SING CO

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L.N.

SESSION
2022-2023
MEDICAL SURGICAL NURSING- I

SEMINAR
SeminarON GLAUCOMA
on Blindness

SUBMITTED TO SUBMITTED BY
Mrs Siddhi Parmar Mr Sumit Tiwari
Asst. Professor Msc Nursing 1st Year
 BLINDNESS
INTRODUCTION
Blindness is a lack of vision. It may also refer to a loss of vision that cannot be corrected with
glasses or contact lenses.

 Partial blindness means you have very limited vision.

 Complete blindness means you cannot see anything and do not see light. (Most people
who use the term "blindness" mean complete blindness.)
People with vision that is worse than 20/200 with glasses or contact lenses are considered
legally blind in most states in the United States. Vision loss refers to the partial or complete
loss of vision. This vision loss may happen suddenly or over a period of time. Some types of
vision loss never lead to complete blindness. Your eyes and your brain work together to see.
the eye is made up of many different parts, including the cornea, iris, lens, and retina. These
parts all work together to focus on light and images. Your eyes then use special nerves to
send what you see to your brain, so your brain can process and recognize what you're seeing.
In eyes that work correctly, this process happens almost instantly.

DEFINITION
Blindness: Loss of useful sight. Blindness can be temporary or permanent. Damage to any
portion of the eye, the optic nerve, or the area of the brain responsible for vision can lead to
blindness. There are numerous (actually, innumerable) causes of blindness. The current
politically correct terms for blindness include visually handicapped and visually challenged.

INCIDENCE

 The estimated number of people visually impaired in the world is 285 million, 39
million blind and 246 million having low vision; 65 % of people visually impaired
and 82% of all blind are 50 years and older
 In India, there were 7.2 million blind people in 1990, which rose to 8.8 million in
2015, making the country the home of almost a quarter of the total 36 million blind
people.

TYPES

Color blindness is the inability to perceive differences in various shades of colors,

particularly green and red, that others can distinguish. It is most often inherited (genetic) and
affects about 8% of males and under 1% of women. People who are color blind usually have
normal vision otherwise and can function well visually. This is actually not true blindness.

Night blindness is a difficulty in seeing under situations of decreased illumination. It can be

genetic or acquired. The majority of people who have night vision difficulties function well
under normal lighting conditions; this is not a state of sightlessness.
 Snow blindness is loss of vision after exposure of the eyes to large amounts of ultraviolet
light. Snow blindness is usually temporary and is due to swelling of cells of the corneal
surface. Even in the most severe of cases of snow blindness, the individual is still able to see
shapes and movement.

ETIOLOGY

Some other conditions that cause vision loss at the time of birth or in infancy include:

 Genetic or metabolic diseases.

 Defects or abnormalities in the eye itself (coloboma, glaucoma, cataracts)
 Infections, such as cytomegalovirus (CMV)
 Neurological Visual Impairment (NV) Cataracts are the No.1 cause of blindness here but,
fortunately, the condition can be easily treated and the blindness reversed. ...
 Under corrected refractive errors. ...
 Glaucoma. ...
 Macular degeneration. ...
 Diabetic retinopathy.
RISK FACTORS
 poor prenatal care,
 premature birth,
 advancing age, poor nutrition,
 failing to wear safety glasses when indicated,
 poor hygiene, smoking,
 a family history of blindness, the presence of various ocular diseases and the existence
of medical conditions including diabetes mellitus, hypertension, cerebrovascular
disease, and cardiovascular disease
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
If you’re completely blind, you can see nothing. If you’re partially blind, you might
experience the following symptoms:

 Cloudy vision
 An inability to see shapes
 Seeing only shadows
 Poor night vision
 Tunnel vision

Symptoms of visual impairment in young children can include:

 Constant eye rubbing

 An extreme sensitivity to light
 Poor focusing
 Chronic eye redness
 Chronic tearing from their eyes
 A white instead of a black pupil
 Poor visual tracking, or trouble following an object with their eyes
 Abnormal eye alignment or movement after 6 months of age

HEALTH ASSESSMENT AND DIAGNOSTIC EVALUATION

1) History Collection- Age, gender, Weight, Family history etc…data collected

2) Physical examination-

 Visual acuity – It is central vision and is used to look at objects in detail, such as
reading a book or watching television.
 Visual field – It is the ability to see around the edge of vision while looking straight
ahead.

TREATMENT OF BLINDNESS

Conjunctivitis

 Cleaning of the eyes.

