1. Ophthalmoscopy 2. Slit-lamp examination 3. Color vision testing 4. Amsler grid 5. Ultrasonography 6. Fluorescein and indocyanine green angiography

MS EYES Flashcards by Mariela Colangan

ASSESSMENT AND EVALUATION OF VISION

● Ocular history
● Visual acuity
● Snellen chart
● Finger count or hand motion

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Record each eye 20/20 means the patient can read the “20” line at a distance of 20 feet

Snellen chart

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EXAMINATION OF THE EXTERNAL STRUCTURES

● note any evidence if irritation, inflammatory process, discharge
● assess eyelids and sclera
● assess pupils and pupillary response l, use darkened room
● note gaze and position of eye
● assess extraocular movements
● ptosis: drooping eyelid
● nystagmus: oscillating movement of eyeball

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drooping eyelid

● ptosis

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oscillating (move or swing back and forth at a regular speed.) movement of eyeball

● nystagmus

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DIAGNOSTIC TESTS

Ophthalmoscopy
Slit-lamp examination
Color vision testing
Amsler grid
Ultrasonography
Fluorescein and indocyanine green angiography

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examines cornea, lens, retina

Ophthalmoscopy

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a. a standard diagnostic procedure, which is also known as biomicroscopy.
b. combines a microscope with a very bright light.
c. Help diagnose the following: macular degeneration, a chronic condition affecting the part of the eye that is responsible for central vision. detached retina, a condition when the retina, which is an Important layer of tissue at the back of the eye, becomes detached from its base.

Slit-lamp examination

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a. Inability to distinguish certain shades of color.
b. The term “color blindness” is also used to describe this visual condition, but very few people are completely color blind.

Color vision testing

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a. Tests the vision for many of the signs of intermediate and late-satege age-related muscular degeneration
b. Normal vision: able to see all areas on the grid, and all lines appear straight

Amsler grid

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ability to obtain an impression of depth by superimposition of 2 subjects; perceiving 3D

Stereopsis

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DIAGNOSTIC EVALUATION

Tonometry:
Gonioscopy:
Perimetry testing

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Measure IOP

Tonometry

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Visualizes the angle of the anterior chamber

Gonioscopy

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Evaluates field of vision

Perimetry testing

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blind areas in the visual field

Scotomas

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IMPAIRED VISION

❖ Refractive errors:
❖ Emmetropia:
❖ Myopia:
❖ Hyperopia:
❖ Astigmatism:
❖ Presbyopia:
❖ Anisometropia:

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Can be corrected by lenses which focus light rays on the retina

❖ Refractive errors

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vision in one eye is worse than the vision in the other due to a difference in refractive error.

❖ Anisometropia

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normal vision

❖ Emmetropia:

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: nearsighted

❖ Myopia

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farsighted

❖ Hyperopia

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: a refractive error that makes it hard for middle-aged and older adults to see things up close

❖ Presbyopia

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distortion due to irregularity of the cornea

❖ Astigmatism

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PHYSIOLOGIC CHANGES OF THE EYE RELATED TO AGING

● Decreased flexibility and elasticity of the lens to decrease or loss of accommodation. ● The lens yellows with age. ● Senile miosis (smaller size pupil) ends in the distortion of colors. ● Corneal, sclera, lens and vitreal changes produce increased light scatter in the eye causing glare. ● Decrease in lens transparency or increased opaqueness of the lens (cataract). ● Quantity and quality of tears are decreased ● irregular curvature of the corneal, causing distorted and blurred image (astigmatism)

Sudden onset localized swellings of the eyelid.

HORDEOLUM OR STYE

●can be painful but often heal without medical intervention ●can be external or internal ● home remedies: warm compress, pain meds over the counter

HORDEOLUM OR STYE

● In most cases, the cause of the infection is the Staphylococcus bacteria. ● An inflammation of the oil gland.

HORDEOLUM OR STYE

is an inflammation of the eyelid associated with a small collection of pus

HORDEOLUM OR STYE

ASSESSMENT: ● Tenderness ● Crusting of the margins of the Eyelids ● Burning sensation ● Itching of the eye ● Blurry vision ● Discharge of mucus from the eye ● Light sensitivity ● Tearing discomfort when blinking

HORDEOLUM OR STYE

CAUSES AND RISK FACTORS (STYE)

- Using cosmetics after their expiry date - Not removing eye makeup before going to bed - Not disinfecting contact lenses before putting them in changing contact lenses without hand washing - inadequate nutrition

TREATMENT (STYE)

