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149 Cards in this Set

  • Front
  • Back
The ____ produce tears to wash the eye and clear away debri
lacrimal ducts
Because the conjunctive is ___ it is a specific site where medications can be administered
mucosal
the outer layer of the eye contains the ___ and the ____.
sclera and cornea
The ___ is the white of your eye. It is a tough tissue that provides protection and where the intraocular muscles attach.
The ___ is the white of your eye. It is a tough tissue that provides protection and where the intraocular muscles attach.
The cornea has a ___ shape. This beds light as it enters the eye.
convex
The image appears on the ___ upside down and ____
on retina upside down and backwards
The ___ is the colored part of your eye. It is a muscular structure that contracts and relaxes giving the illusion that the pupil is contracting or dilating. It controls the amount of light entering the eye
iris
The __ is where light passes through the eye. The ___ controls how much light passes through.
Pupil
iris
The lens of the eye is ____. It has the ability to change shape when objects are near
biconvex
The ____ has suspensory ligaments that holds the lens in place. It secretes aqueous humor. It contains ciliary muscles that enables the lens to ___ ___ during accomodation.
ciliary body.
aqueous humor.
ciliary
change shape
_____ is the substance the fills the space between the lens and the cornea. It maintain the shape of the anterior chamber of the eyeball
aqueous humor
____ causes too much of the aqueous humor to be produced or it doesnt allow the fluid to be drained
glaucoma
The ___ supplies blood to the ciliary body, the iris and the retina.
choroid.
The ___ is the innermost layer of the eye. it is made up mostly of ____, so once the tissue is damaged...it cannot be regenerated.
retina

neurons/nerve tisse
The retina has ___ and ____. ___work in dim environments and ____ help us see in color.
rods and cones

rods -dim environment
cones - see in color
What is presbyopia
a condition in the elderly where the lens of the eye loses its ability to focus making it difficult to see objects up close.
HTN affects the retina. This is called ____ _____. As a result central vision is lost. We have trouble seeing what is right in front of us.
macular degeneration.

central vision is lost
Name some diseases that can affect the eyes
diabetes, HTN, cancer, multiple sclerosis, and thyroid disorders
If the pt has a hx of heart problems or COPD, be cautious if they are taking ___ ____ medications for their eyes.
beta adrenergic
a disorder in which the two eyes do not line up in the same direction, and therefore do not look at the same object at the same time. The condition is more commonly known as "crossed eyes."
What is strabismus?
Impaired or dim vision without obvious defect or change in the eye.
What is amblyopia?
increasing the intraocular pressure will alter _____. Check if the has been trauma to the eye that may have caused swelling.
vision
____ and ____ medicines can dilate the pupil.
antihistamines and cold medicines
Use of ___ over a long period of time can cause development of glaucoma or cataracts
corticosteroids
How would you do a physical assessment of the eye?
Inspect external structures.
Is the eye pink or red (conjunctiva?)
Is the sclera white, is the cornea clear
PERRLA, visual fields
Check the pts six cardinal positions of gaze
Use Snellen chart to test visual acuity
What chart is used as a baseline test to test visual acuity
Snellen chart
How does a patient read a Snellen chart? (standard eye chart)
Pt sits 20 ft from chart and reads the smallest line they can with <50% errors one eye covered at a time then with both eyes.
A Jaegar chart is used to test _____ ____ ____. The chart is held 14 inches from face
near vision acuity
Name some refractive disorders. When there is a alteration in the structure of the eye, the light does not refract correctly and as a result we get vision disturbances.
Myopia and Hyperopia
presbyopia
astigmatism
aphakia
If a person has the refractive disorder Myopia, they are ____. this means light rays focus in front of the retina. A person with myopia can see objects up close well but objects far away are blurry. This can be corrected with glasses or contacts.
nearsighted
Surgical alterations of shape of cornea

