VISUAL NURSING BULLETS

If both an eye drop and eye ointment are scheduled to be administered at the same time, administer
the eye drop first.
Blurred vision and decreased color perception are early signs of a cataract.
Instruct the client with conjunctivitis about the importance of infection control measures such as good
handwashing and not sharing towels and washcloths.
Safety is a priority concern for the client with macular degeneration, because the client experience
blurred vision and distortion and a decline in central vision.
Instruct the client with glaucoma about the importance of adhering to the prescribed medication
regimen. Failure to do so can result in increased intraocular pressure, resulting in damage to the optic
nerve and blindness.
Following cataract surgery, instruct the client to contact the surgeon if severe eye pain occurs.
Following cataract surgery, instruct the client to wear an eye shield over the eye at night to prevent
injury to the operative site during sleep.
If both an eye drop and an eye ointment are prescribed to be administered at the same time,
administer the eye drop first.
Following cataract surgery, the head of the clients bed should be elevated 30 to 45 degrees to prevent
edema at the operative site and resultant increased intraocular pressure.
The risk for injury is a concern for the client with altered vision.
Bilateral eye patches may be prescribed for the client with retinal detachment to minimize eye stress
and prevent further detachment.
Instruct the client with glaucoma about the importance of the need for lifelong medication use.
A cataract is an opacity of the lens that distorts the image projected onto the retina and that can
progress to blindness.
Instruct the client with glaucoma about the need for lifelong medication use.
Following cataract surgery, the client needs to be instructed to avoid rubbing or placing pressure on the
eyes.
Tonometry is a test that is used primarily to assess for an increase of intraocular pressure and potential
glaucoma. Normal intraocular pressure is 10 to 21 mm Hg.
Normal intraocular pressure is 10 to 21 mm Hg; intraocular pressure varies throughout the day and is
normally higher in the morning. The health care provider should always document the time of
intraocular pressure measurement.
Trabeculectomy is a procedure that may be prescribed for the client with open-angle glaucoma. This
procedure allows drainage of aqueous humor into the conjunctival spaces by the creation of an
opening.
Long-term use of corticosteroids can result in the formation of cataracts. The nurse should assess the
client who uses corticosteroids on a long-term basis for visual changes associated with cataracts.
For the client with bilateral aphakia, in addition to wearing corrective glasses, the client can wear
contact lenses or undergo the implantation of artificial lenses known as pseudophakia.
Hyphema (bleeding into the anterior chamber of the eye) usually resolves within 5 to 7 days. The nurse
should instruct the client to rest in a semi-Fowlers position until it resolves.
Postoperatively following cataract surgery, elevate the head of the bed (semi-Fowlers to Fowlers
position) and position the client on the back or the nonoperative side to prevent the development of
edema at the operative site.
Fluorescein angiography is a test that is used for assessing problems with retinal circulation, such as
those that occur in diabetic retinopathy, retinal bleeding, and macular degeneration, or to rule out
intraocular tumors. If prescribed, the nurse should assess the client for allergies or previous reactions
to dyes.
The client with a hordeolum (sty) should avoid wearing contact lenses as well as avoid applying
makeup and lotions close to the affected area in order to prevent spreading the infection.

