CD Eyes

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Dry Eye Syndrome

AKA Keratoconjunctivitis SiccaCondition in which tear production

is inadequateUsually occurs in women between50-60 years of age

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P rimary Causes

1. Lacrimal Duct Malfunction2. Mucin Deficiency

3. Mechanical Abnormalities thatprevent the spread of tears acrossthe surface of the eyes

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Clinical Manifestations

Burning sensationItchiness

Foreign Body SensationRednessP ain

Difficulty moving eyelids

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Diagnosis

Slit-lamp examinationHistory

P hysical exam

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Management

Determine degree of injuryArtificial tears (eyedrops & lubricants)

Use of airtight goggles to prevent tearevaporationFor post menopausal women, HRT

may be recommended.Surgery to open lacrimal duct or torepair lid problems

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DacrocystitisInflammation of the tear drainagesystemP us-like drainage or red lump near

the punctaCause bacterial infection

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Clinical Manifestation

Tender, red, swelling at innercanthus

ManagementInitially topical warm compress

& oral antibioticsIf unsuccesssful I & D orDacryocystorhinostomy (DCR)

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CanaliculitisInflammation of lacrimal canalLess pain & swelling than dacrocystitisCause Bacterial infection sometimessecondary to obstruction of lacrimalcanal

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ManagementInitially Topical Antibiotics

If unsuccessful - Canaliculotomy


Unilateral tenderness, redness,swelling at inner canthus

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Blepharitis

Chronic inflammation of the eyelidmargins

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2 Types

1. Staphylococcal Blepharitis Usually ulcerative and more serious

due to the involvement of the base of hair follicles

2. Seborrhic Blepharitis Usually chronic and is usually resistant

to treatment Caused by Seborrhic dermatitis

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Causes

Blepharitis occurs when tiny oilglands located near the base of theeyelashes malfunction

Seborrheic dermatitis A bacterial infection Malfunctioning oil glands in your eyelid

Rosacea Allergies Eyelash mites

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Watery eyes

Red eyesA gritty, burning sensation in the eyeEyelids that appear greasy

Itchy eyelidsCrusted eyelashes upon awakeningSensitivity to lightMisdirected eyelashes

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Diagnosis

Eye ExamSwab Skin for Testing

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Management

Lid Hygiene Warm compresses should be applied to

loosen crusts, followed by a light

scrubbing with a cotton swab and amixture of water and baby shampoo

Topical AntibioticsSteroid eye drops or ointmentsArtificial TearsTreatment of underlying condition

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HordoelumAKA StyeP ustular infection of an eyelashfollicle or sebacious gland on an

eyelid marginCommonly caused by Staphylococcus

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Clinical Manifestationredness, tenderness, and pain in theaffected area.may feel irritated or "scratchy."Later symptoms: swelling, discomfortduring blinking, watering of the eye, andlight sensitivity.A small, yellowish spot at the center of the bump that develops as pus expands inthe area.

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Management

P lace a warm compress on theaffected area for 10 minutes, four tosix times a day.A stye should not be pressed orsqueezed to facilitate drainage.Antibiotics

If a stye persists for several days, adoctor may perform an I&D underlocal anesthesia.

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Chalazion

AKA meibomian cyst, tarsal cyst, orconjunctival granuloma

Inflammation of the meibomiangland

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Initially, the eyelid may appear red,tender and swollen

After several days it changes to apainless, slow growing lumpBlurred vision, if large enough to pressagainst the eyeball.

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Managementwarm compressesAntibiotic drop or ointment to be usedimmediately after the compresses.

If the chalazion persists and is causingan unsightly lump, it can be removedsurgically through the inside of the lid.

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Conjunctivits

AKA P ink EyeInflammation of the

conjunctivaMost commonocular disease in theworldHighly contagiousSeveral Types

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G eneral Signs and Symptoms

RednessSwelling

TearingP ainItching

Discharge from the eye

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Bacterial ConjunctivitisCommon causative agents

S. Pneumoniae H. Influenzae S. Aureus

usually infects both eyes andproduces a thicker, yellow-green

dischargeVery contagious

More common in children

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Viral Conjunctivitis

Common causative agents: Adenovirus Corona virus Herpes Simplex virus

Typically begins in one eye,produces a watery discharge

Within a few days the other eyebecomes involved.A swollen lymph node may be felt

just in front of the ear.

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Management

no treatment for mostcasesAntiviral medicationsmay be an option if caused by the herpessimplex virus.warm compress or lightcold compress for 10minutes 4-5X/day

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Allergic Conjunctivitis

affects both eyes and is a responseto an allergy-causing substancesuch as pollenintense itching, tearing andinflammation of the eyes aswell as sneezing and watery nasaldischarge.