RK is ___
PRK is ____
LASIK is _____
RK is slit in cornea
PRK is laser to reshape cornea
LASIK is layer of cornea removed
___ is the opposite of Myopia. This means the pt is ____. They can see really well far off, but not close-up. The light rays focus behind the eye and the image on the retina is blurred. Occurs because the eyeball is too short. Seen mostly in older adults.
Hyperopia-farsighted
___ the loss of accomodation, meaning people cannot focus on near objects. This affects us as we age (normal aging process) and is caused by loss of flexibility in the lens and ciliary body.
presbyopia
In the case of ___, the cornea is irregular, so the light is reflected incorrectly. The eye makes tiny movement to correct the distortion and make an image. People with this move their eyes constantly to fix the image.
astigmatism
___ is the absence of the lens. This can be related to trauma or surgery. The will have a lens implant
aphakia
All refractive disorders can be corrected with glasses. The ___ of the glasses depends on the refractive disorder present.
curvature
If RSVP occurs, pts should take out contact lenses and call their eye doctor. What does RSVP stand for?
R redness
S sensitivity
V vision problems
P pain
Name three TYPES of eyes surgery
Laser
Implant
Thermal
Laser surgeries such as LASIK and PRK do what?
Correct myopia, hyperopia, and astigmatism. They change corneal shape and change the refraction of light
Implants placed in the ____ changes its shape and alters refraction of light to improve vision. This is usually used to treat ____ conditions
cornea
myopic conditions
Thermal procedures such as ____ can be used to treat pts with hyperopia or presbyopia. This uses laser heat or radio waves to heat up the cornea and change its shape. It is done on the ____ eye, so one eye has near vision and the other has far vision
keratoplasty

done on less dominant eye
What is considered legal blindness?
20/200 or worse. The person can not see at 20 ft what the normal person can see at 200 ft.
What is considered total blindness?
Can not see any light at all
What is considered functional blindness?
People have some light perception, but cannot make out shapes
Almost all blindness is related to diseases such as (4). The other small percentage is due to injuries that have occurred to the eye.
glaucoma
cataracts
macular degeneration
retinopathy (diabetes)
Assessment of the Visually impaired?
Is the vision loss new or has it been on going
how does it affect their ability to function with daily activities
can they see to read and write
does the visual impairment negatively affect them socially
Nursing goals for pt with visual impairment are focused on....
helping the pt adjust to and cope with visual impairments
To prevent further impairment of the eyes, you should be ___ with treatment regimens, ____ eyes with goggles, and ____ changes or loss of vision
compliant
protect
report
3 ways Nurses can provide care to the visually impaired..
Emotional Support
Foster Independence
Provide Resources
4 types of eye trauma injuries
blunt
penetrating
chemical
heat
eye injury symptoms
pain
blurred/lost vision
photosensitivity
swelling, redness, bruising
tearing
bleeding
Nursing assessment for eye trauma
How did it happen?
Assess visual acuity
Nursing Interventions for:
chemical eye trauma-
foreign body eye trauma-
any eye injury-
chemical eye trauma - irrigate w/ NS
foreign body eye trauma - stabilize
any eye injury - cover w/ sterile patch or shield
How do you decrease the intraocular pressure
Keep HOB >45 degrees
NO nose blowing
Bump on eyelid - _____, also known as a stye is caused by an inflammation or infection located in a follicle or gland. There is no discharge. Treat w/ ___ and ____. Visual acuity is unaffected
hordoleum
Treat w/ warm compress and antibiotics
Bump on eyelid - _____, is an inflammation or infection caused by a blocked gland. Painful. No discharge. Treat w/ ___ or ___. Visual acuity is unaffected
Chalazion
warm compress or surgical I & D
____ is an inflamed lash line w/ crusty discharge caused by infection of seborrhea. Treat w/ ___ and ____. Visual acuity unaffected
blepharitis

Treat w/ antibiotics and special shampoo
____ is an inflammation or infection of the conjunctiva. Infections can be bacterial or viral. What is the difference between bacterial or viral w/ this ailment? How is each treated?
conjunctivitis

bacterial conjunctivitis (aka pink eye) - There is a thick yellow drainage. It is treated w/ antibiotic drops.

