- continuous with skin, cover eyeball d.

) Lacrimal sac​
Sensory system - organ or part and keeps it lubricates and protects e.) Nasolacrimal duct
receiving and perceiving stimuli from debris through blinking f.) Tears
- Compose of LIPOID,
Cranial Nerves AQUEOUS, AND MUCOID
1.​ Ilong smell > Extraocular muscles (LAM) layer
2.​ Basa sight - 6 muscles: abduct, adduct, elevate - any defect of tear layer
3.​ Taas eye up or depress affect cornea integrity
4.​ Baba eye down - 2 muscles: laterally, inferiorly, or
5.​ Bibig chewing superiorly > Eyebrow
6.​ Super gilid eye side - Eye movements - Short, coarse hair
7.​ Bibig taste - CN 3 (oculomotor), 4(Trochlear), - above eyes on superior orbital
8.​ Tenga hearing and 6(Abducens) ridges of skull
balance - shade eyes and keep sweat away
9.​ Leeeg swallow 4 rectus muscle (turns temporally)
10.​ Puso 1.​ Superior Rectus - upward >Eyelashes
11.​ Balikat shoulder head and toward nose -project at eyelids
12.​ Blee tongue 2.​ Inferior rectus - down -Blinking reflex - protect eyes from
toward nose foreign things
3.​ Lateral Rectus - toward
EYES temporal side Problem at eyelids and eyelash -
4.​ Medial Rectus - toward blepharitis
EXTERNAL STRUCTURE nose
> Eyeball / Globe LEARN: Chelation, introprion,
-sits in a protective bony structure 2 oblique muscle (turn nasally) ectropion
(ORBIT) 1.​ Inferior oblique - rotate up
and to temporal side >Palpebral fissure
> Orbit 2.​ Superior oblique - rotate - space between the open eyelids
- Protective bony structure that down and to temporal side
holds eyeball >Conjunctiva
- 4cm high, wide and deep Strabismus - problem in EOM -mucus membrane, lines anterior
- Surrounded by sinuses on 3 sides eye and inner eyelids
(ETHMOID, FRONTAL, > Lacrimal Apparatus - Barrier to external environment
MAXILLARY) - Secrete, distribute, drain tears - Nourish eye
- like 4 sided pyramid (shape) - Moisten eye surface - goblet cell - secrete lubricating
mucus
> Optic Foramen Tears pathway- lacrimal gland,
- where the optic nerve enter puncta, caniculi, lacrimal sac and a. Bulbar Conjunctiva - covers
nasolacrimal ducts sclera
Optic Neuroma - disorder of optic b. Fornix - palpebral and bulbar
nerve a.) Lacrimal Gland meet
- upper outer edge of each c. Palpebral conjunctiva - inside
> Eyelids/ Palpebrae eye surface eyelid
- Two movable, musculo-fibrous - produce tear - whitish if anemic
folds LIMBUS -
- Think elastic skin that covers b.) Lacrimal duct
striated and smooth - inner edge of eye
muscle. -tears drain thru this ducts INTERNAL STRUCTURE
- Distribute tear by blinking
- Protect eyes from irritation c.). Puncta -small holes in LAYERS OF THE EYE - SCLERA,
- Restricts amount of light entering eyelid, caniculi - ducts CHOROID, RETINA
>Sclera -Yellow spot - Vitreous - Gel like substance that
- tough outer layer which maintains - highest visual acuity gives form
shape of eyeball - maintain shape
- white of eye Nerve cell: - keep retina attached to choroid
- covered by cornea a. Rods - transmit light ray
- protect intraocular content from - dim light & peripheral & night
trauma vision Blood vessels
- thinnest at anterior and thickest at - Rhodopsin > ophthalmic artery
the back nearing optic nerve b. Cones > ophthalmic vein
- colors, central vision, bright light
Young children - bluish tinge - absent in the fovea Common among diabetic px -
Adults - dull white - red, green, blue diabetic retinopathy cause blindness
Elderly - slightly yellow (red hue in
hospital most optimal) (presbyopia) Landmarks of Retina >Aqueous Humor
Blue & violet - not identified in eye 1.Optic disk - 10-21mmHG - normal IOP
- Pink, oval, sharp margin, - glaucoma - increased IOP
> Choroid . Uvea - entrance of optic nerve to - purpose - if equal flow maintain
- middle vascular layer retina IOP
- contains extensive capillaries that - Blind spot - produce in ciliary body (ring of
provide nutrients to eye muscle)
- include ciliary body, suspensory 2. Retinal vessel - drain via Trabecular meshwork and
ligament (produce aqueous humor, - form superior and inferior Canal of Schlemm
glaucoma - problem with a. humor) arcade
& iris pathway of aqueous humor - start at
- Pupil - center of iris 3. Macula choroid > produced in ciliary body
- Iris - colored part - center for fine central, & color by beta cells > flow to sphincter> to
- general problem - uveitis vision anterior chamber which is nourished
- REMEMBER ICS > absorbed in trabecular meshwork
> canal of Schlemm
> Retina > Cornea
- innermost layer - Transparent, avascular, domelike > Iris
- compose of rods and cones - difference in curvature - - Colored part
- Macula Lutea - Center with keratoconus (nagtaliwis - produce - behind cornea, front of lens
sharpest vision ghost image) - contracts and expand in response
- change light to nerve impulses - Refract / bends light to light
- transmit to the optic nerve to - regulate pupil movement
interpret image Layers:
- Rhodopsin needs Vit A. (retinol) - a. Epithelium Melanin (absorb light) - dark eyes
lacking affects night vision b. Bowman’s membrane No melanin - Blue eyes
-retinal detachment - detach from c. Stroma
choroid d. Descemet’s membrane > Pupils
-like wet tissue e. Endothelium - colored ring of muscle fibers
-extension of optic nerve - let light into back of the eye
- changes energy of light rays to CHAMBERS - round and constrict symmetrically
nerve impulses for interpretation - 20% unequal pupil size
- problem - macular degeneration 1. Anterior cavity - sphincter pupillae muscle -
(bleeding in macula) - front of the lens controlled by sympathetic NS
-optic neuroma a. anterior chamber - cornea to iris - dilator pupillae muscle - exert pull
b. Posterior chamber - iris to lens when eye turn nasally
Fovea centralis
- within the macula, sharpest image 2. Posterior / Vitreous Cavity > Lens
when focused here.
