Jewel June Gutierrez N-31

Rosejel Mae Lagura

SENILE CATARACT

I. Introduction
Senile Cataract or Age-Related Cataract is the most common form of cataract
affecting people above 50 years of age. These lesions are frequently preceded
by the formation of a dense nuclear sclerosis. Nuclear sclerosis is the clouding
of the lens of the eye. Nuclear sclerotic cataracts become a problem when it
becomes severe or symptomatic. One eye is affected earlier followed by the
other eye.

 Types:
o Cortical (soft) Cataract
 Cuneiform – radiates in peripheral cortex.
 Punctate Perinuclear – in the cortex next to the nucleus.
 Cupuliform – radiates in the posterior cortex.
o Nuclear (hard) Cataract – the acceleration of the normal
densification process of the innermost lens fibers.
 Risk factors:
o Age – usually above 50 years old, if it occurs below 50, it is
called “pre-senile”.
o Heredity – Age of onset and maturation is seen as a genetic trait.
o UV radiations
o Smoking – Causes accumulation of pigmented molecules and
cyanates leading to protein denaturation.
 Stages of Maturation
o Lamellar Separation – This can be seen under slit lamp
examination only, there is demarcation of cortical fibers, where
they start to separate by fluid.
o Incipient Cataract – In this stage two different forms can be
seen.
 Cuneiform – wedge shaped opacity with clear areas in
between.
 Cupuliform – saucer shaped opacity which extends
outwards.
o Immature Senile Cataract – Opacification further progresses in
this stage.
o Mature Senile Cataract – In this stage opacification becomes
complete.
o Hyper mature senile cataract – It develops when mature cataract
is untreated.
 Morgagnian hypermature cataract – The cortex liquifies
and lens becomes a bag of milky fluid. Small brownish
nucleus settles at the bottom, altering its position with
head posture.
 Sclerotic type – The cortex becomes disintegrated and
the lens shrinks due to leakage of water. The anterior
 capsule is wrinkled and thickened due to proliferation of
anterior cells and dense white capsular cataract may be
formed in the pupillary area. The anterior chamber
becomes deep due to shrinkage of lens.
 Signs and Symptoms
o Glare or intolerance of bright light.
o Uniocular polyopia such as doubling or trebling or visions due
to irregular refraction by the lens.
o Colored halos – owing to the splitting of light by water
droplets in lens.
o Black spot in front of eyes.
o Distortion of images and blurring.
o Loss of Vision which is painless and gradually progressive.

II. Medical Management:

No time-tested, FDA-approved, or clinically proven medical treatment exists to
delay, prevent, or reverse the development of senile cataracts.
 Being investigated:
o Aldose reductase inhibitors
 Which are believed to inhibit the conversion of glucose to sorbitol, have
shown promising results in preventing sugar cataracts in animals.
o Other anticataract medications include: sorbitol-lowering agents, aspirin,
glutathione-raising agents, and antioxidant vitamins C and E. (Ocampo and
Dahl, 2018).

III. Surgical Management:

The definitive management for senile cataract is lens extraction.
 Extracapsular cataract extraction
o Involves the removal of the lens nucleus through an opening in the anterior
capsule with retention of posterior capsular integrity.
 Intracapsular cataract extraction
o It involves extraction of the entire lens, including the posterior capsule and
mechanical or enzymatic lysis of the zonular support structures. The
procedure has a relatively high rate of complications due to the large
incision required and pressure placed on the vitreous body.
 Phacoemulsification
o In this technique, a very small incision (2-3 mm) is produced on the surface
of the eye in or near the cornea. A thin ultrasound probe is inserted into
the eye and uses ultrasonic vibrations (40,000 Hz) to dissolve
(phacoemulsify) the clouded lens. These tiny, fragmented pieces are then
suctioned out through the same ultrasound probe. Once the cataract is
removed, an artificial lens is placed into the thin capsular bag that the
cataract previously occupied. In phacoemulsification, cataract surgery can
perform in less than 30 minutes and usually requires only minimal sedation
and no stitches are used to close the wound. (Vasudevan and Abraham,
2016).
 IV. Nursing Management:
 Prevention: Nurse instruct the patient
o Quit smoking
 The patient should avoid smoking because it is one of the greatest
contributing factors to cataract.
o Wear sunglasses
 Wearing of sunglasses shields the eye from too much exposure to UV
rays that predisposes to cataract.

