Diagnostic Evaluation

 Ophthalmoscopy or slit-lamp examination with full pupil dilation

shows retina as gray or opaque in detached areas. The retina is
normally transparent.

Primary Nursing Diagnosis

 Sensory-perceptual alterations (visual) related to decreased sensory

reception

Medical Management

 Surgical intervention aims to reattach the retinal layer to the

epithelial layer and has a 90% to 95% success rate.

Techniques include:

1. Photocoagulation, in which a laser or xenon are “spot welds” the

retina to the pigment epithelium.
2. Electrodiathermy, in which a tiny hole is made in the sclera to drain
subretinal fluid, allowing the pigment epithelium to adhere to the
retina.
3. Cryosurgery or retinal cryopexy, another “spot weld” technique that
uses a super cooled probe to adhere the pigment epithelium to the
retina.
4. Scleral buckling, in which the sclera is shortened to force the
pigment epithelium closer to the retina; commonly accompanied by
vitrectomy.
Pharmacologic Intervention

 Drops as prescribed of Cyclopentolate hydrochloride (Cyclogyl) a

cycloplegic agent that causes dilation of the pupil and rest of the
muscles of accommodation
 Drops as prescribed of antibiotics Gentamicin; prednisolone acetate
to prevent eye infections
 Other Drugs: Antiemetics and analgesics are ordered to manage
nausea, vomiting, and pain.

Nursing Intervention

1. Prepare the patient for surgery.

o Instruct the patient to remain quiet in prescribed
(dependent) position, to keep the detached area of the
retina in dependent position.
o Patch both eyes.
o Wash the patient’s face with antibacterial solution.
o Instruct the patient not to touch the eyes to avoid
contamination.
o Administer preoperative medications as ordered.
2. Take measures to prevent postoperative complications.
o Caution the patient to avoid bumping head.
 o Encourage the patient no to cough or sneeze or to
perform other strain-inducing activities that will increase
intraocular pressure.
3. Encourage ambulation and independence as tolerated.
4. Administer medication for pain, nausea, and vomiting as directed.
5. Provide quiet diversional activities, such as listening to a radio or
audio books.
6. Teach proper technique in giving eye medications.
7. Advise patient to avoid rapid eye movements for several weeks as
well as straining or bending the head below the waist.
8. Advise patient that driving is restricted until cleared by
ophthalmologist.
9. Teach the patient to recognize and immediately report symptoms
that indicate recurring detachment, such as floating spots, flashing
lights, and progressive shadows.
10. Advise patient to follow up.

Documentation Guidelines

 Visual acuity
 Reaction to activity restrictions; ability of patient to participate in
activities of daily living independently
 Complications such as bleeding,infection,decreased visual
acuity,falls
 Response to medications and ability of the patient to instill eye drops
 Understanding of eye care at home

Discharge and Home Healthcare Guidelines

 Have the patient or significant others demonstrate the correct

technique for instilling eye drops. Instruct the patient to wash her or
his hands before and after removing the dressing; using a clean
washcloth, cleanse the lid and lashes with warm tap water; tilt the
head backward and inclined slightly to the side, so the solution runs
 away from the tear duct and other eye to prevent contamination;
depress the lower lid with the finger of one hand. Tell the patient to
look up when the solution is dropped on the averted lower lid; do not
the place drop directly on the cornea.
 Do not touch any part of the eye with the dropper; close the eye after
instillation, and wipe off the excess fluid from the lids and cheeks.
Close the eye gently so the solution stays in the eye longer.
 Teach the patient to use warm or cold compresses for comfort
several times a day. Note that the patient should wear either an eye
shield or glasses during the day, during naps, and at night.
 Teach the patient to avoid vigorous activities and heavy lifting for the
immediate postoperative period.
 Teach the patient the symptoms of retinal detachment and the action
to take if it occurs again.
 Instruct the patient about the importance of follow-up
appointments,which may be every few days for the first several
weeks after surgery.
