Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Neurology Module: Neurology Module:

CataractCataract

Cataract: DescriptionCataract: Description

A cataract is a lens opacity or cloudinessA cataract is a lens opacity or cloudiness

Cataract is a leading cause of blindness Cataract is a leading cause of blindness worldwide (WHO)worldwide (WHO)

Cataract: Aetiology/ Risk FactorsCataract: Aetiology/ Risk Factors

AgeingAgeing

An associated eye condition (retinal An associated eye condition (retinal detachment, uveitis, herpes)detachment, uveitis, herpes)

Toxins: corticosteroids, metals, tobaccoToxins: corticosteroids, metals, tobacco

Malnutrition: obesity, poor nutritionMalnutrition: obesity, poor nutrition

Physical: trauma, chronic dehydrationPhysical: trauma, chronic dehydration

Systemic disorders: Downs syndrome, Systemic disorders: Downs syndrome, DM, renal, musculoskeletal, lipid disorders DM, renal, musculoskeletal, lipid disorders

Cataract: PathophysiologyCataract: Pathophysiology

May develop in one or both eyesMay develop in one or both eyes

Classification according to location in lens:Classification according to location in lens:

NuclearNuclear

CorticalCortical

Posterior sub-capsularPosterior sub-capsular

Ageing may cause clumping or breakdown Ageing may cause clumping or breakdown of lens protein (yellow pigmentation), ↓ O2 of lens protein (yellow pigmentation), ↓ O2 uptake, ↑ sodium and calcium uptake, ↑ sodium and calcium

Cataract: ClassificationCataract: Classification

NuclearNuclear: associated with ↑ myopia: associated with ↑ myopiaCorticalCortical: Anterior, posterior or equatorial : Anterior, posterior or equatorial cortex of lenscortex of lensLess effect on vision but vision worse in Less effect on vision but vision worse in bright sunlight (also areas of high sunlight bright sunlight (also areas of high sunlight exposure ↑ prevalence)exposure ↑ prevalence)PosteriorPosterior sub-capsularsub-capsular: younger people, : younger people, corticosteroids, trauma, inflammation. corticosteroids, trauma, inflammation. Near vision ↓; sensitive to glareNear vision ↓; sensitive to glare

Cataract: Clinical ManifestationsCataract: Clinical Manifestations

Painless, blurred visionPainless, blurred visionReduced visual acuityReduced visual acuityReduced light transmissionReduced light transmissionSensitivity to glareSensitivity to glareColour shiftColour shiftMyopia (short-sightedness)Myopia (short-sightedness)AstigmatismAstigmatismDiplopliaDiploplia

Cataract: DiagnosisCataract: Diagnosis

History and clinical pictureHistory and clinical picture

Snellen visual acuity test (visual acuity Snellen visual acuity test (visual acuity proportional to lens density)proportional to lens density)

OphthalmoscopyOphthalmoscopy

Slit lampSlit lamp

Above tests establish degree of cataract Above tests establish degree of cataract formation formation

Cataract: ManagementCataract: Management

No medical treatmentNo medical treatmentSurgery if severe visual problemsSurgery if severe visual problemsMost common surgery is extra-capsular Most common surgery is extra-capsular cataract extraction with intraocular lens cataract extraction with intraocular lens implant (IOL) (posterior chamber lens):implant (IOL) (posterior chamber lens):Portion of anterior capsule removed to Portion of anterior capsule removed to allow extraction of lens nucleus and cortexallow extraction of lens nucleus and cortexPosterior capsule and zonal support left Posterior capsule and zonal support left intactintact

Post-Operative Eye Drops/ Post-Operative Eye Drops/ OintmentOintment

AntibioticsAntibiotics

Anti-inflammatoryAnti-inflammatory

CorticosteroidsCorticosteroids

Cataract Surgery: ComplicationsCataract Surgery: Complications

Haemorrhage (suprachoroidal: profuse)Haemorrhage (suprachoroidal: profuse)Rupture of posterior capsuleRupture of posterior capsuleInfection: acute and persistent low-grade Infection: acute and persistent low-grade inflammation/ granulomainflammation/ granulomaSuture-related problemsSuture-related problemsMalposition of IOL (implant)Malposition of IOL (implant)Opacification of posterior capsuleOpacification of posterior capsuleRisk of retinal detachmentRisk of retinal detachment

Cataract: Nursing ConsiderationsCataract: Nursing Considerations

Monitor degree of visual impairmentMonitor degree of visual impairmentLifestyle aids if necessaryLifestyle aids if necessaryEmotional/ psychological supportEmotional/ psychological supportPatient education pre-surgery: Patient education pre-surgery: Performed under local anaestheticPerformed under local anaestheticAnticoagulants with-heldAnticoagulants with-heldMydriatic eye-drops dilate pupil to prepare Mydriatic eye-drops dilate pupil to prepare for surgeryfor surgery

Cataract: Cataract: Nursing Considerations (cont)Nursing Considerations (cont)

Post-surgery: Post-surgery: Verbal and written instructions on eye Verbal and written instructions on eye protection (ensure patient understands)protection (ensure patient understands)Eye covered with sterile pad for 24 hours Eye covered with sterile pad for 24 hours until 1st dressing by surgeon (avoid until 1st dressing by surgeon (avoid sleeping on affected side)sleeping on affected side)Dark glasses by day and shield cover at Dark glasses by day and shield cover at night to prevent self-damagenight to prevent self-damageInstructions to family about eye-drops. Instructions to family about eye-drops. Arrange district nurse if no carer.Arrange district nurse if no carer.

Cataract Surgery: Cataract Surgery: Follow-up Instructions Follow-up Instructions

Always wear dark glasses/ eye shield as Always wear dark glasses/ eye shield as instructedinstructedWash hands before touching eye/ instilling Wash hands before touching eye/ instilling dropsdropsClean eye with clean tissue: wipe closed Clean eye with clean tissue: wipe closed eye eye onceonce from inner to outer canthus from inner to outer canthusAvoid stooping/ climbing stairs/ lifting until Avoid stooping/ climbing stairs/ lifting until instructedinstructedAssistance and caution showering Assistance and caution showering