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39 Cards in this Set
- Front
- Back
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Protection of the eye
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Orbit, blink reflex, lacrimal reflex (tear production to remove foreign body), eyebrows, eyelashes, sebaceous cysts (produces oily substance that lubricates and prevents evaporation of tear film), tears/tear film (washes out foreign bodies, bacteriostatic, provide nutrition and moisture to the cornea, lubricate for smooth movement over the eyelid
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Ptosis
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drooping of the eyelid
Causes: edema, muscle weakness, congenital defect, neurological problems, trauma or disease |
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Glaucoma
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a group of ocular condition in which the damage to the optic nerve is related to the increase intraocular pressure caused by the congestion of the aqueous humor, leading cause of blindness of adults in the US, incidence increases with age, seems to be hereditary, IOP will be > 21mm Hg
3 types: open-angle (primary), angle-closure (pupillary block), congenital S/S: called the "silent theif" due to the patient is unaware of the condition until there is significant vision loss (due to damage of the optic nerve, permanent), including peripheral vision loss, blurring, halos, difficulty focusing, and difficulty adjusting eyes to low lighting, may also experience aching or discomfort around the eyes, or headache Cause: aqueous humor are not balanced in production and drainage, when the flow is blocked pressure builds up in the eye, increased IOP causes irreversible mechanical and/or ischemic damage Tx: Beta-blockers are the preferred topical medication |
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Open-angle glaucoma
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free access to trabecular meshwork and normal angle size, 90% of all glaucoma, frequently familial, usually bilateral
S/S: mild aching in the eyes, gradual loss of peripheral vision, optic disc may appear pale or gray with increased size and depth of the physiologic cup Cause: overproduction of aqueous humor,obstruction of aqueous humor outflow Tx: goal is to prevent further optic nerve damage, maintain IOP within a range unlikely to cause damage Meds: Cholinergic agents or Miotics - constrict pupil to enhance outflow of aqueous humor (Pilocarpine), Beta-blockers - Beta adrenergic antagonists decreases formation of aqueous humor (Timolol), Carbonic Anhydrase Inhibitors - decreases aqueous humor formation (Diamox (diuretics)), Osmotic diuretics - oral (glycerol) or IV (mannitol) hyperosmotic agents reduce IOP by decreasing osmolality of the plasma and drawing water from the eye into the circulation, short-term use, pre-op to allow surgery in normotensive eye, transient glaucome, Adrenergic agents - reduce IOP by increasing aqueous outflow and decreasing production (Epinephrine) Surgery: laser trabeculoplasty, laser iridotomy, filtering operations: drainage implants or shunts |
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Acute angle closure glaucoma
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formerly called closed angle glaucoma, the iris blocks the trabecular meshwork and limits the outflow of aqueous humor, rapid onset (EMERGENCY), extremely high IOP
Causes: may be due to bulging iris or thickened iris, or trauma to the eye S/S: excruciating, throbbing eye pain, n/v, blurred vision - halos, edema iris and ciliary body, red eye, cloudy cornea, dilated and non-reactive pupil Tx: Meds: Miotics (cause pupil constriction), topical ocular hypotensive agents (Pilocarpine and beta-blockers (betaxolol), Carbonic anyhydrase inhibitors, Osmotic agents (acetazolamide (Diamox) - used in open and closed angle glaucoma Surgery: peripheral iridotomy |
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Cataracts
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an opactity or cloudiness of the lens, increased incidence with aging (by age 80, more than half of Americans have cataracts), a leading cause of disability in the US
