ASSESSMENT OF VISION:

A. ACUITY – visual acuity tests measure the client’s distance and near vision.= uses snellen chart; rosenbaum chart

b.CONFRONTATIONAL TEST= is performed to examine visual fields or peripheral vision.

C. EXTRAOCULAR MUSCLE FUNCTION= SIX cardinal positions of gaze

(®lateral-upward&®, down & ®, (L), upward & (L), down & (L)

D. COLOR VISION= uses ISHIHARA PLATE –

consists of numbers that are composed of colored dots located within a circle of colored dots.= the test is sensitive for the diagnosis of red/green blindness.

E. PUPILS= LIGHT = CONSTRICT ; LIGHT =

DILATES.= CONSTRICTION OF THE EYE IS A DIRECT RESPONSE TO THE SHINING LIGHT = NORMAL

CONSTRICTION OF THE OPPOSITE EYE IS KNOWN AS CONSENSUAL RESPONSE.

F. SCLERA AND CORNEA= NORMAL COLOR = WHITE= YELLOW = INDICATES JAUNDICE OR SYSTEMIC PROBLEMS.= IN DARK SKINNED PERSON, THE SCLERA MAY NORMALLY APPEAR YELLOW ; PIGMENTED DOTS MAY BE PRESENT= CORNEA is transparent, smooth, shiny and bright.

CLOUDY AREAS OR SPECKS ON THE CORNEA MAY BE A RESULT OF AN ACCIDENT OR EYE INJURY.

G. OPHTHALMOSCOPY= ophthalmoscope is an instrument

used to examine the external structures and the interior of the eye

= as the instrument is directed at the pupil, A RED GLARE (RED REFLEX) IS SEEN IN THE PUPIL.

= ABSENCE OF REFLEX INDICATES OPACITY OF THE LENS

DIAGNOSTIC TESTS:

1. FLOURESCEIN ANGIOGRAPHY= detailed imaging and recording of ocular circulation by a series of photographs after the administration of a dye.

2. COMPUTED TOMOGRAPHY= a beam of x-rays scans the skull and orbits of the eye.

3. SLIT LAMP = allows examination of the anterior ocular structures under microscopic magnification= the client leans on a chin rest to stabilize the head while the narrow beam of light is aimed.

4. TONOMETRY= used primarily to assess for an IOP and potential glaucoma.= normal IOP is 10-21 mmHg.

GENERAL CARE FOR EYE SURGERIES:

• PREOPERATIVE CARE:- if both eyes are to be covered after surgery, the patient needs to be oriented to the staff and the physical environment, call light must be placed within reach

- the child should practice having the eyes covered to decrease postoperative fear.

- instillation of eye drops the day of surgery may include to DILATE the pupil.

• POSTOPERATIVE:- prevent increase of IOP thru;

= pt must keep the head still, avoid coughing, vomiting & sneezing.= should lie on the unoperative site.= a burning sensation felt after 1 hr

postoperatively means that anesthetic is wearing off.

= avoid bending and lifting to prevent stress on suture line.

*ANY SENSATION OF PRESSURE, REDNESS AND SHARP PAIN = BLEEDING!! MUST BE REPORTED IMMEDIATELY ASAP TO AP!

COMMON DISORDERS OF THE EYE* EYELID DISORDERS:

1. blepharitis – inflammation of eyelid margins; =Irritation, burning, itching, ulceration, eyelashes fall out.

=d/t staphyloccus infxn or seborrheic in origin2. Chalazion – internal stye. Painless, slow-growing, hard non-tender mass.

-infection or retention cyst in meibomian glands.

Hordeolum (sty)- infxn of 1 or more sebaceous glands of the eyelid either in ext. or int. margins

of the eyelid

COMMON DISORDERS OF THE EYE

* DISORDERS OF THE CONJUNCTIVA, SCLERA AND CORNEA:1. conjunctivitis – inflammation which results from bacterial/viral infections.-redness, swelling, lacrimation, pain,

itching, discharges from eyea. Acute – bacterial, viral, fungal; no pain

b. Trachoma – chronic caused by chlamydia trachomatis ; blindness; contagious (fomites, personal contact)

2.IRITIS/uveitis – idiopathic or autoimmune; very red eye, painful to move, photophobia,

- uveal tract is the middle vascular layer of the eye; choroid, ciliary body & iris3. KERATITIS – corneal inflammation.

