The Eye

Presented by 4E
 Definition of terms
• Vision: passage ray of light from an object through the
cornea, aqueous humor, lens, & vitreous humor to the
retina its appreciation in the cerebral cortex.
• Emmetropia: normal vision (20/20)
• Ametropia: abnormal vision
» Myopia: nearsightedness
» Hyperopia: farsightedness
 Definition of terms
• Accomodation: focusing apparatus of the eye adjusts to
object at different distances by means of increasing the
convexity of the lens.
• Prebyopia: elasticty of the lens decreases with increase age
• Astigmatism: uneven curvature of the cornea causing the
patient to be unable to focus horizontal and vertical rays
of light on the retina at the same time.
 Common Abbreviation
• OD (oculous dexter): R eye
• OS (oculus sinister): L eye
• OU (oculus unitas): both eyes
• IOP: intarocular pressure
• IOL: inraocular lens
• EOL: extraocular lens
 Eye Specialists
• Ophthalmologists: medical doctor specialist in
diagnosing and treating the eye.
• Optometrist: examine, diagnose, and manage visual
problems and diseases; does not perform
surgery
• Optician: fits, adjusts, and give eyeglasses as
prescribe.
• Ocularist: technicians who makes ophthalmic
prostheses.
 Anatomy and Physiology
(An Overview)
• Eyeball: it is a protective bony structure known as the
orbit.
– Line with muscle and connective adipose
tissue
– 4 sided pyramid surrounded on 3 sides of

Eyelids: composed of thin elastic skin that covers striated

and smooth muscles
Protect the anterior portion of the eye
Contain multiple glands (sebaceous, sweat, &
accessory lacrimal glands)
Upper lid, covers the uppermost portion of iris and
is innerviated by oculomotor nerve (CN III)
Eyelids: triangular spaces (inner/medial canthus &
outer/lateral canthus)
With every blink of the eyes, the lid wash the
cornea and conjunctiva.

Lacrimal Gland: form TEARS; secreted in response to reflex

or emotional stimuli.

Conjunctiva: a mucous membrane, provides a barrier to the

external environment and nourishes the eye.
Goblet cells (secrete lubricating mucus)
Bulbar conjunctiva covers sclera
Palpebral conjunctiva lines the inner surface of the
upper and lower eyelids.
Fornix, junction of the 2 portions
Sclera: white eye; dense, fibrous structure that makes
up the posterior five sixthes of the eye.
Helps maintain the shape of the eyeball and protect
intraocular contents from trauma
Limbus, outermost edge of the iris (conjunctiva &
cornea meets)

Cornea: transparent, avascular, dome like structure,

forms the most anterior part portion of the
eyeball.
Main refracting surface of the eye
5 Layers:
Epithelium
Bowman’s membrane
Stroma
Descemet’s membrane
Endothelium
Anterior chamber: filled with continually replenished
supply of clear aqueous humor (nourishes the
cornea)
Produced by cleary body
Production r/t the IOP
N.V. IOP 10-12 mmHg

Uvea: iris, ciliary body, & choroid

Iris: colored part of the eye; highly vascularized,
pigmented collection of fibers surrounding the pupil.
Pupil: space that dilatyes and constricts in response to
light.
Normal: round & constrict symmetrically when a
bright light shines on them
Dilation & Constriction: controlled by the sphincter
& dilator pupillae muscle
Lens: behind the pupil & iris
Colorless, biconvex structure held in position by
zonular fibers
Avascular & has no nerve or pain fiber
Responsible for accomodation

Posterior chamber: small spaces between the vitreous and

the iris
Choroid: lies between the retina and the sclera
Avascular tissue, supply blood to the closest
position of retina

Ocular Fundus: largest chamber of the eye

Contains vitreous humor (clear, gelationous
substance that mostly of H2O & encapsulated by a
heploid membrane & helps maintain the shape of
the eye.
Retina: neural tissue
Landmarks:
Optic Disc: point of entrance of the optic
nerve; pink-oval/circular form
Retinal Vessels: emanating inside the
physiologic depression
Macula: responsible for central vision