S/S: painless, blurry vision, sensitivity to glare, reduced visual acuity, myopic shift, astigmatism, diplopia (double vision), color shifts including brunescent (colorvalue shift to yellow-brown) Dx: decreased visual acuity and opacity of the lens by opthalmoscope, slit-lamp, or inspection Surgery: if reduced vision does not interfere with normal activities, surgery is not needed, surgery is performed as outpatient with local anesthesia, takes < 1 hr and discharge is soon after Complications: swelling of retina or cornea, IOP, ptosis, loss of vision, bleeding, infection |
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Corneal disorders
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Risk factors: aging, myopia, herpes zoster in eye, retinal detachment/retinal surgery, long-term/high-dose corticosteroid use, alkaline chemical burns, smoking, poor nutrition, obesity, DM
Tx: phototheraputic keratectomy, keratoplasty, use of donor tissue for transplant, need for follow-up and support, potential graft failure; teach signs and symptoms S/S of graft failure: blurred vision, discomfort, tearing, or redness of the eye Tx: hourly topical corticosteroids, and periocular corticosteroid injections, if severe systemic immunosuppressive agents Contraindications for transplant donor: AIDS, high risk for HIV, hepatitis, eye/systemic infection, malignant tumors of the eye, hx of eye trauma, LASIK surgery Refractive surgery: elective surgeries to recontour corneal tissues and correct refractive errors (ex: Lasix), patients need counseling regarding potential benefits, risks and complications |
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Retinal disorders
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Retinal detachment, retinal vascular disorders (central retinal vein occlusion, macular degeneration)
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Retinal detachment
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separation of the sensory retina and retinal pigment epithelium (RPE), retina detatches from the choroid, may be spontaneous after 40 y/o
Causes: retinal tear, complications of surgery, trauma, tumor S/S: painless, sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, sudden onset of floaters, decrease in visual acuity Dx: assess visual acuity, assess retina by indirect opthalmoscope, slit-lamp, stereo fundus photography, and floroescein angiography, tomography and ultrasound can also be used Tx: assess vision, bed rest, sandbags to side of head, bandage both eyes, sedate After area of detachment is determined: position so area of detachment is in dependent side (Ex: right temporal detachment, right side) Surgery: 90-95% effective, cryosurgery:cold probe causes scarring ---> re-adherence of retina and choroid Nsg care: promote comfort, watch for complications (IOP, other retinal detachments, development of cataracts, loss of turgor in the eye) |
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Cholinergics (miotics)
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Pilocarpine, Carbachol
Action: increases aqueous fluid outflow by contracting the ciliary muscle and causing constriction of the pupil SE: periorbital pain, blurry vision, difficulty seeing in the dark Teach: caution patients about diminished vision in dimly lit areas |
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Adrenergic agonists
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dipivefrin, epi
Action: reduces production of aqueous humor and increases outflow SE: eye redness and burning, palpitations, elevated BP, tremor, HA, anxiety |
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Beta-blockers
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betaxolol, timolol
Action: decreases aqueous humor production SE: bradycardia, exacerbation of pulmonary disease, hypotension Teach: contraindications include patients with asthma, COPD, 2nd or 3rd degree heart block, bradycardia, or cardiac failure |
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Alpha-adrenergic agonists
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apraclonidine, brimonidine
Action: decrease aqueous humor production SE: eye redness dry mouth and nasal passages |
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Effect of Separation:
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Marriage is not terminated by living apart, nor by a separation agreement. Community is not terminated UNLESS an agreement so provides.
