2. On completion of this chapter, the learner will be able to:
1. Identify significant eye structures and describe their
functions.
2. Identify diagnostic tests for assessment of vision and
evaluation of visual disabilities.
3. Discuss clinical features, diagnostic assessment and
examinations, medical or surgical management, and
nursing management of ocular disorders.
4. Describe therapeutic effects of ophthalmic medications.
3. On completion of this chapter, the learner will be able to:
5. Define low vision and blindness and differentiate between
functional and visual impairment.
6. List and describe assessment and management strategies
for low vision.
7. Demonstrate orientation and mobility techniques for
patients with low vision in a hospital setting.
8. Demonstrate instillation of eye drops and ointment.
4. On completion of this chapter, the learner will be able to:
9. Discuss general discharge instructions for patients after
ocular surgery.
10. Discuss strategies for patient safety in ophthalmology.
22. Decrease or loss of accommodation (presbyopia)
Lens yellow with age
Senile miosis
Increased light scatter in the eye causing glare
Decrease in lens transparency (cataract)
Dryness or scratchiness of the eyes
Distorted or blurred image (astigmatism)
23.
24.
25.
26.
27.
28.
29.
30. If the patient is wearing contact lenses, have him
remove them before the test, unless the test is being
performed to evaluate the fit of the contact lenses.
When instilling dilating drops, tell the patient that his
near vision will be blurred for 40 minutes to 2 hours.
Advise him to wear dark glasses in bright sunlight until
his pupils return to normal diameter.
Don’t administer dilating eyedrops to the patient who
has angle closure glaucoma, is hypersensitive to
mydriatics, or has an intraocular lens implant.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40. Tell the patient that a small transducer will be placed on
his
closed eyelid and that the transducer will transmit high-
frequency sound waves that will reflect off the structures
in the eye.
Inform him that he may be asked to move his eyes or
change his gaze during the procedure; explain that his
cooperation will help to ensure accurate results.
After the test, remove the water-soluble jelly that was
placed on the patient’s eyelids.
41.
42.
43.
44.
45.
46.
47. Check the patient’s history for an intraocular lens implant,
glaucoma, and hypersensitivity reactions, especially
reactions to contrast media and dilating eye drops.
If miotic eye drops are ordered, tell the patient with
glaucoma not to use them on the day of the test.
Explain to the patient that eye drops will be instilled to
dilate his pupils and that a dye will be injected into his
arm. Remind him to maintain his gaze position and
fixation as the dye is injected. Tell him that he may briefly
experience nausea and a feeling of warmth.
48. Observe the patient for hypersensitivity reactions to the
dye, such as vomiting, dry mouth, metallic taste, sudden
increased salivation, sneezing, light-headedness, fainting,
and hives.
Remind the patient that his skin and urine will be a yellow
color for 24 to 48 hours after the test and that his near
vision will be blurred for up to 12 hours.
49.
50.
51.
52.
53. Because an anesthetic is instilled before the test, tell the
patient not to rub his eyes for at least 20 minutes after the
test, to prevent corneal abrasion.
If the patient wears contact lenses, tell him not to reinsert
them for at least 30 minutes after the test.
If the tonometer moved across the cornea during the test,
tell the patient that he may feel a slight scratching
sensation in the eye when the anesthetic wears off.
54.
55.
56.
57. Regular ocular and physical examinations
Avoid dangerous items
Early identification and treatment of strabismus in children
Early treatment when eye symptoms occur
Routine instillation of appropriate drops of every newborn
Blood test during pregnancy to identify syphilis
Inoculation against rubella
Regulation of oxygen concentrations in premature infants
Avoid habitual rubbing of eyes
58. Adequate lighting when reading
Periodically rest eyes during prolonged periods of close
eye work
Reduce glare and wear protective glasses
Keep eye glasses clean, protected from scratching,
breakage and properly aligned
Do not use eye medications unless prescribed by a doctor
Never use soiled wash cloth around eyes
Use care when using aerosol sprays
59. Maintain a state of good health and eat a well – balanced
diet with adequate vitamins A, B and C
Use care when using solvents, lye solutions, ammonia,
caustic solutions to avoid splashing or spilling into eyes
60.
