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Eye 1329
| Question | Answer |
|---|---|
| function of the eye | to transform light energy to the cerebral cortex to be interpreted |
| The ability to move the eyeball is accomplished by sing muscles including: | superior and inferior rectus; medial and lateral rectus; superior and inferior oblique |
| 6 cranial nerves they eye is innervated with | optic (main nerve), oculomotor nerve, trochlear nerve, trigeminal nerve, abducens nerve, facial nerve |
| extraocular structures | eyelids and eyelashes |
| eyelids include: | sebacous gland, sweat glands, lacrimal glands, nasolacrimal duct |
| eyelids produce: | tears (water, NaCL, lysozyme) - for lubrication, natural wash of eyes |
| function of eyelashes: | trap foreign debris before getting into eyes |
| first layer of the eye | sclera (white of the eye, protects the eye) |
| The sclera is connected to the: | cornea, anterior chamber, iris and pupil |
| second layer of the eye | uvea |
| The uvea is the ___________ layer of the eye. | vascular |
| The uvea houses the: | chroid, iris, pupil, ciliary body, anterior chamber, lens, posterior chamber and vitreous humor |
| blood vessels and dark pigmented cells the prevent shattering of light | choroid |
| colored part of the eye | iris |
| opening that dilates and constricts in response to light | pupil |
| made up of ciliary processes and ciliary; produces aqueous humor (liquid that nourishes the cornea). When we age, theses muscles weaken an cause presbyopia. | ciliary body |
| filled with aqueous humor that nourishes the cornea | anterior chamber |
| space behind the lens | posterior chamber |
| The ciliary body produces aqueous humor that is sent to the anterior chamber and drained through the: | canal of Schlemm |
| gelatin substance that keeps the shape of the eyeball andplacement of the retina | vitreous humor |
| third layer of the eye composed of neurosensory layer which contains nerves from the optic nerve, rods, and cones | retina |
| used for night/dim vision; distinguishes black from white | rods |
| used for day/bright light vision; distinguishes colors | cones |
| resides in the center of the retina and composes of many rods and cones; used for detailed central vision | macula lutea |
| anterior surfaceof the optic nerve | optic disk |
| light rays bend and change speed to visualize an object | refraction |
| turns light energy upside down and focused on the retina | lens |
| sends nerve impulses to visual cortex of the occipital lobe where image is interpreted | rods and cones |
| process where lens can change shapes to allow image to "fall" on correct place on the retina | accommodation |
| visual pathway of light: | light enters the eye, passes through transparent cornea, aqueous humor, lens, and vitreous humor. These structures together are called REFRACTIVE MEDIA. |
| to bend horizontal and vertical light rays so that the light rays focus on the retina | refract |
| on retina, light rays are reversed and ________ | upside down |
| Images are carried as impulses through the: | optic nerve |
| At the optic chiasm, fibers from the left field from each eye join to form the ______ optic tract. | left |
| Fibers from the right field of the eye join to form the _______ optic tract. | right |
| Images are transmitted to the brain by way of the ___________. | optic nerves |
| Age related changes in the eye: | skin around eye becomes wrinkled and loose; eyelids usually have some excess tissue (not important unless it interferes with vision), amount of fat around the eye decreases, eyeball sinks deeper into orbit; tear secretion diminishes; cornea less sensitive |
| More age related changes: | grayish ring may be around the outer margin of the iris; pupil is smaller and responds more slowly to light; presbyopia (ability to focus) is impaired |
| see table 41-1 pg. 599 | |
| History to obtain from patient: | past eye problems, visual acuity, current treatment and response, illnesses that can affect vision (esp. DM, HTN) |
| Assess for: | symmetry, inflammation or drainage, loss of eyelashes, pupil size and response |
| drooping of upper eyelid | ptosis |
| extended or protruded upper eyelid that prevents lids from closing | proptosis |
| uncontrolled movement of the eye | nystagmus |