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Management

Allergy Drops(antihistamines,decongestants, mast

cell stabilizers, steroidsand anti-inflammatorydrops)Avoid allergensCold Compress

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Toxic Conjunctivitis

AKA Chemical or IrritantConjunctivitis

Can be the result of medications,chlorine from swimming pool,exposure to toxic fumes or otherirritants such as smoke, hair sprays,acids and alkalis

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Management

Irrigate immediately and profusely withsaline or sterile watermay require topical steroids

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DiagnosisEye ExaminationLaboratory Exam

of discharge

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Trachoma

Chronic infectious disease of theconjunctiva and cornea caused bych lamydia tra ch omatis

Spread by direct contact and byfomites and very contagiousCauses blindness if left untreated(leading cause of preventableblindness in the world)

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Signs and Symptoms

The principal signs and symptoms inthe early stages of trachoma include:

Mild itching and irritation of the eyes and

eyelids Discharge from the eyes containing

mucus or pus

As the disease progresses: P hotophobia Blurred vision Eye pain

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Risk Factors

P overtyCrowded living conditionsP oor sanitationAgeSexP oor access to waterFliesLack of latrines

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Diagnosis

initial stages display no signs orsymptoms.

In areas where the disease isendemic, through a physicalexamination or through sending asample of bacteria from eyes to becultured and tested in a laboratory.

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Keratitis

Inflammation of the corneaMay or may not involve an infectionNoninfectious keratitis caused by a relatively minor injury, such

as a fingernail scratch, or from wearingcontact lenses too long.

Infectious keratitis caused by bacteria, viruses, fungi andparasites usually from contaminatedwater

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RednessForeign Body Sensation

P ainP hotophobiaLacrimation

BlepharospasmDecreased Vision

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Risk Factors

Contact lensesReduced immunity

Warm climateCorticosteroidsEye injury

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ManagementNoninfectious keratitis

Treatment of noninfectious keratitis variesdepending on the cause.

a 24-hour eye patch topical eye medications

Infectious keratitis Bacterial keratitis.

antibioticscorticosteroid eyedrops

Fungal keratitis

antifungal

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Viral keratitisantiviral eyedrops

Acanthamoeba keratitiscaused by the tiny parasiteacanthamoebaAntibiotic eye drops may be helpfulcorneal transplant (keratoplasty).

If unresponsive to medication, or if

permanent damage to the cornea occursthat significantly impairs vision, a cornealtransplant may be recommended.

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Scleritis

inflammation of the sclerausually associated with infections,chemical injuries, or autoimmunediseases

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ScleritisVery red eye in onepart or the wholescleraP ain (deep, boringache) especially

when movedP hotophobiaBlurred visionTearing

EpiscleritisP ink or P urple

color of episcleraP ain

TendernessP hotophobiaTearing

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Diagnosis

Eye ExamP hysical Exam

Blood Tests

Management

CorticosteroidsNSAIDSTreatment of underlying causes

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UveitisInflammation of the uveal tractCauses

Local or systemic diseases Injury Unidentified factors

P anuveitis occurs when all layers of the

uvea are inflamed.

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Clinical ManifestationsEye redness & P ainLight sensitivityBlurred vision

Dark, floating spots in your field of vision (floaters)Small P upils

Whitish area (hypopyon) inside thelower part of the iris

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DiagnosisComplete Eye ExamComplete medical history

Management

Mydiatics (Atropine SO 4)Steroids

Dark G lassesAnalgesics (Aspirin, Acetaminoiphen)

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Inflammation of the affected eye(Exciting eye) followed by the othereye (sympathizing eye)P hotophobiaBlurred vision

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Retinitis

Inflammation of the retinaOften associated with disease of thechoroidsCaused by bacteria, toxoplasmosis,fungi, cytomegalovirus

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Reduced Visual AcuityChanges in Visual field

Alteration in shape of objectsDiscomfort in eyesP hotophobia

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Diagnosis

Eye Exam

Ophthalmoscope

ManagementRest eyes

P rotect eyes from lightAtropine SO 4

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FeverP ainful swelling of upper and lowereyelids

Shiny, red or purple eyelidEye P ainDecreased vision

Bulging eyesG eneral malaiseP ainful or difficult eye movements

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Diagnosis

CBCBlood Culture

Spinal Tap (in extremely sickchildren)X-ray

CT Scan/MRICulture of eye or nose drainageThroat Culture

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Management

AntibioticsMonitor changes in visual acuity, CNSfunction, displacement of the globe,EOM, pupillary signs. EtcSurgery may be needed to drain theabscess


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HyphemaP resence of blood inthe anteriorchamber

Occurs as the resultof injuryUsually resolves in 5

7 days

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Interventions

Encourage to rest in semi-fowlers positionAvoid sudden eye movements for 3 5days to decrease bleeding

Administer cyclopegic eye drops asprescribed to relax eye muscle and placeeye at restInstruct to use eye shield or eye patchInstruct to avoid reading or watchingtelevision

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P enetrating Injuries

P enetrating injuries orsever blows to the headmay cause severe opticnerve damageVisual loss

Immediate usually

irreversible Delayed better prognosis

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Management

Never remove objectCover object with cupDon t allow the client to bend downDon t place pressure on the eyeCorticosteroids to reduce optic nerveswelling

