NCLEX: Eye disorders

Eye disorders: Treatments

Focus topic: Eye disorders

For eye disorders, treatments consist of drug therapy and surgery.

Eye disorders: Drug therapy

Focus topic: Eye disorders

Topical medications are commonly used to treat eye disorders; however, the practitioner may also prescribe systemic medications. These medications include anti-infectives, anti- inflammatories, miotics, mydriatics, vasoconstrictors, and other medications. It’s essential to provide proper patient teaching on instillation of these topical agents.

Eye disorders: Surgery

Focus topic: Eye disorders

Surgical treatments for eye disorders include cataract removal, iridectomy, laser surgery, scleral buckling, and trabeculectomy.

Cataract removal

Two techniques allow the removal of cataracts: intracapsular cataract extraction (ICCE) and extracapsular cataract extraction (ECCE).

Eye disorders

Eye disorders: Intra is out

Focus topic: Eye disorders

In ICCE, the entire lens is removed, most commonly with a cryoprobe. However, this technique isn’t widely used today. In ECCE, the patient’s anterior capsule, cortex, and nucleus are removed, leaving the posterior capsule intact. This is the primary treatment for congenital and traumatic cataracts.

Eye disorders: In with the implant

Focus topic: Eye disorders

Immediately after removal of the natural lens, many patients receive an intraocular lens implant. An implant works especially well for elderly patients who can’t use eyeglasses or contact lenses (because of arthritis or tremors, for example).

Eye disorders: Patient preparation

Focus topic: Eye disorders

Tell the patient he’ll need to:

  • temporarily wear an eye patch after surgery to prevent traumatic injury and infection
  • get help when getting out of bed
  • sleep on the unaffected side to reduce IOP.

Eye disorders: Monitoring and aftercare

Focus topic: Eye disorders

After the patient returns from surgery, follow these important steps:

  • Notify the practitioner if the patient has severe pain. Also, report increased IOP.
  • Because of the change in the patient’s depth perception, assist him with ambulation and observe other safety precautions.
  • Make sure the patient wears the eye patch for 24 hours, except when instilling eye drops as ordered, and have him wear an eye shield, especially when sleeping.
  • Instruct the patient to continue wearing the shield at night or whenever he sleeps for several weeks, as ordered.

Eye disorders

Eye disorders: Home care instructions

Focus topic: Eye disorders

Before discharge, teach the patient:

  • how to administer eyedrops or ointments
  • to contact the practitioner immediately if sudden eye pain, red or watery eyes, photophobia, or sudden vision changes occur
  • to avoid activities that raise IOP, including heavy lifting, straining during defecation, and vigorous coughing and sneezing
  • not to exercise strenuously for 6 to 10 weeks
  • to wear dark glasses to relieve glare
  • that changes in his vision can present safety hazards if he wears eyeglasses
  • how to use up-and-down head movements to judge distances to help compensate for loss of depth perception
  • how to insert, remove, and care for contact lenses, if appropriate, or how to arrange to visit a practitioner routinely for removal, cleaning, and reinsertion of extended-wear lenses
  • when to remove the eye patch and when to begin using his eyedrops.

Iridectomy

Performed by laser or standard surgery, an iridectomy reduces IOP by easing the drainage of aqueous humor. This procedure makes a hole in the iris, creating an opening through which the aqueous humor can flow to bypass the pupil. An iridectomy is commonly performed to treat acute angle-closure glaucoma.

Eye disorders: Another angle

Focus topic: Eye disorders

Because glaucoma usually affects both eyes eventually, patients commonly undergo preventive iridectomy on the unaffected eye. It may also be indicated for a patient with an anatomically narrow angle between the cornea and iris. An iridectomy is also used for chronic angle- closure glaucoma, with excision of tissue for biopsy or treatment, and sometimes with other eye surgeries, such as cataract removal, keratoplasty, and glaucoma-filtering procedures.

Eye disorders: Patient preparation

Focus topic: Eye disorders

Make it clear to the patient that an iridectomy doesn’t restore vision loss caused by glaucoma but that it may prevent further loss.

