Age-Related Eye Problems

(Cataract & glucoma)

Gerontological Nursing Clinical Presentations

Prepared by: Gerantological department
 Prepared By:

Mustafa Muhammed Ragab

Mona Sobhy Algohary

Mai Muhammed Muhammed

Nermin Elsayed Esmail

 outlines

Common Eye Problems Among Elderly

Cataract
- Definition
- Anatomy
- Incidence
- Risk Factors
- Pathophysiology
- Manifestation
- Classification (by anatomy, maturity, causes)
- Investigations
- Medical Treatment (Phacoemulsification, Extracapsular
Surgery)
 -Objectives:

• At the end of this presentation, all students will be able to:

• 1-Recognize the anatomy and physiology of the Eye.
• 2-Disscus the vision changes that occur in geriatrics.
• 3-List most common eye problems in geriatrics.
• 4-Define Glaucoma and cataract.
• 5-Understand the pathophysiology of Glaucoma and cataract.
• 6-Enumerate causes and risk factors of Glaucoma and Cataract.
• 7-List Signs and Symptoms and types of Glaucoma and Cataract.
• 8-Descripe the treatment of Glaucoma and Cataract.
• 9- Apply the role of geriatrics health nurse in case of Glaucoma and cataract.
• 10-Defferantiate and compare between to problems: Glaucoma and Cataract.
 Definition

cataract is a lens opacity or cloudiness

Which lead to a decrease in vision

Senile cataract
Gradually, Progressive lens opacification
 Anatomy

a transparent biconvex structure ,

Non- vascular, colourless
Divided into nucleus, cortex and capsule

Function → refractive media , focus rays

of light on the retina
the lens receives it nutrients and
antioxidants from the aqueous and vitreous
humors
 incidence

Cataracts are responsible for % 51 of world

blindness, representing about 20 million people

More than %90 of cataracts are age-related.

about %51 of blindness cases around the world were mainly

caused by cataracts

000,400new cases of cataract development are diagnosed

each year
 Risk Factors

Advancing Tobacco use ,high alcohol intake,

age

long-term use of medications such

diabetes as corticosteroids

excessive exposure to sunlight

intraocular
tumor
penetrating trauma family history of cataracts
 Pathophysiology

The lens is made mostly of water and protein fibers.

↑↑PH → ↑↑acidity → activation of alph beta
protein → break down in protein chain → Ability
of the lens to refract lights reduce
which cause reduce visual acuity.
 Manifestation

Faded color Glare from light

Difficult of reading
Poor night vision
Frequent change of glasses
Decrease visual acuity

Loss of vision
Blurred vision
visual acuity
 Classification

According to the anatomy or the site

According to the degree of maturity

According to the onest or causes

 According to the anatomy or the site

Subcapsular cataract
Anterior subcapsular cataract
Posterior subcapsular
cataract
Nuclear cataract
Involves the nucleus of lens .Yellow to brown coloration
Cortical cataract
Wedge shaped or radial spoke-like opacities.
 According to the degree of maturity

IMMATURE Cataract is one in which the lens is partially opaque.

MATURE Cataract is one in which the lens is completely opaque.

HYPERMATURE Cataract is shrunken and wrinkled anterior capsule

due to leakage of water out of the lens
 According to the onset or causes

Age related cataract (senile cataract)

Pre -senile cataract <60 years

Metabolic → diabetes

Traumatic cataract

Drug induced cataract

Secondary cataract
 Investigation

History & physical Biometry

examination

slit lamp Visual

examination acuity

Ophthalmoscope A-scan

Glare test
slit lamp
Ophthalmoscope → ocular infection or retinal detachment
Galer test
Biometry
 Medical treatment

Extracapsular Surgery

Phacoemulsification

Lens Replacement
 PHARMACOEMULSIFICATION

Two small incisions are made in the eye where the clear front
covering)cornea (meets the white of the eye) sclera.
A circular opening is created on the lens surface (capsule)

A small surgical instrument (phaco probe) is inserted into the eye.

Sound waves) ultrasound (are used to break the cataract into
small pieces.
 Cont.........

Sometimes a laser is used

too .
The cataract and lens
pieces are removed from
the eye using suction.
Usually ,the incisions seal
themselves with
stitches.
 Extracapsular cataract extraction (ECCE)

it is usually done if the cataract is too large to be destroyed

by ultrasound
An 5 mm to 6 mm incision is made in the eye where the clear front
covering of the eye (cornea)meets the white of the eye(sclera).