● warm compress ● antibiotics

- An internal stye an inflammation of the Meiborian gland, with painless growing, hard, non-tender round mass on the eyelid

CHALAZION

Chalazion is Painless

True

COMPLICATIONS (STYE)

● Chalazion or Meibomian cyst ● Pre septal or periorbital cellulitis

Stye is painful

True

CAUSES AND RISK FACTORS: (CHALAZION)

- Often occur in people with underlying inflammatory conditions that affect the eyes or skin, such as: - Chronic blepharitis - Acne rosacea - Seborrheic dermatitis - Meibomian gland dysfunction

TREATMENT (CHALAZION)

- Apply hot/warm compresses: helps stye come to a head, rupture, and spontaneously drain - An external stye that does not resolve with compresses may need to be drained by a doctor. - Because an internal stye rarely ruptures by itself, a doctor may have to surgically drain it. - Gentle massage

- An eye inflammation of eyelid margins, with irritation, burning, itching, ulceration and eyelashes will fall out

BLEPHARITIS

Inflammation is often on the eyelids and the edge of the eyelids.

BLEPHARITIS

- Chronic bilateral inflammation of the eyelid margins. - Usually involving hair follicles and glands. - Characterized by the formation of excessive oil in the glands near the eyelid which is the preferred environment by bacteria that are normally found on the skin.

BLEPHARITIS

* Pain (mild to severe) on the eyelids. * Lacrimation (watery eyes always. * Restless due to itching / pain. * Patients feel there is something in the eye. * Embarrassment and lack of confidence due to the effects of the disease (the lashes fall out and not replaced). * Eyes blurred and visual acuity decreased.

SUBJECTIVE DATA (BLEPHARITIS)

A. Redness, scales and can also form a scab or shallow open sores on the eyelids. B. Eyes and eyelids are itchy, hot, and red. Eyelid swelling can occur and a few strands of eyelashes fall out. C. Eyes become red, watery and sensitive to bright light. It could also form a scab firmly attached to the edge of the eyelid; if scab is released, bleeding can occur. D. During sleep, eye secretions dry up, so that when you wake, difficult eyelids open.

CLINICAL MANIFESTATIONS (BLEPHARITIS)

1. Acute pain r / + inflammation due to bacterial infection. 2. Anxiety r / t visual impairment, damage to the eyelids. 3. Risk for injury r / + the deficit of knowledge, blurred vision or decrease the sharpness of the eyes. 4. Knowledge Deficit r / + less information about the disease. 5. Risk for infection r / + invasive procedures. 6. Disturbed Sensory perception(visual) r / + disruption reception status sensory organs.

NURSING DIAGNOSIS: (BLEPHARITIS)

> Itchy eyelids > Swollen eyelids > Red or inflamed eyelids > Burning sensation in the eyes > Oily eyelids > Feeling that something is in or on your eyes > Red eyes > Watery eyes > Crust on your eyelashes or in the corners of your eyes > sensitivity to light

SYMPTOMS (BLEPHARITIS)

TWO TYPES IF EYELID INFLAMMATION

1. Anterior eye inflammation: outside of eye where eyelashes are located 2. Posterior eyelid inflammation: inner edge of eyelids closest to eye.

SYMPTOMS (BLEPHARITIS)

TREATMENT (BLEPHARITIS)

- Washing eyes and apply a warm compress can reduce inflammation.

COMPLICATIONS OF EYELID INFLAMMATION

- scarring on the eyelid - stye - chronic pink eye

- Inflammation of the conjunctiva, which is a tissue that lines the eyelids and covers the sclera or the white part of the eye,

CONJUNCTIVITIS

common cause of eye redness and, subsequently, a common complaint in the emergency department, urgent care, and primary care clinics.

CONJUNCTIVITIS

SIGNS AND SYMPTOMS OF CONJUNCTIVITIS

a. Pink eye B. Chemosis c. Increased tear production d. The feeling of a foreign body stuck in the eye, which may be accompanied by an urge to rub the affected eye e. Itching, irritation, and burning sensation in the affected eye f. Eye discharge - may differ depending on the organism causing the conjunctivitis. Viral conjunctivitis produces thick discharge, while bacterial conjunctivitis has more of a watery discharge. g. Crusting of the eyelids or lashes - most noted in the morning h. In people wearing contact lenses, the feeling of the lens not staying in place may be experienced.

swelling of the conjunctiva

Chemosis

CAUSES OF CONJUCTIVITIES

1. Bacterial Conjunctivitis 2. Viral Conjunctivitis 3. Allergic Conjunctivitis 4. Conjunctivitis secondary to eye irritants 5. Contact lens use can also lead to conjunctivitis - Exposure to allergens and exposure to other people infected by it can increase an individual's vulnerability to the infection. - Extended use of contact lenses is also a risk factor.

caused by certain bacteria such as trachomatis and Neisseria gonorrhoeae. It can be easily spread, and it is more commonly seen in children than in adults.