2Layes:
Retinal pigment epithelium
Sensory retina
 DIAGNOSTIC EVALUATION:
• Direct Opthalmoscopy: Hand-held instruments with variousplus and minus
lenses.
• Indirect Opthalmoscopy: Used by the opthalmologist to see larger areas of the
retina, although in an unmagnified state.
• Slit- Lamp Examination: Binocular microscope mouted ona table with a
magnification of 10-40 times the real image.
• Color Vision: ability to differentiate colors has a dramatic effect on the activities
of daily living.
• Amsler Grid: Used for patients with macular problems, such as macular
degeneration.
• Ultrasonography: is a ver valuable diagnostic technique, especially when the
view of the retina is obscured by opaque media such as cataract or hemorrhage.
• OptiacalCoherence Tomography: emerging technology that involves low
coherence interferometry.
• Fluorescein Angioraphy: clinically significant macular edema, documents
macular capillary non perfusion and identifies retinal and choroidal
neovascularization in age-related macular degeneration.
• Indocyanine Green Angiography: Used to evaluate abnormalities in the
choroidal vasculature.
• Tonometry: Measures IOP by determining the amount of force of
pressure necessary to indent or flatten a small anterior area of the global
of the eye.
• Perimetry Testing: evaluates the field of vision.
 CATARACT
• Derived from the greek word cataractos, which
means running water.
• Lens opacity or cloudiness.
• Changes in the clarity of the natural lens inside the
eye that gradually degrade visual quality.
 CATARACT:
PATHOPHYSIOLOGY
• Cataract formation is characterized chemically by the
reduction in oxygen uptake and an initial increase in water
content followed by dehydration of the lens. Sodium and
calcium contents are increased: potassium, ascorbic acid and
protein content decreased. The protein in the lens undergoes
numerous age- related changes, including yellowing from
formation of fluorescent compounds molecular change. These
change, along with photoabsorption of violet radiation
throughout life, suggest that cataract maybe caused by photo
chemical process.
 CATARACT:
STAGE OF DEVELOPMENT
• Immature Cataract - incomplete opaque, and some
light is transmitted through them, allowing useful
vision.
• Mature Cataract – completely opaque
• Intumescent Cataract – the lens absorbs water and
increases size.
 CATARACT: TYPES
• Congenital Cataracts or infantile – occurs at birth
• Nuclear Cataract – the central portion of the lens is mostly
affected
• Cortical Cataract - Opacities at the lens cortex ( outside of
the lens.)
• Subcapsular Cataract - Opacity develops immediately to the
lens capsule(common in posterior portion.)
• Senile Cataract - commonly occurs with aging
• Aphakia - absence of crystalline lens
 CATARACT:RISK FACTORS
• Aging: Loss of lens transparency, Clumping or aggregation of the
lens, Accumulation of yellow – brown pigment due to the
breakdown of the lens protein, Decrease oxygen uptake, Increase in
sodium and calcium, Decrease in levels of Vit. C, protein and
glutathione.
• Associated Ocular Conditions: Retinitis pigmentosa, Myopia,
Retinal detachment and retinal surgery, Infection
• Toxic Factors: Corticosteroids, especially at high doses and in long
term use, Alkaline chemical eye burns, positioning, Cigarette
smoking, Calcium. Copper, iron, gold and mercury, which tent to
deposit in the papillary area of the lens
• Nutritional Factor: Reduced levels of antioxidants, Poor
nutrition, Obesity
• Physical Factors: Dehydration associated with chronic
diarrhea, use of purgatives in anorexia nervosa, and use of
hyperbaric oxygenation, Blunt trauma, perforation of the lens
with a sharp object or foreign body, electric shock,
ultraviolent radiation in sunlight and x-ray.
• Systemic Disease and Syndromes: DM, Down Syndrome. d/o
r/t lipid metabolism, Renal d/o, Musculoskeletal d/o.
 CATARACT:
•
CLINICAL
Painless, blurry vision
MANIFESTATION
• Person perceives that surroundings are dimmer, as if his or her glasses need
cleaning.
• Light scattering
• Reduced contrast sensiitvity
• Sensitivity to glare
• Reduces visual acuity
• Myopic shift
• Astigmatism
• Monocular diplolia
• Brunescens
 CATARACT: COMPLICATION
• Secondary Glaucoma
• Postoperative Infections
• Bleeding
• Macular edema
• Wound leaks
 CATARACT: ASSESSMENT AND
DIAGNOSTIC FINDINGS
• Decreased visual acuity

• DIANOSTIC EVALUATION:
– Slit-lamp exam
– Tonometry
– Direct and indirect opthalmoscopy
– Perimetry
 CATARACT:
NSG. DX & PLANNING
• Disturbed visual secondary perception r/t altered sensory
reception, status of sense organs and therapeutically
restricted.
• Risk for injury: Risk factor may include poor vision, reduced
hand/ eye coordination.