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Prostaglandin analogs
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latanoprost
Action: increases uveoscleral outflow SE: darkening of the iris, conjunctival redness, possible rash |
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Surgical care for cataracts
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Pre-op: withhold anticoag therapy for 5-7 days, dilating drops. Antibiotic, anti-inflammatory, and corticosteroid drops may also be administered to prevent infection and inflammation
Post-op: minimal discomfort, mild analgesic, antibiotic, anti-inflammatory, and corticosteroid drops prescribed Teach: wear protective eye patch for 24 hrs after surgery, then glasses during the day, and metal shield at night for 1-4 weeks, wear sunglasses outdoors, slight morning discharge, redness, and scratchy feeling is expected the first few days, notify physician IMMEDIATELY if floaters, flashing lights, decrease in vision, pain, or increase in redness, wash hands before touching eye, avoid water in eye, avoid lying on side of the affected eye the night after surgery, keep activity light, no push, pull or lift > 15lbs, avoid bending or stooping, be careful when climbing stairs |
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Central retinal vein occulsion
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Common and found in patients older than 50 y/o
Dx: direct opthalmoscopy of the retina shows optic disc swelling, venous dilation, retinal hemorrhages, cotton-wool spots, and bloody appearance of the retina |
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Macular degeneration
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Most common cause of visual loss in people older than 60 y/o, characterized by tiny, yellowish spots called drusen beneath the retina, two types: wet and dry, 85-90% have dry
Risk factors: increasing age, smoking hx, HTN, overweight, hyperopia, family hx, use of thyroid hormones and hydrochlorithiazides Dry: gradual decrease in central vision, missing letters in words, blank spots Wet: rapid visual changes, straight lines appear distorted |
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Ocular trauma
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Make no attempt to remove foreign body, do not apply pressure or patch, instead use metal shield if available or stiff paper cup until medical treatment
Tx: cycoplegic agents (paralyze the ciliary muscle), antibiotic ointment and patch after foreign body is removed |
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Penetrating injuries and Contusions
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Hyphema-caused by contusion, tears the vessels of the iris and damage the anterior chamber angle, goal is to prevent rebleeding and prolonged IOP, corticosteroids are prescribed, antifibrinolytic (Amicar) is used to stabilize the clot formation at the site of the hemorrhage, Aspirin is contraindicated
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Ocular burns
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Alkali burns (lye, ammonia) cause the most severe injury because they penetrate the ocular tissues rapidly and continue to cause damage long after the initial injury is sustained, cause an immediate increase in IOP
Acid burns (bleach, car batteries) cause less damage because the precipitated necrotic tissue proteins form a barrier to further penetration and damage Tx: immediate irrigation with tap water should be started before medical treatment arrives, irrigation is continued until pH is between 7.3-7.6, any foreign matter is removed Thermal burn is caused by exposure to a hot object (curling iron, tobacco, ash), photochemical injury results from exposure to ultraviolet irradiation or infrared exposure (exposure to the reflection from snow, sun gazing, viewing an eclipse without adequate filter), antibiotics and pressure patch is worn for 24 hrs |
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Dry eye syndrome
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deficiency in the production of any of the aqueous , mucin, or liquid tear film components, lid surface abnormalities, or epithelial abnormalities (thyroid, Parkinson's), infection, injury, or complications of meds (antihistamines, oral contraceptives)
S/S:scratchy or foreign body sensation (most common), itching excessive mucus secretion, inability to produce tears, burning sensation, redness, pain, difficulty moving eyelids Dx: slit-lamp exam Tx: instillation of artificial tears during the day and ointment at night |
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Conjunctivitis
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inflammation of the conjunctiva, most common ocular disease worldwide, characterized by pink appearance
S/S: foreign body sensation, scratchy or burning sensation, itching, photophobia, may be unilateral or bilateral, usually starts in one and move to the other by hand contact 4 types: bacterial, viral, allergic, toxic Dx: type of discharge (watery, mucopurulent), type of conjunctival reaction (follicular or papillary), presence of pseudomembranes or true membrance, presence or abscence lymphadenopathy |
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Bacterial conjunctivitis
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acute or chronic
S/S: redness, burning, purulent discharge, matting of the eyes, papillary formation |
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Viral
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acute or chronic, can include corneal involvement, tends to last longer than bacterial
S/S: watery discharge, follicles are prominent, (extreme tearing, redness and foreign body sensation with corneal involement), lid edema, ptosis, hyperemia (dilation of the conjunctival blood vessels) Causes: adenovirus (highly contagious) and herpes simplex virus |
