Velez College – College of Nursing

NCM 116: NURSING CARE OF EYE AND VISION DISORDERS

Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

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REFRACTIVE ERRORS

• Vision is impaired due to a shortened or

elongated eyeball that prevents light
rays from focusing sharply on the retina
VISION IMPAIRMENT AND BLINDNESS
• Vision Impairment – best corrected
visual acuity of 20/40 or worse in the
better seeing eye
• Low Vision – requires use of devices
to perform tasks
• Blindness – best corrected visual
acuity that can range from 20/400 to
no light perception
• Legal Blindness – best corrected
visual acuity does not exceed 20/200
in the better seeing eye

NURSING MANAGEMENT

NCM 116: NURSING CARE OF CLIENTS WITH EYE AND VISION DISORDERS. Page 1 of 7
Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH
 Velez College – College of Nursing
NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

• Subconjunctival Injection
• Better absorption in the anterior
chamber
• Intravitreal Injections
• Better for posterior chamber
• Contact lenses and collagen
shields

GLAUCOMA
• Group of ocular conditions
characterized by elevated
IOP
• More common in ages 40 years old and
older

OCULAR PHARMACOLOGY
• Main Objective: To maximize amount of
medication that reaches the ocular site
of action in sufficient concentration to
produce a beneficial therapeutic effect
• Natural barriers of absorption:
• Limited Size Of The
Conjunctival Sac
• Corneal Membrane Barriers
• Blood-ocular Barriers
• Tearing, Blinking, And Drainage
• Aqueous Solutions
• Most commonly used
• Least expensive
• Interfere the least with vision
• Low retention time (diluted with
tears)
• Ophthalmic Ointments
• Extended retention time
• Higher substance concentration
• Can cause blurred vision
• Best for eyelids and eyelid
margins

NCM 116: NURSING CARE OF CLIENTS WITH EYE AND VISION DISORDERS. Page 2 of 7
Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH
 Velez College – College of Nursing
NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

INTRAOCULAR PRESSURE • Teat one eye first then the other

eye once optimal dose is
determined
• Normal: 10 – 21 mmHg
• Surgical Management
• Determined by: rate of production of
• Done only when medications fail
aqueous humor, resistance of flow,
• Goal: To improve fluid drainage
drainage of aqueous humor
• Trabeculectomy
• Increased with:
• Laser trabeculoplasty
• Blinking, tight lid squeezing,
• Peripheral/Laser iridotomy
upward gazing
• Diabetes
• Uveitis and retinal detachment CATARACTS
• Lens opacity of cloudiness
PATHOPHYSIOLOGY • By age 80, more than half of
• Direct Mechanical Theory Americans will have cataracts
• High IOP Retinal
damage Impaired Vision
• Indirect Ischemic Theory
• High IOP Microcirculation
compression Cell
injury/death  Impaired Vision

MANIFESTATIONS
• Called as “silent thief of the night”
• Blurred vision or “halos” around lights
• Difficulty focusing
• Loss of peripheral vision
• Aching around the eyes
• Headache

ASSESSMENT AND DIAGNOSIS

• Tonometry – to measure IOP
• Ophthalmoscopy:
• Pallor and cupping of optic nerve
disc
MEDICAL MANAGEMENT
• Cannot be cured; lifelong therapy
needed
• Aim: Prevention of optic nerve damage
through achievement of safe IOP
• Initial Target: IOP that is 30% lower than
current pressure
• Pharmacologic Therapy
• Initial Medication: Topical Beta
Blockers
• Other Drugs: Alpha-2 agonists,
carbonic anhydrase inhibitors,
prostaglandins
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Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH
 Velez College – College of Nursing
NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

