Cataract

A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope (lens capsule), varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract, the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colors. Cataracts typically progress slowly to cause vision loss, and are potentially blinding if untreated. The condition usually affects both eyes, but almost always one eye is affected earlier than the other. A senile cataract, occurring in the elderly, is characterized by an initial opacity in the lens, subsequent swelling of the lens and final shrinkage with complete loss of transparency.[2] Moreover, with time the cataract cortex liquefies to form a milky white fluid in a Morgagnian cataract, which can cause severe inflammation if the lens capsule ruptures and leaks. Untreated, the cataract can cause phacomorphic glaucoma. Very advanced cataracts with weak zonules are liable to dislocation anteriorly or posteriorly. Such spontaneous posterior dislocations (akin to the historical surgical procedure ofcouching) in ancient times were regarded as a blessing from the heavens, because some perception of light was restored in the cataractous patients.

Signs and Symptoms

Adult cataracts develop slowly and painlessly. Vision in the affected eye or eyes slowly gets worse.

Mild clouding of the lens often occurs after age 60, but it may not cause any vision problems. By age 75, most people have cataracts that affect their vision.

Visual problems may include the following changes:

Photophobia Cloudy, fuzzy, foggy, or filmy vision Difficulty seeing at night or in dim light Double vision (monocular diplopia) Loss of color intensity Problems seeing shapes against a background or the difference between shades of colors Seeing halos around lights

Red reflex seen with direct opthalmoscope is distorted or absent

Risk Factors

to ultraviolet light

galactosemia, Lowe syndrome, Werners syndrome and Downs syndrome) From intraocular disorders (iridocyclitis, retinitis, retinal detachment and onchocerciasis) infectious mononucleosis)

to ionizing radiation, such as that used in X-rays and cancer radiation therapy

Nursing Interventions
History and PE Documentation of visual acuity Ask client to describe visual disturbances Assist client to gain or maintain as much independence as possible Evaluate clients lifestyle, abilities, and home environment Postop Care: o The eye is covered with a dressing and eye shield to protect it from injury o The patient is allowed out of bed the day following surgery o Daily change of dressing. After 7 to 10 days, all dressings are usually removed o During the first month, protect the eye with a shield at night o Administer eye drops as ordered

Medical Management
There is no known treatment other than surgery that prevents or reduces cataract formation. But some research presented that egg yolks may improve vision. Preoperative eyedrops may include a dilating agent such as tropicamide (Mydriacyl) to

facilitate surgery. A cycloplegic cyclopentolate (Cyclogyl) may be administered to paralyze ciliary muscles.

Surgical Management
Intracapsular technique. Removal of cataract within its capsule. (ICCE) Extracapsular technique. An opening is made in the capsule and the lens is lifted without disturbing the membrane. An aphakic person is very farsighted (hyperopic) (ECCE) Cryoextraction, the cataract is lifted from the eye by a small probe that has been cooled to a temperature below zero and adheres to the wet surface of the cataract. Iridectomy. Done preceeding cataract extraction to create an opening for the flow of the aqueous humor which may become blocked postop when the vitreous humor moves forward. This is to prevent secondary glaucoma. Phacoemulsion. A method of cataract removal which breaks up the lens and flushes it out in tiny pieces.

Aging Process And Health Deviation

Geriatric Variations: External eye examination reveals the following: Conjunctiva thins and becomes yellowish White ring around iris (arcus senilis) does not affect vision Dry eyes due to decreased tear production Drooping eyelids (senile ptosis) Entropion and ectropion common in the older adult Clouding of lens (cataracts) Yellowish nodules on bulbar conjunctiva (pinguecula) common Visual examination reveals the following:

Presbyopia (decreased near vision due to decreased elasticity of lens) common in clients older than 45 years Slowed pupillary response and slowed accommodation Poorer night vision and decreased tolerance to glare Visual field examination reveals the following:

Decreased peripheral vision Difficulty differentiating blues from greens Funduscopic examination reveals the following :

Pale narrowed arterioles

The lens is made of mostly water and protein. The protein is arranged in a specific way that keeps the lens clear and allows light to pass through it to focus a clear image onto the retinal surface. As we age, some of the protein may clump together and start to cloud a small area of the lens. This is our understanding of the cause of an age-related cataract. Over time, the cataract may become more dense or cloud more of the lens, making it more difficult to see through. A cataract is not a growth or tumor.

DONA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION COLLEGE OF NURSING JACINTHS 2013

WRITTEN OUTPUT (CATARACT)

SUBMITTED BY: GROUP 5 NORIEGA, YVONNE MARIAN NUEVA, NOEMI ALEXANDRA PAGBA, AISYR MON JOVI RONA, RHEO BETH SORRILLA, PATRICIA MARI

SUBMITTED TO: MRS. BERNALYN PASCUAL, RN. CLINICAL INSTRUCTOR