Care of patient with eye and vision problems
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What is Blepharitis and why does it occur?
-an inflammation of the eyelid edges, itchy, red, burning and Seborrhea of eyebrows and lids
-occurs in older adults and dry eye syndrome
-reduced tear production leads to bacterial infection b/c tears inhibit bacteria growth
How do you treat Blepharitis?
-warm, moist compress followed by gentle scrubbing with dilute baby shampoo
-avoid rubbing eye as can spread infection
what is seborrhea
excessive secretion of sebum resulting in greasy, itching scaling
what is entropion? How do you care for it?
-turning inward of the eyelids causing the lashes to rub against the eye.
-demonstrate instillation of eye drops
-leave patch on until appointment with ophthalmologist
-report any draining or pain, clean surgical site and apply ointment
What is ectropion?
-turning outward and sagging of the eyelid, occurs with aging, muscle relaxation/weakness
-reduces washing action of tears leading to corneal drying and ulceration (constant tears)
-surgery to correct, care same as with entropion
what is hordeolum?
-infection of the sweat glands in the eyelid (external hordeolum) or of the eyelid sebaceous gland (internal hordeolum)
-red, swollen, tender area occurs on the skin surface sid of the eyelid
-vision not affected, effects one eye at a time
How do you treat a hordeolum?
-apply warm compress 4 times a day and apply antibacterial ointment
-pus will drain and pain will subside
-ointments may cause blurred vision, remove from eyes before driving by close eye and wipe from nasal outward
How do you instill ointment?
-each eye should have different bottle, label right and left
-wash hands, gloves
-stand behind sitting patient with head tilted back
-pull down lower lid, squeeze ointment in from nasal outward, gently release lid
-instruct pt not to squeeze lid when closed, wipe away excess, keep eye closed for 1 min.
How do you apply an Ocular Compress?
-fold clean washcloth into 4ths
-soak under warm running water
-place cloth over closed eye, keep in place with minimal pressure until cloth cools
-refold so new section will be applied to eye, resoak, repeat applications 3 times, as many times as prescribed
How do you apply an eye patch?
-apply skin preparation to the patient's forehead and cheek
-instruct to close both eyes and apply patch, tape from cheek to forehead, cover patch with overlapping pieces of tape
How do you apply a pressure eye patch?
-apply skin preparation to pts forehead and cheek, close both eyes
-fold one eye patch in half, place over eye and apply unfolded patch over top
-tape from cheek to forehead with overlapping pieces over patch
what is chalazion?
-inflammation of a sebceous gland in the eyelid, pt /o eye fatigue, light sensitivity,a nd excessive tearing
-apply warm compress 4xper day and ointment
-if removed surgically, eye patch for 6 hours, remove and apply warm compress, eyedrops
What is keratoconjuctivitis sicca, and how is it managed?
(Dry eye syndrome)
-changes in tear production from diseases or drugs
-pt c/o foreign body sensation in eye, burning, itching, light sensitivity, mucous strands in tears
-eyedrops, artificial tears, lubricating ointment, sx repair of eyelid
How can hemorrhage occur?
-blood vessels break with increased pressure, sneezing, coughing, vomiting, hypertension, trauma or blood clotting problems
-no pain or visual impairment, resolves within 14 days w/o tx
what is the difference b/w allergic conjuctivitis and bacterial conjuctivitis?
-allergic caused from allergens or irritants, c/o edema, burning, bloodshot, excessive tears and itching
-bacteria caused c/o blood vessel dilation, mild edema, tears, and discharge (watery and pus)
What is trachoma?
-chronic conjuctivitis caused by Chlamydia, scars conjuctiva causing blindness
-control infection oral and topical antibiotics are used
what do corneal disorders cause?
-reduce the refracting power of the cornea and some can lead to blindness
what is corneal abrasion? Ulceration?
