1. JOFRED M. MARTINEZ, RN

2. On completion of this chapter, the learner will be able to:
1. Identify significant eye structures and describe their
functions.
2. Identify diagnostic tests for assessment of vision and
evaluation of visual disabilities.
3. Discuss clinical features, diagnostic assessment and
examinations, medical or surgical management, and
nursing management of ocular disorders.
4. Describe therapeutic effects of ophthalmic medications.

3. On completion of this chapter, the learner will be able to:
5. Define low vision and blindness and differentiate between
functional and visual impairment.
6. List and describe assessment and management strategies
for low vision.
7. Demonstrate orientation and mobility techniques for
patients with low vision in a hospital setting.
8. Demonstrate instillation of eye drops and ointment.

4. On completion of this chapter, the learner will be able to:
9. Discuss general discharge instructions for patients after
ocular surgery.
10. Discuss strategies for patient safety in ophthalmology.

21. Retina
Optic nerve
Optic chiasm
Optic tracks
Lateral geniculate bodies
Optic radiations
Visual cortex area of the brain

22.  Decrease or loss of accommodation (presbyopia)
 Lens yellow with age
 Senile miosis
 Increased light scatter in the eye causing glare
 Decrease in lens transparency (cataract)
 Dryness or scratchiness of the eyes
 Distorted or blurred image (astigmatism)

30.  If the patient is wearing contact lenses, have him
remove them before the test, unless the test is being
performed to evaluate the fit of the contact lenses.
 When instilling dilating drops, tell the patient that his
near vision will be blurred for 40 minutes to 2 hours.
 Advise him to wear dark glasses in bright sunlight until
his pupils return to normal diameter.
 Don’t administer dilating eyedrops to the patient who
has angle closure glaucoma, is hypersensitive to
mydriatics, or has an intraocular lens implant.

40.  Tell the patient that a small transducer will be placed on
his
 closed eyelid and that the transducer will transmit high-
frequency sound waves that will reflect off the structures
in the eye.
 Inform him that he may be asked to move his eyes or
change his gaze during the procedure; explain that his
cooperation will help to ensure accurate results.
 After the test, remove the water-soluble jelly that was
placed on the patient’s eyelids.

47.  Check the patient’s history for an intraocular lens implant,
glaucoma, and hypersensitivity reactions, especially
reactions to contrast media and dilating eye drops.
 If miotic eye drops are ordered, tell the patient with
glaucoma not to use them on the day of the test.
 Explain to the patient that eye drops will be instilled to
dilate his pupils and that a dye will be injected into his
arm. Remind him to maintain his gaze position and
fixation as the dye is injected. Tell him that he may briefly
experience nausea and a feeling of warmth.

48.  Observe the patient for hypersensitivity reactions to the
dye, such as vomiting, dry mouth, metallic taste, sudden
increased salivation, sneezing, light-headedness, fainting,
and hives.
 Remind the patient that his skin and urine will be a yellow
color for 24 to 48 hours after the test and that his near
vision will be blurred for up to 12 hours.

53.  Because an anesthetic is instilled before the test, tell the
patient not to rub his eyes for at least 20 minutes after the
test, to prevent corneal abrasion.
 If the patient wears contact lenses, tell him not to reinsert
them for at least 30 minutes after the test.
 If the tonometer moved across the cornea during the test,
tell the patient that he may feel a slight scratching
sensation in the eye when the anesthetic wears off.

57.  Regular ocular and physical examinations
 Avoid dangerous items
 Early identification and treatment of strabismus in children
 Early treatment when eye symptoms occur
 Routine instillation of appropriate drops of every newborn
 Blood test during pregnancy to identify syphilis
 Inoculation against rubella
 Regulation of oxygen concentrations in premature infants
 Avoid habitual rubbing of eyes

58.  Adequate lighting when reading
 Periodically rest eyes during prolonged periods of close
eye work
 Reduce glare and wear protective glasses
 Keep eye glasses clean, protected from scratching,
breakage and properly aligned
 Do not use eye medications unless prescribed by a doctor
 Never use soiled wash cloth around eyes
 Use care when using aerosol sprays

59.  Maintain a state of good health and eat a well – balanced
diet with adequate vitamins A, B and C
 Use care when using solvents, lye solutions, ammonia,
caustic solutions to avoid splashing or spilling into eyes

61.  Orient the client to the staff and physical environment if
both eyes will be covered after surgery.
 If the client is a child, practice covering the eyes.
 Administer mydriatics / cycloplegics as prescribed
• Atropine sulfate
• Cyclomydril
• Scopolamine
• Mydriacyl

62. To prevent or relieve the following:
 Increased intraocular pressure
 Stress on the suture site
 Hemorrhage on the anterior chamber
 Infection
 Pain

63.  Position the client supine or turned to the unaffected side.
 Burning sensation about one hour after surgery is normal.
 Use eye patch for 5 to 7 days. Use eye shield during the
night for four weeks.
 Instruct the client to avoid the following:
• Rubbing the eyes
• Lifting the head or hips
• Sudden, jerky head movements
• Sneezing and coughing

64. • Nausea and vomiting
• Straining during defecation
• Bending and stooping
• Heavy lifting
• Reading for few days
• Watching fast moving objects
 Feeling of “something in the eye” 4 to 5 days postop is
normal.
 Sensation of pressure within the eye and sharp pain in the
yes indicates bleeding.