• Planning: The client will gain improved vision and will adapt
to change in visual correction.
 CATARACT: INTERVENTIONS
• Surgical Interventions:
– Intracapsular Cataract Extraction: Entire lens is removed and
fined sutures are used to close the incision.
– Extracapsular Cataract Extraction: Involves smaller incisional
wounds and maintains the posterior capsule of the lens.
– Phacoemulsification: Method of extracapsular surgery uses
an ultrasonic device that liquefies the nucleas and cortex,
which are then suctioned out through tubing.
– Lens Replacements
 CATARACT: INTERVENTIONS
• Nursing Interventions:
– Administer dilating drops every 10 min for 4 doses atleast
1 hour before surgery.
– Antibiotic, corticosteriod and anti-inflammatory drops amy
be administered prophylactically to prevent postoperative
infection and inflammations.
– After the surgery the patient receives verbal and written
instruction about how to protect eye, administer
medications, recognize complications and obtain
emergency care.
– The nurse also explains that there should be minimal discomfort
after surgery.
– Instruct patient self care to prevent accidental rubbing of the
eye.
– Teach patient self care to prevent accidental rubbing of the eye.
– Patient should wear a protective eye patch for 24 hours after
surgery, followed by eyeglasses worn during the day and a
metal shield worn at night for 1 to 4 weeks.
– Teach client eye patch is removed after first follow – up
appointment.
 CATARACT: EVALUATION
• Adaption to restored normal vision is usually rapid.
• Adaption to limited vision requires more time based
on individual variations.
 RETINAL DETACHMENT
• a medical emergency requiring prompt surgical treatment to
preserve vision.
• The retina is the light-sensitive tissue that lines the inside
back wall of your eye. In retinal detachment, the retina is
pulled away from the underlying choroid – a thing layer of
blood vessels that supplies oxygen and nutrients to the retina.
• Retinal detachment leaves retinal cells deprived of oxygen.
The longer the retina and choroid remain separated, the
greater the risk of permanent vision loss in the affected eye.
 RETINAL DETACHMENT:
SYMPTOMS
• Retinal detachment is painless, but visual symptoms almost
always appear before it occurs. Warning signs of retinal
detachment include:
1. The sudden appearance of many floaters – small bits of
debris in your field of vision that look like spots, hairs or
string and seem to float before your eyes
2. Sudden flashes of light in one or both eyes
3. A shadow or curtain over a portion of your visual field
4. A sudden blur in your vision
 RETINAL DETACHMENT:
CAUSES
1. Trauma
2. Advanced diabetes
3. An inflammatory disorder, such as sarcoidosis or
cytomegalovirus retinitis
4. Sagging or shrinkage of the jelly-like vitreous that
fills the inside of your eye
 RETINAL DETACHMENT:
PATHOPHYSIOLOGY
• Retinal detachment occurs when vitreous liquid (vitreous humor)
leaks through a retinal tear and accumulates underneath the retina.
Leakage can also occur through tiny holes where the retina has
thinned due to aging or other retinal disorders. Less commonly,
fluid can leak directly underneath the retina, without a tear or
break. As liquid collects underneath it, the retina can peel away
from the underlying layer of blood vessels (choroid). Over time
these detachment areas may expand, like wallpaper that, once
torn, slowly peels off a wall. The areas where the retina is detached
lose their blood supply and stop functioning, leading to loss of
vision.
 RETINAL DETACHMENT:
•
RISK FACTORS
Aging – retinal detachment is more common in people older than age 40
• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury or trauma
• Weak areas on the sides (periphery) of your retina
 RETINAL DETACHMENT:
TEST AND DIAGNOSIS
• An ophthalmologist may be able to see a retinal hole, tear or
detachment by looking at the retina with an ophthalmoscope.
• If blood in your vitreous cavity blocks the view of your retina,
ultrasound examination may be useful.
• Photocoagulation – a light beam is passed through the pupil,
causing a small beam and producing an exudates between the
pigments epithelium and retina.
 RETINAL DETACHMENT:
NURSING DIAGNOSIS
• Anxiety r/t visual deficit and surgical outcome
• Risk for injury r/t eye surgery
 RETINAL DETACHMENT:
TREATMENTS AND DRUGS
• Surgery is the only effective therapy for a retinal tear, hole or
detachment.
• Pneumatic retinopexy – for a relatively uncomplicated
detachment with the tear located in the upper half of the
retina; usually done under local anesthesia.
• Scleral buckling – this is one of the most common surgeries
for repairing retinal detachment.
 RETINAL DETACHMENT:
TREATMENTS AND DRUGS
• Vitrectomy - removing portions of the vitreous itself is
occasionally necessary when vitreous clouding blocks the
surgeon’s view of the detached retina or retinal scarring limits
the effectiveness of pneumatic retinopexy or scleral buckling.
• Electrodiathermy – an electrode needle is passed through the
sclera to allow subretinal fluid to escape
• Retinal cryopexy – supercooled porbe is touched to the
sclera.
 RETINAL DETACHMENT:
NURSING MANAGEMENT
• Provide supportive care
• Promote comfort
• Teach about complication
• Sedation, bed rest, and eye patch to restrict eye
movements