-aids focusing and refracting light -> NUMERATOR denotes the - 3 mirror lens, 10-40x magnified,
image into retina distance in feet at which the test binoculars, beam of light
-accommodation - eye adjust to is conducted - cataracts, ulcers, infection, foreign
near or far image fragments, bleeding
- regulate accommodation of light -> DENOMINATOR the distance at - Hyphema - bleeding between iris
- protein accumulation cause which the smallest letters read on and cornea
contraction the Snellen chart should be seen - anterior chamber examines for
- change shape to focus light onto by an average normal eye. inflammation
retina -cataracts - evaluated by changing
- hold in place by Zonular Fibers - 20/200 legal blindness angle of light
- transparent, biconvex, elastic - larger denominator, poor visual -Normal- external and internal eye
- blurred - cataract acuity structures normal
-continue at gallery hahahaha
>Ciliary Body >Extraocular Movement
- maintain IOP by secreting aqueous - test muscle function (CN 3,4,6) >Visual Field test
humor - check gaps in peripheral vision
-controlling lens shape 6 cardinal position of gaze:
- Suspensory Ligaments - hold lens 1.​ Client’s right (lateral position) a. Confrontational
in place, assist in focusing lens 2.​ Up & right (temporal pos.) - peripheral vision
3.​ Down & right - cover eye, examiner moves an
> Schlemm’s Canal 4.​ Client’s left (lateral position) object along a horizontal plane into
- drainage of aqueous humor 5.​ Up & left (temporal pos.) central view from peripheral points
6.​ Down & left about one-half the distance between
> Optic Nerve (CN II) them.
- transmit / Receive impulses > Ophthalmoscopy
- connect eye and brain - examine fundus (retina) of eye b. Amsler Grid Test
- macular degeneration (problem at
Optic disk a . Direct fovea, loss of vision at center of
-blind spot (center) - hand held instrument (no visual field)
-no rods or cones lesions) - eye tested separately
-entry for artery that supplies retina - w/o eyedrops - geometric grid - grid should be
- dark room, steady w/o blinking viewed by the patient wearing
Emmetropia - normal - 3-5 min. normal reading glasses.
Myopia - Nearsighted - abnormal - square faded or wavy
Hyperopia - Farsighted b. Indirect lines
Astigmatism - irregular Vision - Complete view of retina
- larger areas of retina use bright c. Perimetry
ASSESSMENT AT ALL AGES: see & intense light - peripheral visual field
PPT (unmagnified) - measure boundary of field of vision
- eye dilated, dark room - 90° normal
CBQ - elderly not see blue or purple - shine light - client press button every time light
- ask to look in diff direction & flash
Presbyopia apply pressure
Opacity of lens - cataract - 5-10 min. d. Bjerrum Tangent screen
Smaller size pupil - senal miosis -should see orange since red ang - central field of vision
Astigmatism - curvature of cornea retina and yellow light and - use black screen w/ concentric
free of lesions circle
VISION TESTING (Non Invasive) - 3-6 ft client signal where she can
> Snellen test / Chart > Slit lamp Biomicroscopy see mark point
- Visual Acuity - asses anterior portion
- 20/20 normal - diagnose astigmatism > Color Vision Test
- Distinguish solar
- suspected retinal or optic nerve - irregularities of corneal surface not 1-2%)
disease, Color Blindness easily detected - burning sensation after 1hr.
