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Retinal detachment

Terms in this set (21)

Overview
Partial or complete separation of the sensory retina from the underlying pigment epithelium
May be primary or secondary
Commonly occurs spontaneously
Usually involves only one eye; may occur in the other eye later
Rarely heals spontaneously; usually can be reattached successfully with surgery
Carries varying prognosis depending on the retinal area affected
Two major categories: rhegmatogenous (most common)—caused by a break or tear in the retina; nonrhegmatogenous —caused by leakage or exudates from beneath the retina (exudative) or by traction of the vitreous pulling on the retina (tractional)
Overview-Pathophysiology
Most commonly, a hole or tear in the retina allows the liquid vitreous to seep between the retinal layers (rhegmatogenous).
Tumor growth or inflammation allows subretinal fluid to accumulate and cause detachment (exudative or serous).
Adhesions between the vitreous gel and retina are exposed to mechanical forces, causing separation of the retina from the retinal pigment epithelium without any break (tractional).
Liquid separates the sensory retinal layer from its choroidal blood supply. (See Understanding retinal detachment.)
Overview-Causes
Age-related degenerative changes
Hereditary factors, usually related to myopia
Intraocular inflammation
Systemic disease
Traction placed on the retina by vitreous bands or membranes, such as diabetic retinopathy, sickle cell disease, and penetrating trauma
Trauma
Tumors (serous detachments)
Overview-Risk Factors
Myopia
Cataract surgery
Trauma
History of uncontrolled diabetes
Glaucoma
Overview-Incidence
Retinal detachment usually occurs in individuals between ages 40 and 70.
It affects males younger than age 45 more commonly than it affects females of the same age.
This disorder is more common with increased age.
Overview-Complications
Severe vision impairment
Blindness
Assessment-History
Sensation of seeing floaters and flashes
Painless vision loss, described as the sensation of looking through a veil, curtain, or cobweb (which may obscure objects in a particular area of the visual field)
Assessment-Physical Findings
Visual field loss
Visual acuity of 20/200 or worse with loss of central vision (if macula is detached)
Elevation of retina, with or without a tear
Diagnostic Test Results-Imaging
Ocular ultrasonography, used to examine the retina if the lens is opaque, shows intraocular and intraorbital pathology; it also commonly detects retinal detachments, which characteristically produc a dense, sheetlike echo on a B-mode scan.
Diagnostic Test Results-Diagnostic Procedures
Direct ophthalmoscopy shows folds or discoloration in the usually transparent retina.
Indirect ophthalmoscopy shows retinal tears.
Fundoscopic examination shows debris in the vitreous and white fibrous ring (called a Weiss ring).
Treatment-General
Varies with location and severity of detachment
Treatment-Diet
Nothing by mouth before surgery
Treatment-Activity
Bed rest before surgery
Restriction of eye movements before surgery, by patching the affected eye
Treatment-Medications
Antiemetics
Analgesics
Mydriatics
Cycloplegics
Corticosteroid eyedrops
Antibiotic eyedrops
Treatment-Surgery
Cryothermy
Laser photocoagulation or cryoretinopexy
Scleral buckling (may be followed by vitreous replacement with silicone, oil, air, or gas)
Diathermy
Pneumatic retinopexy
Vitrectomy
Nursing Considerations-Nursing Diagnoses
Anxiety
Impaired tissue integrity
Ineffective health maintenance
Risk for infection
Risk for injury
Nursing Considerations-Expected Outcomes
verbalize strategies to reduce anxiety
regain the previous level of visual functioning
regain adequate perfusion to the retina
maintain current health status
show no signs or symptoms of infection
avoid injury and complications.
Nursing Considerations-Nursing Interventions
Prepare the patient for surgery, if indicated.
Give prescribed antibiotics and cycloplegic or mydriatic eyedrops.
In macular involvement, maintain bed rest to prevent further retinal detachment.
Postoperatively, position the patient as directed.
Discourage activities that increase intraocular pressure.
With retrobulbar injection, apply a protective eye patch.
Apply cold compresses if ordered.
Avoid putting pressure on the eye.
Encourage the patient to verbalize feelings and concerns; provide encouragement and emotional support; encourage the use of positive coping strategies.
Nursing Considerations-Monitoring
Localized corneal edema and perilimbal congestion after laser therapy
Persistent pain
Vital signs
Visual acuity
Response to treatment
Nursing Considerations-Associated Nursing Procedures
Cold application
Eye ointment application
Eyedrop administration
Eye patch application
Pain management
Postoperative care
Preoperative care
Preparing a patient for ophthalmic surgery, OR
Patient Teaching-General
disorder, underlying causes, diagnosis, and treatment
possible persistence of blurred vision for several days after laser therapy
importance of avoiding driving, bending, heavy lifting, and other activities that affect intraocular pressure for several days after surgery
eye protection measures, including avoiding activities that could cause eye trauma
prescribed medications, such as a topical antibiotic as prophylaxis for 7 to 10 days and a cycloplegic agent and topical corticosteroid agent for about 1 month
proper technique for instilling eyedrops, including the rationale for use, drug name, frequency of administration, and duration of therapy
importance of wearing sunglasses and eye protection
signs and symptoms of increasing ocular pressure and infection
signs and symptoms of retinal detachment, including a new onset of floaters or flashes, an increase in floaters or flashes, the appearance of a curtain or shadow in the peripheral visual field, or decreased vision, and the need to notify the practitioner immediately if they occur
need to minimize eye movement for about 2 weeks after laser photocoagulation or cryoretinopexy
importance of adhering to follow-up care, including re-examination in 3 to 4 weeks.
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