Eye disorders: Monitoring and aftercare

Focus topic: Eye disorders

After an iridectomy, take the following steps:

  • Watch for hyphema (hemorrhaging into the anterior chamber of the eye) with sudden, sharp eye pain or the presence of a small half-moon-shape blood speck in the anterior chamber when checked with a flashlight. If either occurs, have the patient rest quietly in bed, with his head elevated, and notify the practitioner.
  • Administer a topical corticosteroid to decrease inflammation and medication to dilate the pupil.
  • Administer a stool softener to prevent constipation and straining during bowel movements, which increases venous pressure in the head, neck, and eyes. This increased pressure can led to increased IOP or strain on the suture line or blood vessels in the affected area.

Eye disorders: Home care instructions

Focus topic: Eye disorders

Before discharge, teach the patient to:

  • report sudden, sharp eye pain immediately, because it may indicate increased IOP
  • refrain from strenuous activity for 3 weeks
  • refrain from coughing, sneezing, and vigorous nose blowing, which raise venous pressure
  • move slowly, keep his head raised, and sleep with two pillows under his head.

Laser surgery

The treatment of choice for many ophthalmic disorders is laser surgery because it’s relatively painless and especially useful for elderly patients, who may be poor surgical risks. Depending on the type of laser, the finely focused, high-energy beam shines at a specific wavelength and color to produce various effects. Laser surgery can be used to treat retinal tears, diabetic retinopathy, macular degeneration, and glaucoma.

Eye disorders: Patient preparation

Focus topic: Eye disorders

Before the procedure, take these steps:

  • Tell the patient he’ll be awake and seated at a slit lamp–like instrument for the procedure.
  • Explain that his chin will be supported and that he’ll wear a special contact lens that will prevent him from closing his eye.
  • Explain that laser use requires safety precautions, including eye
    protection for everyone in the room.

Eye disorders: Monitoring and aftercare

Focus topic: Eye disorders

After the procedure, the patient may occasionally have eye pain. Apply ice packs as needed to help decrease the pain. The patient may be discharged after this office procedure.

Eye disorders: Home care instructions

Focus topic: Eye disorders

Instruct the patient to receive follow-up care as scheduled. Tell him that ice packs may ease eye discomfort.

Scleral buckling

Used to repair retinal detachment, scleral buckling involves applying external pressure to the separated retinal layers to bring the choroid into contact with the retina. Indenting (or buckling) brings the layers together so that an adhesion can form. It also prevents vitreous fluid from seeping between the detached layers of the retina, which could lead to further detachment and possible blindness.

Eye disorders

Eye disorders: A frigid look

Focus topic: Eye disorders

Another method of reattaching the retina is pneumatic retinopexy. This procedure involves sealing the tear or hole with cryotherapy and introducing gas to provide a tamponade of the retina and the layer beneath it.

Eye disorders: Patient preparation

Focus topic: Eye disorders

Depending on the patient’s age and the surgeon’s preference, advise him whether he’ll receive a local or general anesthetic.

Eye disorders: Monitoring and aftercare

Focus topic: Eye disorders

After the procedure, take these steps:

  • Notify the practitioner immediately if you observe eye discharge or if the patient experiences fever or sudden, sharp, or severe eye pain.
  • As ordered, administer mydriatic and cycloplegic eyedrops to keep the pupil dilated, an antibiotic to prevent infection, and a corticosteroid to reduce inflammation.
  • For swelling of the eyelids, apply ice packs.
  • Because the patient will probably have binocular patches in place for several days, institute safety precautions while he’s hospitalized. Raise the side rails of his bed, and help him when he walks.
  • Advise the patient to avoid activities that increase IOP, such as hard coughing or sneezing, or straining during defecation. If he’s nauseated, administer an antiemetic, because vomiting increases IOP.

Eye disorders: Home care instructions

Focus topic: Eye disorders

Before discharge, instruct the patient to:

  • notify the practitioner of signs of recurring detachment, including floating spots, flashing lights, and progressive shadow
  • report fever, persistent excruciating eye pain, or drainage
  • avoid activity that risks eye injury
  • avoid heavy lifting, straining, or any strenuous activity that increases I OP
  • use dilating, antibiotic, or corticosteroid drops as prescribed
  • avoid rapid eye movements.

Trabeculectomy

Trabeculectomy is a surgical filtering procedure that removes part of the trabecular mesh work to allow aqueous humor to bypass blocked outflow channels and flow safely away from the eye. This procedure creates an opening under the conjunctiva. An iridectomy is then performed to prevent the iris from prolapsing into the new opening and obstructing the flow of aqueous humor. A trabeculectomy helps treat glaucoma that doesn’t respond to drug therapy.