- view through blue filter, blink after anesthesia is wearing off (normal)
a. Ishihara plate dye is applied, contact lenses - soothing or something in eye after
- circle/dots with colors remove 4-5 days (normal)
-morphoishihara - may shape lol - bright green areas non-intact - Pressure & sharp pain = bleeding
corneal epithelium = report to surgeon asap
> Ultrasonography
- probe place in eye > Radioisotopic Scanning > Parasympathomimetic drugs
- Identify orbital tumor, retinal - use to locate tumors - effect like stimulation of
detachment, change in tissue - differentiate an intraocular tumor parasympathetic nerve
composition. from a hemorrhage, - as mitioc - contract/constrict pupils
- control IOP (widen filtration outflow
> Color Fundus photography EYE SPECIALIST humor)
- document fine detail of fundus for >Optometrist
study and future comparison - licensed non medical a. Group I (cholinergic drugs)
- measure refractive error & eye - on myoneural junction
> Tonometry muscle disturbance - strong contraction of iris & ciliary
- Indirect measure of IOP - does not treat or diagnose body
- 10-21 mmHg normal - Pilocarpine HCl (0.5-10%)
- Increase Glaucoma > Optician
- anesthesia, avoid rubbing eye, - Prepares and grinds lenses on b, Group II (cholinesterase
potential scratching of cornea frame and adjust inhibitors)

> Computed tomography > Ophthalmologist (MD) > Parasympatholytic drugs

- scan skull (x-ray) - specializes in dx & tx of defects (anticholinergic drugs)
- computer image cross-sectional and disease - effects like the interruption of the
- perform surgery and prescribe parasympathetic nerve
>Retinoscopy glasses - Eye exam & refraction
> Cover Uncover test - relax iris & ciliary body
- both for refractive error > Orthoptist - Mydriasis (dilate)
- medical technician who assists the
VISION TEST (Invasive) oculist in the examination and care - Mydriatics
> Fluorescent angiography of clients with disorders of ocular (Neo-Synephrine 2.5 + 10%;
- imaging & recording of ocular movements Euphthalmine 2-5%)
circulation (w/ dye)
- ask for allergies OPHTHALMIC SYMBOLS - Cycloplegics
- Mydriatic medication 1hr before OD (oculus dexter) - Right eye, RE (atropine sulfate- 0.5%;
- dye injected in arm OS (oculus sinister) - Left eye, LE Hyoscine-0.25%; homatropine
- rest, more fluid, yellow skin will OU (oculus uterque) - Both eyes hydrobromide – 2- 5%; cyclogyl-
disappear EOM - Extra ocular muscle 1.0-2%; Hydriacyl – 0.5+1%)
- urine bright green as dye excreted Gtts(s) - gutta, guttae, drops
- avoid direct sunlight IOP - Intraocular pressure > Sympathomimetic drugs
- photophobia normal and back to (adrenergic drugs)
normal MEDICATION - mydriasis and vasoconstriction
> Local Anesthetic (increase outflow of humor)
> Gonioscopy - prevent eye pain during ocular - not cause cycloplegia
- Visual angle of anterior chamber procedures - reduce IOP
- congenital & secondary glaucoma - Topical anesthetic - adrenaline (1:100);
(Pontocaine,0.5%) - neosynephrine- 1.125-10%
> Corneal Staining - Injectable local anesthetic
- topical dye to conjunctiva (Novocaine, 1-2%); Xylocaine, > Antibiotic
- chloromycetin; neosporin; - allow to pull their own char
polymyxin B sulfate; bacitracin - Let client take your arm when NURSING MANAGEMENTS
walking (client 1 step behind) > Installation of eyedrop
> Adrenal Corticosteroids - enter the conjunctival sac by
- nonpyrogenic inflammation capillary attraction
and allergy EYE SURGERY - Excess can be wiped off
- cortisone acetate; prednisone Preop - close eyes, do not not squeeze
- orient client to staff and for even distribution
Miotic - Constriction / Little pupils environment if both eyes are - tilt head backward
Mydriatic - Dilation/ Big pupils covered after surgery - admin on lower culdesac
- if child, practice covering eyes
>Carbonic anhydrase inhibitors (decrease fear & restlessness) >Ointment
- production of aqueous humor - explain procedure and expected - from inner canthus outward to
- for glaucoma and reduce IOP outcomes. prevent contamination of the
-Oratrol, Diamox - Lie on unoperated side lacrimal duct.
- avoid constipation - from tip of tube w/o contact with
VISUAL IMPAIRMENTS - avoid Coughing & Vomiting (admin lid
> Legally blind - 20/200 or less antiemetic) - hold in hand for several minutes
> Blind - loss ability to see - wash hair, neck hyperextend to warm
- pull eyelid down and 1cm in
>Blindness Postop pocket formed
a. Congenital - in born - Prevent increase IOP - cleanest to dirtiest
b. Acquired - during infancy, - stress on suture
childhood, teen, adult or aging - hyphema >Eye patch
process - infection - cataract or any surgery
-pain - close eyes
>Partially Sighted - supine or lie on unaffected side - secure 2 strips of tapes
- Visual acuity 20/70-20/200 - burning sensation means - never apply pressure
anesthesia is wearing off (1 hour - never change eye patch w/o
>impairment invision postop, normal) physician’s order
- VA 20/70 require special services - eye patch and eye shield 5-7 days a. Aluminum shield
- eye shield at night 4wks b. Stiff paper cup shield
IMPLEMENTATION/PLAN - “something in the eye” 4 to 5 days
Goal: help client lead normal life as normal due to suture >Glasses
much as possible -pressure within the eye and sharp - Attractive frames