Bacterial Conjunctivitis

is commonly caused by adenoviruses and is very contagious. Since it is viral in origin, it is normally self-limiting

Viral Conjunctivitis

Body's allergic reaction to allergens. It is not contagious, and it can be seasonal depending on what triggers the allergic reaction.

Allergic Conjunctivitis

Fumes, dust, smoke, chemicals, and any other foreign body that can irritate the eyes can cause conjunctivitis.

Conjunctivitis secondary to eye irritants

Proper handling of contact lenses is required to avoid introducing infection and irritants to the eyes

Contact lens use can also lead to conjunctivitis

Treatment (Conjunctivitis)

● Use of antimicrobials. Antibiotics are not normally prescribed. Its use is not particularly helpful, especially if the cause is viral. ● Antibiotics in viral cases can only cause possible reduction of susceptibility to the antibiotic in the future. ● Antivirals are sometimes prescribed in cases where the conjunctivitis is caused by herpes simplex virus or herpes zoster virus.

Nursing Management (Conjunctivitis)

* Check visual acuity * Educate the patient on the disease * Apply cool compress * Administer medications as prescribed * Encourage hand washing * Use artificial tears if the eye is irritated . Advise not to share personal care items * Keep children at home until symptoms subside * Wear sunglasses when going out * If the discharge is purulent, return to ED

Viral and bacterial conjunctivitis can spread by direct contact and have high transmission rates.

true

Patients should be instructed to avoid touching their eyes, shaking hands, sharing personal items such as cosmetics or towels, and avoiding swimming pools while infected. Medical instruments should be disinfected and admitted patients with active conjunctivitis should be isolated.

true

The importance of hand hygiene for patients, staff, family, and friends should be highlighted.

true

the inflammation of the cornea and is characterized by corneal edema, infiltration of inflammatory cells, and /ciliary congestion.

KERATITIS

Symptoms of Keratitis

- Red eyes - Pain and irritation on the affected eye - Vision changes, such as blurriness or inability to see - Sensitivity to light - Inability to open the eye - Eye discharge - Excessive tearing

Causes of keratits

● bacteria ● fungi

- Inflammation of the uveal tract that can affect the iris, the ciliary body or the choroid.

UVEITIS

2 TYPES OF UVEITIS:

Non - granulomatous Granulomatous

uveitis can have more insidious onset and can involve any portion of the uveal tract. It tends to be chronic.

Granulomatous

- more common type of uveitis which manifests as an acute condition with: a. Pain b. Photophobia c. A pattern of conjunctival infection, especially around the cornea d. The pupil is small or irregular and vision is blurred

Non - granulomatous

Symptoms include (Uveitis)

- Photophobia - Pain may be minimal - Vision is markedly and adversely affected - Conjunctival infection is diffused, and there may be Vitreous clouding.

- Photophobia is a common symptom, patients should wear dark glasses outdoors

true

EYE DISORDERS

A. Retina *MACULAR DEGENERATION *RETINAL DETACHMENT *RETINOPATHY OF PREMATURITY B. Cataract C. Glaucoma D. Traumatic Eye Injuries

most common cause of visual loss in people older than age 60. Commonly called (AMD), it is characterized by tiny. yellowish spots called drusen beneath the retina. - AMD accounts for 54% of all blindness in older adults (center for disease control (CDC], 2016).

MACULAR DEGENERATION AMDG (age-related macular degeneration)

Age-related macular degeneration, also known as AMD, is a leading cause of irreversible visual impairment and blindness in older persons. At the back of the eye is a light-sensing nerve tissue called the retina.

true

there are yellow deposits called drusen on the macula and you may not have noticeable or significant symptoms.

EARLY AMD

the central vision is affected. A person who has * AMD may have difficulty seeing fine details: there may be shadows or blurred spots in the central vision and straight lines may look wavy.

LATE AMD

TREATMENT FOR AGE-RELATED MACULAR DEGENERATION: While there is currently no treatment for * AMD, a healthy lifestyle can help keep your eyes healthy.

Early AMD

TREATMENT FOR AGE-RELATED MACULAR DEGENERATION: Studies have shown that the Age-Related Eye Disease Study-2 (AREDS-2) supplements can slow vision loss.

