Introduction to Cataract:-
A cataract is opacity or cloudiness of the lens of the eye that may cause the loss of visual acuity. In the cataract color and structure of the lens is destruct and change in the milky white colors. Cataracts rank as it were behind arthritis and heart disease as a leading cause of disability in more seasoned grown-ups. Cataracts influence about 20.5 million Americans who are 40 a long time of age or more seasoned or approximately one in every six individuals in this age run. By age 80, more than half of all Americans have cataracts. Concurring to the World Health Organization, cataract is the driving cause of visual impairment within the world.
Cataract Causes and Risk factor:-
- Age:- Incidence increase After 50 years.
- Ultravoilet radiation / rays.
- Long term use of corticosteroids.
- Cigarette smoking.
- Intro ocular infection.
- Various crystals, Glucose, and any other factors accumulate on the lens.
- Resulting in the structure and color of the lens is totally changed.
- Due to the opacity of the lens, the rays are net transmit towards the retina.
- Resulting blurred vision and blindness is occur.
Types of Cataract:-
The there most common types of cataracts are defined by their location in the lens, Nuclear, Cortical, and posterior subcapsular.
- Nuclear Cataract:- A nuclear cataract tends to have a substantial genetic component that causes a central opacity in the lens. It is associated with myopia (nearsightedness).
- Cortical Cataract:- It involves the anterior Posterior or equatorial cortex of the lens. Vision is worse in very bright light. Sunlight exposure is a risk factor in cortical cataract formation.
- Posterior subcapsular cataract:- It occurs in front of the posterior capsule. It typically develops in younger people and is associated with prolonged corticosteroid, Use, diabetes, or ocular trauma. Near vision is diminished and the eye is increasingly sensitive to glare from bright light.
Cataract Clinical Feature:-
- Cataract is painless.
- Difficulty in vision in the bright light.
- Sensitivity to glare.
- Reduce visual acuity.
- Blurred vision.
- Double vision (Diplopia).
- Decrease colours vision.
- Light scattering.
Cataract Diagnostic Evaluation:-
- Snellen Visual Acuity test.
- Slit-lamp biomicroscopic examination.
Cataract Surgical Management:-
Surgery is definitive treatment for cataract. Two type of surgeries:-
1.Extra Capsular Cataract Extraction:-
It consist of removing of lens and the anterior portion of lens capsule manually. The posterior capsule is left nitact to support the intraocular lens (IOL).
In this method of extracapsular cataract surgery, a portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex while the posterior capsule is left intact to support an intraocular lens. An ultrasound device is used to liquefy the nucleus and cortex, which are then suctioned out through a tube.
Implantation of Intraocular Lens:-
After removing the cataract an Intraocular lens is usually implanted into the eye either through a small incision using a foldable intraocular lens. The lens implanted is inserted through the incision into the capsular back.
2.Intracapsular Cataract Extraction:-
An ICCE Instrument is used to remove the entire lens and capsule manually. From the late 1800s until the 1970s, the procedure of choice for cataract extraction was intracapsular cataract extraction (ICCE). The whole lens (ie, nucleus, cortex, and capsule) is evacuated, and fine sutures close the incision. ICCE is infrequently performed nowadays; however, it is indicated when there’s a need to remove the complete focal point, such as with a subluxated cataract (ie, partially or completely dislocated lens).
Nursing Management For Cataract:-
Assess the patient’s distance and close visual acuity. In the event that the patient is planning to have surgery, particularly note the visual acuity in the patient’s unoperated eye. Utilize this data to determine how visually compromised the patient may be while the operative eye is healing. In addition, evaluate the psychosocial impact of the patient’s visual disability and the level of knowledge regarding the disease process and therapeutic options. Postoperatively, assess the patient’s level of comfort and capacity to follow the postoperative regimen.
Pre operative Nursing Care for Cataract:-
- History taking and physical examination.
- Monitor and record the vital sign of the patient.
- Explain the surgery to the patient and his family members and relatives.
- Instruct the patient not to have food for approximately 6-8 hours.
- Instillate the eye drops 2-3 times in a day for any inflammation.
- Prepare the client psychologically and physically for the surgery.
- Take the written concern from the client or family members.
- If the Intraocular pressure is increased then immediately administered the mannitol to normalize the Intraocular pressure.
Post Operative Care for Cataract:-
- Closely observe the client for an anesthetic effect.
- Elevate the head side up to 30-45 to prevent the increased intraocular pressure and intracranial pressure.
- Keep the sterile dressing under doctor’s orders.
- Avoid any work and provide the proper rest to the client.
- Maintain the intake and output.
- Finally when the dressing is removed then place the eye patches on the affected eye for several hours.
- Encourage the patient to wear eyeglasses during the day after surgery or to prevent exposure to bright light.
- Encourage the patient to wear an eye shield at night to protect the operated eye.
- Avoid lifting, pushing, or pulling objects or do heavy exercise.
- Avoid lying on the side of the affected eye.
- Keep activity light (Walking, reading, watching T.V.), etc.
Home Care For Intraocular Lens Implant:-
- Wear glasses or metal eye shields at all times following surgery as instructed by the physician.
- Always wash hands before touching or cleaning the postoperative eye.
- Clean the postoperative eye with a clean tissue; wipe the closed eye with a single gesture from the inner canthus outward.
- Bathe or shower; shampoo hair cautiously or seek assistance.
- Avoid lying on the side of the affected eye the night after surgery.
- Keep activity light (eg, walking, reading, watching television). Resume the following activities only as directed by the physician: driving, sexual activity, unusually strenuous activity.
- Remember not to lift, push, or pull objects heavier than 15 lb.
- Avoid bending or stooping for an extended period.
- Be careful when climbing or descending stairs.
- Know when to call the physician.*
- Brunner and Suddarth’s, Textbook of Medical-Surgical Nursing, 10th edition, SENSORINEURAL FUNCTION.
- Lewis Dirksen Heitkemper Bucher, Medical Surgical Nursing, Assessment and Management of Clinical Problems, Ninth Edition, SECTION 4 Problems Related to Altered Sensory Input.