pain = bleeding, report asap! - proper fitting
- Do not shout, Use normal tone of - Admin Miotic - change as recommend to keep up
voice • Carbotic (Carbachol) with shifts in visual acuity
- avoid phrases “see what I mean” • Humorsol (Demecarium
- Introduce self every contact Bromide) >Cold compress
- explain every activity you do • Floropryl (Isoflurophate) - bleeding & edema
- announce everytime you leave • Isopto Carpine (Pilocarpine)
>Warm compress
> Guideline to facilitate Increase IOP prevention by - 46-49C
independence: providing:
- Place clothing in specific location 1.​ Valsalva Maneuver > Eye irrigation
in drawer 2.​ Excess fluid - remove secretion & cleanse preop
- Place food & utensil in specific 3.​ Avoid Anger - NSS - soothing less pain
places 4.​ Avoid Heavy lift (over 5lb) or
- encourage use of cane walking bending >Contact Lenses
- clock placement for food 5.​ Rubbing eyes a.sclera
description 6.​ Avoid Coughing & Vomiting
- over cornea and conjunctiva, >EYELID DISORDER - pain or drainage – bleeding –
sclera report
- pathological conditions a.Blepharitis - teach clean suture line (clean to
- Inflammation of eyelid dirty/inward to out)
b. Corneal margin/edges - antibiotic ointment
- Fit anterior cornea - eyelash fall out
- older adult w/ dry eye syndrome
VISUAL IMPAIRMENT AID - Chronic Bilateral Eyedrops - cul de sac, press to
>Cane - Staphylococcal blepharitis avoid it entering the system
- orientation & mobility - Base of hair follicle Eye ointment - inner to outer
- explore by touching immediate - Seborrheic production canthus
environment
- white & red tip 1. seborrheic type c.Ectropion
- held in dominant hand several 2. Staphylococcal Blepharitis ( - eyelid turned out/sagging
inches off the floor require antibiotic ointment and lid - often occur with aging, spasm or
hygiene clean and free from relaxation
> Guide Dog or Seeing eye dog exudates)
- assist orientation or mobility Cause
- client able to explore by touching Ss/sx - relaxation od orbicular muscle –>
immediate environment - itchy red eye reduce washing of tear –>
- burning eyes corneal drying and irritation
>Braille - seborrhea - often present
- raised dots to read by finger - scaly scabs Ss/sx
- Braille cell – unit of space for - pain & swelling of eyelid margin
braille symbol Mx - purulent drainage
- full braille cell – 6 raised dots -Warm moist compress - beady, small swollen areas on the
arranged in two parallel rows - gentle scrubbing w/ baby shampoo conjunctival side of eyelid
having 3 dot - avoid rubbing
- hand washing / proper hand Mx
Mydriasis – dilate pupils hygiene - eye patch , surgery
Cyclophegia – relax ciliary muscle - same with entropion

Mydriatics & Cyclopedics b.Entropion d.Hordeolum /external stye

- contraindicated for glaucoma, - eyelid turned in - infection of Zeis gland in follicle of
causes increase IOP - eyelash rub in eye lash
- disorder in EOM - postular infection of eyelash follicle
Open mouth - when sneezing & in eyelid margin
coughing Cause:
- Eyelid muscle spasm -> scarring Cause:
EYE DISORDERS and deformity due to trauma - Staphylococcus aureus
Risk: - S. Epidermidis
- Aging process - due to decrease Ss/sx - Streptococcus
of protein in eye - pain & tears
- Congenital - corneal abrasion 1.external
- DM - diabteic retinopathy - eyelid turn inward -infection of sweat gland in eyelid at
- Hereditary - red conjunctiva where eyelashes exit from the
- Trauma - ex. Retinal detachment eyelid
Mx
> EOM DISORDER - surgery & cover w/ eyepatch 2. internal
a. Strabismus/ tropia/ hypertropia / (5-7days) - infection of the eyelid sebaceous
squint eyes/ - demo eyedrop admin glands
- leave patch in place
Mx Ss/sx
- warm compress qid (3-4 a day - Photophobia 3. Allergic conjunctivitis
10-15 mins) - Burning & eye itching - part of allergic rhinitis
- antibiotic ointment (with incision - Corneal reflex dulled or distorted
and drainage PRN) - pain when moving eyelids S/Sx:
- remove ointment (blurred vision) - extreme pruritus, epiphora
before driving or machinery Mx (excessive secretion of tears),
- Incision and drainage if not - Restasis – cyclosporine injection, and usually severe
improve after 48hrs ophthalmic emulsion photophobia
(increase tears
e.Chalazion production) 4. Toxic Conjunctivitis
- Infection of Meibomian -artificial tear - meds, chlorine, toxic fumes, other
gland/sebaceous gland -lubricating ointment - night use irritants
-PAINLESS, SLOW GROWING, - surgery - common
NON TENDER ROUND MASS - Punctal occlusion – plugs puncta
GROWING (silicon) Ss/sx
- single or multiple granuloma - Lateral tarsorrhaphy – unite eyelid - itching
-internal stye edges -discharge due to accumulation of
- Graftings bacteria
- photophobia
Ss/sx - scratching & burning sensation
- redness
- tenderness, CONJUNCTIVAL DISORDER Bacterial:
- gradual painless non tender mass - blood vessel dilation
in eyelid >Hemorrhage - mild conjunctival edema
- absence of inflammation (fully - breakage of conjunctive blood - watery tears to thicker discharge
developed stage) vessel with shreds of mucus
- resolve 14 day w/o treatment
Mx General symptoms:
-Warm compress for 15 min. qid Cause: - foreign body sensation
(3-4x a day 10-15min) - HTN, trauma, blood clotting - scratching or burning sensation,
- ophthalmic ointment problems itching, and photophobia.
