- develops slowly with gradual loss of visual fields (asymptomatic in early stages) - ↓ outflow of aqueous humor - peripheral vision is going - more common
What is Closed-angle glaucoma
- sudden onset of visual loss - iris moving against cornea obstructs outflow of vitreous humor
What are seven S/S of closed angle glaucoma?
- headache - eye pain - N & V - sudden blurred vision - red sclera - froggy cornea - non-reactive pupil
Who is at risk for glaucoma? (3)
1. African americans > age 40 2. Others > age 60 3. Family history
What are four things that can help someone with Disturbed sensory perception: visual?
1. telephone & clocks with large numbers 2. Large print books & newspapers 3. Large print cards & games 4. Assistance with meals, transportation & medication preparation
What are Miotics (Cholinergics) (3) & their implications (2)?
- produces constriction of the pupil & contraction of the ciliary muscle - May cause ↓ acuity in low light - Systemic = ↑ parasympathetic response Implications: 1. good light for task 2. monitor HR & BP
2 Examples of Miotic drugs
pilocarpine HCL (Pilocar)
What are Beta Adrenergic Blockers (2) & their implications (3)?
- ↓ aqueous humor production & ↑ absorption - Systemic = block sympathetic beta response Implications: 1. ↓ risk of SE if oral beta blocker 2. monitor BS if DM 3. do not stop abruptly
3 Examples of Beta Adrenergic Blockers
end in OLOL
What are Carbonic Anhydrase Inhibitors (3) & their implications (2)
- ↓ aqueous humor formation - Systemic = ↑ urine excretion of H2O, K, bicarb - caution if sulfa allergy Implications: 1. shake before using 2. wait 15 min before inserting contacts
2 Examples of Carbonic Anhydrase Inhibitors
end in ZOLAMIDE
What are Prostaglandin Agonists (3) & their implications (1)?
- dilates vessels in eye to ↑ absorption of aqueous humor - permanent darkening of iris - lengthens lashes Implication: - can impair vision if used in eye with normal IOP
3 Examples of Prostaglandin Agonists
end in OPROST
What are Mydriatics (Adrenergic Antagonists) (2) & their implications (3)?
- ↑ pupil size to improve aqueous flow & ↓ aqueous humor - can cause HTN crisis if taken with MAO inhibitor (people on psych meds) Implications: 1. monitor BP 2. wear sunglasses 3. wait 15 min before inserting contacts
Example of a Mydriatics drug?
What are Osmotic Diuretics (2) & their implications (1)?
- pull water from eye & brain to ↓ IOP & ICP (ex. head injuries) - emergency situations Implications: 1. monitor VS, LOC, I&O, serum osmo & Na+
2 Examples of Osmotic Diuretics
1. glycerin (Osmolyn) PO
2. mannitol (Osmitrol) IV = volume expander, helps you pee
Prostaglandin agonists ↓ IOP by?
dilating the blood vessels in the eye
What are three glaucoma surgeries?
1. Laser trabeculoplasty = increase size of aqueous humor outflow spaces by using laser to tighten surrounding fiber network 2. Filtering microsurgery = create a drainage hole in the iris 3. Conventional = shunt implanted to drain fluid out of eye
What is Macular Degeneration & what are two types?
- deterioration of the macula that leads to blindness - blurred central blindness
- 2 types; wet or dry
- can slow down but can't stop / will lead to permanent blindness
what are three nursing diagnoses for macular degeneration?
1. Disturbed sensory perception: visual 2. Risk for injury 3. Social isolation
What is WET (Macular Degeneration) (3)?
- growth of fragile new vessels can be harmed & scar - may be age related - exudative type not age related (pigmented cells detach & scar)
What are two WET Surgical Interventions?
1. Laser therapy (seals leaking vessels) 2. Photodynamic therapy (drug attaches to new vessels & helps to occlude them so they don't leak) a. veteprofin IV b. Laser light c. Photosensitive for 1-3 months - ranizbizumab (Lucentis)
What is DRY (Macular Degeneration) (3)
- capillaries are blocked (Htn) - ischemia & death to cells - early stage is blurred vision
This type of medication is injected into the eye to block new blood vessel growth
What are four Macular Degeneration risk factors?
- age - smoking - genetics - obesity
What are four Macular Degeneration preventions?
- antioxidants (leafy veggies, fish) - exercise - no smoking - Vitamins & minerals = A, C, E, zinc & copper
What is Retinal Detachment & what is the symptom?
separation of the sensory retina from pigmented epithelium
symptoms: curtain being pulled over the eye
What is Retinal Tear & what is the symptom?
break in integrity of peripheral sensory retina
symptoms: sudden dark flashes of light or dark spots
List 3 treatments for Retinal Detachment or Tears
- Laser Surgery
- Cryoplexy (freezing)
- Scleral buckle = repair of wrinkles or folds so retina can assume normal position. OR silicone & band placed against sclera promote reattachment
What are two nursing diagnoses & four interventions for retinal detachment or tear?
1. Risk of injury 2. PC: increased IOP a. eye patch b. report pain with nausea c. no close work for 1 week d. no ↑ IOP activities