viral conjunctivitis - There is NO drainage. It is treated w/ corticosteroids for symptom relief.
Chlamydial infections are aka _____ . This is a major cause of blindness worldwide and is preventable. This is transmitted through contact with infected ___ and ____. Redness, irritation, yellow drainage. STD in the eye!!! Risk for??
trachoma

infected hands and flies

coma associated blindness
signs and symptoms of allergen conjunctivitis. Drainage is usually ___ or ____. Treat symptoms w/ ___ and ___
ITCHING, redness, irritation.
Drainage white or clear
antihistamines and corticosteroids
____ is an infection or inflammation of the cornea. If the cornea and conjunctiva are involved, then it is called ____.
keratitis

kerato-conjunctivitis
keratitis can be bacterial, viral, fungal, and parasitic. ____ is the most common virus to cause viral keratitis and the most common cause of blindness. May be treated w/ antiviral drops called ____. These pts should NOT have ______ bc they can cause further ulceration of the cornea.
herpes simplex virus

Viroptic (sp?)

NO corticosteroids
The ____virus can also cause keratitis. It is ok to have corticosteroids if this virus caused the keratitis. This type of keratitis is extremely painful. Pts will receive ____ and _____ such as ____ to treat the viral infection systemically
varicella

pts will receive strong analgesics and oral antivirals such as
Zovirax
Parasitic keratitis is called _____ and is usually caused by ____.
acanthamoeba keratitis

contaminated contact lens solution
Nursing assessment for infection or inflammation of the eye
Assess for:
increased redness
edema
drainage
pain
changes in visual acuity
Nursing Intervention for infection or inflammation of the eye...3 things
Prevent spread of infection
maintain comfort
administer eye gtts
What is keratoconjunctivitis sicca? Who is most likely to get it? It is caused by a dysfuntion of the lacrimal duct. Pt complains of sandy, gritty feeling in eyes.
What is the treatment?
Dry eye disorder
Elderly or
People w/ systemic diseases such as:
lupus or scleroderma

Treatment: hot compress, lid massage, artificial tears
an autoimmune disorder associated w/ keratoconjunctivitis sicca that affects the moisture producing glands of the body.
Sjogren's syndrome
_____ can be caused by thyroid disease, neuromuscular disorder, cerebral lesions, and can c/o double vision. There are 4 kinds..what are they?
Strabismus

esotropia -eye points in
exotropia - eye points out
hypertropia - eye points up
hypotropia - eye points down
___ ____ may be necessary if the cornea has been damaged. A penetrating keratoplasty is the ____ cornea. A ____keratoplasty is the partial cornea. These are donated from cadavers. Visual improvement is gradual for 1 yr.
Corneal transplant
full cornea
Lamellar -partial
What are the complication of a corneal transplant?
Graft rejection (bad storage, surg. trauma, immunologic rejection)
wound leakage, bleeding, glaucoma, cataract, infection
self care for corneal transplant
medications:
protection
teaching:
meds - steroids and antibiotic gtts (topical steroids may be indefinite
Protection: eye patch or shield
Teach: s/sx of rejection -RSVP
s/sx of infection or increased IOP
____ are an opacity that is w/ in the lens. It is the 3rd leading cause of preventable blindness.
cataracts
___ cataracts are found in older people caused by the accumulation of water due to ultrametabolic processes and structure changes in the lens
senile
Younger people can get cataracts too, especially if they have certain diseases such as ____ or if they've had a ____ ___ to the eye.
diabetes
traumatic injury
Some drugs like long-term _____ use can cause cataracts to form. This is the leading cause of blindness
steroid
s/sx of cataracts
decreased vision
blurred
diplopia - visual impairment when an object is seen as two objects
photophobia
glare
People with cataracts have better vision in ____ because ____
dim light - pupils dilate more
To diagnose cataracts, opacities are observed using a ____ or _____
opththalmoscope

