MEDICAL –SURGICAL NURSING

MANAGEMENT OF PATIENTS WITH

EYE CONDITIONS-1
AWOTUNDE T. A (MRS. )
BOWEN UNIVERSITY,IWO
 29/06/2025 05:36 PM

2 OUTLINE OF THE LESSON

At the end of the lesson learners should be able to;

• describe the anatomy of the eye
• describe the structures and functions of the eyes
• discuss the techniques for assessing the eyes
• discuss the diagnostic tests for diagnosing eye disorders
•
 29/06/2025 05:36 PM

3
 29/06/2025 05:36 PM

4 INTRODUCTION

• The components of sensory mechanism responsible for

sight are the eyes ,optic nerves and the tracts ,visual
cortex and association areas of the brain
• The eyes are organs of sight
• Located in the orbital cavities in the skull and attached to
the extrinsic muscles of the eye
 29/06/2025 05:36 PM

5 INTRODUCTION

• The accessory structures enables the eyes to scan

and focus on object in the environment
• Also help in protecting and maintaining the optical
properties of the eyes
• The eye is spherical in shape and about 2.5cm in
diameter
 29/06/2025 05:36 PM

6 STRUCTURES OF THE EYES

• The eye is a hollow ball filled with fluid (vitreous humor) and
composed of three layer
 fibrous outer layer — sclera, bulbar conjunctiva, and
cornea
 vascular middle layer — iris, ciliary body, and choroid
 inner layer — retina( contains photoreceptive cells )
• The length of an adult eye is approximately 24mm
 29/06/2025 05:36 PM

7
Outer Layer of the Eye

• The outer layer consist of the fibrous white

sclera posteriorly and the transparent cornea
anteriorly
• The junction of the two is called the limbus
• The sclera is a firm membrane and maintain the
forms of shape of the eye
 29/06/2025 05:36 PM

8
Outer Layer of the Eye

• The cornea is transparent due to avascularity ,

well supplied with nerve endings from the
trigeminal nerve
• Permit rays of light from the external environment
to pass through it to inner part of the eye
 29/06/2025 05:36 PM

9 Middle layer of the eye

• Known as the uvea tract , highly

vascularized ,pigmented and nutritive
• Consist of the choroid and the Ciliary body and the
Iris
• The choroid lines the sclera in the posterior
compartment of the of the eyes and continues into the
ciliary body into which are inserted into the suspensory
ligaments(ciliary muscles are called muscles of
accomodation )
 29/06/2025 05:36 PM

10 Middle layer of the eye contd

• These ligament extends into the lens and hold it in position

• The contraction and relaxation of the ciliary body changes
the shape of the lens and controls the refractive and
focusing power
• Iris, extend anteriorly from the ciliary body covering the
remaining 1/6 of the eye ,lying just behind the cornea
• The Iris contains both circular & inner radiating muscles
fibres which control the size of the pupils
 29/06/2025 05:36 PM

11 Middle layer of the eye contd

• At the center of the Iris is a circular aperture

called the Pupils through which the light enters the
interior of the eye to reach the lens
• The pupil varies in size depending on the amount
of light present
• The size of the pupils is altered by the muscles of
the Iris which controls the amount of light entering
the eye
 29/06/2025 05:36 PM

12 Middle layer of the eye contd

• The iris contain a pigment called melanin which

determines the color of the anterior part of the eye

• The colors depend on upon the number of pigment

cells present ,In Albinos there are no cells
• The space between the cornea and the iris is called
the posterior chamber while the space between
the iris and the lens is called anterior chamber
 29/06/2025 05:36 PM

13 Middle layer of the eye contd

• Both muscles of the iris and the ciliary body

constitute the extrinsic muscles of the eye
• Lens is behind the iris, transparent biconvex and
enclosed in a thin elastic capsule. Its thickness is
controlled by the ciliary muscles
• suspended from the ciliary body by the
suspensory ligaments
 29/06/2025 05:36 PM

14 Middle layer of the eye contd

• These two chambers are filled by a clear watery fluid

called the Aqueous humor
• Aqueous humor is secreted by the ciliary glands then
flow through the iris to reach the pupil before filling
the anterior and posterior chamber
 29/06/2025 05:36 PM

15 Middle layer of the eye contd

• The aqueous humor is continuously absorbed

through the filtration angle (Iridocorneal angle) into
the canal of Schlemm before emptying into the veins
that pierce the sclerae
• The pressure of the aqueous humor normally is
25mmHg
• An imbalance between the formation and absorption
of the aqueous humor leads to increased intra-ocular
pressure or tension called Glaucoma
 29/06/2025 05:36 PM