| danger signs of eye disease: | persistent redness of the eye; continuing pain or discomfort; visual disturbance; light flashes, loss of vision in certain areas; crossing of the eyes; growths on the eye or eyelids; opaque lenses; discharge; pupil irregularities |
| eye chart used for distance vision | Snellen eye chart |
| eye chart used for near vision | Jaeger eye chart |
| plates for color blindness | Ishihara |
| 20/20 vision | can see at 20 feet what most people see at 20 feet |
| Corneal light reflex tests checks for: | eye alignment |
| test that checks for extraocular muscle function | cover-uncover test |
| test that checks eye muscle strength, cranial nerve function | positions test |
| examination of the fundus or interior of the eye; usually done with an ophthalmoscope; looks at lens, retina, blood vessels and optic disk | opthalmoscopy |
| a hand held instrument that produces a line of light; used in conjuction with corrective lenses; determines the focusing power of the eye | retinoscopy |
| measures intraoccular pressure | tonometry |
| normal occular pressure | 10-21 mm Hg |
| tests for tonometry; greatest accuracy; indentation method may be used because it is smaller and more portable; requires a topical anesthesia | applanation tonometry |
| tonometry test that blows a puff of air agains the cornea; less accurate | non-contact tonometer |
| measures peripheral vision and detects gaps in the visual field | visual field examination |
| disorders associated with loss of visual fields | glaucoma, stroke, brain tumor, or retinal detachment |
| client instructed to star at grid of squares to check for distortion; if macular problems, wavy lines are present | Amster Grid |
| binocular microscope that magnifies the surface of the eye; used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts | slit lamp |
| used to detect vascular changes and blood flow through the retinal vessels; detects vascular changes that occur with diabetes, hypertension, drug toxicity, tumors, and AIDS; tints skin yellow for 6-8 hours and uring for 24-36 hours | retinal angiography |
| used when conditions such as opaque lens, cloudy cornea, or bloody vitreous make it difficult to look directly in the eye; anesthetic drops used to allow probe to be placed directly on cornea | ultrasonography |
| uses laser scanning to look at the retina without dilating the eye; detects disorders such as diabetic retinopathy and provides baseline screening | retinal imaging |
| test done with object 12 inches away; object moved in all directions; eye movements should be smooth; if not, extraocular muscle weakness or dysfunction of cranial nerve | Positions Test |
| normal vision | emmetropia |
| inherited or result of surgical treatment of disorders of the cornea or lens | refractive errors |
| 4 types of refractive errors | myopia; hyperopia; presbyopia; astigmatism |
| natural degenerative changes; assessment findings - blurred vision, recurrent headaches | presbyopia |
| diagnostic test for presbyopia | Snellen, Jaegar charts; retinoscopy |
| medical management of presbyopia | eyeglasses; contact lenses |
| surgical management of presbyopia | RK; LASIK; PRK; ICRS; IOLs; CK |
| medical term for nearsightedness; objects held closer to see; elongated eyeballs; light focuses on the vitreous body before they reach the retina | myopia |
| medical term fo rfarsightedness; objects held at a distance to see; shorter eyeball; light focuses on a spot after the retina | hyperopia |
| poor accommodation that is due to loss of elasticity of the ciliary muscles; r/t aging and deals with near vision; degenerative changes and loss of eleasticity of the lens | presbyopia |
| examination of the fundus or interior of the eye; usually done with an ophthalmoscope; looks at lens, retina, blood vessels and optic disk | opthalmoscopy |
| a hand held instrument that produces a line of light; used in conjuction with corrective lenses; determines the focusing power of the eye | retinoscopy |
| measures intraoccular pressure | tonometry |
| uses a laser to reshape the cornea; top layer of cornea is removed; laser-assisted in situ keratomileusis (lasik) where a thin layer of the cornea is peeled back and the middle layer is reshaped | photorefractive keratectomy (PKR) |
| normal occular pressure | 10-21 mm Hg |
| nursing management for PKR | eye exams; referral to eye specialist |
