Anatomy

 Shape
 a biconvex lens and capable of changing shape
 colorless
 transparent
 avascular
 size
4mm thick and 9mm in
diameter
 position
 behind the iris and
the pupil
 In front of the vitreous
 suspended by suspensary ligament
Lens
Anatomy
 structure
 capsule:an elastic transparent basement membrane
admit water and electrolytes pass through
the lens fibers are enveloped in it
epithelium : this single cell layer located anteriorly and

extending to the equator

 fibers:continuously produced by epthelium
the nucleus:old fibers ,harder at the centre
the cortex: new fibers,softer, at the periphery
With age,the lens gradually becomes larger, harder
and less elastic
Physiology
 composition
 water -64% The water content of the lens decreases with
age.
 protein -35% the highest protein content in any body tissue
 soluble protein
 insoluble protein:With age, the percent of it increases

 1%- A trace of minerals are present (Potassium, Ascorbic

acid and Glutathione)
The lens has complex metabolic process. It`s nourishment
comes from aqueous humor.When there are changes of
aqueous or capsule or metabolism,the transparent lens
becomes opaque.
Physiology
 Function
 one of important refractive medias
 focus light rays upon the retina
 filter a part of ultraviolet rays ,it is beneficial
to the retina
Cataract
Cataract –transparent lens becomes
opaque
Cataract
 Epidemiology
 Cataract is a common ocular disease and one of the
main causes of blindness.It is estimated that 30 to
45 million people in the world are blind,with cataract
accounting for as much as 45% of this blindness.
 The prevalence of cataract varies widely with striking
regional differences.It is more common in areas
where people eyes expose to sunlight greatly.
 The prevalence rises with age and is higher in
females.
 WHO defines blindness as best corrected visual
acuity less than 20/400(0.05) or visual field restricted
to 10°or less.
Classification
 Senile cataract-age related cataract
 Complicated cataract-due to ocular inflammation or
degeneration affects lens metabolism
 Congenital cataract-a result of developmental
disturbance of lens during the process of
development of fetus
 Traumatic cataract-eye trauma cause lens opacities
 Metabolic cataract-metabolic disturbance
 Toxic cataract-many drugs and chemicals have been
shown to induce cataracts
 After-cataract-after cataract surgery,remained cortex
and epithelial cells exfoliated to form opacity
CAUSES
Cataracts have several causes and may be
age-related, present at birth, or formed as
a result of trauma or exposure to a toxic
substance, Cataracts are classified by the
cause
 Senile cataracts develop in elderly people
 Congenital cataracts occur in neonates
from inborn errors of metabolism or from
maternal rubella infection during the first
trimester
 Traumatic cataracts develop after a foreign
body injures the lens with sufficient force to
allow aqueous or vitreous humor to enter
the lens capsule
 Complicated cataracts occur secondary to
uveitis, glaucoma, retinitis pigmentosa, or
retinal detachment
 Toxic cataracts result from drug or chemical
toxicity with prednisone, ergot alkaloids,
naphthalene, and phenothiazines.

Genetic Considerations; Epidemiological studies

indicate that cataracts have strong genetic
components. Several loci have been identified
for an autosomal dominant form of cataracts.
Congenital cataracts occur with galactosemia
and these can appear within just a few days of
birth. The specific genetic contributions of the
more common age-associated cataracts are
still unclear. Ethnicity and race have no known
effect on the risk of cataracts
Senile cataract
Senile cataract is by far the most common type. It
often occurred over the age of 40. With aging,it`s
incidence increases.we call it “age related cataract”
 Etiology
It is a lens disorder formed on the basis of
decreasing
of lens metabolic function with aging of whole body
and plus many other factors.
It has relation to
 Heredity
 Ultraviolet rays-plateau (expanse of level land high
above sea-level) long periods of strong sunlight
 Systematic disorders-diabetes
 Nourishment condition
Senile cataract
 Clinical findings
 Symptom:progressively blurred vision is the
only symptom
 Types:according to the place of opacity
appear first
 Cortical cataract
 Nuclear cataract
 Posterior subcapsular cataract
Senile cataract-cortical cataract
There are 4 stages in its developing
 Incipient stage (beginning;in an early stage)
 The lens is only slightly opaque
 These spoke-like opacities
begin in the lens periphery
 Pupillary area isn`t affected
 No blurred vision takes place
Senile cataract-cortical cataract

 Intumescent stage (immature stage)

 Lens opacity develop gradually,the fibers absorb
water,the lens edema,the cortex become swollen.
 The anterior chamber is shallow .
It is easy to induce
onset of glaucoma.
 Visual acuity
decrease.
Senile cataract –cortical cataract
 Mature stage
 The lens is completely opaque,
 The color is greywhite.
 The depth of the anterior
chamber restores to
normal. Because the
swollen decreases.
 The vision is
obviously decreased
to FC or HM
Senile cataract-cortical cataract
 Hypermature stage
 The degenerated cortex has been decomposed
to form milklike substance.
 The lens nucleus
fall down.
 The capsule wrinkled
and shrunk.
Due to water
escaping from lens.
Senile cataract-nuclear cataract
 The nucleus becomes harder(sclerotic) and
increasingly pigmented with age.
 At beginning, nucleus appears yellowish,its color
becomes more and more dark with development