Eye disorders: Patient preparation

Focus topic: Eye disorders

Inform the patient that this procedure will probably prevent further vision impairment but that it won’t restore vision that’s already lost.

Eye disorders: Monitoring and aftercare

Focus topic: Eye disorders

After a trabeculectomy:

  • Report excessive bleeding from the affected area.
  • Observe for nausea; if necessary, administer an antiemetic because vomiting can raise IOP.
  • Administer eyedrops (usually a miotic such as pilocarpine [Carpine]).
  • Immediately instill a cycloplegic such as atropine. If ordered, give a corticosteroid to reduce iritis, an analgesic to relieve pain, and a beta-adrenergic blocker to reduce pressure.
  • Continue previously prescribed eye drops — a miotic such as pilocarpine or a beta-adrenergic blocker — in the unaffected eye.
  • Remind the patient that he should avoid all activities that increase IOP, including trying to avoid hard coughing or sneezing as well as straining during defecation.

Eye disorders: Home care instructions

Focus topic: Eye disorders

Instruct the patient to:

  • immediately report sudden onset of severe eye pain, photophobia, excessive tearing, inflammation, or vision loss
  • understand that glaucoma isn’t curable but can be controlled by taking prescribed drugs regularly to treat this condition
  • avoid constrictive clothing, coughing, sneezing, or straining because they can increase IOP
  • anticipate changes in his vision that present safety hazards and that to overcome the loss of peripheral vision, he should turn his head fully to view objects at his side.

Eye disorders: Nursing diagnoses

Focus topic: Eye disorders

When caring for patients with eye disorders, you’ll find that several nursing diagnoses may be used over and over. These diagnoses are listed here, along with nursing interventions and rationales. See NANDA-I taxonomy II by domain, page 936, for the complete list of NANDA diagnoses.

Eye disorders: Disturbed sensory perception (visual)

Focus topic: Eye disorders

Related to a vision impairment, Disturbed sensory perception (visual) refers to the patient’s deprivation of environmental stimuli. It’s associated with nearsightedness, farsightedness, diabetes mellitus, cataracts, detached retina, glaucoma, hemianopsia, macular degeneration, optic nerve damage, and blindness.

Expected outcomes

  • Patient performs self-care activities safely and within limits.
  • Patient uses adaptive and assistive devices.

Nursing interventions and rationales

  • Allow the patient to express his feelings about his vision loss. Allowing him to voice his fears helps him to accept vision loss.
  • Remove excess furniture or equipment from the patient’s room, and orient him to his surroundings. If appropriate, allow him to direct the arrangement of the room. This promotes patient safety while allowing him to maintain an optimal level of independence.

Eye disorders: Skip the fine print

Focus topic: Eye disorders

  • Modify the patient’s environment to maximize any vision the patient may have. Place objects within his visual field, and make sure he’s aware of them. Provide large-print books. Modifying the environment helps the patient meet his self-care needs.
  • Always introduce yourself or announce your presence when entering the patient’s room, and let him know when you’re leaving. Familiarizing the patient with his caregivers helps reality orientation.
  • Provide non visual sensory stimulation, such as talking books, audiotapes, and the radio, to help compensate for the patient’s vision loss. Non visual sensory stimulation helps the patient adjust to his vision loss.
  • Teach the patient about adaptive devices, such as eyeglasses, magnifying glasses, and contact lenses. A knowledgeable patient will be better able to cope with vision loss.
  • Refer the patient to appropriate support groups, community resources, or organizations such as the American Foundation for the Blind. Post discharge support will help the patient and his family cope better with vision loss.

Eye disorders: Risk for infection

Focus topic: Eye disorders

Related to eye surgery, Risk for infection refers to the patient’s risk of contracting an infection.

Expected outcomes

  • Patient has a normal temperature.
  • Patient develops no infection post operatively.
  • Patient states that he understands postoperative care and the signs and symptoms of infection.

Nursing interventions and rationales

  • Minimize the patient’s risk of infection by performing hand hygiene before and after providing care and by wearing gloves when providing direct care. Hand hygiene is the single best way to avoid spreading pathogens, and gloves offer protection when handling wound dressings or carrying out various treatments.
  • Monitor the patient’s temperature. Report elevations immediately. An elevated temperature lasting longer than 24 hours after surgery may indicate ocular infection.