| tests for tonometry; greatest accuracy; indentation method may be used because it is smaller and more portable; requires a topical anesthesia | applanation tonometry |
| educate client on: | eye protection; medication administration; proper care of contacts (see Nursing Guidelines 48-1 and 48-2 - Glasses and Contacts and Post Op Care) |
| tonometry test that blows a puff of air agains the cornea; less accurate | non-contact tonometer |
| An important aspect of the post-op care of pts having eye surgery is to ________________. Caution patients against: | prevent increased intraocular pressure; straining, leaning forward, lifting and lying of the affected side |
| measures peripheral vision and detects gaps in the visual field | visual field examination |
| disorders associated with loss of visual fields | glaucoma, stroke, brain tumor, or retinal detachment |
| legal term for best corrected visual acuity (BCVA) of 20/200 or less even with corrective lenses | blindness |
| client instructed to star at grid of squares to check for distortion; if macular problems, wavy lines are present | Amster Grid |
| Many people who are considered blind perceive: | light and motion |
| binocular microscope that magnifies the surface of the eye; used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts | slit lamp |
| Severe loss of ____________- may also be considered blind. | visual fields |
| used to detect vascular changes and blood flow through the retinal vessels; detects vascular changes that occur with diabetes, hypertension, drug toxicity, tumors, and AIDS; tints skin yellow for 6-8 hours and uring for 24-36 hours | retinal angiography |
| Blindness may be congenital or caused by injury, high fever, or disorders such as: | cataracts; glaucoma; retinal detachment; macular degeneration; tumors |
| used when conditions such as opaque lens, cloudy cornea, or bloody vitreous make it difficult to look directly in the eye; anesthetic drops used to allow probe to be placed directly on cornea | ultrasonography |
| uses laser scanning to look at the retina without dilating the eye; detects disorders such as diabetic retinopathy and provides baseline screening | retinal imaging |
| BCVA between 20/70 and 20/200 (in better eye with glasses) | visual impairment |
| test done with object 12 inches away; object moved in all directions; eye movements should be smooth; if not, extraocular muscle weakness or dysfunction of cranial nerve | Positions Test |
| causes of visual impairment: | congenital, injury, optic nerve damage, disorders, tumors |
| normal vision | emmetropia |
| inherited or result of surgical treatment of disorders of the cornea or lens | refractive errors |
| 4 types of refractive errors | myopia; hyperopia; presbyopia; astigmatism |
| eye injuries may result from: | wind, sun, chemical sprays, direct blows to the tye, lacerations and penetrating objects |
| natural degenerative changes; assessment findings - blurred vision, recurrent headaches | presbyopia |
| diagnostic test for presbyopia | Snellen, Jaegar charts; retinoscopy |
| medical management of presbyopia | eyeglasses; contact lenses |
| surgical management of presbyopia | RK; LASIK; PRK; ICRS; IOLs; CK |
| medical term for nearsightedness; objects held closer to see; elongated eyeballs; light focuses on the vitreous body before they reach the retina | myopia |
| medical term fo rfarsightedness; objects held at a distance to see; shorter eyeball; light focuses on a spot after the retina | hyperopia |
| poor accommodation that is due to loss of elasticity of the ciliary muscles; r/t aging and deals with near vision; degenerative changes and loss of eleasticity of the lens | presbyopia |
| irregularity in the cornea or lens; unequal curves in the shape of the cornea | astigmatism |
| assess for: | blurred vision; HA; vision deficits diagnosed with visual screening tests; Snellen, Jaeger |
| primary treatment of errors of refraction is the prescription of: | corrective lenses |
| uses a laser to reshape the cornea; top layer of cornea is removed; laser-assisted in situ keratomileusis (lasik) where a thin layer of the cornea is peeled back and the middle layer is reshaped | photorefractive keratectomy (PKR) |
| nursing management for PKR | eye exams; referral to eye specialist |
| educate client on: | eye protection; medication administration; proper care of contacts (see Nursing Guidelines 48-1 and 48-2 - Glasses and Contacts and Post Op Care) |