Another small incision is made into the front portion of the lens
capsule .The lens is removed ,along with any remaining lens material.
 outlines

Glaucoma
- Definition
- Physiology
- Pathophysiology
- Risk Factors
- Types (Primary open-angle, Angle-closure, Normal-
tension, Secondary)
- Diagnostic Tests
- Medical & Surgical
- Treatment
- Prevention
- Nursing Managment
 Definition

Glaucoma is a group of ocular conditions

characterised by optic nerve damage .The optic
nerve damage is related to the IOP caused by
congestion of aqueous humor in the eye .

Increased intraocular pressure and damage to

the optic nerve causes narrowing of the visual
field
Physiology
 Physiology

Vitreous humor →75% of total water of the eyes (fixed)

Aqueous humor → minimum amount (circulating )

Production of aqueous humor →cillary body

Drainage of aqueous humor →trabecular meshwork

channle →schlemm
Pathophysiology
Aqueous humor circulate in the front portion of the eye and
responsible for IOP

Blockage of cillary body or obstruction in chelmm channel

↑↑IOP >21 mmHg → mechanical back pressure on retina and

optic nerve

Damage of optic nerve →visual field loss → irreversible

blindness
 Risk factor
Family history of Migraine syndromes
glaucoma

Nearsightedness) myopia(
African American race
Eye trauma
Older age
Prolonged use of topical or
Diabetes systemic corticosteroids

Cardiovascular
disease
 Types
Primary glucoma Secondary glucoma
Truma
Open angle glucoma
Cataract
Closed angle
glucoma Inflammation
Normotensive Tumor
glucoma
Medication
Congenital glucoma
Surgery
 (1) PRIMARY OPEN ANGLE

The most common form ,is a multifactorial disorder that is often

genetically determined ,bilateral ,insidious onset slow in progress

Referred to as see the" thief in the night "because no early clinical

manifestations are present to alert the client that vision is being loss

Aqueous humor flow is slowed or stopped because of obstruction by the

trabecular meshwork is slowed
Usually bilateral ,but one eye maybe more severely affected than the other.
 (2) ANGLE-CLOSURE

An acute attack of angle-closure glaucoma can develop only in an

eye in which the anterior chamber angle is anatomically narrow .The

attack occurs because of a sudden blockage of the anterior angle
by the base of the iris

Obstruction in aqueous humor outflow due to the complete or

partial closure of the angle from the forward shift of the peripheral
iris to the trabecula .The obstruction results in an increased IOP
 (3) NORMAL-TENSION

Optic nerve becomes damaged eventhough eye pressure is within

the normal range

No one knows the exact reason for this.

Sensitive optic nerve ,or may have less blood being supplied to
optic nerve.

Caused by atherosclerosis the buildup of fatty deposits(plaque) in

the arteries that impair circulation
 Diagnostic test

Test Aim
l Tonometry To measure intraocular pressure

l Ophthalmoscope Test optic nerve damage

l Visual field test Check visual field loss

l pachymetry test Corneal thickness

l Gonioscopy Drainage angle

Gonioscopy
pachymetry test
Tonometry
Medical treatment

Topical treatments (eye drops):

B-blockers ,eg timolol (decrease aqueous secretion)

prostaglandin ,eg latanoprost (improve drainage ,may darken iris)

A - agonists ( decrease aqueous production)
carbonic anhydrase inhibitors ,eg dorzolamide (decrease aqueous
secretion)
 Oral treatments : carbonic anhydrase inhibitors ,eg
acetazolamide very powerful

Surgical treatment :
trabeculectomy — operation to improve aqueous outflow .

Argon laser trabeculoplasty —(applied to the trabecular meshwork)

may be effective .
 Prevention of Cataract & Glaucoma

Exercise safely: Regular ,moderate exercise may reducing eye pressure.

Take prescribed eyedrops regularly

Wear eye protection .: Wear eye protection when using power tools or playing
high- speed racket sports in enclosed courts
Reduce alcohol use & Quit smoking
Have regular eye examinations
Choose a healthy diet that includes plenty of fruits and vegetables

Manage other health [Link] diabetes ,HTN or other medical conditions that
can increase risk of cataracts and glucoma.
Nursing management for
Cataract & Glucoma
1) Assessement

Demographic data of age and race because Cataract & glaucoma occurs most often
in clients more than 40 years of age and in blacks

Determine whether there is a family history of Cataract & glaucoma or other eye
problems and whether the client has had ocular surgery ,infections ,or trauma,

An accurate list of current medications is because over-the -counter medications)

such as antihistamines (may dilate the pupil ,increasing the risk for angle-closure
glaucoma .