Eye disorders: Keeping it clean

Focus topic: Eye disorders

  • Use strict aseptic technique when suctioning the lower airway, inserting indwelling urinary catheters, providing wound care, and providing I.V. care. This technique helps prevent the spread of pathogens.
  • Teach the patient about good hand hygiene, factors that increase infection risk, and the signs and symptoms of infection. These measures allow the patient to participate in his care and help the patient modify his lifestyle to maintain optimal health.

Eye disorders: Common eye disorders

Focus topic: Eye disorders

Cataracts, glaucoma, retinal detachment, and vascular retinopathies are common eye disorders.

Eye disorders: Cataracts

Focus topic: Eye disorders

A common cause of vision loss, a cataract is a gradually developing opacity of the lens or lens capsule of the eye. Cataracts commonly occur bilaterally, with each progressing independently. Exceptions are traumatic cataracts, which are usually unilateral, and congenital cataracts, which may remain stationary. Cataracts occur most frequently in patients over age 70. Prognosis is usually good, with surgery improving vision in 95% of cases.

What causes it

  • 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.

Eye disorders: It gets complicated

Focus topic: Eye disorders

  • Complicated cataracts can occur secondary to uveitis, glaucoma, retinitis pigmentosa, or detached retina. They may also occur in the course of a systemic disease (such as diabetes, hypoparathyroidism, or atopic dermatitis) or can result from ionizing radiation or infrared rays.
  • Toxic cataracts result from drug or chemical toxicity with ergot, naphthalene, phenothiazine and, in patients with galactosemia, from galactose.

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
  • hypermature — deteriorating lens proteins and peptides that leak through the lens capsule, which may develop into glaucoma if intraocular out flow is obstructed.

What to look for

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.

What tests tell you

  • 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).

How it’s treated
Treatment consists of surgical extraction of the opaque lens and postoperative correction of vision deficits. The current trend is to perform the surgery as a 1-day procedure.

What to do

  • For information on care of the patient undergoing cataract removal surgery, see “Cataract removal,” page 175.
  • For patient teaching topics on cataract removal.

Eye disorders: Glaucoma

Focus topic: Eye disorders

The term glaucoma refers to a group of disorders characterized by abnormally high IOP that can damage the optic nerve. It occurs in three primary forms: open-angle (primary), acute angle-closure, and congenital. It may also be secondary to other causes. In the United States, glaucoma affects 2% of the population over age 40 and accounts for 12.5% of all new cases of blindness. Its incidence is highest among blacks. Prognosis is good with early treatment.

What causes it

Risk factors for chronic open-angle glaucoma include genetics, hypertension, diabetes mellitus, aging, race (blacks are at increased risk), and severe myopia. Precipitating risk factors for acute angle-closure glaucoma include drug-induced mydriasis (extreme dilation of the pupil) and excitement or stress, which can lead to hypertension. Secondary glaucoma may result from uveitis, trauma, steroids, diabetes, infections, or surgery.

Eye disorders

Pathophysiology

Chronic open-angle glaucoma results from overproduction of aqueous humor or obstruction of its outflow through the trabecular mesh work or Schlemm’s canal, causing increased IOP and damage to the optic nerve. In secondary glaucoma, such conditions as trauma and surgery increase the risk of intraocular fluid obstruction caused by edema or other abnormal processes.

Eye disorders: Pressure’s rising

Focus topic: Eye disorders

Acute angle-closure glaucoma, also called narrow-angle glaucoma, results from obstruction to the outflow of aqueous humor from anatomically narrow angles between the anterior iris and the posterior corneal surface. It also results from shallow anterior chambers, a thickened iris that causes angle closure on pupil dilation, or a bulging iris that presses on the trabeculae, closing the angle (peripheral anterior synechiae). Any of these conditions may cause IOP to increase suddenly.

What to look for

Patients with IOP within the normal range of 8 to 21 mm Hg can develop signs and symptoms of glaucoma, and patients who have abnormally high IOP may have no clinical effects. Nonetheless, each type of glaucoma has specific signs and symptoms.

Eye disorders: Slow but steady

Focus topic: Eye disorders

Chronic open-angle glaucoma is usually bilateral and slowly progressive. Symptoms don’t appear until late in the disease. These symptoms include:

  • mild aching in the eyes
  • gradual loss of peripheral vision
  • seeing halos around lights
  • reduced visual acuity, especially at night, that’s uncorrectable with glasses.