 Antibiotic drops like chloramphenicol.
 Use of dark goggles.

Glaucoma
 Medical line of treatment – eye drops & tablets.
 Surgical.
Laser treatment
Corneal Ulcer

 Use of eye drops. It is depend upon type of ulcer.

 Use of dark goggles.
 Cleaning of eyes.
 Rest to the eyes by mydriatics.
Iritis
 Local Steroid eye drops and ointments, cycloplegics, systemic steroids, ocular anti–
hypertensive drugs.

Cataract
 Surgery (IOL).

Refractive Errors
 Providing spectacles.

Trachoma
 Tetracycline/Erythromycin eye ointment.

Retinopathy
 Treatment of complication, control of diabetes & hypertension.

Squint
 Surgery, correction of refraction.

Night Blindness
 Treatment with Vitamin A.

Corneal Opacity
 Surgery (Keratoplasty)

CONSIDERATIONS FOR TREATMENT

For management for patients some considerations are important

 The degree of impairment, disability, or handicap

 Cause of visual impairment and possible outcome
 Age of the patient and level of development
 General health of the patient
  Patient’s other impairment and adjustment to the vision loss and patient’s
expectations from therapy

MANAGEMENT

The treatment of blindness depends on the cause of blindness.

-Blindness due to nutritional defificiency: It can be addressed by dietary changes.

-Visual impairment due to refractive error: It can be addressed by doing a refraction and

providing appropriate spectacles.

-Inflammatory and infectious causes of blindness can be treated with medication in the form

of drops or pills.

-Most of people are blind due to cataract: In these patients, cataract surgery would, in most
cases, restore their sight. Usually an intraocular lens (IOL) is implanted in the eye after
removal of the opaque natural lens.

TREATMENT AND MANAGEMENT OF VISUAL IMPAIRMENT INCLUDE

 Control of diabetes – This prevents progression of diabetic retinopathy and resulting

visual impairment to some extent. However in advanced cases this may be of little
help.
 Cataract surgery – In cases of visual impairment due to cataracts, surgery may be
opted. Usually an artificial lens is placed within the eye as a replacement of the
damaged and clouded lens. This, more often than not restores vision.
 Magnification systems – This is achieved using appropriate lens, reading telescopes or
surgical systems etc. Hand magnifiers may also be offered. For improvement of visual
fields prisms and mirror systems may be prescribed.
 Glaucoma – medications in eye drops are prescribed to control glaucoma. These may
contain drugs like Latanoprost, tafluprost, travoprost which are prostaglandin
analogues.

The drugs may include Beta-blockers like betaxolol hydrochloride or carbonic

anhydrase inhibitors dorzolamide and Sympathomimetics like brimonidine tartrate.
 Glaucoma may also be managed surgically using open microscopic surgery, laser
corrections, etc.

 At present there are no cures for age-related macular degeneration (AMD) especially
of the dry variety.

For the wet AMD there are therapies that help to stop the progression. These include
Photodynamic therapy. This uses a light-sensitive medicine called verteporfin injected
into a vein of the arm.

The drug identifies the abnormal blood vessels in the eyes and attaches itself to the
proteins in these blood vessels. This is followed by a low-powered laser therapy.

Some new types of medications called Anti-VEGF medication may also be used. One
example is Ranibizumab that has recently been approved by the National Institute for
Health and Clinical Excellence (NICE) for use on the NHS.

NURSING PRIORITIES

 Need to improve self care deficit

 Need to reduce anxiety

 Need to prevent infection

DIETARY MANAGEMENT

Experts suggest high-quality eye and vision supplements should contain at least the following
ingredients for optimum effect:

 vitamin C (250 to 500 mg)

 vitamin E (400 IU)

 zinc (25 to 40 mg)

 copper (2 mg)

 vitamin B complex that also contains 400 mcg of folic acid

 omega-3 fatty acids (2,000 mg)

NURSING DIAGNOSIS

 Disturbed Sensory Perception (visual) related to blindness.

 Self care deficit related to visual impairment.
 Anxiety related to surgery that will be undertaken and the possibility of failure to obtain a
sight again.
 Risk for Injury related to impaired sensory function secondary to diplopia as evidence by
patient reporting he is seeing double.
 Knowledge deficit related to disease condition and treatment
SL ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE EXPECTED
NO OUTCOME
1 Objective data: Disturbed To improve Assess the visual acuity To provide baseline data .
Sensory sensory level of the patient. for further intervention.
I observed that Perception perception
patient is not (visual)
able to see related to Orient the patient to To provide improved
properly. blindness. environment, the staff, and comfort and familiarity
everyone else in the area. and also helps to
decreases anxiety and
disorientation.