 A mnemonic tool may be useful in teaching the client to remember the signs of graft rejection (RSVP).
It stands for redness, swelling, decreased vision, and pain.
Enucleation is performed for the removal of ocular tumors. After the eye is removed, a ball implant is
inserted to provide a firm base for a socket prosthesis and to facilitate the best cosmetic result.
Legal blindness is defined as the best visual acuity with corrective lenses in the better eye of 20/200 or
less, or the visual field is no greater than 20 degrees in its widest diameter in the better eye.
If a chemical splash to the eye occurs, treatment should begin immediately; the client should be
transported to the medical facility immediately after the eye has been irrigated for 15 to 20 minutes.
To check the clients vision test using a Snellen chart, the procedure is done for one eye, repeated for
the other eye, and then both eyes together may be tested.
Anatomical changes in the eye affect the individuals visual ability, leading to potential problems with
activities of daily living.
Early signs of glaucoma include diminished accommodation and increased intraocular pressure.
Tonometry is a test used primarily to assess for an increase of intraocular pressure and potential.
Normal intraocular pressure is 10 to 21 mm Hg.
Restrictions in activity and positioning following repair of a detached retina depend on the physicians
preference and the surgical procedure performed; check the prescriptions following repair to determine
the necessary interventions.
It is important for the nurse to educate the client with retinal detachment regarding positioning and
measures to reduce eye movement. If detachment becomes complete, blindness can result.
Treatment for an eye contusion begins at the time of injury. Ice is applied immediately. The client then
should be seen by a physician and receive a thorough eye examination to rule out the presence of
other eye injuries.
The client who sustains an eye injury needs to be evaluated by a physician immediately.
If a chemical splash to the eye occurs, treatment (flushing the eyes) should begin immediately.
Following eye removal (enucleation), an ocular prosthesis is inserted to provide a firm base for a socket
prosthesis and to facilitate the best cosmetic result.
A cataract is an opacity of the lens that distorts the image projected onto the retina and that can
progress to blindness. Institute safety precautions for the client with cataracts.
Following cataract extraction, instruct the client to avoid rapid head movements, straining, sneezing,
coughing, bending, vomiting, or lifting objects heavier than 5 pounds; to take measures to prevent
constipation; and follow instructions for dressing changes and prescribed eye drops and medications.
To test the clients eyes using a Snellen chart, instruct the client to leave on glasses or leave in contact
lenses; if the glasses are for reading only, they are removed, because they can blur distant vision.
Increased intraocular pressure that occurs in glaucoma results from inadequate drainage of aqueous
humor from the canal of Schlemm or overproduction of aqueous humor.
Acute angle-closure glaucoma is a medical emergency that causes sudden eye pain and possible
nausea and vomiting.
Presbyopia and cataract formation are changes that commonly affect the eyes of older adults.
Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular
pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision.
Following cataract surgery, the nurse should elevate the head of the bed (semi-Fowlers to Fowlers
position) and position the client on the back or the nonoperative side to prevent the development of
edema at the operative site.
For the client with macular degeneration, initiate strategies to assist in maximizing remaining vision
and maintaining independence.
The client should be instructed to seek medical assistance if growths are noted in the region of the eye
or if the eye has redness, drainage, or changes in vision.
Contact precautions need to be instructed for the client diagnosed with conjunctivitis.

 A cataract is an opacity of the lens that distorts the image projected onto the retina and that can
progress to blindness; safety precautions should be instructed for the client with cataracts.
Instruct the client who sustained an eye injury and has a hyphema in the use of eye shields or eye
patches as prescribed. This will rest the eye and promote healing. Additionally, the client should be
instructed to restrict reading and limit watching television.
A contusion in the area of the eye can cause a black eye; the discoloration disappears in about 10
days. Pain, photophobia, edema, and diplopia may occur.
If the eye injury is the result of a penetrating object, the object may be noted protruding from the eye.
This object must never be removed except by the ophthalmologist because it may be holding ocular
structures in place.
If a chemical splash to the eye occurs, treatment should begin immediately; flush the eyes at the scene
of the injury with water for at least 15 to 20 minutes.
Following keratoplasty, report the presence of any redness, watery or purulent drainage, or edema in
the eye to the physician.
If an eye injury is the result of a penetrating object, the object may be noted protruding from the eye.
This object must never be removed except by the ophthalmologist because it may be holding ocular
structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body
and cause further tearing of the cornea.
Intraocular pressure varies throughout the day and is normally higher in the morning. Therefore it is
important to document the time of intraocular pressure measurement.
Fluorescein angiography is used in diagnosing many diseases, including macular degeneration, diabetic
retinopathy, and intraocular tumors.
Infection of the conjunctiva of the eye is known as conjunctivitis. Bacterial or viral conjunctivitis is
extremely contagious. Instruct the client in infection-control measures such as good handwashing and
not sharing personal items such as towels and wash cloths.
Diabetic retinopathy is a chronic and progressive impairment of the retinal circulation that eventually
causes hemorrhage. It leads to permanent vision changes, and blindness can occur.
To assess the six cardinal fields of gaze, the client is asked to hold the head steady, and then follow
movement of an object through the positions of gaze.
Primary open-angle glaucoma is painless, and vision changes are gradual.
Acute angle-closure glaucoma is a medical emergency that causes sudden eye pain and possible
nausea and vomiting.
Diplopia is a sign of digoxin toxicity for a client taking digoxin (Lanoxin). Other signs of toxicity include
blurred vision, yellow-green halos, photophobia, drowsiness, fatigue, and weakness.
For the client with acute angle-closure glaucoma, administer medications immediately as prescribed to
lower intraocular pressure.
Advise the client undergoing fluorescein angiography to avoid direct sunlight for a few hours after the
test and to wear sunglasses if staying inside is not possible.
Intervention for the client with macular degeneration are aimed at maximizing the remaining vision.
Covering both eyes with patches may be prescribed for the client with retinal detachment to prevent
further detachment.
A primary concern following cataract surgery is increased intraocular pressure, so activities that
naturally increase the pressure should be avoided postoperatively.
Management of glaucoma and the minimization of long-term damage to the eye is best accomplished
when the client is proactive in screening and effective with the skills needed to aid in therapy, such as
the administration of eye medication.
Cataract formation can be influenced by several different types of factors including environmental,
external, and internal events such as other diseases.
A cataract is an opacity of the lens that distorts the image projected onto the retina. It can progress to
blindness.