- pain, photophobia, lacrimation, blepharospasm, decreased vision

a. Ulcerative – inflammation & ulceration

b. Non-ulcerative

4. corneal ulcer – local necrosis d/t infxn, trauma or misuse of contact lenses

- tearing, severe pain, ↓ v.a., blepharospasm

TX: Trifluriding(Viroptic), Idoxuridine (IDU), Adenine Arabinoside (Vira-A)

• Topical anti infectives• Anti histamines (conjunctivitis)• Cortecosteroids (keratitis)• Immunosuppressive (uveitis)• analgesics

UVEAL TRACT DISORDERS:

1. UVEITIS* IRITIS – inflammation of the iris.* Iridocyclitis – inflammation of the iris and ciliary body* Choroiditis * choroidiretinitis – choroid & retina

Causes: local or systemic disease, injury, unidentified factors

ASSESSMENT := pain in the eyeball radiating to the forehead and temple

= blurred vision, photophobia, redness of the eyes with purulent discharge, small pupil and lacrimation

COLLABORATIVE MANAGEMENT:• Mydiatrics ( AtSO41% or .25%,

Scopolamine)-to dilate pupils, preventing adhesion of iris and the lens

• Steroids• Dark glasses• analgesics

RETINAL DETACHMENT• Separation of the two primitive layers of retina.• Elevation of both retinal layers away from the

choroid because of the presence of tumor.

CAUSES:- myopic degeneration, trauma, aphakia (absence of crystalline lens), hemorrhage, sudden severe physical exertion.

ASSESSMENT:-peripheral vision is lost*-flashes of light

-blurred vision ; sense of curtain being drawn-on ophthalmoscopy, vitreous appears cloudy, portion of retina hanging like gray cloud.

COLLABORATIVE MANAGEMENT:-keep the pt quiet in bed with the eyes covered to try to prevent further detachment.-EARLY SURGERY is required!

SURGICAL PROCEDURES:

1. Draining fluid from the sub retinal space so that the retina can return to the normal position.

2. Sealing the retinal breaks by CRYOSURGERY, a cold probe applied to the sclera, to stimulate inflammatory response leading to adhesions.

3. DIATHERMY, the use of an electrode needle and heat through the sclera.

4. SCLERAL BUCKLING, to hold the choroid and retina together with a splint until scar tissue forms closing the tear.

GLAUCOMA

= increased IOP, results from inadequate drainage of aqueous humor from the canal of schlemm or overproduction of aqueous humor.

= silent thief of vision

= the condition damages the optic nerve and can result to blindness.

ACUTE GLAUCOMA is a rapid ONSET of IOP greater than 50 to 70mmHg.

CHRONIC GLAUCOMA is a slow, progressive, gradual onset of IOP greater than 30-50mmHg.

TYPES: acute or chronicACUTE (narrow/closed angle) = eye

disease char by suddenly impaired vision due to intraocular tension caused by an imbalance in production and excretion of aqueous humor.

= it is the result of corneal flattening & an abnormal displacement of iris against the angle of the anterior chamber

CHRONIC (NARROW/CLOSED ANGLE) = follows an untreated attack of acute closed-angle glaucoma; less common

CHRONIC (simple/wide or open); open-angle= due to actual obstruction in the excretion of

aqueous humor. It develops slowly at first, symptoms may be absent. Permanent vision loss may occur before the individual is aware of having the disease.

- 90% ; most common;ant. Chamber bet. Iris & cornea are N but flow of AH is obstructed

* Vision loss in glaucoma is IRREVERSIBLE!! Due to neuronal ischemia & compression and damage to the retina and optic nerve.