Eye disorders: Rapid reaction

Focus topic: Eye disorders

The onset of acute angle-closure glaucoma is typically rapid, constituting an ophthalmic emergency. Unless treated promptly, this glaucoma produces permanent loss of or decreased vision in the affected eye. Signs and symptoms include:

  • unilateral inflammation and pain
  • pressure over the eye
  • moderate pupil dilation that’s nonreactive to light
  • cloudy cornea and blurring and decreased visual acuity
  • photophobia and seeing halos around lights
  • nausea and vomiting.

Eye disorders

What tests tell you

  • Tonometry (using an applanation, Schiøtz’, or pneumatic tonometer) measures the IOP and provides a reference baseline.
  • Slit-lamp examination is used to assess the anterior structures of the eye, including the cornea, iris, and lens.
  • Gonioscopy determines the angle of the eye’s anterior chamber, enabling differentiation between chronic open-angle glaucoma and acute angle-closure glaucoma. The angle is normal in chronic open-angle glaucoma; however, in older patients with chronic open-angle glaucoma, partial closure of the angle may also occur, so the two forms of glaucoma coexist.
  • Ophthalmoscopy shows the fundus, where cupping and atrophy of the optic disk are apparent in chronic open-angle glaucoma. A pale disk appears in acute angle-closure glaucoma.
  • Perimetry establishes peripheral vision loss in chronic openangle glaucoma. Fundus photography recordings are used to monitor the optic disk for changes.

How it’s treated

For open-angle glaucoma, patients initially receive a betaadrenergic blocker (such as timolol [Timoptic] or betaxolol [Betoptic]), epinephrine, or a carbonic anhydrase inhibitor (such as acetazolamide) to decrease IOP. Drug treatment also includes miotic eyedrops, such as pilocarpine, to promote the outflow of aqueous humor.

Eye disorders: Plan B

Focus topic: Eye disorders

Patients who don’t respond to drug therapy may be candidates for argon laser trabeculoplasty or a surgical filtering procedure called trabeculectomy, which creates an opening for aqueous outflow.

Eye disorders: Emergency action

Focus topic: Eye disorders

For acute angle-closure glaucoma — an ophthalmic emergency — drug therapy may lower IOP. When pressure decreases, the patient undergoes laser iridotomy or surgical peripheral iridectomy to maintain aqueous flow from the posterior to the anterior chamber. Iridectomy relieves pressure by excising part of the iris to reestablish aqueous humor outflow. The patient typically undergoes prophylactic iridectomy a few days later on the normal eye.
Medical emergency drug therapy includes acetazolamide to lower IOP; pilocarpine to constrict the pupil, forcing the iris away from the trabeculae and allowing fluid to escape; and I.V. mannitol (20%) or oral glycerin (50%) to force fluid from the eye by making the blood hypertonic. The patient with severe pain may need a opioid analgesic.

What to do

  • For the patient with acute angle-closure glaucoma, give medications, as ordered, and prepare him psychologically for laser iridotomy or surgery.
  • Retinal detachment rarely heals spontaneously. Surgery — including scleral buckling, pneumatic retinopexy, or vitrectomy, or a combination of these procedures — can reattach the retina.

What to do

  • Provide emotional support because the patient may be understandably distraught about his loss of vision.
  • Position the patient face down if gas has been injected to maintain pressure on the retina.
  • Evaluate the patient. With successful treatment, he’ll experience restored vision without impairment. He should follow up as directed.

Eye disorders: Vascular retinopathies

Focus topic: Eye disorders

Vascular retinopathies are noninflammatory disorders that result from disruption of the eye’s blood supply. The four distinct types of vascular retinopathy are central retinal artery occlusion, central retinal vein occlusion, diabetic retinopathy, and hypertensive retinopathy.

Eye disorders: Backup on the central artery

Focus topic: Eye disorders

Central retinal artery occlusion typically causes permanent blindness. However, some patients experience resolution within hours of treatment and regain partial vision.

What causes it

Central retinal artery occlusion may be idiopathic (no known cause) or result from:

  • embolism, atherosclerosis, or infection (such as syphilis or rheumatic fever)
  • conditions that retard blood flow, such as temporal arteritis, massive hemorrhage, or carotid blockages by atheromatous plaques.

Eye disorders: In the same vein

Focus topic: Eye disorders

Central retinal vein occlusion can result from:

  • trauma or external compression of the retinal vein
  • diabetes, phlebitis, thrombosis, atherosclerosis, glaucoma, polycythemia vera, or sickling hemoglobinopathies.

