Retinal Detachment And

Glaucoma
Retinal detachment
 Objectives
• What Is Retinal detachment. Types of Retinal
detachment.
• Epidemiology of Retinal detachment.
• Etiology and pathophysiology of retinal detachment.
• Sign and symptoms and diagnosis of retinal
detachment.
• How is Retinal detachment Treated.
• Medical, Surgical and Nursing Management of
Retinal detachment.
 Definition
• Retinal detachment is a serious eye condition
that happens when your retina a layer of
tissue at the back of your eye that processes
light pulls away from the tissue around it.
 Types
• Retinal Detachment Causes and Types
• There are three main types of retinal
detachment:
• Rhegmatogenous. This is the most common
kind. It happens because of a retinal tear. Age
usually causes it, as the vitreous gel that fills
your eyeball pulls away from your retina. You
can also have it because of an eye injury,
surgery, or nearsightedness.
 Cont..
• Tractional. This type happens when scar tissue pulls
on your retina, usually because diabetes has
damaged the blood vessels in the back of your eye.
• Exudative. This kind happens when fluid builds up
behind your retina, but there’s no tear. The fluid
pushes your retina away from the tissue behind it.
Common causes include leaking blood vessels and
swelling because of conditions such as an injury,
inflammation, or age-related macular
degeneration.
 Epidemiology
• The incidence of retinal detachment in otherwise
normal eyes is around 5 new cases in 100,000
persons per year. Detachment is more frequent
in middle-aged or elderly populations, with rates
of around 20 in 100,000 per year. The lifetime
risk in normal individuals is about 1 in 300.
• Although retinal detachment usually occurs in
just one eye, there is a 15% chance of it
developing in the other eye
 Etiology
• Trauma
• Advanced diabetes
• Shrinkage of the jelly-like vitreous that fills the inside of
the eye
• Myopia
• Degenerative disorders
• Inflammation and infections
• Scarring and fibrous material due to retinopathy and
hemorrhages
• Ocular tumors
 Pathophysiology
• Due to etiological factors (a torn or break in
retina)
• Vitreous fluid or serous fluid leaks in between
the layers of retina or behind the retinal layers
• Detachment of retinal layer
• Retina can peel away from the underlying layer
of blood vessels
• Lack of oxygenation in tissues of retina
• Vision disturbances
 Sign & Symptoms
• Retinal detachment itself is painless. But warning
signs almost always appear before it occurs or has
advanced, such as:
• The sudden appearance of many floaters — tiny
specks that seem to drift through your field of vision
• Flashes of light in one or both eyes (photopsia)
• Blurred vision
• Gradually reduced side (peripheral) vision
• A curtain-like shadow over your visual field
 Diagnosis
• Retinal detachment can be examined by:
• Retinal examination.
• Ultrasound imaging.
• Fluorescein Angiography
• Tonometry
• Ophthalmoscopy
• Refraction Test
• Color Vision Test
• Visual Acuity
• Slit-lamp Examination
 Treatment
• Your treatment may involve one or more of
these procedures:
• injecting a bubble of gas into your eye to push
the retina against the back of your eye
(pneumatic retinopexy).
• Laser (thermal) or freezing (cryopexy).
• Pneumatic retinopexy.
• Scleral buckle.
• Vitrectomy.
 Medical Managements
 Mydriatic, cycloplegic
 Photocoagulation of retnial break
 External beam radiation therapy or brachytherapy with
a plaque may be used for choroidal melanoma.
 Metastatic lesions respond to chemotherapy or
localized radiation therapy.
 Choroidal hemangiomas may respond to laser
photocoagulation or plaque brachytherapy.
 Retinoblastomas may be shrunk with chemotherapy
and then treated locally with heat, laser, or cryotherapy.
 Surgical management
Retinal detachment:
• pneumatic retinopexy
• scleral buckling
• vitrectomy
 Cont..
• Pneumatic retinopexy. This works well for a tear that’s small and
easy to close. Your doctor injects a tiny gas bubble into your
vitreous gel. It presses against the upper part of your retina,
closing the tear. You’ll need to hold your head in a certain position
for several days to keep the bubble in the right place.
• Scleral buckle. Your doctor sews a silicone band (buckle) around
the white of your eye (called the sclera). This pushes it toward the
tear or detachment until it heals. This band is invisible and is
permanently attached.
• Vitrectomy. This surgery repairs large tears or detachment. Your
doctor removes the vitreous gel and replaces it with a gas bubble
or oil. A Vitrectomy also might require you to hold your head in
one position for some time.
 Nursing Management
• Nursing Diagnosis:
• Disturbed sensory perception (visual).
• Anxiety.
• Risk for injury.
 Nursing Management
• Interventions:
• Provide emotional support to the patient who may be
distraught at the potential loss of vision.
• Prepare the patient for surgery by cleaning his face and
giving him antibiotics and eyedrops, as ordered.
• Teach the patient about the role of the retina and why
floaters, flashes of light, and decreased vision occur.
• Allow the patient and family to discuss their concerns.
 Complications
• Any surgical procedure has some risks. Surgery
for a detached retina can lead to:
• Infection
• Bleeding
• Higher pressure inside your eye (glaucoma)
• Fogging of the lens in your eye (cataract)
 Preventions
• Get to your eye doctor right away if you see
new floaters, flashing lights, or any other
changes in your vision.
• Use protective eye wear to prevent eye
trauma.
• Control of blood sugar in diabetic patients.
• Frequent visits to eye specialist.
 Objectives
• What Is Glaucoma.
• Epidemiology of glaucoma.
