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149 Cards in this Set
- Front
- Back
The ____ produce tears to wash the eye and clear away debri
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lacrimal ducts
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Because the conjunctive is ___ it is a specific site where medications can be administered
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mucosal
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the outer layer of the eye contains the ___ and the ____.
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sclera and cornea
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The ___ is the white of your eye. It is a tough tissue that provides protection and where the intraocular muscles attach.
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The ___ is the white of your eye. It is a tough tissue that provides protection and where the intraocular muscles attach.
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The cornea has a ___ shape. This beds light as it enters the eye.
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convex
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The image appears on the ___ upside down and ____
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on retina upside down and backwards
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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
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iris
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The __ is where light passes through the eye. The ___ controls how much light passes through.
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Pupil
iris |
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The lens of the eye is ____. It has the ability to change shape when objects are near
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biconvex
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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.
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ciliary body.
aqueous humor. ciliary change shape |
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_____ is the substance the fills the space between the lens and the cornea. It maintain the shape of the anterior chamber of the eyeball
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aqueous humor
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____ causes too much of the aqueous humor to be produced or it doesnt allow the fluid to be drained
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glaucoma
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The ___ supplies blood to the ciliary body, the iris and the retina.
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choroid.
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The ___ is the innermost layer of the eye. it is made up mostly of ____, so once the tissue is damaged...it cannot be regenerated.
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retina
neurons/nerve tisse |
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The retina has ___ and ____. ___work in dim environments and ____ help us see in color.
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rods and cones
rods -dim environment cones - see in color |
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What is presbyopia
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a condition in the elderly where the lens of the eye loses its ability to focus making it difficult to see objects up close.
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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.
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macular degeneration.
central vision is lost |
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Name some diseases that can affect the eyes
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diabetes, HTN, cancer, multiple sclerosis, and thyroid disorders
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If the pt has a hx of heart problems or COPD, be cautious if they are taking ___ ____ medications for their eyes.
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beta adrenergic
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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."
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What is strabismus?
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Impaired or dim vision without obvious defect or change in the eye.
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What is amblyopia?
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increasing the intraocular pressure will alter _____. Check if the has been trauma to the eye that may have caused swelling.
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vision
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____ and ____ medicines can dilate the pupil.
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antihistamines and cold medicines
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Use of ___ over a long period of time can cause development of glaucoma or cataracts
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corticosteroids
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How would you do a physical assessment of the eye?
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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 |
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What chart is used as a baseline test to test visual acuity
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Snellen chart
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How does a patient read a Snellen chart? (standard eye chart)
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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.
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A Jaegar chart is used to test _____ ____ ____. The chart is held 14 inches from face
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near vision acuity
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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.
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Myopia and Hyperopia
presbyopia astigmatism aphakia |
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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.
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nearsighted
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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 |
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___ 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.
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Hyperopia-farsighted
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___ 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.
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presbyopia
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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.
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astigmatism
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___ is the absence of the lens. This can be related to trauma or surgery. The will have a lens implant
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aphakia
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All refractive disorders can be corrected with glasses. The ___ of the glasses depends on the refractive disorder present.
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curvature
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If RSVP occurs, pts should take out contact lenses and call their eye doctor. What does RSVP stand for?
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R redness
S sensitivity V vision problems P pain |
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Name three TYPES of eyes surgery
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Laser
Implant Thermal |
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Laser surgeries such as LASIK and PRK do what?
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Correct myopia, hyperopia, and astigmatism. They change corneal shape and change the refraction of light
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Implants placed in the ____ changes its shape and alters refraction of light to improve vision. This is usually used to treat ____ conditions
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cornea
myopic conditions |
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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
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keratoplasty
done on less dominant eye |
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What is considered legal blindness?
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20/200 or worse. The person can not see at 20 ft what the normal person can see at 200 ft.
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What is considered total blindness?
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Can not see any light at all
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What is considered functional blindness?
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People have some light perception, but cannot make out shapes
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Almost all blindness is related to diseases such as (4). The other small percentage is due to injuries that have occurred to the eye.
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glaucoma
cataracts macular degeneration retinopathy (diabetes) |
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Assessment of the Visually impaired?
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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 |
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Nursing goals for pt with visual impairment are focused on....
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helping the pt adjust to and cope with visual impairments
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To prevent further impairment of the eyes, you should be ___ with treatment regimens, ____ eyes with goggles, and ____ changes or loss of vision
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compliant
protect report |
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3 ways Nurses can provide care to the visually impaired..
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Emotional Support
Foster Independence Provide Resources |
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4 types of eye trauma injuries
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blunt
penetrating chemical heat |
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eye injury symptoms
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pain
blurred/lost vision photosensitivity swelling, redness, bruising tearing bleeding |
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Nursing assessment for eye trauma
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How did it happen?