Eye disorders

Eye disorders: It’s all in a name

Focus topic: Eye disorders

The names of the two types of vascular retinopathy indicate their causes. Diabetic retinopathy can stem from diabetes, and hypertensive retinopathy can result from prolonged hypertension.

Pathophysiology

Central retinal artery occlusion and central retinal vein occlusion occur when a retinal vessel becomes obstructed. The diminished blood flow causes vision deficits.

Eye disorders: Diabetes dysfunction

Focus topic: Eye disorders

Diabetic retinopathy results from the microcirculatory changes that occur with diabetes. These changes occur more rapidly in poorly controlled diabetes. Diabetic retinopathy may be non proliferative or proliferative; proliferative diabetic retinopathy produces fragile new blood vessels (neovascularization) on the disk and elsewhere in the fund us.

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Eye disorders: Hypertension havoc

Focus topic: Eye disorders

In hypertensive retinopathy, prolonged hypertension produces retinal vasospasm and consequent damage to and narrowing of the arteriolar lumen.

What to look for

Signs and symptoms of vascular retinopathies depend on the cause:

  • central retinal artery occlusion — sudden painless, unilateral loss of vision (partial or complete) that doesn’t pass; this may follow transient episodes of unilateral loss of vision
  • central retinal vein occlusion — reduced visual acuity that’s painless except when it results in secondary neovascular glaucoma (uncontrolled proliferation of blood vessels)
  • diabetic retinopathy — in nonproliferative form, possibly no signs or symptoms, or loss of central visual acuity and diminished night vision from fluid leakage into the macular region; in proliferative form, sudden vision loss from vitreous hemorrhage or macular distortion or retinal detachment from scar tissue formation
  • hypertensive retinopathy — signs and symptoms dependent on the location of retinopathy (for example, blurred vision if located near the macula).

Eye disorders

What tests tell you

Tests depend on the type of vascular retinopathy.

How it’s treated

Treatment depends on the cause of the retinopathy.

Eye disorders: Central retinal artery occlusion

Focus topic: Eye disorders

No known treatment exists, although the practitioner may attempt to release the occlusion into the peripheral circulation. To reduce IOP, therapy includes acetazol amide, eyeball massage using a Goldman-type gonioscope and, possibly, anterior chamber paracentesis. The patient may receive inhalation therapy of carbogen (95% oxygen and 5% carbon dioxide) to improve retinal oxygenation. The patient may also receive inhalation treatments hourly for 48 hours, so he should be hospitalized for careful monitoring.

Eye disorders: Central retinal vein occlusion

Focus topic: Eye disorders

Anticoagulant administration is the treatment of choice. The practitioner may also recommend laser photocoagulation for patients with widespread capillary nonperfusion to reduce the risk of neovascular glaucoma.

Eye disorders: Diabetic retinopathy

Focus topic: Eye disorders

Treatment includes controlling the patient’s blood glucose levels and laser photocoagulation to cauterize weak, leaking blood vessels. If a vitreous hemorrhage occurs when one of these weak blood vessels breaks and it isn’t absorbed in 3 to 6 months, the patient may undergo vitrectomy to restore partial vision.

Eye disorders: Hypertensive retinopathy

Focus topic: Eye disorders

Treatment consists of controlling the patient’s blood pressure.

What to do

  • Arrange for immediate ophthalmologic evaluation when a patient complains of sudden, unilateral loss of vision. A delay in treatment may result in permanent blindness.
  • Administer acetazolamide I.M. or I.V. as ordered. During inhalation therapy, monitor vital signs carefully and discontinue if blood pressure fluctuates markedly or if the patient becomes arrhythmic or disoriented. Monitor the patient’s blood pressure if he complains of occipital headache or blurred vision.
  • Evaluate the patient. After successful therapy, the patient with a chronic illness should receive follow-up care as directed and comply with the treatment regimen.
  • A patient with diabetes should understand the need for a stable blood glucose level.
  • A patient with hypertension should keep his blood pressure in a safe range.
  • If vision worsens, the patient should seek immediate medical attention and follow safety precautions to prevent injury.

Eye disorders: Removing obstacles

Focus topic: Eye disorders

  • Maintain a safe environment for a patient with vision impairment, and teach him how to make his home safer (by removing obstacles and throw rugs, for instance).

Eye disorders

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