16 The inner layer of the eye

• The inner most layer of the eye lining is called the

retina
• Lines about three-quarter of the eyeball
• Extremely delicate membrane ,photosensitive layer
• Contain several million photoreceptive cells
responsible for converting light into electric impulses
 29/06/2025 05:36 PM

17 The inner layer of the eye Contd

• Also have sensory optic nerve endings called Cones

and Rods
• Retina consist of two layers
 Pigmented outer layer that lines the choroid
 Inner most neural layer which is in contact with
the
• The cones shaped cells are sensitive to bright
light and colours vitreous humour
 29/06/2025 05:36 PM

18 The inner layer of the eye Contd

• Rod-shaped cells are sensitive to dim light

• Rod shape cells contain the pigment called visual purple
or Rhodopsin which gives purple color to the retina
• Rhodopsin bleaches during bright light but re-synthesize
by vitamin A in the blood stream
• Near the centre of the posterior part of the retina ,there is
a small depression called macula Lutea containing
yellow cells
 29/06/2025 05:36 PM

19 The inner layer of the eye contd

• At the centre of the macula lutea is another

depression called Fovea centralis (the most highly
sensitive part of the Retina)
• Fovea centralis contains only cone –shape cells where
inverted images are formed (most vital part of retina
)
• Situated near the macula lutea but towards the nasal
side is an opening called Optic disc
 29/06/2025 05:36 PM

20 The inner layer of the eye contd

• Optic disc is also called the Blind spot of the eye

• The optic nerves fibres passes through the optic
disc and the central retina veins leaves the
eye ,while the central retina artery enters the eye
• The optic disc contains no sensitive cells to light
 29/06/2025 05:36 PM

21

Extrinsic muscles of the

eye
superior rectus muscles
Inferior rectus muscles
Lateral rectus muscles
Medial rectus muscles
The two remaining muscles
lies oblique; superior and
inferior oblique muscles
 29/06/2025 05:36 PM

22 Accesory structures of the eye

• The anterior aspect of the eyeball is protected by the

eyebrow, eyelids and eyelashes
1. Eye brow and the hair serve as protective structures
for the eye as well as preventing sweat from entering the
eye from the forehead
• Also help to reduce some light entering the eye when
frowning
 2. Eye lid and eye lashes: forms the upper and lower
29/06/2025 05:36 PM

coverings for the eye

23 The edges of the lids are called free margin from which
tough hairs called eyelashes grows .This is to prevent
irritation of the sclera and the cornea
3.Two muscular layer(Outer orbicularis oculi and inner
levator palpabrae)

4. Lacrimal glands: produces tears , excess tears are

drained from the eyes via the lacrimal apparatus at the
inner canthus into the lacrimal sac and then into the nose
through the nasolacrimal duct
 29/06/2025 05:36 PM

2 . The meibomian glands; reduces the evaporation rate of tears and

4 prevent eyelids from sticking together during sleep

6. The innermost part of the lid is lined with conjunctiva

 The conjunctiva protects the delicate cornea and front of the eye .
The lids are lined by mucus membrane
 At the limbus ,the conjunctiva is modified to form a sac or fornix, the
ideal site for instillation of topical drugs

7. The space that is created between the two edges of the eyelids when
they open is called palpebra
8. Posteriorly and laterally the globe is protected by the bony orbit ,the
extraocular recti and by orbital fat
 29/06/2025 05:36 PM

25
 29/06/2025 05:36 PM

26 Blood & Nerve supply

• Arterial blood supply is through ciliary artery and central

retina artery which are branches of ophthalmic arteries
• Venous drainage is by ophthalmic veins into the
carvenous sinus behind the eye
• Nerve supply : ciliary nerves ,branches of ophthalmic
nerves dilates the pupil, while the parasympathetic nerve
constricts the pupil, oculomotor , trochlear & abducent
stimulate the extrinsic muscle of the eye
 29/06/2025 05:36 PM

27 Functions of the eye

• Visualizing objects
• Light perception
• Colour and depth perception
 29/06/2025 05:36 PM

28 ASSESSMENT OF THE EYE

1. History: accurate and complete patient history

 Specific complaints and compare with physical
assessment
 Current health status
 previous health status(blurred vision, eye surgery ,DM)
 Family health status(glaucoma, retina detachment &
cataract)
 Life style pattern (occupation ,wearing googles )
 29/06/2025 05:36 PM

29 ASSESSMENT

2. Physical Assessment
 Assessment of conjunctiva
 Assessment of pupil and ,eye muscle function
 Examining intraocular structures with an
ophthalmoscope
Use PERRL for pupil test
Is the Pupil Equal ,Round, reactive to, Light
 29/06/2025 05:36 PM