| An important aspect of the post-op care of pts having eye surgery is to ________________. Caution patients against: | prevent increased intraocular pressure; straining, leaning forward, lifting and lying of the affected side |
| Because vomiting raises intraocular pressure, treat _________ promptly. | nausea |
| legal term for best corrected visual acuity (BCVA) of 20/200 or less even with corrective lenses | blindness |
| Many people who are considered blind perceive: | light and motion |
| Severe loss of ____________- may also be considered blind. | visual fields |
| Blindness may be congenital or caused by injury, high fever, or disorders such as: | cataracts; glaucoma; retinal detachment; macular degeneration; tumors |
| BCVA between 20/70 and 20/200 (in better eye with glasses) | visual impairment |
| causes of visual impairment: | congenital, injury, optic nerve damage, disorders, tumors |
| medical management of visual impairment: | corrective lenses; rehabilitation; independent living skills; educate of ADLs; guide dogs; braille; canes; need to achieve independence as much as possible |
| eye injuries may result from: | wind, sun, chemical sprays, direct blows to the tye, lacerations and penetrating objects |
| all 3 layers of the eye and vitrous are inflamed; treatment most likely consists of enucleation; secondary infections may follow injury; surgical repair is necessary if internal eye structures are damaged;scar tissue may form affecting refraction of light | endophtalmitis |
| s/s of eye trauma | painful and burning; gritty feeling; blurred vision; asymmetric orbtals if fractured; diplopia (double vision); black eye; changes in iris or pupil shape; purlent drainage |
| medical treatment of eye trauma | eversion of eyelid to remove object; anesthetize eye; antibiotic ointments/drops; eye patch; repair of lacerations; surgical repair if eye structures damaged |
| Enucleation (removal of the eyeball) may occur in relation to: | injury; disease; pain in sightless eye |
| 2 types of enucleation: | sclera left intact and contents removed; entire eyeball and tissues removed from orbit |
| medical treatment of enucleation: | metal or plastic ball buried in capsule of connective tissue where eye removed; after - pressure dressing; HOB ~30 degrees; prosthesis applied 2-4 weeks after surgery or when healing complete; orbit can be sutured shut; same care except no prosthesis |
| nursing care for enucleation - assess for: | bleeding; s/s f infection; fever; tachycardia; tachypnea; chills; drainage; prevention of vomiting, straining, coughing, etc., education of client and family on care |
| inflammation of the conjunctiva caused by microorganisms, allergy or chemical irritants | conjunctivitis |
| bacterial conjunctivitis is commonly called | pink eye |
| conjunctivitis can be passed from one person to another; ____________ may be prescribed | antibiotics |
| conjunctivitis can be characterized by: | redness of the conjunctiva, mild irritation and drainage |
| inflammation of the hair follicles along eht eyelid margin; symptoms include itching, burning, and photophobia | blepharitis |
| With blepharitis, ________ may be seen on the eye lid margins. This should be cleaned with ___________. | scales or cursts; baby shampoo and water |
| Blepharitis can lead to: | hordeolum or chalazion (treated with topical antibiotic) |
| commonly called a stye; inflammation and infection of the oil gland at the edge of the eyelid; causes by staphylococcus aureus; warm, moist compresses several times a day is the primary treatment; severe cases require incision and drainage | hordeolum |
| called a cyst; inflammation of glands ofeyelids; swelling prevents fluid from leaving glands, causing them to become enlarged, hardened and tender; warm compresses may bring some relief in producing drainage; not treated unless interferes with vision | chalazion |
| inflammation or infection or both of the cornea; doesn't produce noticeable drainage but causes considerable pain; can be caused by trauma to the cornea; causes photophobia | keratitis |
| erosion or breakdown of the corneal tissue; at risk for secondary infections; treated with topical anesthetics, mydriatics (dilate pupils), and antibiotics; once scar tissue formed, only treatment is keratoplasty | corneal ulcer |
