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Sensory organ of vision

Absorbs light rays from our environment and transforms them into information for the brain to process

This form of communication between the eye and brain is known as a visual system

Consists of Inner and Outer structures

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Eyeball
Composed of 3 layers:

The outer dense fibrous layer (Sclera), including the sclera and transparent cornea

The middle vascular layer (Choroid), containing the iris, ciliary body, and choroid

The inner neural layer (Retina), including the retina, optic nerve, and visual pathway

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Outer Dense Fibrous Layer (Sclera):

Sclera

Outer covering structure that supports and protects the eye

"White of the eye"

Composed of tough fibrous tissue

Transparent Cornea

Bulge in front of the eye where light bends enters

Contains high concentrations of nerve fibers and is extremely sensitive to touch and pain (corneal reflex)

Middle Vascular Layer (Choroid):

Choroid

Middle vascular layer with many blood vessels to supply nutrients to the retina

Dark brown membrane located between the sclera and the retina

Lines most of the sclera and attached to the retina but can be detached

Reports of a shade or curtain coming across the vision of one eye when detached and no pain

Has dark pigmentation to prevent light from reflecting internally

Ciliary Body

Connects the choroid with the iris and secretes aqueous humor that helps give the eye its shape

Aqueous humor is a clear, watery fluid that fills the anterior and posterior chamber of the eye

Produced by the ciliary processes and drains into the canal of Schlemm

If does not drain properly increases IOP can occur

Muscles of ciliary body control the thickness of the lens

The lens is a transparent structure suspended behind the iris that helps to focus light on the retina by bending light so it falls on the retina

Provides fine-tuning adjustment to cornea

Iris

Colored portion of the eye located in front of the lens.

Has central circular opening known as the pupil

Pupil controls the amount of light (darkness = dilation, light = constriction) admitted to the retina

Controlled automatically by the CNS

Inner Neural Layer (Retina):
Retina

Visual receptor layer of the eye where light waves are changed into nerve impulses

Thin, delicate structure in which fibers of the optic nerve are distributed

Point of entrance between the retina and optic nerve is the optic disc

Optic disc AKA blind spot because it only contains nerve fibers, lacks photoreceptor cells, and is insensitive to light

Bordered externally by the choroid and sclera and internally by the vitreous

The vitreous is a clear jelly-like substance that fills the eye from the lens to the back of the eye

Contains photoreceptors known as rods and cones

Rods are responsible for peripheral vision and night or low light vision by reducing levels of illumination

Cones are responsible for color, central vision, and function at bright levels of illumination

Optic Nerve

The bundle of nerve fibers at the back of the eye that carry visual messages from the retina to the brain

Visual Pathway

The process of which light is converted into nerve impulses and transmitted to the brain through all of the structures listed above

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Movement of the eye:

Lateral rectus -> CN VI (abducens)

Medial rectus -> CN III (oculomotor)

Superior rectus -> CN III (oculomotor)

Inferior rectus -> CN III (oculomotor)

Inferior oblique -> CN III (oculomotor)

Superior oblique -> CN IV (trochlear)

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Conjunctivae

Thin, transparent mucous membranes of the eye that line the posterior surface of each eyelid and covers the sclera

Helps lubricate the eye and protect it from microbes

Lacrimal Gland

Produces tears that are drained through the punctum into the lacrimal duct and sac

Tears protect the eye from damage, dehydration and microbes

Eyebrows + Eyelashes

Thick and delicate hair above the eye and hair that extends from the eyelid

Prevents sweat, water and other debris from falling down into the eye

Eyelids

Thin fold of skin that protects and covers the eye; blinking

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General Patient Assessment with Low vision/Blindness:
•Assess age

•Review medical history/examination

•Asses family history of systemic/CNS disease

•Ask the patient about specific ability to read, see television and history of falls.

•Asses eye and lid for inflammation, edema, positional defects and deviation

•Determine the nature of visual symptoms/onset/degree of visual loss.

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•Lack of eye-to-eye contact

•Abnormal eye movement

•Squinting , frequent blinking

•Bumping

•Diabetes: Glaucoma, cataracts

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•Magnification and image enhancement through the use of low vision aids and strategies

•Medications for glaucoma

•Referrals to community agencies may be necessary for patients with low vision who live alone and cannot self-administer their medications.

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•Introduce self to the patient, and acknowledge visual impairments

•Orient patient to the environment
•Speak before you touch

•Do not make unnecessary changes in room environment

•Provide adequate lighting

•Place meal try, tissues, water and call light within patient’s range of vision/reach.

•Recommend the use of visual aids when appropriate

•Remove environmental barriers

•Maintain bed in low position to prevent falls

•Encourage the patient to use the sense of touch

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Vernon Watkins (book case study) and Teaching

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Vernon Watkins (book case study) and Teaching

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To maintain safe environment for patient with low vision like Vernon Watkins, nurses should :
Provide Adequate lighting.
Make sure all objects he will need are close at hand such as incentive spirometry.
Remove obstacles that may be in his pathway and could cause a fall.
Place all assistive devices that the person uses close at hand; let the person feel the devices so that he or she knows their location.
Identify the location of objects that the person may need (e.g., “The call light is near your right hand”; “The telephone is on the table on the left side of your bed.”)

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Teaching Patients how to Instill Eye Medications

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Teaching Patients how to Instill Eye Medications

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The nurse instructs the patient to:

Never use eye solutions that have changed colors.