 Preoperative Care:
o Ask patients about a history of taking alpha-antagonists.
 Alpha-antagonists can interfere with pupil dilation during the surgical
procedure, resulting in miosis and iris prolapse and leading to
complications. Intraoperative floppy iris syndrome can occur even
though a patient has stopped taking the drug.
o Dilating drops are given prior to surgery.
o Begin patient education about eye medications (antibiotic, corticosteroid,
and anti-inflammatory drops) that will need to be self-administered to
prevent postoperative infection and inflammation.

 Discharge Education: Cataract Care

o Medications and side effects
o Instillation of eye drops
o Follow-up appointments
o Not rubbing the operated eye
o Being alert for postoperative complications: pain, decreased visual acuity,
headache, nausea and vomiting.
o Avoidance of swimming and driving until advised otherwise.
o Wearing an eye shield at night as advised
 For the first week to avoid injury
o Explains that there should be minimal discomfort after surgery and
educates the patient about taking a mild analgesic agent, such as
acetaminophen, as needed.
o Patients prescribed anti-inflammatory or corticosteroid eye drops are
monitored for possible increases in IOP.
o Ocular hygiene
 Slight Morning Discharge: A clean, damp washcloth may be used to
remove slight morning eye discharge.
o Notify Healthcare Provider if these symptoms may occur floaters (dots) in
vision, flashing lights, decrease in vision, pain, or increase in redness
occurs.

NURSE’S NOTES
Date and Time Focus Progress Note
02-23-21 Risk for Injury D
9:00 AM Progressively increasing in glare and
decreasing in visual acuity.
 A
 Oriented the patient about his/her
environment
 Assisted in a comfortable positioned
 Instructed the patient to avoid putting
pressure on the affected eye trauma
 Instructed the patient to use proper
procedures when providing eye drugs
 Encouraged use of sunglasses in strong
light
 Instructed the patient and/or family
regarding the need to maintain a safe
environment.
 Instructed the patient and/or family
regarding safe lighting.
 Instructed the patient to use assistive
devices such as glasses when going out or
doing something
02-23-21 Risk for Injury R
3:00 PM Patient was able to be free of injury

Reference:
Gupta, V. B., Rajagopala, M., & Ravishankar, B. (2014). Etiopathogenesis of cataract: an
appraisal. Indian journal of ophthalmology, 62(2), 103–110.
https://doi.org/10.4103/0301-4738.121141
Kirby, D.B. (n.d). The mechanism of Senile Cataract. VOLUME 16, ISSUE 12, P1041-
1049. DOI:https://doi.org/10.1016/S0002-9394(33)92979-7
Ocampo, V.V. and Dahl, A.A. (2018). Senile Cataract (Age-Related Cataract) Treatment &
Management. Retrieved on February 21, 2021 from
https://emedicine.medscape.com/article/1210914-treatment#:~:text=The%20definitive
%20management%20for%20senile,the%20time%20of%20cataract%20surgery.
Brady, A.M., McCabe, C., and McCann, M. (2013). Fundamentals of Medical-Surgical
Nursing: A Systems Approach. John Wiley & Sons; 1118490932, 9781118490938
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's textbook of medical-surgical
nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
Vasudevan, S. and Abraham, A. (2016). Age Related or Senile Cataract: Pathology,
Mechanism and Management. Retrieved on February 21, 2021 from
https://www.researchgate.net/publication/304825686_Age_Related_or_Senile_Cataract
_Pathology_Mechanism_and_Management
Belleza, M. (2021). Cataract. Retrieved on February 21, 2021 from
https://nurseslabs.com/cataract/