| dilate the pupils | mydriatic eyedrops |
| only treatment for corneal opacity | removal of the scarred cornea and replacement with a healthy cornea (keratoplasty) |
| inflammation of the uveal tract - iris, ciliary body, choroid; cause is unknown; can lead to glaucoma, cataracts, retinal detachment; treated with oral and topical corticosteroids, mydraitic drugs, and antibiotic drops | uveitis |
| condition in which the lower lid turns inward; requires surgical correction | entropion |
| condition in which the lower lid turns outward; requires surgical correction | ectropion |
| Can help prevent cataracts | Vitamin A, vitamin C, Ceratine |
| When lens becomes opaue so that is is no longer transparent; vision decreased r/t decreased light getting to the retina | cataracts |
| cataracts may be congenital, ____________, or degenerative; may also be __________ to eye diseases, DM, HTN | traumatic; secondary |
| Cataracts can be r/t: | DM, UV rays, radiation, steroids |
| With cataracts, assess for: | halos around lights; difficulty reading; distortion of objects; cloudy lens upon inspection |
| medical treatment for cataracts | surgery; intracapsular extraction (lens removed); extracapsular extraction (posterior capsule left); photoemulsification (ultrasound used to break up lens and remove) |
| Complications with cataract surgery include leakage of the vitreous humor, hemorrhage into the eye, and | opening of the incision |
| Intraocular lenses are placed in the eye following | cataract surgery |
| After cataract surgery, assess for: | pain and nausea (treat promptly). Pt is likely to have a patch and shield over the operative eye. |
| After cataract surgery, the pt will continue to: | wear glasses or contacts, or have intraocular lens implant |
| After cataract surgery, vision will be blurred for about: | 1 week |
| nursing management with cataract surgery | verbal and written discharge instructions; assess for and try to prevent n/v, coughing, sneezing, etc; avoid lying client on operative side; pain in eye or near brow (see pg. 621 Nursing Care Plan 42-1) |
| second leading cuase of blindness in the US | glaucoma |
| normal intraocular pressure | 10-21 mm Hg |
| Glaucoma occurs most often cuased by some interference with the: | outflow and production of aqueous humor; exact cause is unknown |
| Glaucoma - excess pressure damages the back portion of the eye and ________________. | impairs blood flow to the optic nerve |
| Glaucoma - increased __________ | IOP |
| Glaucoma - __________ vision is lost first; field of vision gradually narrows until the pt has __________ vision. Complete blindness eventually occurs. | peripheral; tunnel |
| See Figure 42-5 pg. 617 | |
| glaucoma - increased risk for: | African Americans |
| Glaucoma - vision may be restored if treated _________, otherwise, vision loss is permanent | early |
| also called chronic glaucoma; results from some alteration that prevents the normal passage of aqueous humor through the trabecular meshwork | open angle glaucoma |
| see Figure 45-4B, pg 616 | |
| Open angle glaucoma - pts complain of tired eyes or discomfort, occasional __________ vision and _______ around lights. Another clue is frequent changes of eye glass _________. Decrease in ____________ vision. | blurred; halos; presecriptions; peripheral |
| also called acute glaucome; flow of aqueous humor is blocked through the pupil, causing the iris to push forward and blocking the trabecular meshwork; rapid rise in intraocular pressure; considered a medical emergency | angle-closure glaucoma (closed angle glaucoma) |
| angle-closure glaucoma causes sudden, acute pain; n/v, HA on affected side; red conjunctiva; cloudy cornea; vision can be lost in ________ | 1-2 days |
| treatment of angle-closure glaucoma | drugs are used to immediately lower the pressure followed by surgery to prevent recurrence; medications used may have systemic effects (effects on vital signs) |
| drug therapy for angle-closure glaucoma - miotics (constrict pupil) | carbachol (Miostat), Pilocarpine |
| drug therapy for angle-closure glaucoma - Carbonic Anhydrase Inhibitors (decrease the production of aqueous humor) | acetazolamide (Diamox), methazolamide (Neptazane) |
| drug therapy for angle-closure glaucoma - Alpha/Beta Adrenergic Agonists (decrease production of aqueous humor) | brimonidine tartrate (Alphagan) |