Always note a history of allergic reactions ,particularly to medications or dyes .Ask

the client to describe any changes in vision.
1) Assessement

Although the manifestations of primary open-angle glaucoma are insidious ,the client
may describe blind spots in the periphery of an overall decreased visual acuity with

loss of contrast sensitivity ,Decreased ,uncorrectable visual acuity usually Occurs

when there has been irreversible damage to the optic nerve.

Assess the manifestations of cataract

Assess the client's perception of Cataract & glaucoma and the effect it has on quality
of life .
Help the client identify effective coping skills that may have been used in the past .
 2) Nursing Dignosis

Risk for Injury R/T visual impairment

Acute Pain R/T increased intraocular pressure and ocular discomfort
Risk for Impaired Skin Integrity R/T decreased mobility due to vision loss
Deficient Knowledge R/T glaucoma and its treatment regimen
Medication Noncompliance R/T lack of understanding of the importance of eye
drops
Fear R/T potential loss of vision and functional independence
Disturbed Sensory Perception (Visual) R/T progressive visual field loss
Risk for Social Isolation R/T difficulty with navigation due to visual impairment
 3) Nursing Goals

The client will participate in the therapeutic regimen.

The client will maintain the current visual field/acuity without further loss.
The client will appear relaxed and report anxiety is reduced to a manageable
level.
The client will verbalize understanding of the condition ,prognosis ,and treatment.
The client will verbalize understanding of treatment needs.

The client will correctly perform the necessary procedures and explain the
reasons for the actions.
 4) Nursing Interventions

Demonstrate administration of eye drops (counting drops ,adhering to the

schedule , not missing doses).
Stress the importance of meticulous compliance with prescribed drug therapy.
Monitoring Intraocular Pressure and Improving Visual Sensory Perception

Implement measures to assist patients to manage visual limitations such as

reducing clutter ,arranging furniture out of travel path ;turning heads to view
subjects ;
correcting for dim light and problems of nightvision.

Older clients may need reminders ,such as a check -off list and may a to use a
4) Nursing Interventions

Give accurate ,honest information .

Discuss the probability that careful monitoring and treatment can prevent
additional visual loss.

Promote a calm and soothing environment by ensuring adequate lighting ,and

minimizing noise and distractions in the environment.

Reinforce avoidance of activities such as heavy lifting and pushing ,snow

shoveling , and wearing tight or constricting clothing.
Discuss dietary considerations (adequate fluid ,bulk ,or fiber intake).
 Pre & post Operative Care
pre operative care
Perform glaucoma evaluation (IOP ,optic nerve imaging ,visual field tests).
Review systemic conditions such as hypertension and diabetes.
Adjust anticoagulant/antiplatelet medications if advised by the surgeon
Educate the patient about the procedure ,risks ,and expected outcomes.
Address patient anxiety and clarify queries.
Administer prescribed preoperative eye drops (antibiotics ,steroids ,or IOP-lowering
agents).
Advise fasting as per surgical guidelines.
Obtain informed consent after discussing the procedure thoroughly
 Pre & post Operative Care
post operative care
Monitor intraocular pressure (IOP) and vision within 24-48 hours after
surgery.
Use prescribed eye drops (antibiotics, anti-inflammatory agents, and steroids).
Refrain from strenuous activities, heavy lifting, or bending over for two weeks.
Protect the eye from dust, smoke, and pollutants.
Avoid direct exposure to sunlight and wear sunglasses when outdoors.
Stay away from high heat sources like stoves, ovens, or direct heat.
Prevent water, soap, or shampoo from entering the eye while bathing.
Followup regularly to monitor healing,IOP, and potential complications
 Teach the client&family and provide written information
on the following:

Manifestations of infection (redness ,swelling ,drainage ,blurred

vision ,pain)
Manifestations of increased IOP (increasing pain ,nausea ,decrease in vision)

The rationale for eye protection) shield or eyeglasses at all times (to protect
from light and trauma)
Teach the client&family and provide written information
on the following:

Medications and eye drop instillation technique

Scheduled return visit date and time

Treatment of the surgical site :a .Carefully clean the area around the eye
with warm tap water and a clean washcloth.

Do not rub or apply pressure over the closed eye, which may damage
healing tissue.