Assess visual acuity |
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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 |
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How do you decrease the intraocular pressure
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Keep HOB >45 degrees
NO nose blowing |
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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
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hordoleum
Treat w/ warm compress and antibiotics |
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Bump on eyelid - _____, is an inflammation or infection caused by a blocked gland. Painful. No discharge. Treat w/ ___ or ___. Visual acuity is unaffected
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Chalazion
warm compress or surgical I & D |
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____ is an inflamed lash line w/ crusty discharge caused by infection of seborrhea. Treat w/ ___ and ____. Visual acuity unaffected
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blepharitis
Treat w/ antibiotics and special shampoo |
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____ 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?
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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. |
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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??
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trachoma
infected hands and flies coma associated blindness |
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signs and symptoms of allergen conjunctivitis. Drainage is usually ___ or ____. Treat symptoms w/ ___ and ___
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ITCHING, redness, irritation.
Drainage white or clear antihistamines and corticosteroids |
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____ is an infection or inflammation of the cornea. If the cornea and conjunctiva are involved, then it is called ____.
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keratitis
kerato-conjunctivitis |
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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.
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herpes simplex virus
Viroptic (sp?) NO corticosteroids |
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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
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varicella
pts will receive strong analgesics and oral antivirals such as Zovirax |
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Parasitic keratitis is called _____ and is usually caused by ____.
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acanthamoeba keratitis
contaminated contact lens solution |
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Nursing assessment for infection or inflammation of the eye
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Assess for:
increased redness edema drainage pain changes in visual acuity |
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Nursing Intervention for infection or inflammation of the eye...3 things
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Prevent spread of infection
maintain comfort administer eye gtts |
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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 |
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an autoimmune disorder associated w/ keratoconjunctivitis sicca that affects the moisture producing glands of the body.
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Sjogren's syndrome
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_____ can be caused by thyroid disease, neuromuscular disorder, cerebral lesions, and can c/o double vision. There are 4 kinds..what are they?
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Strabismus
esotropia -eye points in exotropia - eye points out hypertropia - eye points up hypotropia - eye points down |
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___ ____ 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.
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Corneal transplant
full cornea Lamellar -partial |
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What are the complication of a corneal transplant?
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Graft rejection (bad storage, surg. trauma, immunologic rejection)
wound leakage, bleeding, glaucoma, cataract, infection |
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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 |
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____ are an opacity that is w/ in the lens. It is the 3rd leading cause of preventable blindness.
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cataracts
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___ cataracts are found in older people caused by the accumulation of water due to ultrametabolic processes and structure changes in the lens
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senile
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Younger people can get cataracts too, especially if they have certain diseases such as ____ or if they've had a ____ ___ to the eye.
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diabetes
traumatic injury |
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Some drugs like long-term _____ use can cause cataracts to form. This is the leading cause of blindness
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steroid
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s/sx of cataracts
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decreased vision
blurred diplopia - visual impairment when an object is seen as two objects photophobia glare |
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People with cataracts have better vision in ____ because ____
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dim light - pupils dilate more
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To diagnose cataracts, opacities are observed using a ____ or _____
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opththalmoscope
split-lamp |
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What is ICCE and ECCE.
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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. |
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You must have surgery to cure cataracts. When is cataract surgery necessary?
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vision is too far gone
Dr. can't see retina intraocular pressure becomes too high |
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Cataract surgery where lens is removed. There is a smaller incision than ICCE or ECCE. 1-3 sutures are required.
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phacoemulsification
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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 |
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___ ___ is the most common post-operative complication w/ cataract surgery
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secondary glaucoma
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____ 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.
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retinopathy
renal artery. HTN or diabetes. |
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Two types of diabetic retinopathy: ____ and ____
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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 |
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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 |
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____ ____ ____ 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.
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retinal artery occlusion
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Pts with retinal artery occlusion will experience a ____. This is a medical emergency.
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sudden, unilateral loss of vision.
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Tx for retinal artery occlusion
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massage by physician to dislodge embolus
O2 @ 95% for 10 min. anticoagulation therapy in early phase surgery to decrease IOP and remove embolus |
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___ ___ 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
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retinal detachment
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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. |
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Goals in Tx for retinal detachment
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-place retinal back in contact with choroid
-seal holes/breaks |
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_____ 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
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phoocoagulation
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____ _____ is a surgical procedure for retinal detachment that creates a dent in the eyeball. It helps seal the break and relieves traction on retina.
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scleral buckling
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___ ____ is the injection of a gas bubble into the eye associated w/ retinal detachment
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pneumatic retinopexy
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What can increase IOP
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bending, coughing, lifting, straining
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____ ____ 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.
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macular degeneration
nonexudative (dry) exudative (wet) |
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what is scotoma?
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blind spot
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Macular degeneration is diagnosed with ____ and the ____ ____ test which can define where the problem is in the eye.
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opthalmoscope
Amsler grid test |
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Treatment for wet macular degeneration includes ____ ____. Side effects are blurred vision, pain, photosensitivity
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intraocular injections
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____ 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 ___ ____
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glaucoma
african americans |
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Who is at greatest risk for glaucoma?