| thin medicated film applied to eye weekly | ocular therapeutic system |
| used for pain from increased IOP | analgesics |
| surgical intervention for increased IOP may be ecommended when: | drugs do not reduce pressure adequately |
| the use of a laser to create multiple holes in the trabecular meshwork | trabeculoplsty |
| holes burned into iris to make exit pathways | laser iredectomy |
| part of iris surgically removed; done if laser iredectomy is unsuccessful | surgical iridectomy |
| iris will appear __________ if removed | black |
| small holes produced at junction of cornea and sclera for drainage | corneal trephine |
| nursing management for surgical interventions | history of diagnosis, family history, medical compliance, pain, drug therapy; decreased sensory stimulation - quiet room, dim lights, prevent activities that increase IOP; no lifting >5 lbs. |
| CONTRAINDICATED IN GLAUCOMA | mydriatics |
| separation of the sensory layer of the eyeball from the pigmented laye; tear in the retina allows fluid to collect between the sensory and the pigmented layers, causing the two layers to seperate | retinal detachment |
| Separation of the two layers deprives the sensory layers of: | nutrients and oxygen |
| Vision is lost to affected area with retinal detachment. | |
| Retinal tears may occur spontaneously or as a result of: | trauma |
| With retinal tears, pts may report seeing ____________ or blind spots. Vision may be _________. Some pts say it seems as if a ______________ has come down on or across the line of vision. Vision may be _______ completely. | flashes of light or floaters; cloudy; curtain; lost |
| surgical repair of retinal detachment | laser reattachment; scleral buckle; cryosurgery; retinopexy |
| lasers used to surgically repair the tears; as the area heals, scar tissue forms that seals the tear | laser reattachment |
| uses cold to cause the scar tissue to form in sclera, choroid, and retina | cryosurgery |
| gas is injected into the eye to apply pressure to the retinal tear; client has to recline 16 hourse before sx; 8 hrs 3 times/week after surgery | retinopexy |
| often done along with laser treatment or cyrosurgery; silicone band that is secured around eyeball under the sclera brnging the layers of tissue back together by pressing from the outside; band is left in place permanently | scleral buckling See Figure 48-13 pg. 787 |
| For retinal tears, physician may inject an air bubble or normal saline into the vitreous humor to apply internal pressure. With air, the pt may have to be __________, whereas with saline, the pt may have to be ___________. | face-down; face-up |
| part of the retina that is responsible for visual perception | macula |
| usually affects both eyes and is progressive, causing central vision to get gradually worse; regular glasses do not improve vision, but special telescopic lenses may be helpful | macular degeneration |
| Macular degeneration - assess for: | blurrd or distorted vision, absence of central vision, diminished color perception |
| treatmet for macular degeneration | photocoagulation, photodynamic therapy |
| laser used to seal serous leak and destroy abnormal blood vessels; must be done early to prevent proression | photocoagulation |
| decreases the growth of abnormal blood vessels | photodynamic therapy |
| nursing management for macular degeneration | assist with ADLs, glasses or other visual aids, brighter lighting - See Pg. 615 for more |
| For the client who is blind | assess degree of impairment; support client through depression, anger or sadness; assist client to be as independent as possible; orient them to area; don't rearrange; open window for light sensation; remove objects in pathway of bathroom and exits |
| continued - allow client to grab your elbow and lead them; bedside table and phone in reach | |
| pain r/t eye trauma | irrigate eye if not contraindicated; decrease lighting; patch eye; anesthetic eye drops; cool compresses to eye; analgesics |
| risk for infection r/t eye trauma | wash hands (also tell pt to wash hands, not to rub eyes); sterile solutions; irrigationof eye aay from inner canthus; avoidance of touching tips of applicators; dressing changes with aseptic technique |
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akgalyean
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