Chapter 79 Med Surg Sensory

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glasses

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Eyeglasses (spectacles) are prescribed to correct the refractive errors of myopia, hyperopia, astigmatism, and presbyopia and for some low-vision (“legally blind”) individuals.
Bifocals, two lenses in one, may be prescribed to correct the problem of presbyopia. Each eyeglass lens has two parts: one part corrects the defect in near vision; the other corrects the defect in far vision. Trifocals are also available and provide an additional option for vision correction.

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contacts

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Contact lenses are designed to fit directly on the cornea, where they float on a layer of tears. Contact lenses may provide better vision than eyeglasses by eliminating minification or magnification of objects. Contact lenses may cause corneal ulcerations.
Hard contact lenses are made of rigid gas-permeable plastic (RGP) and are paper thin. They are kept in place by capillary attraction and by the upper eyelid. Clients usually wear them daily. The lenses require special cleaning, rinsing, and storage solutions for care.
Soft contact lenses are made of hydrophilic plastic of a larger diameter and greater flexibility than RGP lenses. Soft contact lenses are more likely to be damaged by handling because they can easily tear.
Extended-wear soft contact lenses allow oxygen and carbon dioxide to pass freely through the lens. These lenses may be worn for up to 2 weeks before removal. Extended-wear contact lenses have a 10 to 15 times greater risk of infection than daily-wear contact lenses. Some soft lenses are disposable and are discarded after a period for a new set of lenses.

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eye surgery

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keratorefractive surgery (surgical alteration of the corneal curvature), in which a laser or other microsurgical knife reshapes the cornea. Another procedure is radial keratotomy (RK), in which partial-thickness, radial incisions are made in the cornea to correct the refractive error. Photorefractive keratotomy (PRK) and laser-assisted-in-site-keratomileusis (LASIK) are other procedures that correct refractive errors

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conjunctivitis

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Conjunctivitis, also called pink eye, is inflammation of the conjunctiva, the membrane lining the eyelids and covering the sclera (Fig. 79-3). A bacterial, viral, or rickettsial infection or an allergy may cause conjunctivitis.
Conjunctivitis causes pain, redness, swelling, itching, and sometimes purulent discharge (pus). The discharge may be so thick and copious that the eyelids stick together. Following a culture study, antibiotic eye drops or ointments are prescribed for bacterial infections, and antiviral medications for viral infections.
Treatment of allergy-related conjunctivitis includes avoiding the offending allergen, taking antihistamines, and undergoing desensitization. Boric acid or saline solution irrigations or warm soaks may remove discharge, reduce swelling, and decrease pain and itching.
Conjunctivitis is contagious. Proper handwashing, use of gloves, and proper cleaning of the client's linen are essential to prevent the spread of infection.

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trachoma

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form of conjunctivitis found in hot, dry climates. Its cause is the organism Chlamydia trachomatis, which may also cause the infection inclusion conjunctivitis. Trachoma is highly communicable and is one of the world's leading causes of preventable blindness.
Treatment includes topical and systemic antibiotics, which are very effective. Trachoma is rarely seen in the United States.

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blepharitis

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inflammation of the eyelid, and is caused by excessive dryness of the eyes, excessive oiliness of the skin, or infection. This condition is usually characterized by red lid margins and purulent drainage. Treatment consists of applying warm packs to the eye to help loosen crusted drainage. Cleanse the eyelid gently with a mild soap and water once or twice a day. An antibiotic ophthalmic ointment may be prescribed to resolve infection and prevent recurrence.

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hordeolum or stye

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acute inflammation of an oil or sweat gland of the eyelid. Styes are red, raised, swollen, and painful. They contain pus. After the area drains, pain is relieved and healing begins.
Treatment includes applying warm, moist compresses and a topical antibiotic ointment to the area to help localize the infection. In severe cases, the abscess is incised and drained. Teach the client not to squeeze a stye, which could spread infection.

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chalazion (meibomian cyst)

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accumulation of lipid (fatty) material from a chronically obstructed meibomian (sebaceous) gland found on the eyelid. If the lesion is small and does not affect vision, treatment is unnecessary. if it becomes infected or interferes with vision or eyelid closure, incising and draining the area may be necessary.
Keratitis

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Keratitis

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inflammation of the cornea caused by bacterial, viral, or fungal infections, often after trauma. Herpes simplex keratitis is the most common cause of unilateral visual loss from infectious keratitis in the United States.
Symptoms include pain, photophobia (sensitivity to light), blurred vision, purulent drainage, and redness of the sclera. Corneal ulceration is a common sequela (result). After culture studies are done, treatment consists of eye drops to dilate the pupil. Fortified antibiotic drops may be given hourly for bacterial disease. Antiviral or antifungal therapy as necessary may be given for viral or fungal causes.

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ectropinion

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an outward turning of the eyelid due to the aging process. The eye is no longer able to drain effectively and tearing occurs. Surgical intervention is necessary.