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Chapter 49
Care of Patients with Eye and
Vision Problems
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Eyelid Disorders
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Blepharitis
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Entropion
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Inflamed, itchy, red
Greasy scales on brows and lids
Inward turning of lid; lashes rub against eye
Surgical correction required
Ectropion
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Outward turning of lid
Surgical correction required
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Eyelid Disorders (cont’d)
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Hordeolum
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Internal or external stye
Chalazion
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Inflammation of sebaceous gland in eye
What are common approaches to care for eyelid
disorders?
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Ophthalmic Ointment
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Blepharitis
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Entropion vs. Ectropion
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Hordeolum
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Chalazion
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Keratoconjunctivitis Sicca
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“Dry eye syndrome”
Changes in tear composition, lacrimal gland
malfunction, or altered tear distribution
Artificial tears, lubricating ointment
Surgery
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Conjunctival Hemorrhage
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Small, well-defined area of bright red
hemorrhage under conjunctiva
No pain
No visual impairment
Resolves in 14 days without treatment
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Conjunctivitis
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Trachoma
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Chronic, bilateral scarring form of
conjunctivitis
Caused by Chlamydia trachomatis
Chief cause of preventable blindness
Infection control
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Corneal Disorders
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Corneal abrasion, ulceration, infection
Keratoconus
Cataract
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Corneal Transplantation
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Eye Donation
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Corneal tissue from donors
Donors must be free of infectious disease or
cancer at time of death
Care of potential eye donors at death:
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Elevate head of bed 30 degrees
Apply antibiotic eyedrops
Close eyelids; apply small ice pack
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Cataract
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Clouding and blurring of lens
Opacity makes it difficult to see retina
Visual acuity restricted
No pain or eye redness
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Cataract (cont’d)
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Cataract Surgery
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Cataract Surgery (cont’d)
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Preoperative
Intraoperative
Postoperative
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Postoperative Care
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Antibiotics given subconjunctivally
Eye is unpatched, discharge usually occurs
within 1 hour
Dark glasses required
Instill antibiotic-steroid eyedrops
Mild itching normal
Pain indicates complications
Reduce IOP
Prevent infection
Assess for bleeding
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Community-Based Care
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Home care management
Teaching for self-management
Health care resources
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Health Teaching
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Signs of complications:
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Sharp, sudden pain in eye
Bleeding or increased discharge
Lid swelling
Decreased vision
Flashes of light or floating shapes
Avoid activities that might increase IOP
Review procedure for use of eyedrops
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Glaucoma
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Increased ocular pressure
Cupping and atrophy of optic disc
Symptoms:
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Headache or brow pain
Nausea and vomiting
Colored halos around lights
Sudden blurred vision with decreased light
perception
Types:
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Primary open-angle glaucoma
Angle-closure glaucoma
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Diagnostic Tests
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Tonometry
Perimetry
Gonioscopy
Optic nerve imaging
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Glaucoma Drug Therapy
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Types
Patient teaching plan:
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How eyedrops work
How to administer
Monitor for side effects
Compliance, timely dosing
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Other Eye Disorders
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Macular degeneration
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Refractive errors
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Myopia, hyperopia, presbyopia, astigmatism
Trauma
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Mild blurring and visual distortion
Hyphema, contusion, foreign bodies, laceration,
penetrating injuries
Vitreous hemorrhage
Ocular melanoma
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Reduced Vision
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Interventions:
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Communication about use of adaptive items
Safety in familiar settings
Ambulation assisted with care
Promote self-care and independence
Support for difficulty of adapting to lost sight
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A 78-year-old patient tells you that over the past 18
months he has noticed a decrease in visual acuity in his
left eye. He states that he initially thought he had
smudges on his eyeglasses, but when the cloudiness in
his vision continued to develop, he saw his doctor who
referred him to an ophthalmologist. Upon assessment, it
was determined that he has a large cataract that
requires surgical removal.
The patient asks you why the cataract only affected his
left eye. What is your best response?
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(cont’d)
After seeing the ophthalmologist, the patient is scheduled for
cataract surgery.
What preoperative teaching should you provide?
A.
Instruct him that after surgery, different types of eyedrops will
be prescribed for 2 to 4 weeks.
B.
Remind him that immediately after surgery he will have his
best vision.
C.
Tell him that after surgery he will no longer need to wear
eyeglasses for reading.
D.
Caution him to avoid wearing dark glasses because the retina
needs a direct source of light for best vision.
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(cont’d)
After the patient’s cataract surgery has been completed,
he has been brought to the recovery area. You are
preparing to administer eyedrops and other
medications.
Which order for the patient would you question?
A. Antibiotic ophthalmic ointment
B. Steroid ophthalmic ointment
C. Acetaminophen with oxycodone
D. Warfarin (Coumadin)
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(cont’d)
After recovery, you provide postoperative teaching for
the patient.
Which statement by the patient indicates a need for
further teaching?
A. “I will wear dark sunglasses.”
B. “Aspirin will help decrease discomfort.”
C. “My daughter will help me if I need to lift something.”
D. “My surgeon needs to know if I am experiencing
reduced vision.”
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Chapter 49
Audience Response System Questions
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Question 1
What are postoperative expected outcomes for a patient
who has undergone surgery for cataract removal?
A.
B.
C.
D.
Pain early after surgery accompanied by nausea and
vomiting
Change in visual acuity accompanied by tearing and
redness
Yellowish drainage and photophobia
Mild itching and bloodshot appearance
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Question 2
Which is a priority intervention after a patient receives a
corneal transplant?
A.
B.
C.
D.
Keeping the eye covered for the first 24 hours
postoperatively
Avoiding straining to have a bowel movement
Keeping the eye moist
Assessing the eye for signs of infection
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Question 3
Which patient is at greatest risk of developing primary
angle-closure glaucoma?
A.
B.
C.
D.
32-year-old Caucasian female
42-year-old Hispanic/Latino male
52-year-old Asian female
64-year-old African-American male
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