Intermediate AMD

AREDS-2 SUPPLEMENTS

* Vitamin C 500mg * Vitamin E 400 IU * Zinc 80 mg * Copper 2 mg * Lutein 10 mg * Zeaxanthin 2mg

separation of the RPE [RETINAL PIGMENT EPITHELIUM) from the sensory layer.

RETINAL DETACHMENT

The four types of retinal detachment are:

- Rhegmatogenous - traction - A combination of rhegmatogenous and traction - Exudative.

The most common form. In this condition, a hole or tear develops in the sensory retina, allowing some of the liquid vitreous to seep through the sensory retina and detach it from the RPE

RHEGMATOGENOUS DETACHMENT

- Tension, or a pulling force, is responsible for _____ Generally, patients with this condition have developed fibrous scar tissue from conditions such as diabetic retinopathy, vitreous hemorrhage, or the retinopathy of prematurity.

TRACTION RETINAL DETACHMENT

- the result of the production of a serous fluid under the retina from the choroid. Conditions such as uveitis and macular degeneration may cause the production of this serous fluid.

EXUDATIVE RETINAL DETACHMENT

retinal surgeon compresses the sclera often with a scleral buckle or a silicone band; to indent the scleral wall from the outside of the eye and bring the two retinal layers in contact with each other.

sclera buckle -

- intraocular procedure in which 1cm to 4cm incisions are made at the pars plana. One incision allows the introduction of a light source, and another incision serves as the portal for the ________ instrument. The surgeon dissects preretinal membranes under direct visualization while the retina is stabilized by an intraoperative vitreous substitute.

Virectomy

- can happen in premature babies. Can cause abnormal blood vessels to grow in the retina, and can lead to blindness - makes blood vessels grow abnomally in the eye that can leak or bleed. This causes scarring of the retina, the layer of nerve tissue in the eye that sends messages about light to the brain

RETINOPATHY OF PREMATURITY

- lens opacity or cloudiness - rank behind arthritis and heart disease as a leading cause of disability in older adults - according to the WHO, it is the leading cause of blindness in the world

B. CATARACT

Painless, blurry vision characteristics of _________ . The person perceives that surroundings are dimmer, as if their glasses needs cleaning. Light scattering is common, and the person experiences reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity

Cataract

NURSING MANAGEMENT (Providing Preop Care) CATARACT

- receives the usual preop care for ambulatory surgical pts undergoing eye surgery - the standard battery for the preop taste (e.g., CBC, ECG, and urinalysis) commonly performed for most surgeries is prescribed only if indicated by the p’s medical history

- group of ocular conditions characterized by optic nerve damage - optic nerve damage is r/t the IOP caused by congestion of aqueous humor in the eye - there is a range of pressures that have been considered “normal” but that may be associated with vision loss in some pt.

Glaucoma

- one of the leading causes of irreversible blindness in the world

Glaucoma

Classifications/type of Glaucoma

1. Wide-angle glaucoma/Open-angle 2. Congenital Glaucoma

according to the WHO, it is the leading cause of blindness in the world

Glaucoma

Risk factors of Glaucoma

- family history - thin cornea - African American race - older age - DM - cardiovascular disease - migraine syndromes - nearsightedness (myopia) - eye trauma - prolonged use of topical or systemic corticosteroids

a. Narrow-angle glaucoma/angle-closure

1. Wide-angle glaucoma/Open-angle

a. Associated with other conditions, such as developmental anomalies or corticosteriod use

2. Congenital Glaucoma

Clinical manifestations of Glaucoma

“halos” around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching, or discomfort around the eyes, and headache

Clinical manifestations of Glaucoma

Medical Management for Glaucoma

1. Cholinergics 2. Adrenergic Agonists (Dipivefrin, epinephrine) 3. Beta-blockers (betaxolol, timolol) 4. Alpha-adrenergic agonists (apraclonidine, brinonidine)

Surgical Management Glaucoma

- Laser trabeculoplasty - Peripheral iridotomy - Laser iridotomy - Filtering procedures - Trabeculectomy - Drainage implants/shunts

Normal tension glaucoma

< or = to 21mmHg

Primary open angle glaucoma

>21 mmHg

- leading cause of blindness among children and young adults, especially male trauma victims - most common circumstances are occupational injuries, sports, weapons, assault, motor vehicle crashes, and explosions

OCULAR TRAUMA

- injury to the orbit is usually associated with head injury - general medical condition: stabilized before conducting an ocular examination

Orbital trauma

MS EYES Flashcards

(107 cards)