PERCEPTION & COORDINATION LECTURE

EYE CATARACT
BSN 3B GROUP 4
ANATOMY • A biconvex structure attached to
the ciliary process by the zonular

of the LENS fibre, between iris & vitreous

humour
• Non-vascular, colourless and
transparent
• Index of refraction 1.336
• Consists of stiff elongated,
prismatic cells known as lens fibre,
very tightly packed together
• Divided into nucleus, cortex and
capsule
• Helps to refract incoming light and
focus it onto the retina
ANATOMY OF THE LENS
LENS CAPSULE
• Thin transparent, collagen membrane
• Surrounds lens completely

LENS EPITHELIUM
• Single layer below the lens capsule
• Formed of cuboidal cells
• Become columnar at equatorial region
ANATOMY OF THE LENS
LENS FIBER
• The epithelial cells elongated to form
lens fibers which have a complicated
structural forms.
• Mature lens fibers are cells which
have lost their nuclei.
• As the lens fibers are formed
throughout the life, these are arranged
compactly as nucleus & cortex of the
lens.
ANATOMY OF THE LENS
LENS NUCLEUS
• Its is the central part containing the oldest fibres.
• It consists of different zones, which are laid down
successively as the development proceeds.
• Different zones:
I. Embryonic nucleus II. Fetal nucleus
III. Infantile nucleus IV. Adult nucleus

CORTEX
• Its is the peripheral part which compromises the
youngest lens fibres.
WHAT IS A CATARACT?
An ocular opacity, partial or complete, of one or both eyes, on or in the lens or capsule,
especially an opacity impairing vision or causing blindness. The subsequent cloudy
appearance of the eye resulted in the origin of the name cataract.
 CAUSES
• CONGENITAL - familial, intrauterine infections, maternal drug ingestions

• AGE - elderly

• METABOLIC - diabetes, hypocalcemia, Wilson’s disease, galactosemia

• DRUG - INDUCED - corticosteroids, miotics, amiodarone, phenothiazines

• TRAUMATIC AND INFLAMMATORY - post intra-ocular surgery, uveitis

• DISEASE ASSOCIATED - Down’s Syndrome, dystrophia myotonica, Lowe’s

Syndrome, atopic dermatitis

 RISK FACTORS
• Increasing age (protein break in lens)
• Diabetes
• Excessive exposure to sunlight
• Smoking
• Obesity
• High blood pressure
• Previous eye injury or inflammation
 RISK FACTORS
• Previous eye surgery
• Prolonged use of corticosteroid medications
• Drinking excessive amounts of alcohol
• Overproduction of oxidants
• Ultraviolet radiation
• Nutritional deficiency – Vitamin C
 CLINICAL MANIFESTATIONS
• Painless, clouded, blurred or dim vision
• Increasing difficulty with vision at night
• Sensitivity to light and glare
• Need for brighter light for reading and other activities
• Seeing "halos" around lights
• Fading or yellowing of colors
• Double vision in a single eye
• Astigmatism
• Color shift (the aging lens become progressively more
absorbent at the blue end of the spectrum)
• Brunescense (color values shift to yellow-brown)
 DIAGNOSTICS
• Visual acuity test
• Slit-lamp examination
• Retinal exam
• Applanation tonometry
LENS REPLACEMENT
After removal of the crystalline lens, the patient is referred to as
aphakic (ie, without lens).

LENS REPLACEMENT OPTIONS:

• Aphakic eyeglasses
• Contact lenses
• IOL implants.
LENS REPLACEMENT
APHAKIC GLASSES
Although effective, are rarely used. Objects are magnified by
25%, making them appear closer than they actually are. This
magnification creates distortion.

Peripheral vision is also limited, and binocular vision (ie, ability

of both eyes to focus on one object and fuse the two images
into one) is impossible if the other eye is phakic (normal).
LENS REPLACEMENT
CONTACT LENSES
Provide patients with almost normal vision, but because
contact lenses need to be removed occasionally, the patient
also needs a pair of aphakic glasses.

Contact lenses are not advised for patients who have difficulty
inserting, removing, and cleaning them. frequent handling and
improper disinfection increase the risk of infection.
LENS REPLACEMENT
INTRAOCULAR LENS (IOL)
Insertion of IOLs during cataract surgery is the usual approach
to lens replacement. after cataract extraction, or
phacoemulsification, the surgeon implants an IOL.

IOL implantation is contraindicated in patients with recurrent

uveitis, proliferative diabetic retinopathy, neovascular
glaucoma.
 NURSING DIAGNOSES
• DISTURBED SENSORY PERCEPTION
• RISK FOR TRAUMA/INJURY
• DEFICIENT KNOWLEDGE
• DEPRESSION
• POWERLESSNESS
 NURSING INTERVENTIONS
1. If nursing care is provided in the patient’s home, structure the environment with
conducive lighting and reduce fall hazards.
2. Suggest magnifying glasses and large-print books. Explain that sunglasses and
soft lighting can reduce glare.
3. Educate the patient avoid rubbing or putting pressure in the operated eye. Eye
patch could also help prevent the patient from rubbing it.
4. Encourage the patient to verbalize or keep a log on his or her fears and anxiety
about visual loss or impending surgery.
5. Encourage patient to add foods containing Vitamin C & E, bet-carotene, zinc, and
copper in diet.
6. Encourage the patient to report to the ophthalmologist if there is any worsening of
the symptoms.
7. Inform patient to sleep on his/her back or on the opposite side of the eye that was
operated. 
 Thank You
SIVILA, ABLOG, DUQUE. GONZALO, LAPAZ, NOVIDA, VALENCIA

PERCEPTION AND COORDINATION LECTURE