30 ASSESSMENT OF THE EYE -1

• Eye muscle function: testing the six cardinal position of gaze

• Evaluate the function of each six extraocular muscle and
cranial nerves responsible for their movement (cranial III, IV &VI
)
• Examine the retina structures with the ophthalmoscope
(constriction in the vessels of the retina may be a sign of
hypertension )
 29/06/2025 05:36 PM

31 ASSESSMENT OF THE EYE - 2

• Examination of all the ocular structures from outermost

to innermost
 Eyelid & eye lashes: observe position and movement
,swelling or inflammation ,discharges
 Observe position of eyelid - inward turning which may
indicate trachoma (entropion )
 Conjunctiva –observe degree of redness
chemosis ,discharges, foreign body
 29/06/2025 05:36 PM

32 ASSESSMENT OF THE EYE-3

• Sclera- observe for redness or jaundice

• Cornea –observe for haziness across the
cornea ,suture lines
• Anterior chamber –observe depth, clarity, presence
of hyphemia ,hypopyon(pus),no fluid should be
seen , it is normally clear
• Iris-observe color, position ,appearance
 29/06/2025 05:36 PM

33 ASSESSMENT OF THE EYE- 4

• Pupils-observe size ,shape position reaction to light

,
• lens and retina -examine through dilated pupil
using ophthalmoscope (by ophthalmic nurse or
doctor)
• observe for clarity of lens (dense cataract may be
seen with a torch )
 29/06/2025 05:36 PM

34
visual acuity

 The mathematical estimation of

visual function for different
distances
 Good visual acuity means good
eyesight
 Distance and near visual acuity is
assessed using one of the
Snellen test type charts
 29/06/2025 05:36 PM

35 Terms associated with visual acquity

and refractive
• Emmetropia-normal sight
• Ametropia –defective sight due to refractive error
• Myopia- shortsightedness (light rays focus in front of the retina)
• Hypermetropia-long sightedness ;light rays focused behind the retina
• Presbyopia –loss of focused near –vision capacity ,resulting from los of
lens elasticity due to ageing
• Astigmatism-irregular curvature of the cornea which prevents light
rays from focusing at a single point
 29/06/2025 05:36 PM

36 DIAGNOSTIC TESTS

• Tests to determine the presence of eye disorders

include;
 direct evaluation techniques as well as radiologic
and imaging studies
• Direct evaluation include ; refraction, slit-lamp
examination, and tonometry which allow direct
evaluation of various eye structures and functions
 29/06/2025 05:36 PM

37 DIAGNOSTIC TESTS

• Refraction; enables images to focus on the

retina and directly affects visual acuity.
• This test is done routinely during a complete eye
examination or whenever a patient complains of a
change in vision
• It defines the degree of impairment (refractive
error) and determines the degree of correction
required to improve visual acuity with glasses or
contact lenses
 29/06/2025 05:36 PM

38
Diagnostic tests contd

• Slit lamp examination: The slit lamp is an instrument

equipped with a special lighting system and a binocular
microscope
 This tool allows the practitioner to visualize in detail the
anterior segment of the eye, which includes the
eyelids, eyelashes, conjunctiva, sclera, cornea, tear
film, anterior chamber, iris, lens, and anterior portion of
the vitreous humor (vitreous face)
 If abnormalities are noted, special devices may be
attached to the slit lamp to allow more detailed
investigation
 29/06/2025 05:36 PM

39 SLIT LAMP EXAM

 29/06/2025 05:36 PM

 Tonometry allows non-invasive measurement of

40 intraocular pressure (IOP) to detect glaucoma, a common
cause of blindness, at an early stage in the disease

 In the early stages of glaucoma, increased IOP causes the

eyeball to harden and become more resistant to
extraocular pressure

 Pneumotonometry uses a puff of air to the eye to

measure pressure

 Applanation tonometry provides the same information by

measuring the amount of force required to flatten a
known corneal area
 29/06/2025 05:36 PM

41 TONOMETER
 Radiologic and imaging studies include fluorescein
29/06/2025 05:36 PM

4 angiography, ocular ultrasonography, and orbital

2 computed tomography (CT)
 Fluorescein angiography records the appearance of blood
vessels inside the eye through rapid-sequence
photographs of the fundus (posterior inner part of the eye)

Nursing consideration for patient with radiologic

studies
• Check the patient’s history for an intraocular lens implant,
glaucoma, and hypersensitivity reactions, reactions to
contrast media and dilating eyedrops
• Tell the patient with glaucoma not to use miotic eyedrops
ordered on the day of the test
 29/06/2025 05:36 PM