-a scrape/scratch of the cornea that disrupts its integrity
-organisms entered abrasion causing infection-URGENT (no seperate blood supply)
-caused by small foreign body, trauma or contact lenses, malnutrition, dry eye cancer therapies
-c/o pain reduced vision photophobia and eye secretions, cloudy/purulent fluid
-eyedrops qhr for 24hrs, R & L bottles, do not wear contacts, strict orders of applying med routinely as stopping infection can save vision
What is Keratoconus?
-degeneration of the corneal tissue resulting in abnormal corneal shape, trauma or inherited
-scar and lead to visual impairment, need sx
what is keratoplasty?
-(corneal transplant) surgery to improve clarity for a permanentcorneal disorder that obscures vision, human donor
-teach apply antibiotic after sx, pressure patch and shield, lie on non-operative side to reduce intraocular pressure
-do not use an ice pack on the eye, and examine eye
-avoid jogging running, dancing, or jerky movements
-graft rejection, purulent discharge, continuous leak or clear fulid excessive bleeding, floaters, report asap
what steps do you perform on a deceased pt that is an eye donor?
- -raise head of bed 30 degrees
- -antibiotic eyedrops
- -close eyesand apply ice pack
- -contact family and physician
what activities increase intraocular pressure?
- -bending from the waist
- -lifting more than 10lbs
- -sneezing, coughing, blowing nose
- -straining during bowel movement
- -have sexual intercourse
- -keeping head in dependent position
- -wearing tight shirt collars
what is a cataract?
-lens opacity that distorts the image projected on the retina, becomes denser with age as it looses water
-caused by age-related, traumatic, toxic, diseases (diabetes, hypoparathyroidism, down syndrome, chronic sunlight exposure), and chronic ( glaucoma, retinal detachment)
-reduce risk by wearing sun glasses or eye protection during sports that promote risk
-blurred vision and decreased color perception, no pain or eye redness, gradual loss of vision
-sx only cure
how to care for pt after cataract surgery
-antibiotics, leave eye unpatched, pt wears dark glasses
-teach how to instill eyedrops, itching is normal, slight swelling-spply cool compress
-pain can be a sign of hemorrhage or intraocular pressure
-pts expirience vision improvement on day of surgery bur best vision comes 4-6 weeks after
what is glaucoma?
-group of eye disorders resulting in increased IOP (fuid pressure within eye)
-IOP requires a balance b/w production and outflow of aqueous humor otherwise compression of retinal blood vessels occurs causing permanent blindness
what is the difference b/w Primary open-angle glaucoma (POAG) and Primary angle-closure glaucoma (PACG)
-POAG usually effects both eyes, has no symptoms, and gradually increases IOP; tonometry reading b/w 22-32
-PACG sudden onset and is an emergency; tonometry reading >30
-normal tonometry is 10-21 mm Hg
What instructions can you give a patient in order to tx glaucoma with a drug therpay?
- -stick to precribed schedule of q 12 hrs
- -dont skip doses
- -wait 10-15 b/w medication administartion of seperate eye meds
- -keep hand and eyedropper clean
- -PUNCTAL OCCLUSION-pressure on corner of eye near nose to prevent systemic absorption of the drug
what is a vitreous hemorrhage?
-bleeding in the vitreous cavity, aging, systemic diseases, or trauma (detachment from the retina)
- -mild; red haze or floaters
- -moderate; black streaks or black dots
- -severe; reduce visual acuity to hand motion
-may absorb slowly with no tx or with vitrectomy (removal of vitreous)
what is Anterior and Posterior Uveitis?
-Anterior: inflammation of the iris or of the ciliary body; aching, tearing, blurred vision, photophobia, bloodshot
- retinitis-inflammation of the retina, chorioretinitis-inflammation of the choriod and the retina; tuberculosis, syphalis, toxoplasmosis
how do you manage uveitis?
-steroid drops to rest the ciliary bodies and dilate the pupil
-cool/warm compresses to reduce pain, darkening the room, wearing sun glasses
what is macular degeneration
-deterioration of the macula (area of central vision)
-age-related(AMD) dry and wet
-dry is more common, no cure can slow progression with antioxidants, vitamin B12, and carotenoids
what is a retinal hole?
-a break in the retina
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