CATARACT

INTRODUCTION
A cataract is a clouding of the lens inside the eye which leads to a decrease in vision.
Cataracts are the most common cause of vision loss in people over age 60 and are the principal cause
of blindness in the world. In fact, there are more cases of cataracts worldwide than there are
of glaucoma, macular degeneration and diabetic retinopathy.

DEFINITION

“A cataract is a clouding or opacity within the crystalline lens that leads to gradual
painless blurring and eventual loss of vision. The patient may have a cataract in one or both eyes. If
present in both eyes, one cataract may affect the patient’s vision. The cataracts are third leading cause
of preventable blindness.”
OR

“Cataract is any opacity or cloudy appearance in the lens or its capsule rather developmental or
acquired is called cataract.”

CLASSIFICATION

Types

Congenital Acquired

Senile Senile Traumatic Pathological

Cortical Nuclear Cataract Cataract

1. Congenital Cataract- It present at birth or form during a baby’s first year, are less common
than age related cataracts.

2. Acquired Cataract- It is 4 types:

 Senile Cortical- Cortical cataracts are wedge shaped and form around the edges of the
nucleus.
  Senile Nuclear- Nuclear cataracts form in the middle of the lens and cause the
nucleus, or the centre, to become yellow or brown.
 Traumatic cataract- It develops after an injury to the eye, but it can take several
years for this to happen.
 Pathological Cataract- It develops after any disease of the eye.

RISK FACTORS:

 Age: The incidence increases dramatically after the age of 6o.

 Sex: Cataracts are slightly more common in women than men.
 Ultraviolet light exposure:
– More common in persons living in warm sunny climates.
– More common in persons who have worked outdoor extensively.
 Drug effects: Use of corticosteroids, phenothiazines and selected chromotherapeutic agents.
 Poorly-controlled diabetes mellitus accumulation of sorbitol (by product of glucose).
 Trauma to the eye.

ETIOLOGY

 Degenerative changes. Senile cataracts develop in elderly patients, probably because of the

degenerative changes in the chemical state of lens proteins.
 Genetic defects. Congenital cataracts occur in neonates genetic defects or as a sequel of
maternal infections during the first trimester
 Foreign body injury. Traumatic cataracts occur after a foreign body injures the lens with
sufficient force to allow aqueous or vitreous humor to enter the lens capsule and also dislocate
the lens.
 Secondary effects. Complicated cataracts occur as secondary effects in patients with uveitis,
glaucoma, or retinitis pigmentosa, or in the course of a systemic disease, such as diabetes,
hypoparathyroidism, or atopic dermatitis.
 Drug or chemical toxicity. Toxic cataracts result from drug or chemical toxicity with
prednisone, ergot alkaloids, dinitrophenol, naphthalene, phenothiazines, or pilocarpine, or
from extended exposure to ultraviolet rays

PATHOPHYSIOLOGY

Due to etiological factors

Lens consist of 65% of H2O & 35% of protein and minerals

Formation of new proteins

Protein amount of lens increase & clumps to old proteins of lens

Clumps compacted into centre of lens

 Cloudens the lens

Prevents lights from passing clearly leading to blurred vision & blindness

CLINICAL MANIFESTATION

 Blurred vision. Blurred vision is usually the first symptom of cataracts.

 Glare. Glare refers to the pain felt when the patient looks directly into the light
 Halos. Halos are formed when the patient looks at a bright light and there is still the vision of
the light after looking away.
 Double vision. Double vision is also one of the early symptoms of cataract.
 Maternal Malnutrition. Develops congenital cataract.
 Coagulation of protein. Cause irreversible opacity.
 UV rays. Due to long term effect.
 Disease of the eye. Inflammatory disease of eye i.e. Koroditis.
 Blunt trauma
 Electric shock

DIAGNOSTIC TESTS

 History taking
 Plane Mirror Examination (to find out the opacity)
 Slit lamp examination ( to magnify the opacity)
 Direct or indirect Opthalmoscopy (To find out retinal disease)
 Perimetery ( to check vision)
 Tonometery ( To check intra ocular pressure)

MANAGEMENT

Diagnosis of cataract based on decreased visual acuity or other complaints of visual dysfunction.

Medical management

Medications administered pre and postoperatively are:

 Dilating drops. Dilating drops are administered every 10 minutes for four doses at least 1 hour
before surgery.
 Antibiotic drugs. Antibiotic drugs may be administered prophylactically to prevent
postoperative infection and inflammation.
 Intravenous sedation. Sedation may be used to minimize anxiety and discomfort
before surgery.

