Cataracts


  1. General information
    1. Opacity of the ocular lens
    2. Incidence increases with age
    3. May be caused by changes associated with aging ("senile" cataract); may be congenital; or may develop secondary to trauma, radiation, infection, certain drugs (corticosteroids)
  2. Assessment findings
    1. Blurred vision
    2. Progressive decrease in vision
    3. Glare in bright lights
    4. Pupil may develop milky-white appearance
    5. Diagnostic test: ophthalmoscopic exam confirms presence of cataract
  3. Nursing interventions: prepare client for cataract surgery.


Cataract Surgery

  1. General information
    1. Performed when client can no longer remain independent because of reduced vision
    2. Surgery performed on one eye at a time; usually in a same-day surgery unit
    3. Local anesthesia and intravenous sedation usually used
    4. Types
      1. Extracapsular extraction: lens capsule is excised and the lens is expressed; posterior capsule is left in place (may be used to support new artificial lens implant).
      2. Phacoemulsification: a type of extracapsular extraction; a hollow needle capable of ultrasonic vibration is inserted into lens, vibrations emulsify the lens, which is then aspirated.
      3. Intracapsular extraction: lens is totally removed within its capsule, may be delivered from eye by cryoextraction (lens is frozen with a metal probe and removed).
    5. Peripheral iridectomy may be performed at the time of surgery; small hole cut in iris to prevent development of secondary glaucoma
    6. Intraocular lens implant often performed at the time of surgery.
  2. Nursing interventions: preoperative (see also Perioperative Nursing)
    1. Assess vision in the unaffected eye since the affected eye will be patched post-op.
    2. Provide pre-op teaching regarding measures to prevent increased intraocular pressure post-op.
    3. Administer medications as ordered.
      1. Topical mydriatics and cycloplegics to dilate the pupil
      2. Topical antibiotics to prevent infection
      3. Acetazolamide (Diamox) and osmotic agents (oral glycerin or IV mannitol) to decrease intraocular pressure to provide a soft eyeball for surgery
  3. Nursing interventions: postoperative
    1. Reorient the client to surroundings.
    2. Provide safety measures: elevate side rails, provide call bell, assist with ambulation when fully recovered from anesthesia.
    3. Prevent increased intraocular pressure and stress on the suture line.
      1. Elevate head of bed 30°-40°.
      2. Have client lie on back or unaffected side.
      3. Avoid having client cough, sneeze, bend over, or move head too rapidly.
      4. Treat nausea with antiemetics as ordered to prevent vomiting.
      5. Give stool softeners as ordered to prevent straining.
      6. Observe for and report signs of increased intraocular pressure: severe eye pain, restlessness, increased pulse.
    4. Protect eye from injury.
      1. Dressings are usually removed the day after surgery.
      2. Eyeglasses or eye shield used during the day.
      3. Always use eye shield during the night.
    5. Administer medications as ordered.
      1. Topical mydriatics and cycloplegics to decrease spasm of ciliary body and relieve pain
      2. Topical antibiotics and corticosteroids
      3. Mild analgesics as needed
    6. Provide client teaching and discharge planning concerning
      1. Technique of eyedrop administration
      2. Use of eye shield at night
      3. No bending, stooping, or lifting
      4. Report signs or symptoms of complications immediately to physician: severe eye pain, decreased vision, excessive drainage, swelling of eyelid.
      5. Cataract glasses/contact lenses
        1. if a lens implant has not been performed, the client will need glasses or contact lenses.
        2. temporary glasses are worn for 1-4 weeks, then permanent glasses fitted.
        3. cataract glasses magnify objects by 1/3 and distort peripheral vision; have client practice manual coordination with assistance until new spatial relationships become familiar; have client practice walking, using stairs, reaching for articles.
        4. contact lenses cause less distortion of vision; prescribed at one month.

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