6. Introduction
⢠Cataract is a latin word cataracti which means âwaterfallâ
⢠A cataract is a opacity of the normally clear lens which may develop as a
result of aging,
Metabolic disorders, trauma or heredity
⢠A Cataract is a CLOUDING OF EYE.
⢠Cataract may be attributed due to old age, ultra violet light, cigratee smoking,
Alochol intake and Corticosteriod medications.
⢠About 50% of americans age 65 or older age have cataracts or have already
underwent surgery.
7. ⢠An ocular opacity, partial or complete ,one or both eyes,on or in the lens or
capsule,especially an opacity imparing vision or causing blindness.
⢠The subsequent cloudy appearance of eye resulted in the orgin of cataract.
8. DEFINITIONS
⢠A cataract is a clouding or opacity of the lens in the eye which leads to a
decrease in the normal vision
Acc. To barabara.k
⢠A cataract is a clouding of clear lens of the eye
Acc. To lippincot
⢠A cataract is a lens of the eye becomes cloudy, includes blurred vision ,
double vision , sensitivity to light ; and difficulty seeing at night , cataract
leads to blindness
Acc. To lewis
9.
10. CONT. DEFINITIONS
⢠A cataract is a clouding of the normally clear lens of eye, is a dense, cloudy
area that froms in the lens of the eye
acc. To brunner and siddanth
⢠a cataract is an opacity with in the lens
acc.to Pradeep sharama
11.
12. INCIDENCE
⢠Cataract is one of the leading cause of blindness in the world
⢠More than 1.3 million cataract procedures are performed in world
⢠Age related cataract is responsible for 48%of world blindness.
⢠Senile cataract is responsible for 5% of blindness
⢠Congenitally occurs 3 in 1000 live births
⢠88% of clients cannot access to healthcare facilities.
⢠Female:male ratio : 1:2
18. SUB CAPSULLAR CATARACT
⢠This type of cataract begins as a small opaque or cloudy on the âposteriorâ
or back surface of the lens.
⢠It is called sub capsular because it froms beneath the lens capsule, which is
a small sac or membrane that encloses the lens and holds it in place
it is of two types
1.anterior subcapsular
2.posterior subcapsullar
19. ⢠ANTERIOR SUBCAPSULLAR
⢠Lies directly under the lens capsule
⢠Fibrous metaplasia of lens epithelium
⢠POSTERIOR SUBCAPSULLAR
⢠Lies infront of posterior capsule
⢠Granular or plaque like cataract
22. NUCLEAR CATARACT
⢠This is the most common type of age related cataract.
⢠Which is caused by the hardening and yellowing of the lens over
time.
⢠Nuclear refers to the gradual clouding of the central portion of the
lens called nucleus.
24. CORTICAL CATARACT
⢠Cortical refers to white opacities or cloudy areas that develop in the lens of
cortex.
⢠Which is the peripheral edge of the lens changes in the water content of the
lens.
⢠Fibers create clefts or fissures, that look like the spokes of wheel pointing
from then outside edge of wheel pointing from the outside edge of the lens in
toward the center.
26. LAMELLAR CATARACT
⢠Also known as zonular cataract.
⢠A hereditary cataract that is transmitted in an autosomal dominant mode .
⢠This cataract is usually bilatetral and symmentrical.
27. SUTURAL CATARACT
In sutural cataract opacity is in the from Y following the anterior and posterior
sutures of the lens.
This congenital condition usually not visually significant and does not progress.
28. AGE OF ONSET
⢠Congenital
⢠Infantile
⢠Juvinile
⢠Presenile
⢠senile
29. CONGENITAL CATARACT
⢠Congenital cataract refers to a lens opacity present at birth.
⢠congenital cataracts may be unilateral or bilateral
ETIOLOGY
⢠Heriditary
⢠Environmental
⢠Virus infection
⢠Mal nutrition
⢠Radiation
⢠Drugs
⢠Systemicc disease
⢠Vitimin D deficiency
30. INFANTILE AND JUVENILE CATARACT
⢠Cataracts are one of the most treatable causes of visual
impairment during infancy period.
31. PRESENILE CATARACT
⢠Presenile cataract is rare, some cases have a heridatary
cause and others may related to trauma or chromosal
abnormalities.
⢠A sizable percentage is not known
32. SENILE CATARACT
⢠Now it is called age related cataract.
⢠Most commonly seen in old age group.
⢠>50 years old.
⢠>80 years old.
⢠Degenartive changes.
⢠Senile cataract is an age related, vision impairing disease characterized by
gradual progressive thickening of the lens of the eye.
⢠It is the worldâs leading cause of treatable blindness
35. INTUMENSCENT CATARACT
⢠It is a mature cataract that progress, the lens becomes swollen from the
osmotic effect or degenaratedlens protein, and this may lead to secondary
angle closure glaucoma
37. MATURE CATARACT
⢠Mature cataract that produces swelling and opacity of the entire lens.
⢠Cataracts are removed before maturity
38. HYPERMATURE CATARACT
⢠Hypermature cataract one in which the entire lens caps is wrinkled and
contents have become solid and shrunken or soft and liquid
39. PATHOPHYSIOLOGY
Due to three biochemical changes (hydration,denaturation of lens proteins,slow
sclerosis)
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Altered metabolic process with in the lens
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Reduced oxygen uptake
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Increased in water content followed by dehydration
|
Protein in the lens undergoes age related changes
41. CLINICAL MANIFESTATIONS
⢠Clouded, blurred vision or dim vision .
⢠Glare fers to pain felt when patient looks directly into the light).