Surgical management

Lens replacement- There are three lens replacement options:

  Phacoemulsification. A portion of the anterior capsule is removed, allowing extraction of the
lens nucleus and cortex while the posterior capsule and zonular support are left intact.
o Aphakic glasses. In aphakic glasses, objects are magnified by 25%, making them appear
closer than they actually are.
o Contact lenses. Contact lenses provide patients with almost normal vision, but because
contact lenses need to be removed occasionally, the patient also needs a pair of aphakic
glasses.
 Extra capsular cataract extraction (ECCE). ECCE removes the anterior lens and cortex,
leaving the posterior capsule intact.
 Intra capsular cataract extraction. This procedure removes the entire lens within the intact
capsule.
 
Nutritional Management

Nursing Management

Nursing assessment
The nurse should assess:
 Recent medication intake. It is a common practice to withhold any anticoagulant therapy to
reduce the risk of retrobulbar hemorrhage.
 Preoperative tests. The standard battery of preoperative tests such as complete blood count,
electrocardiogram, and urinalysis are prescribed only if they are indicated by the patient’s
medical history.
 Vital signs. Stable vital signs are needed before the patient is subjected to surgery.
 Visual acuity test results. Test results from Snellen’s and other visual acuity tests are
assessed.
 Patient’s medical history. The nurse assesses the patient’s medical history to determine the
preoperative tests to be required.

Nursing diagnosis
  Disturbed visual sensory perception related to altered sensory reception or status of sense
organs.
 Risk for trauma related to poor vision and reduces hand-eye coordination.
 Anxiety related to threat of permanent loss of vision/independence.
 Deficient knowledge regarding ways of coping with altered abilities related to lack of
exposure or recall, misinterpretation, or cognitive limitations.

Nursing goal

 Regaining of usual level of cognition.

 Recognizing awareness of sensory needs.
 Be free of injury.
 Identifying potential risk factors in the environment.
 Appearing relaxed and reporting anxiety is reduced at manageable level.
 Verbalizing feelings of anxiety.
 Identifying healthy ways to deal with and express anxiety.
 Identified potential risk factors in the environment.
 Appeared relaxed and reporting anxiety is reduced ti a manageable level.
 Verbalized feelings of anxiety.
 Identified healthy ways to deal with and express anxiety.

Intervention

 Providing preoperative care. Use of anticoagulants is withheld to reduce the risk of retro

bulbar haemorrhage.

 Providing postoperative care. Before discharge, the patient receives verbal and written
instructions about how to protect the eye, administer medications, recognize signs of
complications, and obtain emergency care.

HEALTH EDUCATION:

 Teach patient and family proper hygiene and eye care techniques to ensure that medications
dressing, and/or surgical wound are not contaminated during necessary eye care.
 Teach patient and family about signs and symptoms of infection and how to report those to
allow early recognition and treatment of possible infection.
 Instruct patient to comply with postoperative restrictions on head positioning, to optimize to
visual outcomes and prevent increased IOP.
 Instructs patient to instil eye medications using aseptic techniques and to comply with
prescribed eye medications routine to prevent infection.
 Instruct patient to monitor pain and take prescribed medication for pain as directed and to
report pain not relieved by prescribed drug.
 Activities. Activities to be avoided are instructed by the nurse.
 Protective eye patch. To prevent accidental rubbing or poking of the eye, the patient wears a
protective eye patch for 24 hours after surgery, followed by eyeglasses worn during the day
and a metal shield worn at night for 1 to 4 weeks.
 Expected side effects. Slight morning discharge, redness, and a scratchy feeling may be
expected for a few days, and a clean, damp washcloth may be used to remove slight morning
eye discharge.
 Notify the physician. Because cataract surgery increases the risk of retinal detachment, the
patient must know to notify the surgeon if new floaters in vision, flashing lights, decrease in
vision, pain, or increase in redness occurs.
CONCLUSION

 Cataract is a clouding of the lens in the eye which leads to a decrease in vision. Cataract surgery is

the principal refractive surgical procedure performed in older adults. Technological advances have
allowed for improved surgery through smaller incisions, resulting in better outcomes. Improvements
in lens implants provide better visual outcomes than were previously possible.
 BIBLIOGRAPHY

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3. Lillis Carol & et al. (2001) Foundation of Nursing art & Science of Nursing Care (4th
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4. Rosdahl Bunker Caroline & Kowalski T. Many (2002) Textbook of basic Nursing (8th
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 JABALPUR INSTIUTE OF NURSING
SCIENCES AND RESEARCH
SUBJECT ON –NURSING EDUCATION

PRACTICE TEACHING ON

CATARACT

Submitted To Submitted By

MRS. SURBHI R.KEHARI MISS PREETI

SHARMA
PROFESSOR M SC (N) 1ST YEAR
JINSAR JINSAR