Surgery Optic Nerve Decompression orEnucleationBed rest with BR P for 1-2 daysObserve for Sympathetic Ophthalmia

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Intraocular Foreign Body

S/Sx Blurred Vision Discomfort

Diagnosis Slit-lamp biomicroscopy CT Scan UTZ

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Management

Don t attempt to remove if lodgedinto corneaAvoid pressure in the eyes (norubbing/ touching)Avoid activities that increase IO P

Cover for additional protectionConsult doctor immediately

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Contusions

Bleeding into the soft tissue as a result of injuryCauses black eye, which disappears within

10 daysP ain, P hotophobia, Edema and diplopiamay occur

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Management

Ice Compress ImmediatelyInstruct to undergo eye exam

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Ocular Burns

Eye injury which chemical agentsenters the eyesAlkali more damagingAcid less damagingChemical may appear superficial orcomplete marbleizing of cornea

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Ac id BurnAlk a li Burn

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ManagementTIME is of the essenceIRRIG ATE with tap water (if at home) orwith NSS or any neutral solution (if inhealth care setting) until pH normalizes

Local anesthetic and lid speculum may beusedP articulates are removed with moistenedcotton-tipped applicatorArtificial tearsSurgery done to restore ocular surface,corneal integrity and optical clarity


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Cataract

Opacity or clouding of the lens

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Classification

1. Senile Associated with aging (>50 y/o)

2. Traumatic Associated with injury

3. Congenital Occur at birth if the mother contracts an

infection (measles, rubella) during the 1 sttrimester of pregnancy

Central removal is between 6-8 weeks

4. Secondary Occur following other eye or systemic

disease

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Types

1. Nuclear Cataract Central opacity Has substantial genetic component

Associated with worsening myopia If dense, severe blurred vision*** P eriodic changing of prescription

glasses

2 C i l C

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2. Cortical Cataract Anterior, posterior, peripheral cortex of

lens affected Has little effect on vision Vision is worse at very bright light P rogress at highly variable rate

3. P osterior Subcapsular Cataract Occur in front of posterior capsule Typically in younger people

Associated with corticosteroid use,diabetes or ocular trauma Near vision diminished and increasingly

sensitive to glare from bright lights

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Risk FactorsIncreasing ageDiabetesDrinking excessive amounts of alcoholExcessive exposure to sunlight

Exposure to ionizing radiation, such as thatused in X-rays and cancer radiation therapyFamily history of cataractsHigh blood pressureObesityP revious eye injury or inflammationP revious eye surgeryP rolonged use of corticosteroid medicationsSmoking

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P athophysiology

Reduction in oxygen & initialincrease in water content

Increase in Na & Ca; Decrease in

CHON, Vit. C & K

Undergo numerous age-related changes(formation of fluorescent compounds)& molecular changes

P hotochemical process due to photo-absorption of UV radiation throughoutlife

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How a cataract affects your vision

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How cataracts obscure vision

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Diagnosis

Visual AcuitySlit-lamp examinationDirect ophthalmoscopeRetinal Examination

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Management

Surgery is the only satisfactory treatmentAdvised when cataract interferes with aperson s mobility and ability to perform ADLsBefore surgery:

Make sure your eyeglasses or contact lenses arethe most accurate prescription possible

Use a magnifying glass to read Improve the lighting in your home with more or

brighter lamps When you go outside during the day, wear

sunglasses or a broad-brimmed hat to reduce glare Limit your night driving

Intracapsular Cataract Extraction

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Intracapsular Cataract Extraction(ICCE)

Removal of cataract within its capsule

Extracapsular Cataract Extraction

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Extracapsular Cataract Extraction(ECCE)

Opening is made in the capsule andlens is lifted without disturbing themembrane

*** a person with A P HAKIA is veryhyperopic

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Cryoextraction

The cataract is lifted from the eye bya small probe that has been cooledto a temperature below zero andadheres to the wet surface of thecataract

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P hacoemulsion

A method of cataract removal whichbreaks up the lens and flushes it out intiny pieces

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P re-Op Care

Orient to staff and physical environmentof both eyes will be covered after surgeryIf client is a child, practice covering botheyesAdminister mydriatics/cyclopegics asprescribed

Atropine SO 4

Cyclophentolate &P

henylephrine(Cyclomydril) Cyclophentolate HCl (Cyclogyl) Tropicamide (Mydriacyl)

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P ost-Op Care

The eye is covered with dressing(eyepad) and eye shieldElevate head of bed 30 45 degreesDaily change of dressing.Maintain eye patchOrient patient to environment andplace belongings on unaffected sideAdminister eye drops as ordered

T l b ib d 1

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Temporary glasses may be prescribed 1-4 weeks post op (at 6-12 weeks,

permanent glasses or contact lenses) Aphakic glasses magnify so everything

appears about closer than it is. Client hasto learn to judge distance.

Contact lenses improves visual correctionand better cosmetic appearance

Assist with ambulation and maintain

side rails

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CD Eyes

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