- surgical excision - sneezing, cough, vomiting - may be unilateral or bilateral
- Corticosteroid injection
>Conjunctivitis Asses/ 4 clinical features:
> Keratoconjunctivitis Sicca - inflammation of conjunctiva 1. discharge (watery, mucoid,
- dry eye syndrome purulent, or mucopurulent))
- deficiency in any of LAM Cause: 2. Type of conjunctival reaction
- change in tear composition - allergy (follicular or papillary
- lacrimal gland malfunction - infection 3. Presence of pseudomembranes
-altered tear distribution - trauma or true membranes
4. Presence or absence of
Cause: 1. Bacterial or Viral lymphadenopathy (enlargement of
- Drug (antihistamine, - pink eye the preauricular and
beta-adrenergic blocking agent, - extremely contagious submandibular lymph nodes
anticholinergic drugs) - S. aureus, H. influenza, P. where the eyelids drain)
- disease (RA, MS, Leukemia, aeruginosa
Sarcoidosis) Mx
-radiation or chemical burn in eyes 2. Chlamydial Conjunctivitis - hand hygiene (primary)
- injury of CN 7 - rare in children - antibiotic or antiviral
- Vision-enhancing surgery - if child is diagnose -> assess for - eyedrop
possible sexual abuse - Cool compress (for irritation)
- dark glasses (for photophobia) -> Iridocyclitis - inflammation of
- avoid rubbing (give eyeshield) affect iris & ciliary body - MI9NI ASSYMENTRICadial
- DC contact lenses (prevent -> choroiditis – inflammation choroid keratotomy - makes a spoke-like
contamination or re infect) -> chorioretinitis – inflammation pattern of incisions into the cornea
- make-up wash or discarded & choroid & retina to modify its shape
replaced or temporary stop
Types: -corneal transplantation
> Trachoma -Granulomatous (Keratoplasty) - usually from
- chronic infectious disease of -Non granulomatous cadaver within 2-4 hrs after death
conjunctiva & cornea and still viable until 12
- chief cause preventable blindness Cause (refrigerated) and 48 hrs (sterile
in the world - Systemic or local due to injury with gauze with NSS)
-chronic, bilateral scarring - idiopathic
Cause: Chlamydia trachomatis - LASIK (Laser Assisted in situ
Incubation (point where it is highly Ss/sx Keratomileusis )
transmissible) : 5-14 days - pain in eyeball radiating to
forehead and temple The LASIK surgery is performed by
ss/sx - pain an ophthalmologist who uses a
- edema of eyelid - photophobia laser or microkeratome to reshape
- photophobia - blurred vision the eye's cornea in order to
- Itching -lacrimation improve visual acuity
- follicle for on upper eyelid of -redness of eye
conjunctiva -conjunctival injection around > KERATITIS
-Eyelid scarring eyelid turn inward cornea -inflammation of cornea
- acanthamoeba
Dx Mx - Protozoal infection
- Culture and sensitivity - dark glasses - mod to intense pain
- mydriatics (cyclopentolate/
Mx cyclogyl & atropine) Ss/sx
-SET - sulfonamides, - Pain
erythromycins, tetracycline - Reduced vision
- Oral or topical tetracycline CORNEAL DISORDER -Photophobia
(Achromycin, Apo-Tetra) for 4 - Eye discharges (cloudy or purulent
weeks > KERATOCONUS with pus)
- Sulfonamides - degeneration of the cornea - Hazy or cloudy cornea
- Erythromycin ü Azithromycin - autosomal recessive trait - Altered corneal light reflex
(Zithromax) – once per week for 1 - Down syndrome; aniridia, Marfan - fluorescein stain: green and patchy
to 3 weeks syndrome cornea
- hand wash before & after touching - thin and conical shape of cornea
eyes Dx
- keep washcloth, wipe once,launder Ss/sx - No definitive test
separate - Monocular Polyopia (classic - Culture and corneal scrapings
- Stress the importance of symptom)
completing Abs. - ghost image -> multiple ghost Mx
images - Aimed at reducing sx/s, restoring
>Uveitis corneal clarity, and enhancing
- inflammation of uveal tract (affect Mx ability to use the remaining vision.
iris, ciliary body, and Choroid) - surgery - antibiotics, antifungal, and antiviral
- uveal tract (ICC -> iris, ciliary body, - contact lenses, scleral lenses (eye drops/IV/subconjunctivally)
choroid) - Keraflex (Microwas thermoplasty) - Teach to use sunglasses and
-> iritis – inflam of iris collagen fibers to shrink, hence indirect lighting
producing a corneal flattening
- Inform about magnifiers and - cycloplegic eye drops - to relax
special light fixtures. 2. Exotropia ciliary body
- Removal of diseased tissue and - outward/ divergent - eye rest
replacing with tissue from a - eye patch
human donor 3. Hypertropia (sunrise eyes) - restrict tv & reading
- upward
> Keratitis ( exposure) > Cataract
- Ectropion/entropion 4. Hypotropia (sunset eyes) - opacity of crystalline lens
- Exophthalmos - turn down (chemical changes in protein due
- neurologic deficits to age)
Mx - capsule interferes w/ transparency
> Corneal ulcers - tenotomy, resection, and tucking - distorts the image projected
- mechanical/chemical injury; (compression of sclera) - progress to blindness
- drying or infection - corrective lenses/ glasses - Aging
- Occlusion therapy - patch good
eye to train bad eye Cause
EOM - botulinum toxin (Botox) injection – - aging (1st/ common) – opacity of
temporary paralysis , strengthens lenses -> chemical changes in
>Strabismus/ squint eye/tropia/ paralyzed muscle. -> wears off protein of lens
heterotropia after 2 mos. - accomodation – refraction of lens
- not focusing both eyes on 1 thing - secondary cataracts – eye or
- lack of muscle coordination/ systemic disease
paralysis >Amblyopia / Lazy eyes - radiation or UV light exposure
- infection - diminished eye vision - radiation
- deviation of muscle from brain Types : - eye disease
tumor - Deprivation occlusion - hereditary
- normal for young - Strabismus - injury
- Refractive
a. Paralytic/ nonconcomitant - Organic amblyopia PREDISPOSING FACTORS
- weakness & paralysis of 1 or more - recent/past trauma
EOM Cause - use of corticosteroids,
- nearly for all adults - Visual deprivation (cataracts) chlorpromazine, or miotic
Causes: CVA, tumor/inflammation of - Abnormal binocular interactions drugs
CNS,birth injuries/congenital (,strabismus, anisometropia)
Ss/sx
b. Nonparalytic/ concomitant Mx - Progressively worsening blurred
- no primary muscle impairment - treat before 6y.o to avoid vision
- accommodative or suppression phenomenon - cloudy lens
nonaccommodative - treat underlying cause - no pain or redness
- glasses for misalignment and - starburst at night
Ss/sx focusing
- loss of binocular vision Early: Blurred vision
- permanent if vision of not treated >Hyphema Decreased color perception
early - blood in anterior chamber
- impairment of depth perception - from injury Late: Diplopia
- headaches squints or tilts head to - resolve in 5-7days Visual acuity leading to blindness
seaa Absence of red reflex
- amblyopia (diminished eye vision) Mx Presence of white pupil
- semi fowler’s position
EYE DEVIATION: - avoid sudden eye movement for Others: Photophobia; poor night
1. Esotropia 3-5days vision
- eye turn inwards / convergents
a. Senile cataracts (primary) - cataract lifted with small cooled - genetic factor
- common 45 y.o. probe below zero to wet surface of - female
- unilateral cataract - cigarette smoking
- aging - preceded by an iridectomy create
flow of aqueous humor Types:
b. congenital cataracts 1. atrophic nonexudative or “dry”
- at birth d. Phacoemulsification - degrees of atrophy and
- german measles - needle probe vibrate 40k times to degeneration
break lens and flush/suction of the outer retina
c. traumatic cataracts/secondary - Bruch membrane,and the
- from injury, dm, light exposure e. Enzymatic Zonumolysis choriocapillaris
- injecting alpha-chymotrypsin - no leakage of blood or serum.