Put the items needed, or To use in case of

keep the calling bell near to emergency.
bed side.

Teach the patient about To help the patient to cope

adaptive devices, such as up with the vision loss.
eye glasses, magnifying
glasses, and contact lenses.

Consult with an To get adequate care for

ophthalmologist frequently. the eyes.

As per doctor’s order instill To prevent further

eye drops and ointments infection.
with aseptic techniques,
whatever necessary.
SL ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE EXPECTED
NO OUTCOME
2 Objective data: Self care deficit To improve Assess the self care To provide the baseline The activity
related to visual the self care activities. data for further level of the
Patient is not impairment. activities intervention. patient is being
able to do his improved to
daily activities. some extent.

Provide assistance as Provided assistance for

needed. brushing, bathing, eating
food, etc...

Teach the energy Teach the energy

conservation techniques. conservation techniques
by discussing ways of
conserving energy while
bathing, transferring and
performing ADLs.
PREVENTION

There are many different diseases that can cause complete or partial blindness. In some cases,
it will be impossible to avoid this outcome, but usually, you should be able to prevent this
condition by following some simple rules.

 Seek immediate help when you notice any eye problems.

 Go to regular checkups.
Even if your eyes seem perfectly fine, you will need to visit an ophthalmologist once a
year for a routine checkup.

 Protect your eyes from sunlight.

Wearing sunglasses is essential to keep your eyes healthy. Bear in mind that you should
always have them on hand, because UV rays are equally harmful during every season.
Your sunglasses should be of high quality, and preferably with polarized lenses. This way
they won't put much strain on the eyes.

 Avoid eye injuries.

If your work or hobby is associated with high risk of eye injury, you must wear goggles
or eye protectors to prevent it.

 Lead healthy lifestyle.

A well-balanced diet and exercising will keep every part of your body healthy and will
stave off the process of natural eyesight deterioration that is caused by aging.

 Control the time you spend in front of a computer.

Consult your ophthalmologist about wearing special glasses with protective lenses, even
if your eyesight is normal.

 Check your blood pressure regularly.

Burst vessels that are often caused by increased blood pressure can cause partial eyesight
deterioration.

 Control your blood sugar level.

Even if you don't have diabetes, you should be sure that the level of sugar in your blood
remains normal at all times. The more glucose is in your blood, the higher is the risk of
suffering permanent retina damage.
PROGNOSIS

The prognosis for blindness is dependent on its cause. In patients with blindness due to optic-
nerve damage or a completed stroke, visual acuity can usually not be restored. Patients with
long-standing retinal detachment in general cannot be improved with surgical repair of their
detachment. Patients who have corneal scarring or cataract usually have a good prognosis if
they are able to access surgical care of their condition.

CONCLUSION

Blindness is the inability to see anything, even light. If you’re partially blind, you have
limited vision. For example, you may have blurry vision or the inability to distinguish the
shapes of objects. Complete blindness means that you can’t see at all and are in total
darkness. Legal blindness refers to vision that’s highly compromised. What a person with
healthy eyes can see from 200 feet away a legally blind person can see only from 20 feet
away.Seek medical attention right away if you suddenly lose the ability to see. Have someone
bring you to the emergency room for treatment. Don’t wait for your vision to return.
Depending on the cause of your blindness, immediate treatment may increase your chances of
restoring your vision. Treatment may involve surgery or medication.
BIBLIOGRAPHY:-

Books

• Brunner, suddarth’s.(2004). Text book of medical surgical. (Edition-10th).

Philadelphia; Lippincott Williams and Wilkins. Page no. 1022-1025
• Basvanthapa, B.T.(2007). Medical surgical nursing. (Edition-5th). Noida; jaypee
brother’s medical publisher. Page no. 1189-1191
• Lewis. (2004). Medical surgical nursing (6th edition). USA, Mosby publication.
• Luckmann joan (2007). Saunders manual of nursing care (Edition- 2nd).
Philadelphia; W.B. Sunder’s company. page no. 1294-1295
• J. Luck Mann’s. (1987). Medical surgical nursing (3rd edition). Philadelphia;
W.B. Sunder’s company.

Internet

• http://www.medicine net.com
• http://www.cancer.org/offices/saz/programs/z.asp
• http://wwww.pubmed.co.in
• http://www.wrongdiagnosis.com/a/cancer/tests.htm?ktrack=kcplink