ASSESSMENT

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NURSING ASSESSMENT
 Client History: Subjective Data
 Ask the patient about any of the following and
note responses.
• Allergy; Vision changes; Discomfort; Corrective
lenses, Eye redness, Itching.
• Eye medications; Eye trauma, Disease, previous
Surgery
• Family history of eye disease
• Drainage from eyes
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1
NURSING ASSESSMENT
Objective: Physical Examination
 Inspect
• Eyes for any discoloration or drainage
• Conjunctiva and sclera for colour and vascularity
• Lens for clarity
• Eyelid for ptosis
• Symmetry
• Inflammation; Exudate

31

NURSING ASSESSMENT
 Assess
• Vision based on patient’s looking at nurse or Snellen
chart (6m or 20ft)

• Extraocular movements
• Peripheral vision
• PERRLA (Pupils equal, round, reactive to light and
accommodation)

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2
ASSESSMENT TOOLS

Slit Lamp

Snellen
Chart Ophthalmoscope 33

EYE ASSESSMENT
 Visual Screening Tests
• Snellen eye chart: Visual acuity
• Jaeger chart; Rosenbaum Pocket Vision Screener:
Near vision
• Ishihara polychromatic plates: Color vision
 Extraocular Muscle Function
• Corneal light reflex test: Eye alignment
• Cover-uncover test: Extraocular muscle function
• Positions test: Eye muscle strength, cranial nerve
function
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3
DIAGNOSTIC STUDIES
 Ophthalmoscopy: Examination of fundus
 Retinoscopy: Focusing power of each eye
 Tonometry: Intraocular pressure
• Normal IOP: 10 to 21 mm Hg
 Visual Field Examination
• Peripheral vision; Gaps
• Visual field change associations: Glaucoma; Stroke; Brain
tumor; Retinal detachment

 Color Vision Testing: Color differentiation ability

35

DIAGNOSTIC STUDIES
 Amsler Grid: Macular problems
 Slit-lamp Examination: Magnifies eye surface
• Identifies: Corneal abrasions; Iritis; Cataracts;
Conjunctivitis

 Retinal Angiography: Vascular changes, blood flow

 Ultrasonography: Used when posterior of eye
difficult to visualize
 Retinal Imaging: High-resolution; Pupil dilation
unnecessary
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4
NORMAL ASSESSMENT FINDINGS
 Visual acuity 20/20 OU. No diplopia.
 External eye structures symmetric and without
lesions or deformities.
 Lacrimal apparatus non-tender and without
drainage.
 Conjunctiva clear. Sclera white.
 PERRLA - pupils equal, round, reactive to light
and accommodation.
 Lens clear.
 EOMI (extraocular movements intact).
OD – Right eye, OS - Left eye, OU - Both eyes
37

NURSING MANAGEMENT
 Client Education
• Maintenance, preservation of eye function
 Obtain an Accurate Baseline
 Client Assessment for Further Action

38

5
COMMON EYE
DISORDERS
Conjunctivitis
Cataract
Glaucoma
Retinal Detachment

39

CONJUNCTIVITIS
 Conjunctivitis is an infection or inflammation
of the conjunctiva.
 Etiology:
• Chronic Foreign Body
• Bacteria or Viruses
• Allergens or Chemical
Irritants

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6
CONJUNCTIVITIS
 Chronic Foreign Body
• Contact Lens

 Bacteria (staphylococcus aureus )

• Complain of : Discomfort, Pruritus, Redness, and a Mucopurulent
Drainage
• Treatment: Antibiotic drops ( Ciprofloxacin 0.3% [Ciloxan],
Moxifloxacin 0.5% [Vigamox])

 Viruses
• Complain of : Tearing, Foreign Body Sensation, Redness, and Mild
Photophobia.
• Treatment: Antivirals are ineffective, condition is self-limiting
41

CONJUNCTIVITIS
 Allergens or Chemical Irritants
• Etiology: pollens, animal dander, ocular solutions,
and medications
• Defining symptom is itching.
• Complain of: burning, redness, and tearing.
• Treatment: Artificial tears to diluting the allergen
and washing it from the eye; topical antihistamines
(Visine, Pataday, Patanol) and corticosteroids.