Perform hand hygiene before and after the procedure.

Ensure adequate lighting.

Read the label of the eye medication to verify that it is the correct medication.

Remove contact lens as needed.

Assume a comfortable position.

Avoid touching the tip of the medication container to any part of the eye or face.

Hold the lower lid down; do not press on the eyeball. Apply gentle pressure to the cheekbone to anchor the finger holding the lid.

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Instill eye drops before applying ointments.

Apply a 0.25–0.5-inch ribbon of ointment to the lower conjunctival sac.

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Keep the eyelids closed, and apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eye drops.

Use a clean tissue to gently pat skin to absorb excess eye drops that run onto the cheeks.

Wait 5 minutes before instilling another eye drop and 10 minutes before instilling another ointment.

Reinsert contact lens if applicable.

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Glaucoma
Cataracts
Retinal detachment
Age-related Macular Degeneration

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Not going into great depth on eye assessment because we covered this in Fundamentals.

Key things to remember on an eye assessment is to:

Inspect external eye for any abnormalities

Is there any swelling or redness? Is the sclera white or yellow?

Test the cranial nerves r/t eye function with the 6 cardinal fields of gaze

Assess for nystagmus and strabismus

PERRLA

If you would like to brush up on your eye assessment skills, feel free to watch the video below!

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Eye Assessment Nursing | How to Assess Eyes for Head-to-Toe Assessment

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Glaucoma

Educate patients about self care, continuing and transitional care

Educate on ways to prevent further compromised vision

Educate patient about appropriate eye drop administration

Educate patient on the importance of follow up care

Manage pain and anxiety (emotional support and possibly administer medication)

Cataracts

Educate patients about patient receives verbal and written education regarding eye protection, administration of medications, recognition of complications, activities to avoid, what to expect and obtaining emergency care

Promote home, community-based, and transitional care

Educate patients on ways to prevent accidental rubbing or poking of the eye

If recommended patient wears a protective eye patch for about the first 24 hours after surgery, followed by eyeglasses worn during the day and an eye shield at night (educate on application and care).

Educate patients on the importance of follow up appointments in order to monitor visual status and implement prompt intervention if necessary.

Ocular trauma

Immediate treatment is directed at preventing further injury or vision loss.

When assessing the eyes, especially in trauma, always make sure to assess and compare both eyes.

X-ray, CT scan, and MRI scan are all test that can be performed in order to assess  ocular function and diagnostic testing

Educate that there are two types of ocular trauma in which the first response is critical: Chemical burn and foreign object in the eye

With a chemical burn, the eye should be immediately irrigated with tap water or normal saline.

With a foreign body, no attempt should be made to remove the foreign object. The object should be protected from jarring or movement to prevent further ocular damage.

All other traumatic eye injuries should be protected using a patch or shield if available or a stiff paper cup until medical treatment can be obtained

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Discharge education for patients after ocular surgery

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Discharge education for patients after ocular surgery

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Informing patient what to expect:

Bruised or bloodshot eye for 7 days

Itching and mild discomfort for several days

Some fluid discharge

Sensitivity to light

Scratchy, sand-like feeling in the eye for about 2 weeks

Activity Level

Do not drive for 2 days or as instructed by your eye care provider.

Do not drink alcohol for at least 24 hours.

Avoid bending at the waist to pick up objects or lifting anything heavy for 2 days

For the first 24 hours after surgery be sure to take it easy and relax.

Eye protection

Do not rub or press on your eye.

Sleep on your back or on your unoperated side for 2 nights.

If instructed, wear a bandage over your eye for 2 days and 2 nights.

If instructed, wear a shield to protect your eye for 2 days and 2 nights.

Eye Drops

Educate on the effective and proper use of eye drops as prescribed

When to call the doctor

Bleeding or discharge from the eye

Sudden worsening of your vision

Pain that does not improve with the medication

Nausea or vomiting

Chills or fever over 100.4°F (39.1°C)

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Common Ocular Medication Actions and Management Chart

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Common Ocular Medication Actions and Management Chart

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Take the quiz @
https://PollEv.com/surveys/MLGAInA5empKvtT6kCrnX/web
Review your answers @
https://docs.google.com/document/d/1ACtTOR-GmH-PJJrfVEA8Pkng7rDtgN45vVKmxB453yc/edit?usp=sharing

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•Assess for other systemic and/or clinical features such as cutaneous or skeletal conditions or hearing loss.

•Look for color and clarity of iris.

•Assess for presence of strabismus (cross-eyes), amblyopia (lazy eye), nystagmus, astigmatism, and near- or far-sightedness.

•Assess for changes in visual acuity.

•Assess field of vision.

•Inquire about photophobia, night blindness, or double vision

•Assess Aids that improve vison e.g. glasses, contact lenses, bright/natural light

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Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarths Textbook of Medical-
Surgical Nursing (14th ed.). Philadelphia, PA: Wolters Kluwer.

RegisteredNurseRN. (2017, November 16). Eye Assessment Nursing | How to Assess Eyes for Head-to-Toe Assessment. Retrieved March 25, 2019, from https://www.youtube.com/watch?v=pgSj3l9iV6k

The structure of the eye. (n.d.). Retrieved March 26, 2019, from https://www.khanacademy.org/science/health-and-medicine/nervous-system-and-sensory-infor/sight-vision/v/vision-structure-of-the-eye