Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

Chapter 42: Caring for Clients with Eye Disorders By: P.K. Williams, RN


23 Words to Know 02/20 Pg 606 23 Words to Know 02/20 Pg 606

• Astigmatism Cataract Diplopia

• Corneal Transplantation Corneal trephineEmmetropia

• Edophtalmitis Enucleation Glaucoma

• Hordeolum Hyperopia Iridectomy

• Keratitis Keratoplasty Myopia

• Intraocular lens implantPhotophobia

• Macular degeneration Retinal detachment Uvetitis

• Trabeculoplasty Visually impaired


15 Learning Objectives 03/20 Pg 606 15 Learning Objectives 03/20 Pg 606

On completion of this chapter, you will be able to:

01 Explain the different types of refractive errors.

02 Differentiate the terms blindness and visually impaired.

03 Identify appropriate nursing interventions for a blind client.

04 Discuss the nursing management of clients with eye trauma.

05 Describe the technique for instilling ophthalmic medications.

06 Explain how different infectious and inflammatory eye disorders are acquired.

07 Specify the visual changes that result from delayed or unsuccessful treatment of macular degeneration.


15 Learning Objectives 04/20 Pg 606 15 Learning Objectives 04/20 Pg 606

08 Differentiate between open-angle and angle-closure glaucoma.

09 Distinguish categories and mechanisms of actions of medications used to control intraocular pressure.

10 Identify a category of drugs contraindicated in clients with glaucoma.

11 Name activities clients with glaucoma should avoid because they elevate intraocular pressure.

12 Describe methods for improving vision after a cataract is removed.

13 Discuss postoperative measures that help prevent complications after a cataract extraction.

14 Give classic symptoms associated with a retinal detachment.

15 Discuss the care and cleaning of an eye prosthesis.


Refractive Errors 05/20 Pg 606 Refractive Errors 05/20 Pg 606

• Emmetropia: *** Normal vision

• Myopia;***

• Hyperopia;***

• Presbyopia;***

• Astigmatism;***

Figure 42-1 Eyeball shape affects visual acuity in some refractive errors.


Refractive Errors 06/20 Pg 606 Refractive Errors 06/20 Pg 606

• Pathophysiology, Etiology

– Inherited; Surgical treatment result

– Presbyopia: Natural degenerative changes

• Assessment Findings: Blurred vision; Recurrent headaches

• Diagnostics: Snellen, Jaeger charts; Retinoscopy

• Medical Management: Eyeglasses; Contact lenses

• Surgical Management: RK; LASIK; PRK; ICRS; IOLs; CK

• Nursing Management


Blindness, Visual Impairment 07/20 Pg 608 Blindness, Visual Impairment 07/20 Pg 608

• BCVA ≤20/200, even with corrective lenses[Best Corrected Visual Acuity]

• Visual Impairment: BCVA between 20/70 and 20/200 (in better eye with glasses)

• Causes: Congenital; Injury; Optic nerve damage; Disorders; Tumors

• Medical Management: Corrective lenses; Rehabilitation; Independent living skills



Eye Trauma*** 08/20 Pg 607 Eye Trauma*** 08/20 Pg 607

• Pathophysiology, Etiology

– Weather; Chemicals; Injury; Endophthalmitis

• Assessment Findings: Signs and Symptoms

– Pain; “Gritty” feeling; Tearing; Blurred vision; Asymmetric eyes; Diplopia; Edema; Bleeding; Purulent drainage

• Diagnostic Findings

– Fluorescein dye; Slit-lamp examination

– Radiography; CT scan


Eye Trauma 09/20 Pg 610 Eye Trauma 09/20 Pg 610

• Medical, Surgical Management

– Emergency first aid; Antibiotic ointment or drops; Eye patch

– Hospitalization

– Surgical repair


Figure 42-2 Everting the eyelid


Conjunctivitis 10/20 Pg 612 Conjunctivitis 10/20 Pg 612

• Pathophysiology, Etiology: Bacterial; Viral; Rickettsial infection

– Easily transmitted; Can lead to blindness

• Assessment Findings: Redness; Tearing; Burning; Itching; Purulent drainage; Enlarged lymph nodes

