Cataract

Zarka Wahid Bux

Nursing instructor
Siut school of nursing
cataract
A cataract is an opacity in the lens of an eye that impairs vision.
● There are three types of cataracts:
A subcapsular cataract begins at the back of the lens.
A nuclear cataract forms in the center (nucleus) of the lens.
A cortical cataract forms in the lens cortex and extends from the outside of the lens to
the center.
pathophysiology
• Pathophysiology may vary with each form of cataract. However,
• cataract development typically goes through these four stages:
• immature — partially opaque lens
• mature — completely opaque lens; significant vision loss
• tumescent — water-filled lens, which may lead to glaucoma
• hyper mature — deteriorating lens proteins and peptides that leak through the lens
capsule, which may develop into glaucoma if
intraocular outflow is obstructed.
Risk factors
• Advanced age
• Diabetes
• Heredity
• Smoking
• Eye trauma
• Excessive exposure to the sun
• Chronic corticosteroid use
causes
• The cause of a cataract depends on its type:
• Senile cataracts develop in elderly people, probably because of changes in the chemical
state of lens proteins.
• Congenital cataracts occur in neonates as a result of genetic defects or maternal
rubella during the first trimester.
• Traumatic cataracts develop after a foreign body injures the lens with sufficient force to
allow aqueous or vitreous humor to enter the lens capsule.
Sign and symptoms
• Signs and symptoms of a cataract include:
• painless, gradual blurring and loss of vision
• with progression, whitened pupil
• appearance of halos around lights
• blinding glare from headlights at night
• glare and poor vision in bright sunlight.
Diagnostic evaulation
• Diagnosis is made by history, visual acuity test, and direct ophthalmoscopic
exam.cataractvision
• Ophthalmoscopy or slit lamp examination may reveal a dark area in the red reflex.
Ophthalmoscopy or slit lamp examination is a microscopic instrument that allows
detailed visualization of anterior segment of eye to identify lens opacities and other eye
abnormalities
Nursing Diagnosis

• Sensory and perceptual alterations (visual) related to decreased visual acuity

Medical diagnosis
• Ophthalmoscopy or slit-lamp examination confirms the diagnosis by revealing a dark
area in the normally homogeneous red reflex.
• Shining a penlight on the pupil reveals the white area behind it (unnoticeable until the
cataract is advanced).
Surgical management
• Surgical removal of the opacified lens is the only cure for cataracts. The lens can be
removed when the visual deficit is 20/40.
• If cataracts occur bilaterally, the more advanced cataract is removed first.
• Extracapsular cataract extraction, the most common procedure, removes the anterior
lens capsule and cortex, leaving the posterior capsule intact. A posterior chamber
intraocular lens is implanted where the patient’s own lens used to be.
• Intracapsular cataract extraction removes the entire lens within the intact capsule.
An intraocular lens is implanted in either the anterior or the posterior chamber, or the
visual deficit is corrected with contact lenses or cataract glasses.
Pharmacologic Highlights
• Acetazolamide a carbonic anhydrase inhibitor is used to reduce intraocular pressure by
inhibiting times a day inhibitor formation of hydrogen and bicarbonate ions.
• Phenylephrine a Sympathomimetic agent causes abnormal dilation of the pupil
constriction of conjunctival arteries.
• Other Medications: Postoperatively, medications are prescribed to reduce infection
(gentamicin or neomycin) and to reduce inflammation (dexamethasone), taking the
form of eye drops. Acetaminophen is prescribed for mild discomfort; tropicamide is
prescribed to induce ciliary paralysis.
Nursing intervention
• Postoperative care should focus on:
• Preventing infection
• Administering ophthalmic medications
• Providing pain relief
• Teaching the client about self-care at home and fall prevention
• Wear sunglasses while outside or in brightly lit areas.
• Report signs of infection, such as yellow or green drainage
Nursing intervention
• Avoid activities that increase IOP. • Avoid tilting the head back to wash hair.
• Limit cooking and housekeeping.
• Bending over at the waist • Avoid rapid, jerky movements, such as vacuuming.
• Sneezing • Avoid driving and operating machinery.
• Coughing • Avoid sports.
• Report pain with nausea/vomiting – indications of
• Straining increased IOP or hemorrhage.
• Head hyperflexion • Best vision is not expected until 4 to 6 weeks following
the surgery.
• Restrictive clothing, such as tight shirt • The client should report if any changes occur, such as lid
collars swelling, decreased vision, bleeding or discharge, a sharp,
sudden pain in the eye, and/or flashes of light or floating
• Sexual intercourse shapes.
complications
Infection
Infection can occur after surgery.
Client Education
■ Signs of infection that the client should report include yellow or green drainage, increased
redness or pain, reduction in visual acuity, increased tear production, and photophobia.
● Bleeding
Bleeding is a potential risk several days following surgery.
Client Education
■ Clients should immediately report any sudden change in visual acuity or an increase in pain.