Dx - frees attachment of lens capsule -> - blockage
- ophthalmoscopy (fundus) remove w/o tearing lens
- slit-lamp examination (anterior 2. Exudative or “wet” form
chamber) – milky white color of f. Intraocular lens - formation of a choroidal membrane
pupil - implantation of synthetic lens (with weaker walls) that separates
designed for a distance visio the pigmented epithelium from the
Mx neural retina; growth of blood
- surgery (satisfactory Tx) Surgery vessels make it prone to leakage
- remove eye lens (1 eye at a time) - explain outpatient basis
- len implantation/replacements - explain admin of pre-op meds Ss/sx
- all give mydriasis mydriatics - Macular drusen (pale yellow spot)
- aphakia - (absence of lens) is very - semi fowler on non operative side in nonexudative
farsighted (hyperopic) so give post op to avoid edema on site - loss of central vision
aphakic glasses. - importance of eyepatch / shield - scotoma
- ABC common - report severe pain (admin - blurred vision
analgesic & atropine eyedrop)
a. Extracapsular Cataract Extraction - patch will be change by surgeon Mx
(ECCE) - avoid rubbing, straining, pressure - large print books and public
- opening is made in the capsule of eye, lifting, coughing, sneezing transpo and referral to orgs that
and the lens w/o membrane - steroid or antibiotic -> caution px provide wide range of adaptive
disruption or removing lens sensitivity to bright environment
- lens capsule is excised and the - avoid constipation – valsalva
lens is expressed by pressure in increase IOP -Argon laser photocoagulation –
the eye from below w/ metal - used in treating the
spoon neovascularization that occurs in
- may be w/ Phacoemulsion - the Excision of chalazion – incision & exudative form
lens is broken up by ultrasonic curettage of meibomian gland
vibrations & extracted - Photodynamic therapy – a
Canthotomy – incision of canthus nonthermal process used to halt
b. Intracapsular Cataract Extraction neovascularization in exudative
(ICCE) > Macular Degeneration form.
- LENS is removed within its -loss of central vision
capsule -destructive changes of the macular >GLAUCOMA
- small incision in capsule or yellow pigmented area - Group or disorder w/ increase IOP
- greater risk for retinal detachment surrounding the central fovea. -> optic nerve damage
& loss of supportive structure of - idiopathic - associated with progressive loss of
IOL implant. peripheral vision.
Risk:
c. Cryoextraction - old age Cause
- white race
- obstruction of circulation of - avoid ABC (atropine benadryl SURGERY – improve drainage, less
aqueous humor to meshworks at cogentin) iop
anterior chamber >Iridecleisis
- congenital 2. chronic/ wide/ open-angle - the formation of fistula between the
- trauma glaucoma anterior chamber and the
- inherited - blockage/thickening in trabecular subconjunctival space
meshwork & canal of schlemm
Risk - bilateral >Corneoscleral trephining (+Elliot’s
- familiar - insidious onset Operation)
- over 40 y.o - hereditary -small opening is made at the
- DM, HTN - common in adults junction of the cornea and sclera
leaving a permanent opening
Ss/sx Ss/sx through which aqueous humor
- Increase iop - gradual loss of peripheral vision may drain.
- narrow visual field - increase iop
- atrophy optic nerve - halo lights >Langrange’s operation
- decrease Visual acuity - mild headache (sclerotomy)
- hard focus near object in dark loss - sclera is excised combined with
1. acute/ close angle/ narrow of peripheral iridectomy
glaucoma Vision (tunnel vision) before central
- displacement of iris vision >Trabeculectomy (important)
- narrowing/blockage of anterior - frequent changes of glasses; - is excision of a rectangle of sclerae
chamber - difficulty in adjusting to darkness that includes the trabeculae sclera
- develope on one eye - misty vision; headache; pain canal and sclera spur.
- sudden behind the eyeball; nausea;
- rare vomiting; halos >Cyclodialysis- a new passage from
-asian, aging - failure to detect changes in color; the anterior chamber to the
- dilation -> mydriatic drug -> tearing suprachoroidal space. The
blockage of outflow principle of operation employing
Mx low voltage and high-frequency
Ss/sx - lifelong meds currents (cyclodiathermy or cyclo
- hereditary predisposition to the - MIOTICS (PILOCARPINE) to electrolysis) is to cause atrophy or
thickening of meshwork. construct the destruction of the ciliary process,
- blurred/loss vision pupil -> muscle of the iris away since one of their functions is the
- iop increase from the canal of schlemm to retraction of aqueous humor.