 It generally produce
more blurring of
distance vision than
near vision
Senile cataract-
posterior subcapsular cataract
 Golden yellow or white particles,mixed with
small vacuoles in them occur at shallow
layer of subcapsular cortex in posterior pole
lens.
 The opaque area situates in the area of
visual axis,so blurred vision takes place in
early stage
Congenital cataract
○ It is a result of developmental disturbance of
lens during the process of development of
fetus
○ Etiology
 Genetic factor-autosomal dominant inheritance
 Damage of fetal lens caused by systemic disorders
of mother or fetus-viral infections,nourishment and
metabolic disturbance of mother
 Congenital cataract

 Commonly are as follows:

polar cataract,nuclear cataract,lamellar
cataract,complete cataract,coronary cataract
axiality cataract
Complicated cataract
It is a lens opacity induced by ocular
inflammation or degeneration disorder
Uveitis,glaucoma,too low IOP,retinal
pigmentary degeneration
Traumatic cataract
It may be caused by mechanical
injury,physical forces(radiation,electrical
current,heat and cold),and osmotic influences

Penetrating cataract
Metabolic cataract
 Diabetic cataract
 Hypocalcemic cataract
Toxic cataract and After cataract
Many drugs and chemicals have been
shown to induce cataract-
After cataract surgery,remained cortex and
epithelial cells exfoliated onto lens posterior
capsule proliferate to form opacity
Management of cataract
 Medical management
 No medical treatment has been proven
conclusively to delay,prevent,or reverse the
development of cataract
 Indication for surgery
 The most common indication for cataract
surgery is the patient`s desire for improved
visual function.
 When visual acuity impairment interferes with
the patient`s normal activities,the surgery of
cataract well be performed.
Lens surgery
 Microsurgical techniques is employed for all
cataract surgery.
 There are 3 principal types of lens extraction
 Intracapsular cataract extraction(ICCE)
 It involves complete removal of the lens within its
capsule.
through a larger (12mm length) superior limbal
incision
 The larger incision may increase the risk of wound-
related problems.
Lens surgery
 Extracapsular cataract extraction(ECCE)
 It involves removal of the lens nucleus and
cortex through an opening in the anterior
capsule, leaving the posterior capsule in place.
 A superior limbal incision is made,it is shorter
than ICCE
 The anterior portion of the capsule is ruptured
and removed
 The nucleus is extracted
 The cortex is either irrigated or aspirated from
the eye leaving the posterior capsule behind.
ECCE and IOL
IOL
Lens surgery
 Phacoemulsification(Phaco)
 It is a relatively new technique.In recent years, it
has become popular.
 It is a method of extracting the nucleus through
a small incision(3mm).
 The nucleus is extracted by ultrasonic vibration.
 This technique results in a lower incidence of
wound-related complications, faster healing, and
more rapid visual rehabilitation than procedures
requiring larger incisions.
Phaco
ICCE vs ECCE vs Phaco
TYPE ADVANTAGES DISADVANTAGES
ICCE Removes all lens Larger incision
material, no posterior Cystoid macular edema
capsular opacity Vitreous complications
Endophthalmodonesis
Increased incidence of RD
ECCE Smaller incision Posterior capsule opacity
No vitreous complications
Less endophthalmodonesis
Less CME,RD
Allows implants pcIOL
Phaco Smallest incision Demanding technique
Less induced astigmatism Complications while learning
Fastest technique
Visual rehabilitation
 Removal of the lens causes a marked
reduction of the refractive power of the
eye,we call it aphakia
 Aphakia may be corrected by three methods
include spectacles(glasses),contact lens or
intraocular lens(IOL) to increase its
refractive power
 IOL is the best among them and now is
widely used in the world
NURSING MANAGEMENT
PREOPERATIVE
· Because surgery is performed on an
outpatients basis, instruct patient to make
arrangements for transportation home,
care that evening, and a follow-up visit to
the surgeon the next day.
· Withhold any anticoagulants the patient is
receiving, if medically appropriate. Aspirin
should be withheld for 5 to 7 days,
nonsteroidal anti-inflammatory drugs
(NSAIDs) for 3 to 5 days, and warfarin
(Coumadin) until the prothrombin time of
1.5 is almost reached.
INTRAOPERATIVE

  Administer dilating drops every 10

minutes for four doses at least 1 hour
before surgery. Antibiotic, corticosteroid,
and NSAID drops may be administered
prophylactically to prevent postoperative
infection and inflammation.
POSOPERATIVE

 · Instruct patient to wear a protective eye patch for

24 hours after surgery to prevent accidental
rubbing or poking of the eye. After 24 hours,
eyeglasses (sunglasses in bright light) should be
worn during the day and a metal shield worn at
night for 1 to 4 weeks.
 · Provide postoperative discharge teaching
concerning eye medications, cleansing and
protection, activity level and restrictions, diet, pain
control, positioning, office appointments, expected
postoperative course, and symptoms to report
immediately to the surgeon.
 · Instruct patient to restrict bending and
lifting heavy objects.
 · Caution patient that vision may blur for
several days to weeks.
 · Inform patient that vision gradually
improves as the eye heals; IOL implants
improve vision faster than glasses or
contact lenses.
 · Reinforce that vision correction is
usually needed for remaining visual
acuity deficit.
Diagnoses that may occur in Nursing
Care Plans For Cataract

 Anxiety
 Deficient knowledge (diagnosis and
treatment)
 Disturbed sensory perception: Visual
 Risk for infection
 Risk for injury