split-lamp
What is ICCE and ECCE.
cataract surgery-surgical removement of the lens.
ICCE - intra-capsular extraction (rarely done)
ECCE -extra-capsular extraction (ECCE allows for insertion of inttraocular lens and there are few post-op complications.
You must have surgery to cure cataracts. When is cataract surgery necessary?
vision is too far gone
Dr. can't see retina
intraocular pressure becomes too high
Cataract surgery where lens is removed. There is a smaller incision than ICCE or ECCE. 1-3 sutures are required.
phacoemulsification
Two pre-op cataract surgery eye drops.
_____ are dilating eye drops that can be used pre-op. They are alpha-adrenergic agonists that contract the dilator muscle in the iris.
_____ are dilating eye drops which block acetylcholine on the iric sphincter muscle paralyzing the ciliary body allowing the dr. to fully see the vision problem
mydriatics

cycoplegics
___ ___ is the most common post-operative complication w/ cataract surgery
secondary glaucoma
____ is damage in the blood vessels of the retina. It is a progressive problem, meaning it continues to get worse. It is caused by microscopic occlusions on the ____ ___. It is usually associated w/ ___ or ___ and leads to blindness.
retinopathy

renal artery.

HTN or diabetes.
Two types of diabetic retinopathy: ____ and ____
nonproliferative - (most commons) weaking of "old" retinal vessels w/ hemorrhage-leaky old blood vessels

Proliferative - formation of "new" ineffective vessels that hemorrhage-abnormal new leaky blood vessels
Manifestations of Retinopathy
-hemorrhage into vitreaous space
-_______
-_______
-Retinal ischemia
-______
-Macular edema
-_____
-Hemorrage into vitreous space
-black spots / floaters
-complete loss of vision
-Retinal ischemia
-blind spots
-Macular edema
-decreases central vision
____ ____ ____ can occur when emboi from atherosclerosis or valvular heart disease lodge in retinal arteries This causes ischemia (restriction in blood supply to tissues). This can also occur if the blood become viscous and sluggish in the retinal artery.
retinal artery occlusion
Pts with retinal artery occlusion will experience a ____. This is a medical emergency.
sudden, unilateral loss of vision.
Tx for retinal artery occlusion
massage by physician to dislodge embolus
O2 @ 95% for 10 min.
anticoagulation therapy in early phase
surgery to decrease IOP and remove embolus
___ ___ is the separation of the retina from underlying epithelium tissues with fluid accumulation between layers. When the retina detaches, it cannot absorb light and function is lost...sudden painless loss of vision
retinal detachment
retinal detachment is caused by a ____ in the retina which allows fluid to leak and the retina detaches.
Risk factors are: (4)
tear
Risk factors: age, trauma, diabetic retinopathy, surgery, genetics.
Goals in Tx for retinal detachment
-place retinal back in contact with choroid
-seal holes/breaks
_____ is sealing holes or breaks in the retina w/ a laser. It creates a scar. It is used for small breaks w/ little or no retinal detachment
phoocoagulation
____ _____ is a surgical procedure for retinal detachment that creates a dent in the eyeball. It helps seal the break and relieves traction on retina.
scleral buckling
___ ____ is the injection of a gas bubble into the eye associated w/ retinal detachment
pneumatic retinopexy
What can increase IOP
bending, coughing, lifting, straining
____ ____ is an age related eye disorder with central visual deficits. Pts have scotomo-blind spots. There are two types: ____ (dry) which is a build up of deposits in the retinal epithelium or ______ (wet) abnormal leaky blood vessels. If wet is untreated it leads to functional blindness.
macular degeneration

nonexudative (dry)

exudative (wet)
what is scotoma?
blind spot
Macular degeneration is diagnosed with ____ and the ____ ____ test which can define where the problem is in the eye.
opthalmoscope
Amsler grid test
Treatment for wet macular degeneration includes ____ ____. Side effects are blurred vision, pain, photosensitivity
intraocular injections
____ is a group of disorders occurring in the eye that is characterized by increased IOP. When the IOP is too high, the optic nerve is damage and the peripheral visual field is lost. It is the 2nd leading cause of blindness in the U. S. and the 1st in ___ ____
glaucoma

african americans
Who is at greatest risk for glaucoma?
elderly`
african americans
those w/ familial hx of glaucoma
those w/ diabetes mellitus
Glaucoma is caused by increased IOP which is caused by a disrupt in flow of the ___ ___ fluid
aqueous humor
Two types of glaucoma? _____ glaucoma "clogged sink" is when the aqueous humor gets backed up because the trebekucular mesh gets clogged. It is the most common (90% of cases). It is a chronic condition and has a slow onset w/o symptoms. vision deficits gradual