- severe eye pain permit aqueous humor to drain
- abdominal pain out. In morning (decrease visual Non-surgical and LASER
- dilated large pupils acuity in daylight) - approx 50-100 beams are applied
- cloudy eye - wear a Medic-Alert bracelet. to the pigmented band of the
- headache unilateral - to avoid anticholinergic tubular meshwork resulting in
- photophobia medications. permanent increase in tension on
- nausea; vomiting; - Acetazolamide (Diamox) to reduce the trabeculae and opening of the
- rainbow halo in light. formation of outflow channel.
aqueous humor
Mx • Avoid fatigue or stress 3. Secondary glaucoma
- miotics, • Avoid drinking large quantities of - from trauma, eye disease, tumor,
- osmotic agents - glycerol - reduce fluid. dm, or meds (steroid containing)
IOP • Certain limitations are not
- emergency necessary. May drink normal 4. Normal tension
- admin med lower iop amounts of coffee and tea - result in damage to optic nerve
- elevate head in 30 degree angle (1-2cups) and alcoholic beverages - early detect n Dx
- maintain rest in quiet dark room
- combination of laser therapy, drug - Topical epinephrine, which also weight loss, electrolyte imbalance,
therapy and surgery may be used increases the outflow. depression,
to deter its progression. impotence
- Topical beta blockers
5.Pigmentary (levobunolol), >Sympathomimetics - Dipivefrin (
- some of the pigmentary granules drug of 1st choice for lowering IOP) Propine)
in the back of the iris separate or alpha adrenergics
from the iris and move into the (brimonidine), which suppress the > Cholinergics:
eye's drainage system. secretion of aqueous humor. Pilocarpine/Carbachol
- clog -> increase IOP action: increases outflow of aqueous
- Treatment may include laser - Topical or oral carbonic humor
therapy, drug therapy or surgery anhydrase inhibitors which also side effects: pain, blurry vision,
reduce the production of aqueous diminished
6. Congenital humor. vision at dark
- rare condition associated with
congenital malformation & genetic - Prostaglandin F2 > Adrenergics:
anomalies at lower concentrations, increases Epinephrine/Dipivefrin
the outflow of aqueous humor action: decreases production of
DX aqueous
>Tonometry - Dietary restrictions: sodium and humor
measurement of intraocular fluid side effects: tremors, headache,
pressure; reveals IOP - Activity as tolerated redness and
- Monitoring V/S and I/O itching
> Visual field test: - Avoid drugs such as atropine,
used to determine the extent of anticholinergics, or others with SURGERY
peripheral vision loss (see the pupil dilating effects >Laser Trabeculoplasty (main)
section on visual fields); - Uses laser to create an opening in
decreased field of vision Increase Drainage of Aqueous the trabecular meshwork -> scars
Humor in the trabecular meshwork fibers.
> Gonioscopy > Miotics - Pilocarpine hydrochloride
-performed to determine the depth (Isopto Carpine) - The tightened fibers allow
of the anterior chamber and to > Osmotic Diuretics - Glycerin increased outflow of aqueous.
examine the entire circumference Mannitol ( Osmitrol )
of the angle for any abnormal > Prostaglandin Agonists - > Ciliodestructive Procedures
change in the filtering meshwork; Latanoprost (Xalatan) - Uses laser to create an opening in
occluded anterior chamber angle the trabecular meshwork. -> scars
(angle-closure glaucoma) Decrease Production of Aqueous in the trabecular meshwork fibers.
Humor
> ophthalmic visualization > Beta Blockers - Timolol maleate - The tightened fibers allow
- shows atrophy (pale color) and (Timoptic) increased outflow of aqueous.
cupping (indentation) of the optic action: decreases production of
nerve head; edema of the optic aqueous humor >Filtering Procedures
disc (acute attack) or excavation side effects: bradycardia, - Operative procedures such as
(chronic episodes hypotension trephination, thermal sclerostomy,
contraindication: asthma, heart or sclerectomy create an outflow
Mx block, COPD channel from the anterior chamber
GOAL: facilitate the outflow of to the subconjunctival space.
aqueous through remaining >CAIs - Acetazolamide (Diamox)
channels. action: decreases production of > Laser peripheral iridectomy or
- Miotics, which constricts the pupil aqueous humor iridotomy
and increases outflow. side effects: allergy (do not give if - to make an opening in the iris, in
with sulfa allergy), people w/ close-angle glaucoma
 - retina layers separate because of - Encourage DBE but avoid
DISORDER OF REFRACTION accumulation of fluid between coughing.
> Myopia them - If gas has been inserted, position
- Nearsightedness - both retinal layers elevate away as prescribed on the abdomen &
- Concave lens(near-cave) from the choroid due to tumor. turn the head so the unaffected
- light rays come into focus in front - Detach of 2 primitive layers of of eye is down.
of the retina melanin & cones and rods layers - limit reading for 3-5 weeks.
- dark glasses during the day & an
Cause Cause eye patch at night.
-eye ball is longer, familial trait - trauma - Encourage follow-up care
- medications (sulfonamides, - bleeding
acetazolamide, salicylates, and -exudates in front or behind retina SURGERY
steroids); >Cryosurgery
- associated w/ disorders, such as 1.Partial - Sealing retinal breaks ; a cold
influenza, typhoid fever, severe - becomes complete if left untreated probe applied to the sclera, to
dehydration, and large intakes of 2. Complete stimulate an inflammatory
antacids - when detachment is complete, response leading to adhesions.
blindness may occur
Mx > Diathermy
- correction glasses/ lenses, Ss/sx - Uses electrode needle and heat
biconcave -Flashes of light or sparks (light not through the sclera, to stimulate an
- radical keratotomy absorbed by detach melanin) inflammatory response.