MANIFESTATIONS • Instructions on eye protection,

medications, emergency care,
• Can develop in one or both eyes
follow up schedule
• Types:
• Eye protection:
• Traumatic
• Eye patch for 24 hours
• Congenital
• Eye shield for 1 week
• Senile
• Sunglasses outdoors
• Painless, blurry vision
• “As if glasses need cleaning” RETINAL DETACHMENT
• Reduced contrast sensitivity, sensitive • Separation of the RPE from
to glares, reduced visual acuity the neurosensory layer
• Myopic shift • Considered an emergency
• Types:
ASSESSMENT AND DIAGNOSIS
• Rhegmatogenous Detachment
• Decreased visual acuity is directly
• Most common form
proportional to cataract density.
• Tear develops in the
• Degree of lens opacity is not always
sensory retina
correlated with functional status • Traction Retinal Detachment
MEDICAL MANAGEMENT • Caused by tension
• No nonsurgical treatment can cure • Exudative Retinal Detachment
cataracts. • Due to production of fluid
• Best management is prevention. under the retina from the
• Risk reduction strategies: choroid
• Smoking cessation and Weight
reduction
• Blood glucose control
• Sunglasses when outdoors
• Surgical Management –
Cataract Removal MANIFESTATIONS
• Not needed unless ADLs • Painless Distorted Vision:
are affected • “Curtain Vision”
• Done on an outpatient basis and • Floaters
takes less than 1 hour • Bright flashing lights
• Done under topical/intraocular • Cobwebs
anesthesia
• One eye is treated first then the
MEDICAL MANAGEMENT
other eye after several weeks
• Surgical Repair
• Methods:
• Scleral Buckle
• Phacoemulsification
• Compress the sclera to bring
• Lens Replacement
layers in contact with each other
NURSING MANAGEMENT • Vitrectomy
• Pre-Op Care • Injection of gas, oil, or liquids to
• Assess if with history of push retina against the RPE
taking Alpha-antagonists
• Post-Op Care

NCM 116: NURSING CARE OF CLIENTS WITH EYE AND VISION DISORDERS. Page 4 of 7
Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH
 Velez College – College of Nursing
NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

NURSING MANAGEMENT NURSING MANAGEMENT

• Post-Op Care
• Patient must be in prone position
to allow gas bubble to stay in
place
• Follow-up is done the next day
• Amsler grid for monitoring of vision one
eye at time several times each week
with glasses on

CENTRAL RETINAL ARTERY OCLUSION

• Sudden loss of vision
• Considered as a true ocular emergency
• Fundoscopy: Pale retina with a
cherry red spot
• Treatment:
• Ocular massage ORBITAL TRAUMA
• Anterior chamber paracentesis ORBITAL TRAUMA
• Medication: Acetazolamide • Usually associated with head injury
• Oxygen therapy • General medical condition should be
• Most visual loss is severe stabilized first before doing ocular
and permanent examination
AGE-RELATED MACULAR DEGENERATION • Assess visual acuity as soon as possible
• Top priority = Patient to be stabilized
• Accounts for 54% of all blindness in
older adults ORBITAL FRACTURES
• Detected by facial x-rays
• Characterized by drusen beneath the
retina • Usually caused by blunt force from a fist
• Only a small portion experience total or baseball
• Surgery done 1-2 weeks after injury
blindness
• Patients retain peripheral vision
• Types:
• Dry (Non neovascular,
Non Exudative)
• Most common type
• Outer layers of the retina
slowly break down
• Wet (Neovascular, Exudative)
• Abrupt onset
• More damaging
• Straight lines appear
FOREIGN BODIES
crooked and distorted
• Usually tolerated except for copper,
• New blood vessels iron, or vegetable materials
forming • Do not do MRI if foreign body is
MEDICAL MANAGEMENT suspected to be metal!
• Removed if:
• No known effective
• Superficial and anterior in
therapy for dry type
location
• For wet type:
• Have sharp edges that can
• Medications:
VEGF inhibitors damage adjacent structures
• Ranibizumab (Lucentis)
• Bevacizumab (Avastin)
NCM 116: NURSING CARE OF CLIENTS WITH EYE AND VISION DISORDERS. Page 5 of 7
Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH

