmus
Cataracts
Glaucoma
Retinoblastoma
Eye injuries