- Small floaters or spots in the field
> Presbyopia of vision >Laser therapy
- Loss of elasticity of the lens - Floaters (shadow of blood n retinal - to stimulate an inflammatory
(aging) cells cast in retina) response, to seal small retinal
- degenerative changes - Painless, loss of Vision tears before the detachment
- caused by the gradual loss of - Sense of veil, curtain, or cobweb occurs.
elasticity of the lens -> decreased that eliminates part of the visual
ability to accommodate/ focus for field >Scleral buckling (common)
near vision -Loss of a portion of the visual field - to hold the choroid and retina
- the loss of accommodation together with a splint until scar
progresses gradually Mx tissue forms closing the tear
- Provide bed rest 1-2 days
> Hyperopia - Eye patches bilaterally as > Insertion of gas or silicone oil
Farsightedness prescribed to prevent further - to encourage attachment because
- Convex lens (far-vex) detachment. these agents have a specific
- image is focused posterior to - Speak to the client before gravity less than vitreous or air
(behind) the retina due to too approaching. and can float against the retina.
short anterior - Position the client’s head affected
side >Vitrectomy
>Astigmatism -flat. - remove vitreous gel that caused
- Uneven curvature of the cornea - Protect the client from injury. retinal tear
-nonuniform curvature of the - Avoid jerky head movements.
refractive medium - Minimize eye stress. TUMORS
- spread out in retina - Prepare the client for a surgical >Orbital cellulitis
- usually the result of defect in the procedure as prescribed. inflammation of the tissues
cornea & lens/retina - Prevent N&V and monitor for surrounding the eye
- toric lens correction or eye glasses restlessness which can cause
is needed hemorrhage. cause: bacterial, fungal, or viral
- sudden, sharp eye pain – report inflammatory conditions of
>RETINAL DETACHMENT asap contiguous structures, such as the
 face, oropharynx, dental structures such as optic nerve reasons, except for cases of
structures, or intracranial meningiomas. molluscum contagiosum, for which
structures. - Complete removal of the tumor surgical intervention is performed
may endanger visual function. to prevent an infectious process
Causative organisms: that may ensue.
- staphylococci and streptococci in a. Nevi
adults -may be unpigmented at birth and >BENIGN TUMORS OF
- H. influenzae in children may enlarge and darken in CONJUNCTIVA
adolescence or may never acquire - Conjunctival nevus, a congenital,
Ss/sx any pigment at all. benign neoplasm, is a flat, slightly
- Pain elevated, brown spot that
- Lid swelling b. Hemangiomas becomes pigmented during late
- Conjunctival edema - vascular capillary tumors that may childhood or adolescence.
- Decrease ocular motility be bright, superficial, - Treatment consists of surgical
strawberry-red lesions (ie, excision
Mx strawberry nevus) or bluish and
- Immediate high-dose, purplish deeper lesions. MALIGNANT EYELID
broadspectrum, a. Basal cell carcinoma
systemic antibiotics is indicated. c.Milia - most common malignant tumor of
- Cultures and Gram-stained - small, white, slightly elevated cysts the eyelid
smears are obtained. of
- Monitoring changes in visual the eyelid that may occur in b. Squamous cell carcinoma
acuity, multiples. - less frequently but is considered
- Consultation with an the second most common
otolaryngologist, especially when d.Xanthelasma malignant tumor.
rhinosinusitis is suspected. - yellowish, lipoid deposits on both
- In the event of abscess formation lids near the inner angle of the MALIGNANT ORBIT
or progressive eye that commonly appear as a >Rhabdomyosarcoma
loss of vision, surgical drainage of result of the aging of the skin or a - most common malignant primary
the abscess or lipid disorder. orbital tumor in childhood, but it
sinus is performed. can also develop in elderly people
- Sinusotomy and antibiotic e.Molluscum contagiosum - The most common site of
irrigation are also - lesions are flat, symmetric growths metastasis is the lung.
performed. along the lid margin caused by a
virus that can result in Mx (three major therapeutic
>BENIGN TUMORS OF ORBIT conjunctivitis and keratitis if debris modalities)
-infancy and grow rapidly or slowly gets into the conjunctival sac 1. surgery,
and present in later life. 2. radiation therapy,
Mx 3. adjuvant chemotherapy.
Dx - Treatment of benign congenital lid - The degree of orbital destruction is
- superficial external presentation, lesions is important in planning the surgical
palpation x-rays rarely indicated, except when visual approach.
-deep tumor CT scan for precise function is - Resection often involves removal
diagnosis. affected. of the eyeball.
- The psychological needs of the
Mx - Corticosteroid injection to the patient and family are paramount
- To prevent recurrence, excised hemangioma lesion is usually in planning the management
completely when possible. effective, but surgical excision approach
- Subtotal resection may be may be performed. -Emotional support
indicated in deep benign tumors - Verbalize feelings related to loss.
that intertwine with other orbital -Surgical excision, or electrocautery, - Monitor V/S.
is primarily performed for cosmetic
- Assess pressure patch or
dressing.
- Report changes in V/S or the
presence of bright red drainage on
the pressure patch or dressing.

>Enucleation
-removal of the entire eyeball and
part of the optic nerve

>Exenteration
- removal of the eyelids, the eye,
and various amounts of orbital
contents

>Evisceration
- surgical removal of the intraocular
contents through an incision or
opening in the cornea or sclera