65.  Administer miotics as prescribed.
• Carbachol
• Pilocarpine HCl

76.  Corrective eyeglasses
 Surgery
• Advancement, resection and tucking
• Tenotomy

84.  Assessment
• pain, photophobia, lacrimation, blepharospasm,
decreased vision
 Treatment
• Trifluridine (Viroptic), idoxuridine (IDU), Adenine
Arabinoside (Vira – A)
• Mechanical /chemical debridement

91. IRITIS
IRIDOCYSTITIS
CHOROIDITIS
CHOROIRETINITIS

92.  Assessment
• Pain radiating to the forehead and temple, blurred
vision, photophobia, redness without purulent
discharge, small pupil, lacrimation
 Treatment
• Mydriatics and steriods
• Dark glasses
• Analgesics

94.  Assessment
• Inflammation of exciting eye followed by the
sympathizing eye, photophobia, blurred vision
 Treatment
• Enucleation
• Steriods
• Atropine

96.  Assessment
• Reduced visual acuity, changes in visual field,
alterations in the shape of objects, discomfort in the
eyes and photophobia
 Treatment
• Rest the eyes
• Protect eyes from light
• Atropine sulfate

100. RHEGMATOGENOUS DETACHMENT
TRACTION DETACHMENT
COMBINATION OF RHEGMATOGENOUS AND TRACTION
EXUDATIVE DETACHMENT

101.  Assessment
• Floating spots or opacities, flashes of light, progressive
constriction of vision in one area, cloudy vitreous and
portion of retina
 Treatment
• Bed rest and cover eyes
• Dependent position
• Early surgery

108. INITIATING EVENTS
STRUCTURAL ALTERATIONS IN THE AQUEOUS
OUTFLOW SYSTEM
FUNCTIONAL ALTERATIONS
OPTIC NERVE DAMAGE
VISUAL LOSS

110.  Assessment
• Rapid onset of severe pain
• Blurred vision
• Headache
• Rainbows and halos around lights
• Nausea and vomiting
• Inflamed eye
• Fixed dilated pupils

112.  Treatment
• Bed rest in quiet, darkened room, elevate head 30
degrees
• Monitor vital signs
• Miotic eye drops as ordered
• Administer acetazolamide and glycerol
• Provide emotional support
• Assess client’s ability to see

113.  Treatment
• Assist according to degree of visual impairment
• Prepare for eye examinations as ordered – tonometry
• Avoid mydriatics
ABC atropine, benadryl cogentin
• Administer antiemetics for nausea
• Diet as tolerated
• Prepare for surgery if ordered

115.  Assessment
• Tunnel vision which can progress to blindness
• Insidious onset – generally no discomfort
• Persistent dull eye pain in the morning
• Frequent changes of glasses, difficulty in adjusting to
darkness, failure to detect changes in color accurately.
• Rainbows or halos resembling street lights around
lights

117.  Treatment
• Miotics
• Acetazolamide (Diamox)
• Avoid fatigue or stress and avoid large quantities of
fluids
• Surgery

118. Cholinergics (pilocarpine, carbachol)
Adrenergic agonists (dipivefrin, epinephrine)
Beta-blockers (betaxolol, timolol)
Alpha-adrenergic agonists (apraclonidine, brimonidine)
Carbonic anhydrase inhibitors
(acetazolamide, methazolamide, dorzolamide)
Prostaglandin analogs (latanoprost, bimatoprost)

129. SENILE CATARACT
TRAUMATIC CATARACT
CONGENITAL CATARACT
SECONDARY CATARACT

130. NUCLEAR CATARACT
CORTICAL CATARACT
POSTERIOR SUBCAPSULAR CATARACT

132. IMMATURE CATARACT
MATURE CATARACT
HYPERMATURE CATARACT
TUMESCENT CATARACT

133. TREATMENT
 Surgery
• Intracapsular Cataract Extraction (ICCE)
• Extracapsular Cataract Extraction (ECCE)
• Cryoextraction
• Iridectomy
• Phacoemulsification

141. TREATMENT
 Enucleation
 Brachytherapy

152. BLOWOUT
ZYGOMATIC OR TRIPOD
MAXILLARY
MIDFACIAL
ORBITAL APEX
ORBITAL ROOF FRACTURES

156. ENUCLEATION
EVISCERATION
EXANTERATION

160.  Severe injury resulting in prolapse of uveal tissue or loss
of light projection or perception
 An irritated, blind, painful, deformed, or disfigured eye,
usually caused by glaucoma, retinal detachment, or
chronic inflammation
 An eye without useful vision that is producing or has
produced sympathetic ophthalmia in the other eye
 Intraocular tumors that are untreatable by other means

166.  Refer to available facilities.
 Orient to environment.
 Promote independence – ADL
 May have a guide dog or use cane for direction.
 When approaching, talk before touching.
 When assisting in ambulation, have the patient hold your
forearm so that you are a step ahead of him.
 Talk to the patient frequently.
 Explain nursing procedures and what is to be done next.

169.  Do not change the location of the objects in the room
without describing the change.
 Promote safety in the environment.
 Do not rush up and offer help to a blind person unless it is
clear that the person wants help.
 Suggest gifts for a blind person that appeal to senses
other than vision.