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7
CATARACT
 A cataract is an opacity within the lens.
The patient may have a cataract in one or both
eyes. If cataracts are present in both eyes, one
may affect the patient’s vision more than the
other.
 Signs and Symptoms
• Blurred vision/decrease in vision
• Abnormal colour perception
• Glare sensitivity (worst at night)
• Distortion or double vision in the affected eye
43

CATARACT
 Etiology
• Aging process – (senile cataracts)
• Congenital or developmental (maternal rubella)
• Blunt or Penetrating Trauma
• Excessive Radiation or Ultraviolet (UV) light
exposure
• Long-term use of topical corticosteroid
• Ocular inflammation
44

8
CATARACT

45

CATARACT
 Non-Surgical Treatment
• Change in glasses prescription
• Strong reading glasses or magnifiers
• Increased lighting
• Lifestyle adjustment

46

9
SURGICAL MANAGEMENT
Preoperative Care
 The Patient Receives:
• Dilating drops - Mydriatic, cycloplegic agents
• Nonsteroidal antiinflammatory drugs
• Topical antibiotics
• Antianxiety medications (if needed) before the local
anesthesia injection.

47

SURGICAL MANAGEMENT
 Preoperative Dilating Drugs
• One type of drug used for dilation is a mydriatic, an
α-adrenergic agonist that produces pupillary
dilation by contraction of the iris dilator muscle.
• Another type of drug is a cycloplegic, an
anticholinergic agent that produces paralysis of
accommodation (cycloplegia) by blocking the effect of
acetylcholine on the ciliary body muscles.
• Cycloplegics (tropicamide [Mydriacyl, Tropicacyl])
produce pupillary dilation (mydriasis) by blocking
the effect of acetylcholine on the iris sphincter
muscle.
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10
 49

SURGICAL MANAGEMENT
Surgery
• Removal of lens
• Phacoemulsification
• Extracapsular extraction
• Correction of surgical aphakia
• Intraocular lens implantation (most frequent type of
correction)
• Contact lens

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11
SURGICAL MANAGEMENT
 Postoperative
• Topical antibiotic
• Topical corticosteroid or other anti-inflammatory
agent
• Mild analgesia if necessary
• Eye shield and activity as preferred by patient’s
surgeon

51

SURGICAL MANAGEMENT
Include the following information in the teaching plan for
the patient and the caregiver after eye surgery.
 Proper hygiene and eye care techniques to ensure that
medications, dressings, and/or surgical wound is not
contaminated during eye care
 Signs and symptoms of infection and when and how to
report these to allow for early recognition and treatment
of possible infection
 Importance of complying with postoperative restrictions
on head positioning, bending, coughing, and Valsalva
maneuver to optimize visual outcomes and prevent
increased intraocular pressure 52

12
SURGICAL MANAGEMENT
Include the following information in the teaching plan
for the patient and the caregiver after eye surgery.
 How to instil eye medications using aseptic
techniques and adherence with prescribed eye
medication routine to prevent infection
 How to monitor pain, take pain medication, and
report pain not relieved by medication
 Importance of continued follow-up as recommended
to maximize potential visual outcomes
53

GLAUCOMA
 Glaucoma is a group of disorders characterized by
increased IOP and the consequences of elevated
pressure, optic nerve atrophy, and peripheral visual
field loss.
 A proper balance between the rate of aqueous
production (referred to as inflow) and the rate of
aqueous reabsorption (referred to as outflow) is
essential to maintain the IOP within normal limits.
 Normal IOP is 10-21 mmHg
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13
GLAUCOMA
 Primary open-angle glaucoma
(POAG) is the most common
type of glaucoma. In POAG
the outflow of aqueous humor
is decreased in the trabecular
meshwork. The drainage
channels become clogged, like
a clogged kitchen sink.
Damage to the optic nerve can
then result.
55

GLAUCOMA
 Primary angle-closure
glaucoma (PACG) is due to
a reduction in the outflow of
aqueous humor that results
from angle closure.