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Allergic conjunctivitis
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hypersensitivity due allergic rhinitis or can be independent, usually hx of pollen allergy and other environmental allergens
S/S: extreme pruritis, epiphora (excess tears), severe photophobia, stringlike mucoid production assoc with eye rubbing because of severe pruritis, |
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Dry eye syndrome
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deficiency in the production of any of the aqueous , mucin, or liquid tear film components, lid surface abnormalities, or epithelial abnormalities (thyroid, Parkinson's), infection, injury, or complications of meds (antihistamines, oral contraceptives)
S/S:scratchy or foreign body sensation (most common), itching excessive mucus secretion, inability to produce tears, burning sensation, redness, pain, difficulty moving eyelids Dx: slit-lamp exam Tx: instillation of artificial tears during the day and ointment at night |
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Conjunctivitis
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inflammation of the conjunctiva, most common ocular disease worldwide, characterized by pink appearance
S/S: foreign body sensation, scratchy or burning sensation, itching, photophobia, may be unilateral or bilateral, usually starts in one and move to the other by hand contact 4 types: bacterial, viral, allergic, toxic Dx: type of discharge (watery, mucopurulent), type of conjunctival reaction (follicular or papillary), presence of pseudomembranes or true membrance, presence or abscence lymphadenopathy |
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Bacterial conjunctivitis
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acute or chronic
S/S: redness, burning, purulent discharge, matting of the eyes, papillary formation Tx: antibiotics x 1 week |
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Viral
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acute or chronic, can include corneal involvement, tends to last longer than bacterial
S/S: watery discharge, follicles are prominent, (extreme tearing, redness and foreign body sensation with corneal involement), lid edema, ptosis, hyperemia (dilation of the conjunctival blood vessels) Causes: adenovirus (highly contagious) and herpes simplex virus Tx: cold compresses may alleviate symptoms |
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Allergic conjunctivitis
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hypersensitivity due allergic rhinitis or can be independent, usually hx of pollen allergy and other environmental allergens
S/S: extreme pruritis, epiphora (excess tears), severe photophobia, stringlike mucoid production assoc with eye rubbing because of severe pruritis Tx: corticosteroids, cold compresses |
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Toxic conjunctivitis
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can be result of meds, chlorine, exposure to toxic fumes, exposure to irritants
Tx: irrigation |
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Uveitis
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acute inflammation of the uveal tract, affects the iris, cilliary body, and choroid, most common is nongranulomatous
S/S: pain, photophobia, pattern of conjunctival infections, pupil is small, and vision is blurred Tx: atropine to avoid ciliary spasm, in severe cases corticosteroids are used |
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Orbital cellulitis
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inflammation of the tissues surrounding the eye and may result from bacterial, fungal, or viral inflammatory conditions of contagious structure, sinus infections are the most frequent cause
S/S: pain, lid swelling, conjunctival edema, decreased ocular motility. With edema, optic nerve compression can occur and IOP may increase Tx: immediate administration of high-dose, broad-spectrum antibiotics Nsg care: monitor changes in visual acuity, degree of proptosis (downward placement of eyeball), CNS function (n/v, neuro, fever) |
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Enucleation
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removal of entire eye and part of optic nerve
May be performed due to: severe injury resulting in prolapse of uveal tissue or loss of light projection or perception, an irritated, blind, painful, deformed, or disfigured eye (usually caused by glaucoma, retinal detachment, or chronic inflammation), an eye without useful vision that is producing or has produced sympathetic opthalmia in the other eye, intraocular tumors that are untreatable by other means Nsg care: patient's need to know they will have a pressure dressing for 1 week, and topical ointment is applied in the socket TID, there will be loss of depth perception, must be advised that conformers may accidentally fall out of the socket (conformer must be washed, dried and placed back) |
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Diabetic retinopathy
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due to uncontrolled DM
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Cytomegalovirus retinitis
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opthalmic complications associated with AIDS
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Cerumen impaction
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wax build-up that causes otalgia (fullness sensation in ear)
Tx: irrigation, suction, or instrumentation, instilling warmed glycerin, mineral oil, or half strength peroxide can help soften the wax |
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Foreign bodies in ear
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Tx: irrigation, suction, or instrumentation
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