• Medical Management: Antibiotic, antiviral meds; Warm soaks, irrigations; Decongestants; Antihistamines



Uveitis 11/20 Pg 613 Uveitis 11/20 Pg 613

• Pathophysiology, Etiology: Inflammatory changes

– Identified with specific diseases or autoimmune disorders

• Assessment Findings: Blurred vision; Photophobia; Eye pain; Red, congested eye; Pupil reacts poorly to light

• Diagnostic Findings: Slit-lamp examination

• Medical Management: Oral, topical corticosteroids; Mydriatic, antibiotic eyedrops; Analgesics; Sunglasses



Keratitis, Corneal Ulcer 12/20 Pg 613 Keratitis, Corneal Ulcer 12/20 Pg 613

• Pathophysiology, Etiology: Corneal trauma; Infectious agents

• Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness

• Diagnostic Findings: Flashlight illumination; Slit-lamp exam; Fluorescein drops, strips

• Medical, Surgical Management: Topical anesthetics; Mydriatics; Antibiotics; Keratoplasty



Blepharitis 13/20 Pg 613 Blepharitis 13/20 Pg 613

• Pathophysiology, Etiology: Hypersecretion; Infectious agents

• Assessment Findings: Inflamed lid margins; Patchy flakes; Missing eyelashes; Purulent drainage

• Diagnostic Findings: Scraping lid margins; Microscopic examination

• Medical Management: Topical antibiotic; Cleansing: Eye, face, and hair



Hordeolum (Sty)*** 14/20 Pg 614 Hordeolum (Sty)*** 14/20 Pg 614

• Pathophysiology, Etiology: Staphylococcus aureus [infected make up]

• Assessment Findings: Tender, swollen, red pustule

• Medical, Surgical Management: Warm soaks; Topical antibiotic

– Severe cases: Incision; Drainage

• Diagnostic Findings: Exudate culture identifies pathogen (seldom used)



Macular Degeneration*** 15/20 Pg 614 Macular Degeneration*** 15/20 Pg 614

• Pathophysiology, Etiology: Types

– Dry: Gradual onset; Wet: Abrupt onset

• Assessment Findings

– Dry: Blurred vision; Central vision affected

– Wet: Vision distortion; Central vision affected

• Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation; Diet, vitamins



Glaucoma*** 16/20 Pg 616 Glaucoma*** 16/20 Pg 616

• Pathophysiology, Etiology: Aqueous fluid imbalance; Elevated IOP


– Open-angle: Eye discomfort; Temporary blurred vision; Halos; Reduced peripheral vision

– Acute angle-closure: Hard, painful, sightless eyes; N/V; Red conjunctiva; “Steamy” cornea

• Diagnostic Findings: Optic disc visualization; Anterior chamber inspection; Tonometry; Visual field exam

• Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine



Cataracts*** 17/20 Pg 619 Cataracts*** 17/20 Pg 619

• Pathophysiology, Etiology: Aging process; Congenital; Lens injury; Secondary condition

• Assessment Findings: Halos; Difficulty in reading; Color vision changes; Reduced, distorted vision

• Diagnostic Findings: Snellen chart; Ophthalmoscopic and slit-lamp examination; Tonometry

• Surgical Management: Intracapsular or extracapsular extraction; Phacoemulsification

– Post-op vision restoration: Corrective glasses; Contact lens; IOL implant



Retinal Detachment*** 18/20 Pg 620 Retinal Detachment*** 18/20 Pg 620

• Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery


– Blind spots; Flashes of light; Floaters; Complete vision loss

• Diagnostic Findings: Ophthalmoscope

• Surgical Management: Laser surgery; Cryopexy; Diathermy; Retinopexy; Scleral buckling; Pneumatic retinopexy



Enucleation*** 19/20 Pg 623 Enucleation*** 19/20 Pg 623

• Surgical Removal of an Eye due to

– Injury; Disease

– Tumor; Severe pain (damaged, sightless eye)

• Medical, Surgical Management***

– Metal or plastic ball in capsule of connective tissue

– Pressure dressing; Shell-shaped prosthesis

– A shell-shaped prosthesis [painted to match the remaining eye



End of Presentation Now NCLEX

By: P.K. Williams, RN 20/20 Pg 606 [email protected]

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

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