⢠Increasing difficulty with visual disturbing at night.
⢠Sensitivity to light and glare.
⢠Need for brighter light for reading and other activites.
⢠Seeing halos around light .
⢠Frequent changes in contact lens and eye glasses.
⢠Double vision in a single eye.
43. DIAGNOSTIC EVALUTION
⢠Detailed history collection
⢠Physical examination
⢠Eye examination
⢠Visual acuity test
Visual acuity test is done identify the two separate objects at a distance
Pupil dilationn test
Pupil is widened with eye drops to allowed your eye doctor to see more of the
lens and retina and look and for eye problems
46. SLIT LAMP EXAMINATION
⢠Slit lamp examination allows the physician to view the structure in small
sections which make it easier to detect any tiny abnormalities
47. OPTHALMOSCOPE
⢠An instrument used to measure the ocular health
⢠Can also be used for the anterior eye .
⢠Used to view the extended eye
49. MEDICAL MANAGEMENT
⢠There is no medical management for cataract,although use of vitamin C and
E and beta carotene is being investigated.
⢠Glasses or contact bifocal or magnifying lenses may improve visionâ
⢠Mydriatics such as phenylephrine hydrochloride and tropicamideâ
⢠Dialating drops; dialating drops need to be administered every 10
mits before sugery
⢠Antibiotics drugs: administered for prophylactically to prevent
postoperative infection or inflammation.
⢠Intravenous sedation :sedation is used to reduced the anxiety and
discomfort before surgery
50. SURGICAL MANAGEMENT
⢠Removal of lens
⢠Phacoemulsification
⢠Extracapsular extraction
⢠Correction of surgical aphakia
⢠Intra ocular lens implantation
⢠Contact lens
51. PHACOEMULSIFICATION
It is a modern cataract surgery the eyes internal lens is emulsified with an
ultrasonic hand piece and aspirated from the eye .
Aspirated fluids are replaced with irrigation of balanced salt solution to maintain
the anterior chamber
52. EXTRACAPUSULAR CATARACT
SURGERY
⢠Larger incision is made and remove the front capsule of the lens ,cortex,lens
nucleus and cloudy lens comprising the cataract.
⢠The back capsule of the lens is left in place to serve as a place for the
artificial lens to rest , with larger incision, stitches are required and visual
recovery is often slower.
53. INTRA CAPSULAR CATARACT
SURGERY
⢠Larger incision is made and remove the front capsule of the lens cortex, lens
nucleus and cloudy lens comprising the cataract
54. LENS REPLACEMENT
⢠After removal of crystalline lens, the patient is reffered to aphakic.
Lens replacement options
Alphakic eyeglasses
Contact lenses
IOL implants
55. ASSESSMENT
⢠Withhold any anticogulents the patient is receiving , if medically appropriate.
⢠Administer dilating drops every 10 mits for four doses at least 1 hour before
surgery.
⢠Antibiotics, corticosteroids ,and anti inflammatory drops may be administered
prophylactically to prevent post operative infection and inflammation.
⢠Provide patient verabal and written consent.
⢠Explain about discomfort after their surgery.
⢠Antibiotics ,anti inflammatory drugs and corticosteroid eye drops are
prescribed postoperatively .
⢠Monitor vital signs every second hourly.
56. NURSING DIAGNOSIS
⢠Risk for injury related to increased intraocular pressure or trauma.
⢠Disturbed sensory perception related to surgical trauma ,lens removal,
patching.
⢠Acute pain related to tissue trauma.
⢠Anxiety related temporary vision ,impairment activity restrictions.
⢠Ineffective therapeutic treatmen regimen management related to lack of
understanding of a condition /self care.
57. Risk for injury related to increased intra ocular pressure or
trauma
goal:decrease the risk for injury
INTERVENTION
⢠Keep the patient in head elevated
position.
⢠Instruct the patient not impose stress
on operated eye.
⢠Change damp pads as allowed .
⢠Administer eye drops as prescribed by
physicians,such as antibiotics,
corticosteroids.
⢠Administer antiemetic to prevent
nausea and vomitings
RATIONAL
⢠It helps the patient to dcreases the the
IOP.
⢠To decrease pain.
⢠To decrease the infections.
⢠To reduce infection and inflammation.
⢠To stop vomitings
58. Disturbed sensory perception related to surgical trauma,lens
removal,patching
goal:to improve visual impairment and function in environment
without surgery
INTERVENTION
⢠Keep the bed in low position.
⢠Approach the left side place the call
bell and instruct the use.
⢠Removal obstacles in room.
⢠Assist the activites of daily living as
needed
RATIONAL
⢠To decrease the IOP.
⢠For emergency purpose.
⢠For safety of the patient.
⢠To improve activities of the patient.
59. Acute pain related to tissue trauma
goal:to reduce pain
INTERVENTION
⢠Assess the general condition of the
patient .
⢠Assess the level of pain.
⢠Advice not to take stress on affected
part.
⢠Give proper side lying position .
⢠Administer analgesics as prescribed by
physicians
RATIONAL
⢠To know the base line data.
⢠To know the level of .
⢠To decrease the pain on affected eye.
⢠To promote comfort to the patient.
⢠To decrease pain levels
60. COMPLICATIONS
⢠Inflammation
⢠Increased intraocular pressure
⢠Subcojuntival hemorrhage with or without edema.
⢠Toxic anterior segment syndrome.
⢠Malposition of the intraocular pressure.
⢠Chronic endophthalmities
⢠Opacification of posterior capsule
⢠Retinal detachment.