CHRONIC/SIMPLE GALUCOMAASSESSMENT:

*TUNNEL VISION- loss of peripheral vision. Usually begins in one eye, if untreated both eyes often become affected.* Persistent dull eye pain in the morning* frequent changes in glasses, difficulty in adjusting to darkness, failure to detect in color accurately.* Rainbows or halos resembling street lights, may be seen around the lights.

MANAGEMENT:* Objective: to reduce IOP and keep it in a safe level.* Miotics – use to constrict the pupil and draw the smooth muscle of iris away from the canal of schlemm= draining of a. humor.* administer Acetazolamide (diamox) & glycerol orally as ordered = to reduce production of a. humor.* Limit OFI* avoid atropine or other mydriatics as these will dilate the pupil----iris is brought closer---a. humor is obstructed.- prepare for surgery as ordered.

* SURGERY :1. TRABECULECTOMY= for CLOSED

ANGLE2. Laser trabeculoplasty –create multiple

laser burns→ scars cause stretching & opening the meshwork

3. Gonioscopy - 4. Laser iridotomy – creates multiple

perforatiion in the iris

Dx tests

• Tonometry

• Fundoscopy – identifies pallor & ↑ size in optic disk

• Gonioscopy – gonioscope; measures the depth of the ant. Chamber

• Visual field testing

CATARACT= is a clouding or opacity of the lens that leads to blurring of vision ad eventual loss of sight. The opacity is caused by chemical changes in the protein of the lens because of slow degenerative changes of AGE, INJURY, POISON or INTROCULAR INFECTION.

Classification:* SENILE

* SECONDARY – occurs after systemic disease* TRAUMATIC - injury * CONGENITAL

Cataract occur so often in the aged. At 80 years of age, about 85% of all people have some clouding of the lens.

COLLABORATIVE MANAGEMENT:• Surgery is the only satisfactory treatment.

1. ICCE - IntraCapsular Cataract Extraction; removal of the entire lens & its capsule.

2. ECCE – ExtraCapsular Cataract Extractionan opening is made in the capsule and

the lens is lifted without disturbing the membrane.3. CRYOEXTRACTION – the cataract is lifted from the eye by a small probe that has been cooled to a temp below 0.4. PHACOEMULSIFICATION –1/4 in. incision, uses sound waves or ultrasonic vibrations to break up the cloudy lines so it can be removed by suction.

POST-OPERATIVE CARE:* the eye is covered with a dressing, and eye shield to protect from injury.* daily change of dressing is done. After 7-10 days, all dressings are usually removed.* During the first month, protect the eye with a shield at night.* Redness is normal within a few days, but if accompanied with pain==see the DR. ASAP!!* avoid bending, lifting of heavy object.* administer eye drops as ordered.

IOL implant – is an alternative to cataract glasses or lenses. The lens, w/c is made up of polyethyl methacrylate is implanted at the time of cataract extraction. Provides better binocular vision.

REFRACTION ERRORS:* Emmetropia – normal refractive state; N vision* Ammetropia – sight not in proper measure.

1. Hyperopia – farsightedness; parallel rays of light focus behind the retina; corrected with convex lens.

2. Myopia – nearsightedness; light focus in front of the retina; corrected with concave lens or radial

Keratotomy surgery.3. Presbyopia – “old sight”; occurs due to aging

process. blurring of near object or visual fatigue

when doing close eye work; convex reading glasses are recommended.

4. Astigmatism – “distorted vision”; caused by variation in refractive power along different meridians of the eye.

REHABILITATION OF A BLIND PERSON

• Refer blind person to available facilities.• Orient to the environment• Promote independence—ADL• May have guide dog or use cane for direction.• When approaching, talk before touching.• During ambulation, have the pt hold your forearm so

that your step ahead of him.• Do not change the location of objects without

describing it.• Do not rush up and offer help to a blind person unless

it is clear that the person wants help• If significant others ask advise about gifts for a blind

person, suggest gifts that appeal to senses than vision..