56

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 57

GLAUCOMA
Drainage canal blocked; Increased pressure damages
build-up of fluid blood vessels and optic nerve

58

15
GLAUCOMA

59

GLAUCOMA
 Signs and Symptoms
 Primary open-angle glaucoma (POAG)
• Develops slowing without symptoms
 Acute angle-closure glaucoma
• sudden, excruciating pain in or around the eye
• nausea and vomiting
• coloured halos around lights
• blurred vision
• ocular redness.
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16
GLAUCOMA
 Signs and Symptoms
 Subacute or Chronic angle-closure glaucoma
• history of blurred vision,
• seeing coloured halos
• around lights,
• ocular redness, or eye or brow pain.
 Untreated glaucoma results in ‘tunnel vision’

61

GLAUCOMA
 Diagnostic Studies
• History and physical examination
• Visual acuity measurement
• Tonometry
• Ophthalmoscopy (direct and indirect)
• Slit lamp microscopy
• Gonioscopy
• Visual field perimetry

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17
GLAUCOMA
 Chronic Open-Angle Glaucoma
 Drug Therapy
• β-Adrenergic blockers ( IOP, Aqueous production)
• Betopic
• Timoptic, Istalol)
• α-Adrenergic agonists ( Aqueous production & outflow)
• Alphagan
• Cholinergic agents (miotics) ( outflow )
• Pilocarpine
• Carbonic anhydrase inhibitors ( Aqueous production)
• Acetazolamide (Diamox)
63

GLAUCOMA
 Chronic Open-Angle Glaucoma
 Surgical Therapy
• Argon laser trabeculoplasty (ALT)
• Trabeculectomy with or without filtering implant
 Acute Angle-Closure Glaucoma
• Topical cholinergic agent
• Hyperosmotic agent
• Laser peripheral iridotomy
• Surgical iridectomy
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RETINAL DETACHMENT
 A retinal detachment is a separation of the sensory
retina and the underlying pigment epithelium, with fluid
accumulation between the two layers.

 Risk Factors
• Increasing age
• Severe myopia
• Eye trauma
• Cataract surgery
• Family or personal history of retinal detachment
65

RETINAL DETACHMENT
 Etiology & Pathophysiology
• Retinal breaks are an interruption in the full thickness of
the retinal tissue, and they can be classified as tears or
holes.
• Retinal holes are atrophic retinal breaks that occur
spontaneously.
• Retinal tears can occur as the vitreous humor shrinks
during aging and pulls on the retina.

 Once the retina has a break, liquid vitreous can

enter the subretinal space between the sensory
layer and the retinal pigment epithelium layer,
causing a rhegmatogenous retinal detachment.
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19
RETINAL DETACHMENT
 Clinical Manifestations
• Photopsia (light flashes);
• Floaters; and
• A “cobweb,” “hairnet,” or ring in the field of vision
• “Painless loss of peripheral or central vision, “like a
curtain” coming across the field of vision

67

RETINAL DETACHMENT

68

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 RETINAL DETACHMENT
 Preoperative
• Mydriatic, cycloplegic agents
• Photocoagulation of retinal break that has not progressed
to detachment
 Surgery
• Laser photocoagulation
• Cryotherapy (cryopexy)
• Scleral buckling procedure
• Vitrectomy
• Intravitreal bubble
69

RETINAL DETACHMENT
 Postoperative
• Topical antibiotic
• Topical corticosteroid
• Analgesia
• Mydriatics
• Positioning and activity as preferred by patient’s surgeon

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