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8/6/2019 ncm 106,,powerpointMs

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Care of clients with retinal detachment

Retinal detachment

is the separation of the retina from the choroid, a membrane dense with

vessels that is located between the retina and the sclera.

is the thin layer sensitive tissue that lines the back position of the eye

When the retina detaches, it is deprived of its blood supply & source of

nourishment & loses its ability to function. This can impair vision to the

point of blindness.


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Types of Retinal Detachment:

Rhegmatogenous retinal detachment occurs due to a break in the retina that

allows fluid to pass from the vitreous space into the subretinal space between the

sensory retina and the retinal pigment epithelium Retinal breaks are divided intothree types - holes, tears and dialyses. Holes form due to retinal atrophy especially

within an area of lattice degeneration. Tears are due to vitreoretinal traction.

Dialyses which are very peripheral and circumferential may be either tractional or

atrophic, the atrophic form most often occurring as idiopathic dialysis of the young.

Exudative, serous, or secondary retinal detachment occurs due to

inflammation, injury or vascular abnormalities that results in fluid accumulatingunderneath the retina without the presence of a hole, tear, or break. In evaluation of

retinal detachment it is critical to exclude exudative detachment as surgery will

make the situation worse, not better. Although rare, exudative retinal detachment can

be caused by the growth of a tumor on the layers of tissue beneath the retina, namely

the choroid.

Tractional retinal detachment A tractional retinal detachment occurs whenfibrous or fibrovascular tissue, caused by an injury, inflammation or

neovascularization, pulls the sensory retina from the retinal pigment epithelium.


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Predisposing Factor:

Age, Cataract extraction, Degeneration of retina, trauma, severe myopia,

previous retinal detachment in the other eye,family history of retinal detachment

Clinical Manifestation:

Shadow or curtain falling across the field of vision

Shadows or black area in the field of vision are the result of separation of

visual preceptors from the neuro pathway

No pain

Onset is usually sudden & maybe accompanied by a burst of black spots of

floaters indicating that bleeding has occurred as a result of detachment

May also see flashes of light caused by separation of the retina


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Surgical Mgt:

LaserPhotocoagulation

If the retina is torn or detachment is slight, a laser can be used to burn theedges of the tear and halt progression. If the detachment is small, the laser

can seat the retina against the choroid. Laser surgery is usually performed as

an outpatient procedure under local anesthesia.


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Cryopexy

Uses nitrous oxide to freeze the tissue behind the retinal tear, stimulating

scar tissue formation that will seal the edges of the tear usually performed

as an outpatient procedure under local anesthesia.

Pneumatic Retinopexy

Most effective for detachment that occur in the upper portion of the eye.

The eye is numb with local anesthesia & a small gas bubble is injectedinto the vitreous body. Cryopexy or laser is used to seal the retina into

place.


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Scleral Buckling

Surgical procedure to place the retina back in the contact with

choroid.


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Nursing Mgt:

Help the client cope with the fears and reality of loss of vision & adopt to

changes in vision

Encourage the client to resume a regular diet & fluids as tolerated

Postoperative eye medications generally include an antibiotic- steroid

combination eye drop to prevent infection & reduce inflammation

Either warm or cold compresses maybe applied for comfort several times a

day


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Retinal Vascular Disorder

Complications:

Retinopathy

is a general term that refers to some form of non-inflammatory

damage to the retina of the eye. Frequently, retinopathy is an

ocular manifestation of systemic disease.

Causes of retinopathy are varied:

diabetes

arterial hypertension

prematurity of the newborn

direct sunlight exposure

retinal vein or artery occlusion pheochromocytoma


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MGt:

Treatment for diabetic retinopathy depends on the type of diabetic

retinopathy you have, its severity and how well it may have

already responded to previous treatments.

Early diabetic retinopathy

If you have nonproliferative diabetic retinopathy, you may not

need treatment right away. However, your eye doctor will closely

monitor your eyes to determine if you need treatment.


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Macular Degeneration

is a degenerative disease of the retina (a thin layer of nerve cells that lines

the back of the eyeball) that causes progressive loss of central vision.

risk of developing macular degeneration increases with age

most often affects people in their sixties and seventies


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Risk Factors:

Age, gender, race, smoking, family history

Signs and Symptoms:

Increasing blurriness of printed words

Decrease in the intensity or brightness of colors

Difficulty recognizing faces

Visual distortions

Decrease in or loss of central vision


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Care with clients with orbital and ocular trauma

Ocular trauma Common cause of unilateral visual loss in young people. Often as a result of

accident in and around the home.

Signs of possible severe injury:

Pain

Subconjunctival hemorrhage

Conjunctival laceration

Iris defect

Lowered IOP

Extrusion of ocular contents


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Orbital Fracture/ Balack eye

A break in one of the bones that make up the orbit. Since the orbit is the seat of the

globe (the eye), an orbital fracture can be a serious, sight-threatening break.