Velez College – College of Nursing

NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

• Made of copper, iron, or Ocular Burns

vegetable materials • Alkali Burns
• More severe injuries
OCULAR TRAUMA • Penetrate ocular tissues rapidly
• Cause long term damage
• Leading cause of blindness among
• Acidic Burns
children and young adults especially
• Cause less damage
males
• At place of injury: immediate irrigation
• Common causes:
with tap water
• Occupational injuries
• At ER:
(construction workers)
• Identify chemical substance
• Contact sports
(actual container is best)
• Weapons (air guns, BB guns)
• Irrigate with NSS until pH is between
• Assaults
7.3-7.6
• MVC/MVA
• Can apply local anesthetic
• First aid is critical if trauma is a chemical
• Apply antibiotic ointment
burn or foreign object in the eye • Eye patch is worn for 24 hours

ASSESSMENT AND DIAGNOSIS DRY EYES

• Assess pre-injury vision or history • May be caused by:
of past ocular surgery • Decreased Tear Production:
• For chemical eye burns, ask what • Sjogren’s Disease
agent caused injury and pH • Connective Tissue Disease
• Assess pupil size, shape, and light • Increased Tear Evaporation:
reaction of affected eye vs unaffected • Meibomian gland deficiency
eye • Lid disorder
• Assess EOM movement • Vitamin A deficiency
• Reduced blinking
MEDICAL • Contact Lens use
MANAGEMENT Foreign Bodies
MANIFESTATIONS
• Apply antibiotic ointment daily
• Eye patch is worn • Photophobia, foreign body
• Eye is examined daily sensation, burning, stinging,
Penetrating Injuries redness, decreased tearing
• Immediately apply eye patch MEDICAL MANAGEMENT
• Do not attempt to remove penetrating • Long term treatment
object without medical supervision • Artificial tears during the day
• Removal of eyeball is done if globe is
• Ointment at night
irreparable
• Medication: Cyclosporine OD eye drops
• To prevent sympathetic ophthalmia
• Surgery: Punctal occlusion
NCM 116: NURSING CARE OF CLIENTS WITH EYE AND VISION DISORDERS. Page 6 of 7
Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH

Velez College – College of Nursing

NCM 116: NURSING CARE OF EYE AND VISION DISORDERS
Lecturer: William C. Tiu, Jr., RN, MD, FRSPH | 2nd Semester, S.Y. 2021 - 2022

CONJUNCTIVITIS • Cool venitlation

• Commonly called as “pink eye”
• Appearance due to subconjunctival
blood vessel congestion 10-21 mm hg = normal iop

MANIFESTATIONS Age-related macular degeneration

• Foreign body sensation = central vision; peripheral vision
• Scratching/burning sensation remains intact
• Itching Amsler grid = We assess the px
• Photophobia vision by using a grid that will assess
• Starts in one eye then spreads if px is experiencing any distortion
when it comes to straight lines

BACTERIAL CONJUNCTIVITIS
• Common causative agents: S.
pneumoniae, H. influenzae, S. aureus
• Acute onset of redness, burning, and
discharge
• (+) exudates in the morning and eyes
may be difficult to open
• Modes of Transmission:
• Oral-Genital Sex
• Hand to Eye
• Contact with infected swimming
pools
• Usually lasts for 2 weeks even
without treatment

VIRAL CONJUNCTIVITIS
• Common causative agents: adenovirus,
HSV
• Highly contagious
• Usually preceded by URTI
• Self-limited
• Obvious hyperemia
• Very red eye
• Management:
• Cold compress
• Frequent hand hygiene

ALLERGIC CONJUNCTIVITIS
• Hypersensitivity reaction
• Usually part of allergic rhinitis
• Common among children
• (+) history of allergies, asthma, eczema
• Extreme pruritus and watery discharge
accompanied by swelling
 • Management:
• Corticosteroid drops
• Cold compress
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Lecturer: WILLIAM C. TIU, JR., RN, MD, FRSPH