______ glaucoma is also when there is a decreased outflow of aqueous humor but it is caused by the angle closure r/t a bulging lens or pupillary dilation. vision deficits sudden
Open-angle glaucoma - clogged sink

closed-angle glaucoma
symptoms of closed-angle glaucoma include:
sudden eye pain
N/V
blurred vision and halos
frosty cornea
Open-glaucoma is a ____ condition and closed-glaucoma is an ___ condition
Open - chronic
closed - acute
Normal IOP

anything over ___ requires careful monitoring

once the pressure goes over ____mmHg, that pt is at high risk for vision loss.
normal 10-21 mmHg

IOP >23 requires monitoring

high risk for vision loss IOP >30
A ____ can read IOP. It is repeated over time and varying times of day.
Tonometry pin
___ microscopy is used to determine the angle of the cornea and iris
split lamp
_____ allows better visualization of anterior chamber angle
gonioscopy
__ __ photographs are a good tool to use to watch for optic disc cupping. The optic disc becomes wider, deeper, and paler in appearance. This is used over time to monitor ____ angle glaucoma.
optic disc photographs

monitors open angle glaucoma
With glaucoma, you want to assess for pts use of OTC drugs because many such as _____ cause pupillary dilation. This is contraindicated in _____ angle glaucoma
antihistamines are contraindicated with closed angle glaucoma
Glaucoma treatment:
There is ____ ____
damage ____ be reversed
symptoms ____ be controlled
There is no cure
damage cannot be reversed
symptoms can be controlled
Three types of surgery for glaucoma pts to manage symptoms
drain implant
laser surgery
trabicularectomy**
Open angle glaucoma medications (BACC)
Beta blockers
Adrenergics
Cholinergics (miotics)
Carbonic anydrase inhibitors
Closed angle glaucoma medications (MH)
Miotics
Hyperosmolars
Surgical options for open angle glaucoma (3)
Argon Laser Trabeculoplasty
Trabeculectomy
Shunt implant
Surgical options for closed angle glaucoma
Laser irodotomy
With ____ _____, the laser creates scarring and contracts the meshwork so the outflow channels for the aqueous humor are bigger. it is 80% successful in stopping progression of glaucoma, but it needs to be repeated. Topical steroids will be give for 3-5 days post op
Laser Trabeculoplasty
A _____ is also known as filtration surgery. It is done if laser therapy and meds are unsuccessful. The surgeon removes part of the iris and the trabecular meshwork. It allows the aqueous humor to flow out. It is 75-80% successful
Trabeculectomy
If a Trabeculectomy fails, the next option is to place a ____ to drain the aqueous humor
shunt
Pts w/ closed angle glaucoma need immediate medical intervention. Dr will make a slit in the iris to drain aqueous humor. This is called ____ or ____
iridotomy or iridectomy
Post-op glaucoma Nursing management
eye covered / protected
avoid lying on operative side
monitor for:
increased IOP
pain
Nausea
decreased vision
______ medications lower IOP by increasing blood flow to the retina. They contract the ciliary muscle, constric the pupil and widen the trabecular meshwork
Miotics
What are the two types of Miotics? What's the difference? Name the meds.
direct acting cholinergic - controls parasympathetic nervous system ( Carbachol, pilocarpine)

indirect anti-cholinesterase - inactivates cholinesterase and causes pupillary constriction (isopto-Eserine, Humorsol)
***Miotics are contraindicated w/ some disorders. These are:
closed angle glaucoma
asthma
coronary artery disease
To prevent systemic absorption of Miotics-
place pressure on lacrimal ducts when administering
Toxicity symptoms of Miotics include:
bradycardia, vertigo, hypotension, seizure, severe change in vision
____ ____ eye drops are the first in line to treat OPEN angle glaucoma. These decrease the production of aqueous humor to decrease IOP. Name 4 (lols)
beta blocker adrenergic eye drops

timolol (Timoptic)
carteolol (Ocupress)
levobunolol (Betagan)
betaxolol (Betoptic)
Beta blocker eye drops should NOT be give to pts with ___, ____, or ____ because they cause bronchocontriction (asthma)
COPD, asthma, CHF