Symptoms:

A black eye, with swelling and black and blue discoloration around the injured eye;

possible redness and areas of bleeding on the white of the eye and on the inner

lining of the eyelids

Double vision, decreased vision or blurry vision

Difficulty looking up, down, right or left

Abnormal position of the eye (either bulging out of its socket or sunken in)


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Foreign Objects

A foreign object in the eye, such as dirt, an eyelash, a contact lens, or

makeup, can cause eye symptoms.

Symptoms:

Objects may scratch the surface of the eye (cornea) or become stuck on

the eye. If the cornea is scratched, it can be hard to tell whether the object

has been removed, because a scratched cornea may feel painful and as

though something is still in the eye. Most corneal scratches are minor and

heal on their own in 1 or 2 days.


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Small or sharp objects traveling at high speeds can cause serious injury to

many parts of the eyeball. Objects flying from a lawn mower, grinding

wheel, or any tool may strike the eye and possibly puncture the eyeball.

Injury may cause bleeding between the iris and cornea (hyphema), a change

in the size or shape of the pupil, or damage to the structures inside the

eyeball. These objects may be deep in the eye and may require medical

treatment

Ocular Burn

It should be irrigated with copious amounts of physiologic solution or water

immediately

After irrigation the eye is dilated by antibiotics are instilled as prescribed (

collagenase inhibitors such as acetylcysteine ( Mucomyst) or sodium

edentate EDTA as prescribed to treat severe alkali burns.


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Alkali Burns

Alkali substances are lipophilic and penetrate more rapidly than acids.

Saponification of cell membrane fatty acids causes cell disruption anddeath. In addition, the hydroxyl ion hydrolyzes intracellular

glycosaminoglycans and denatures collagen. The damaged tissues stimulate

an inflammatory response, which damages the tissue further by the release

of proteolytic enzymes.


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Acid Burns

Acid burns cause protein coagulation in the corneal epithelium,

which limits further penetration. Hydrofluoric acid is an

exception. It is a weak acid that rapidly crosses the cell membraneas it remains non ionized. In this way, hydrofluoric acid acts like

an alkali, causing liquefactive necrosis. In addition, fluoride ions

are released into the cells. Fluoride ions may inhibit glycolytic

enzymes and may combine with calcium and magnesium to form

insoluble complexes.


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Care with clients with infectious and inflammatory condition

Dry eye syndrome

is a condition in which tear production is inadequate, most commonlyoccurs in women between 50-60 years of age.

3 primary causes are lacrimal gland malfunction, mucin deficiency, &

mechanical abnormalities that prevent the spread of tears across the surface

of the eye.

Manifestation: Burning

Itching eyes

Sensation of something in the eye

Mgt:

Artificial tears ( eyedrop & lubricants)

Using airtight goggles at night to prevent tear evaporation


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Mgt:

Artificial tears ( eyedrop & lubricants)

Using airtight goggles at night to prevent tear evaporation


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Conjunctivitis

Inflammation of the conjunctiva from various microorganism

Manifestation: Redness

Tearing

Exudation of eyelid many progress to eyelid drooping

Abnormal tissue growth

Mgt: Antibiotic eyedrops


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Uveitis

Inflammation of the middle layer of the eye, termed the uvea but in common usage

may refer to any inflammatory process involving the interior of the eye.

Symptoms:

Redness of the eye

Blurred vision

Sensitivity to light

Dark, floating spots along the visual field Eye pain


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Orbital Cellulitis

Is an acute infection of the tissues immediately surrounding the eye including the

eyelids, eyebrow and cheek.

Symptoms:

Fever

Painful swelling of upper and lower eyelids

Eye pain especially with movement

Decreased vision

Bulging eyes

General malaise

Diagnostic Test:

CBC, Blood culture, Spinal tap


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Keratitis

Whenever the epithelium is damaged, the cornea becomes quite susceptible to

infection; even small abrasions provide a point of entry for bacteria.

Develop whenever the cornea is not adequately moistened and protected by theeyelids.

Mgt:

Acetaminophen may be required for pain management

Cycloplegics & mydriatics may be prescribed to alleviate pain and inflammation

Collagen shield may be used when short term corneal protection


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Signs and symptoms:

Swelling on the eyelid

Eyelid tenderness

Sensitivity to light Increased tearing

Heaviness of the eyelid

Mgt:

Topical antibiotic eye drops or ointment (e.g. chloramphenicol or

fusidic acid)


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Salamat sa pakikinig guyZZ!!!

Ang mga gumawa:::

Gringo

LanDO

SubAsGinger

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