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elderly`
african americans those w/ familial hx of glaucoma those w/ diabetes mellitus |
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Glaucoma is caused by increased IOP which is caused by a disrupt in flow of the ___ ___ fluid
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aqueous humor
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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 |
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symptoms of closed-angle glaucoma include:
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sudden eye pain
N/V blurred vision and halos frosty cornea |
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Open-glaucoma is a ____ condition and closed-glaucoma is an ___ condition
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Open - chronic
closed - acute |
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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 |
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A ____ can read IOP. It is repeated over time and varying times of day.
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Tonometry pin
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___ microscopy is used to determine the angle of the cornea and iris
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split lamp
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_____ allows better visualization of anterior chamber angle
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gonioscopy
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__ __ 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.
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optic disc photographs
monitors open angle glaucoma |
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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
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antihistamines are contraindicated with closed angle glaucoma
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Glaucoma treatment:
There is ____ ____ damage ____ be reversed symptoms ____ be controlled |
There is no cure
damage cannot be reversed symptoms can be controlled |
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Three types of surgery for glaucoma pts to manage symptoms
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drain implant
laser surgery trabicularectomy** |
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Open angle glaucoma medications (BACC)
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Beta blockers
Adrenergics Cholinergics (miotics) Carbonic anydrase inhibitors |
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Closed angle glaucoma medications (MH)
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Miotics
Hyperosmolars |
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Surgical options for open angle glaucoma (3)
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Argon Laser Trabeculoplasty
Trabeculectomy Shunt implant |
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Surgical options for closed angle glaucoma
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Laser irodotomy
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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
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Laser Trabeculoplasty
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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
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Trabeculectomy
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If a Trabeculectomy fails, the next option is to place a ____ to drain the aqueous humor
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shunt
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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 ____
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iridotomy or iridectomy
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Post-op glaucoma Nursing management
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eye covered / protected
avoid lying on operative side monitor for: increased IOP pain Nausea decreased vision |
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______ medications lower IOP by increasing blood flow to the retina. They contract the ciliary muscle, constric the pupil and widen the trabecular meshwork
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Miotics
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What are the two types of Miotics? What's the difference? Name the meds.
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direct acting cholinergic - controls parasympathetic nervous system ( Carbachol, pilocarpine)
indirect anti-cholinesterase - inactivates cholinesterase and causes pupillary constriction (isopto-Eserine, Humorsol) |
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***Miotics are contraindicated w/ some disorders. These are:
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closed angle glaucoma
asthma coronary artery disease |
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To prevent systemic absorption of Miotics-
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place pressure on lacrimal ducts when administering
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Toxicity symptoms of Miotics include:
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bradycardia, vertigo, hypotension, seizure, severe change in vision
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____ ____ 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)
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beta blocker adrenergic eye drops
timolol (Timoptic) carteolol (Ocupress) levobunolol (Betagan) betaxolol (Betoptic) |
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Beta blocker eye drops should NOT be give to pts with ___, ____, or ____ because they cause bronchocontriction (asthma)
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COPD, asthma, CHF
In asthma pts - beta blocker cause bronchoconstriction!!!!! |
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_____ 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.
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Prostaglandin analogues - Xalatan, Lumigan
Wait 5 minutes between other eye drops |
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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 |
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side effects of carbonic anhydrase inhibitors
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lethargy, polyuria (diuretic), hypokalemia (diuretic), depression, N/V
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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
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Osmotic diuretics - used to decrease volume of VITREOUS HUMOR ***
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IV form of osmotic diuretic is ____. It is a very strong diuretic; use filter. Ensure IV site extravasation will cause tissue necrosis!
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mannitol (Osmotrol)
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The oral form of osmotic diuretics is called ____. It is a form of glycerin. Diabetics are given a synthetic form called _____
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Osmoglyn.
diabetics get Ismotic |
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Something important to watch for with Osmotic diuretics is
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neurological changes, and other diuretic side effects
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_____ and ____ are used in diagnostic procedures and eye surgery for patients who have open-angle glaucoma
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Mydriatics and cycloplegics
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____ 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 |
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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 ____
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Cycloplegics have anticholinergic properties
Do not give to pts w/ glaucoma |
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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.
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infection or inflammation of inner eye
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Tx for intraocular inflammation and infection
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topical steroids to decrease inflammation
antimicrobial drugs |
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____ is an extensive intraocular infection that spreads to the orbital cavity and eyelids
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Panophthalmitis
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____ is a surgery or injury complication that causes intraocular inflammation or infection. It is rare and causes irreversible blindness
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Edophthalmitis
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_____ _____ intraocular inflammation or infection is caused by having AIDS or being immunosuppressed
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Cytomegalovirus retinitis
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_____ intraocular inflammation is caused by autoimmune diseases such as multiple sclerosis, or malignancies
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Sterile
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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 |
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____ is surgical eyeball removal. Monitor for complications such as: (4)
Teach: topical ointment, wound care, prosthesis care |
Enucleation
complications: bleeding, swelling, pain, fever |