43 FLUORESCEIN ANGIOGRAPHY
44 Nursing consideration for patient with
radiologic studies
• Explain to the patient that eyedrops will be instilled to
dilate his pupils and that a dye will be injected into his
arm, remind him to maintain his gaze position and
fixation as the dye is injected
• Tell him that he may briefly experience nausea and a
feeling of warmth, Reassure him as necessary
• Observe the patient for hypersensitivity reactions to
the dye, such as vomiting, dry mouth, metallic taste,
sudden increased salivation, sneezing, light-
headedness, fainting, and hives
• Remind the patient that his skin and urine will be a
yellow color for 24 to 48 hours after the test and that
his near vision will be blurred for up to 12 hours
 29/06/2025 05:36 PM

45 Ocular ultrasonography measures and reflect of

ocular structures, providing an illustration of the eye’s
structures

• Helps to evaluate a fundus clouded by an opaque medium

such as a cataract
• This test can identify pathologies that ophthalmoscopy
can’t normally detect
• May also be performed before such surgery as cataract
removal or implantation of an intraocular lens
 29/06/2025 05:36 PM

46 OCULAR ULTRASOUND
 29/06/2025 05:36 PM

Nursing considerations in ocular ultrasonography

4 • Tell the patient that a small transducer will be placed
7 on his closed eyelid and that the transducer will
transmit high-frequency sound waves that will reflect off
the structures in the eye

• Inform him that he may be asked to move his eyes or

change his gaze during the procedure; explain that his
cooperation will help to ensure accurate results

• After the test, remove the water-soluble jelly that was

placed on the patient’s eyelids
48 Orbital Computerized Tomography : allows visualization
29/06/2025 05:36 PM

of abnormalities that standard X-rays do not readily show

 Delineate the size, position, and relationship of an
abnormality to adjoining structures
 Help confirm a suspected circulatory disorder,
hemangioma, or subdural hematoma
 It also permits precise diagnosis of many intracranial
lesions that affect vision
Nursing considerations
 Withhold food and fluids from the patient for 4 hours
before the test,If a contrast medium will be administered
 Check his history for hypersensitivity reactions to iodine,
shellfish, or radiographic dyes
 29/06/2025 05:36 PM

4
9 Nursing Considerations contd
 Tell the patient that he’ll be positioned on an X-ray table
and that the head of the table will move into the scanner,
which will rotate around his head and make a whirring
noise

 If a contrast medium will be used for the procedure, tell

the patient that he may feel flushed and warm and may
experience a transient headache, a salty taste, and
nausea or vomiting after injection of the medium

 Reassure him that these reactions to the contrast

medium are typical.
 29/06/2025 05:36 PM

50 TREATMENTS FOR EYE DISORDER

• Drug therapy -Topical medications are commonly

used to treat eye disorders
• These medications include anti-infectives, anti-
inflammatories, miotics, mydriatics, vasoconstrictors,
and other systematic medications
• Surgical treatment include- cataract
removal,iridectomy, laser surgery, scleral buckling,
and trabeculectomy
 29/06/2025 05:36 PM

51 Patient preparation for eye surgery-1

• Discuss the operation using the model of the eye

• Procedure for preoperative eye preparation should be explained
• Managing positioning and activity- position that increases
venous pressure in the head should be avoided in ophthalmic
patients (there is exception with retinal detachment and
vitrectomy )
• Examining the eye (bleeding, loss of sight, sign of infection )
• Managing dressing (cartella shield ,wearing of dark glasses)
 29/06/2025 05:36 PM

52 Patient preparation for eye surgery -2

• Tell patient to wear eye patch/shield temporarily after

surgery
• Get help when getting out of bed
• Sleep on the unaffected side to reduce IOP
• Monitor and report pain to the doctor
• Observe safety precautions
• Instruct patients to wear eye shields at night whenever the
patient sleeps
 29/06/2025 05:36 PM

53 Prevention of eye disorders

• Education on prevention of eye diseases and impairment ,and

injuries
• Regular eye exams
• Nutrition for eye health ( Vitamins A and B )
• Eye safety and preventions
• Eye irrigations in case of foreign bodies in the eye
• Medication administration
 29/06/2025 05:36 PM

54 REFERENCES

• Brunner and Suddart Textbook of Medical Surgical

Nursing 12TH Edition
• Chung, J.K et.al, (2009) Bilateral Cataract Surgery:
A controlled Clinical trial. Japanese journal of
ophthalmology 53(2) 107-13
• Medical-Surgical Nursing Made incredibly Easy
 29/06/2025 05:36 PM

55 REFERENCES

• Mustapha,R.O (2010) The Simplified Anatomy and

Physiology with Pathophysiology of Commonest Diseases
.Pp 287-296 Adewumi printing Press, Ilorin Nigeria
• Stellenberg, E.L and Bruce, J.C.,(2007) Nursing
Practice ;Medical –Surgical for Hospital and Community,
African –Edition Churchill Livingstone, London