• What are the main causes of glaucoma.
• What Are the Symptoms of Glaucoma.
• How Is Glaucoma Diagnosed.
• How Is Glaucoma Treated.
• Medical Surgical and Nursing Management of
Glaucoma.
 Introduction
• Definition:
• Glaucoma is an eye disease that can damage
your optic nerve. The optic nerve supplies
visual information to your brain from your
eyes.
• It gets worse over time. It's often linked to a
buildup of pressure inside your eye. Glaucoma
tends to run in families. You usually don’t get
it until later in life.
 Epidemiology
• Globally, there are an estimated 60 million people with
glaucomatous optic neuropathy and an estimated 8.4
million people who are blind as the result of glaucoma.
These numbers are set to increase to 80 million and
11.2 million by 2020. Glaucoma is the second leading
cause of blindness globally. The highest prevalence of
open-angle glaucoma occurs in Africans, and the
highest prevalence of angle-closure glaucoma occurs in
the Inuit. Population-based screening for open-angle
glaucoma is not recommended. Screening for angle-
closure may be feasible
 Etiology
• Having high internal eye pressure (intraocular
pressure)
• Being over age 60.
• Being black, Asian or Hispanic.
• Having a family history of glaucoma.
• Having certain medical conditions, such as
diabetes, heart disease, high blood pressure
and sickle cell anemia.
• Having corneas that are thin in the center.
 Pathophysiology
• The primary site of damage is the optic nerve
leading to loss of vision.
• In open angle glaucoma, the angle between the
cornea and iris is open.
• In this type the drainage system slowly get clogged
overtime and thus gradual increase in pressure on
optic nerve, results in dec. of peripheral vision, as
the pressure increase even more, continuous
damage to optic nerve, which eventually leads to
loss of central vision.
 Cont..
• In closed angle glaucoma the angle between the iris
and cornea is too small, that means the passage way
for aqueous humor outflow is too narrow and this is
result of lens been pushed against the iris, result of
this leads to blockage of drainage system.
• This is most serious type of glaucoma in which rapid
pressure build up in the eye which can cause onset
of eye pain and redness, blurry vision, headache.
• This may occur due to dilation of lens or pupil which
cause the iris pushing forward and close the angle.
 Clinical Manifestations
• Glaucoma is typically characterized by:
• IOP > 21 mmHg
• Visual field loss
• Glaucomatous retinal nerve damage
• Glaucomatous cupping (Increase in IOP pushes the
optic disc back forming an cup size).
• In close angle glaucoma the pressure lies between 50
to 80 mm Hg. And cause cornea edema.
• The pupil is vertically oval & un reactive to light and
accommodation.
 Sign & Symptoms
• The most common type of glaucoma is primary open-angle glaucoma. It
has no signs or symptoms except gradual vision loss. For that reason, it’s
important that you go to yearly comprehensive eye exams so your
ophthalmologist, or eye specialist, can monitor any changes in your vision.
• Acute-angle closure glaucoma, which is also known as narrow-angle
glaucoma, is a medical emergency.it has following sign & symptoms:
• severe eye pain
• nausea
• vomiting
• redness in your eye
• sudden vision disturbances
• seeing colored rings around lights
• sudden blurred vision
 Diagnosis
• Tonometry: measure intraocular pressure.
• Tonography: measure the outflow of aqueous
humor from the eye.
• Gonioscopy: is used to estimate width of the
anterior chamber angle.
• Perimetry: diagnosis of scotoma (blind spot).
• Visual field testing
• Looking for optic nerve damage, glaucomatous
cupping by imaging.
 Treatment
• The treatment options for early glaucoma have
expanded in recent years and fall into three
categories:
• medications
• laser, and incisional surgery
• Medications or laser are both considered first-
line treatments. It is not imperative that you
start with medications and then proceed to
laser treatment.
 Medical Management
• Most glaucoma medications are administered
topically but the absorption may occurs systemically
as it passes through the lacrimal drainage system.
• It can be overcome by applying a digital pressure on
the lacrimal sac for three minutes so that to enhance
the drug contact time with the eye is prolonged.
• Glaucoma medications should be avoided in
pregnancy if possible, with systemic carbonic
anhydrase inhibitors perhaps carrying the greatest
risk due to teratogenicity concerns.
Major Groups of Drugs Treating Glaucoma

• Prostaglandin Analogues
• ß Blockers
• Carbonic Anhydrase Inhibitors
• Alpha 2 Agonist
• Miotics
• Combined Therapy
• Osmotic Agents
 Surgical management
• Laser surgeries
• Trabeculotomy and goniotomy
• Penetrating filtering surgeriestrabeculectomy
• Non penetrating filtering surgeries
• Cyclo destructive procedures
• Artificial drainage implants
 Nursing Management
• ASSESSMENT:
• History or presence of risk factor: positive
family history, tumor of eye, hemorrhage,
uveitis, trauma etc.
• Physical examination based on those in
general assessment of the eye may indicate:
blurred vision, decreased light perception
redness cloudy appearance etc.
 DIAGNOSIS
• Acute pain related to increased IOP and
surgical complications as evidenced by patient
verbalization or facial expression of the
patient.
• GOAL: The pain of patient will be reduced.
 INTERVENTIONS
• Monitor vital signs of the patient.
• Monitor the degree of eye pain very 30 min
during the acute phase.
• Monitor visual acuity at any time before
hatching ophthalmic agent for glaucoma.
• Maintain the bed rest in semi- fowler position.
• Give analgesic prescription and evaluation of
its effectiveness.