In asthma pts - beta blocker cause bronchoconstriction!!!!!
_____ analogues include drugs that are seen often in the healthcare setting. Drugs such as ___ and ____ decrease IOP. These are as effective as beta blocker in lowering IOP and have fewer side effects. Must wait ____ between these and other eye drops. Pigmentation in eyes can change to brown.
Prostaglandin analogues - Xalatan, Lumigan

Wait 5 minutes between other eye drops
Used for long-term treatment of open-angle glaucome, ______ lowers the production of aqueous humor which in turn lowers the IOP. These are diuretics, so monitor electrolytes, especially K+. Name some.
Contraindicated in pt w/ ____ ____
carbonic anhydrase inhibitors
Azopt, Trusopt (eye gtts)
Diamox (PO)
Cosopt (CAI and beta blocker combo eye gtts)

contraindicated in pts w/ sulfa allergy
side effects of carbonic anhydrase inhibitors
lethargy, polyuria (diuretic), hypokalemia (diuretic), depression, N/V
Used for CLOSED angle glaucoma, ____ ____ are used to decrease the volume of the vitreous humor*** in the bulk of the eyeball. Decreasing the vitreous humor lowers the IOP as well. They work quickly
Osmotic diuretics - used to decrease volume of VITREOUS HUMOR ***
IV form of osmotic diuretic is ____. It is a very strong diuretic; use filter. Ensure IV site extravasation will cause tissue necrosis!
mannitol (Osmotrol)
The oral form of osmotic diuretics is called ____. It is a form of glycerin. Diabetics are given a synthetic form called _____
Osmoglyn.

diabetics get Ismotic
Something important to watch for with Osmotic diuretics is
neurological changes, and other diuretic side effects
_____ and ____ are used in diagnostic procedures and eye surgery for patients who have open-angle glaucoma
Mydriatics and cycloplegics
____ dilate the pupil. Side effects are headache, brow pain. Contraindicated in: (2)
Teach to notify Dr. if blurred vision, dyspnea, flushing, diaphoresis
mydriatics

contraindicated in cardiac dysrhythmia and cerebral atherosclerosis
Cycloplegics have _____ properties. They paralyze the muscles in the eye that allow accomodation to occur. The aqueous humor does not flow out and IOP increases; therefore, Cyclopegics should never be give to pts with ____
Cycloplegics have anticholinergic properties

Do not give to pts w/ glaucoma
Intraocular inflammation or infections are in the inner eye and can be caused by bacteria, fungi, viruses, or parasites. chronic or acute. signs and symptoms include: redness, pupil constriction, pain, blurred vision, and photophobia.
infection or inflammation of inner eye
Tx for intraocular inflammation and infection
topical steroids to decrease inflammation
antimicrobial drugs
____ is an extensive intraocular infection that spreads to the orbital cavity and eyelids
Panophthalmitis
____ is a surgery or injury complication that causes intraocular inflammation or infection. It is rare and causes irreversible blindness
Edophthalmitis
_____ _____ intraocular inflammation or infection is caused by having AIDS or being immunosuppressed
Cytomegalovirus retinitis
_____ intraocular inflammation is caused by autoimmune diseases such as multiple sclerosis, or malignancies
Sterile
A ___ ___ is cancer of the iris. It is the most common cancer of the eye, but rare in occurrence. At risk:
There is a dome shaped brown/gold pigment in the eye
Uveal Melanoma

at risk: fair skin, over 60, chronic UV exposure
____ is surgical eyeball removal. Monitor for complications such as: (4)
Teach:
topical ointment, wound care, prosthesis care
Enucleation
complications: bleeding, swelling, pain, fever