61. Orient the client to the staff and physical environment if
both eyes will be covered after surgery.
If the client is a child, practice covering the eyes.
Administer mydriatics / cycloplegics as prescribed
• Atropine sulfate
• Cyclomydril
• Scopolamine
• Mydriacyl
62. To prevent or relieve the following:
Increased intraocular pressure
Stress on the suture site
Hemorrhage on the anterior chamber
Infection
Pain
63. Position the client supine or turned to the unaffected side.
Burning sensation about one hour after surgery is normal.
Use eye patch for 5 to 7 days. Use eye shield during the
night for four weeks.
Instruct the client to avoid the following:
• Rubbing the eyes
• Lifting the head or hips
• Sudden, jerky head movements
• Sneezing and coughing
64. • Nausea and vomiting
• Straining during defecation
• Bending and stooping
• Heavy lifting
• Reading for few days
• Watching fast moving objects
Feeling of “something in the eye” 4 to 5 days postop is
normal.
Sensation of pressure within the eye and sharp pain in the
yes indicates bleeding.
92. Assessment
• Pain radiating to the forehead and temple, blurred
vision, photophobia, redness without purulent
discharge, small pupil, lacrimation
Treatment
• Mydriatics and steriods
• Dark glasses
• Analgesics
93.
94. Assessment
• Inflammation of exciting eye followed by the
sympathizing eye, photophobia, blurred vision
Treatment
• Enucleation
• Steriods
• Atropine
95.
96. Assessment
• Reduced visual acuity, changes in visual field,
alterations in the shape of objects, discomfort in the
eyes and photophobia
Treatment
• Rest the eyes
• Protect eyes from light
• Atropine sulfate
101. Assessment
• Floating spots or opacities, flashes of light, progressive
constriction of vision in one area, cloudy vitreous and
portion of retina
Treatment
• Bed rest and cover eyes
• Dependent position
• Early surgery
110. Assessment
• Rapid onset of severe pain
• Blurred vision
• Headache
• Rainbows and halos around lights
• Nausea and vomiting
• Inflamed eye
• Fixed dilated pupils
111.
112. Treatment
• Bed rest in quiet, darkened room, elevate head 30
degrees
• Monitor vital signs
• Miotic eye drops as ordered
• Administer acetazolamide and glycerol
• Provide emotional support
• Assess client’s ability to see
113. Treatment
• Assist according to degree of visual impairment
• Prepare for eye examinations as ordered – tonometry
• Avoid mydriatics
ABC atropine, benadryl cogentin
• Administer antiemetics for nausea
• Diet as tolerated
• Prepare for surgery if ordered
114.
115. Assessment
• Tunnel vision which can progress to blindness
• Insidious onset – generally no discomfort
• Persistent dull eye pain in the morning
• Frequent changes of glasses, difficulty in adjusting to
darkness, failure to detect changes in color accurately.
• Rainbows or halos resembling street lights around
lights
116.
117. Treatment
• Miotics
• Acetazolamide (Diamox)
• Avoid fatigue or stress and avoid large quantities of
fluids
• Surgery
160. 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 ophthalmia in the other eye
Intraocular tumors that are untreatable by other means
161.
162.
163.
164.
165.
166. Refer to available facilities.
Orient to environment.
Promote independence – ADL
May have a guide dog or use cane for direction.
When approaching, talk before touching.
When assisting in ambulation, have the patient hold your
forearm so that you are a step ahead of him.
Talk to the patient frequently.
Explain nursing procedures and what is to be done next.
167.
168.
169. Do not change the location of the objects in the room
without describing the change.
Promote safety in the environment.
Do not rush up and offer help to a blind person unless it is
clear that the person wants help.
Suggest gifts for a blind person that appeal to senses
other than vision.
