Cataract: Topic covers the following details,
- Cataract definition,
- Types of cataract,
- Aetiology,
- Cataract risk factors,
- Pathophysiology,
- Clinical manifestations,
- Assessment and diagnostic studies,
- Cataract Management
CATARACT
Definition:
It is defined as the clouding or opaqueness of the lens or the loss of transparency in the lens.
Aetiology:
- Penetrating blunt injury.
- Congenital causes like maternal rubella.
- UV light exposure.
- Long term corticosteroids use.
- Ocular inflammation.
Risk factors:
- Age more than 65 years.
- Women are affected more than men.
- Exposure to ultra violet light exposure.
- Radiation exposure of high dose.
- Prolonged use of corticosteroids, phenothiazines, and a few other chemotherapeutic agents.
- Improper control of diabetes mellitus.
- Eye trauma.
- Secondary to eye diseases.
- Sometimes by the systemic absorption of hair dyes.
Types of cataract:
- Senile cataract - is a type of cataract caused because of aging.
- Traumatic cataract- is caused by injury to the eyes.
- Congenital cataract – is present at birth.
- Secondary cataract - this type is caused after other diseases.
Pathophysiology:
Due to aging
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Alteration in the metabolic processes
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Protein decreases, accumulation of sodium and water within the lens
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Accumulation and disruption of the normal lens structure
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The transparency of the lens is affected
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Vision changes occurs
Clinical manifestations:
- Progressive loss of vision.
- Perceiving the colour abnormally.
- Painless.
- Blurring of vision present.
- Glare.
- Halos around the lights.
- Inability to differentiate between hues and opacity of the lens.
- Affects peripheral vision first and near vision improves later.
Assessment and diagnostic studies:
- History collection.
- Physical examination.
- Visual acuity testing.
- Ophalmoscopic examination.
- Slit lamp microscopy.
- Keratomery.
- Perimetry.
- Ultrasonography.
- Blood investigations.
Management:
- Medical management:
- Mydriatics and cycloplegics are used to dilate the pupil.
- Anaesthetics , anti-inflammatory agents, and antibiotics are used post operatively.
- Usage of glasses.
- Prescribing strong reading glasses and magnifiers.
- Assuring the client with improved lighting and lifestyle modifications.
- Usage of lens.
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- Surgical management:
- Indicated when the medical management no longer provides proper vision
- Removal of lens is done by phacoemulsification and Extracapsular extraction.
- Correction of aphakia.
- Intraocular lens implantation (IOL).
- Nursing management:
- The nurse ensures that the patient have understood about the purpose and the restrictions of the surgery.
- Assists the patient in his activities of daily living following the surgery.
- Position the patient on his back or on the non surgical side to prevent an increase in IOP.
- Siderails must be placed up to prevent fall.
- The things that the patient uses often should be accessible to him usually besides the unoperated eye.
- Bright lights should be avoided.
- Wearing eye shield is a must for a few days after the surgery.
- Call bell should be within the reach.
- Action that increases IOP must be avoided. For eg: sneezing, coughing, vomiting etc.
- Education to the patient and the family about hygienic practices while instilling the medications in the eye.
- Teach the family and the patient about the signs of infection and its early recognition.
- Instruction should be given to the patient about the follow up.
Most of the surgeries are done in ambulatory centers and do not require hospitalization. Though done in hospitals most of the patients are discharged within few hours of surgery.