CATARACT
Definition:
A cataract is a clouding of the natural lens of the eye, which leads to a gradual decrease in vision.
It is one of the most common causes of reversible blindness, especially in older adults.
Causes:
- Aging
- Congenital (present at birth)
- Trauma
- Systemic diseases like diabetes
- Prolonged use of corticosteroids
- Exposure to ultraviolet (UV) radiation or ionizing radiation
Types of Cataract:
1. Nuclear Sclerotic Cataract
Affects the central (nuclear) ppart of the lens. Most common age-related
related cataract. Lens becomes
yellow or brown, causing blurred vision and difficulty in dim light.
2. Cortical Cataract
Starts in the lens cortex (outer layer) and extends to the center. Appears as spoke-like
spoke opacities.
Causes
uses glare, contrast sensitivity issues, especiall
especially at night.
3. Posterior Subcapsular Cataract
Develops at the back of the lens capsule. Progresses rapidly, common in diabetics or steroid
users. Causes glare, halos around lights, and poor near vision.
4. Congenital Cataract
Present at birth or appears in infancy. Caused by infections during pregnancy, genetic conditions,
or metabolic disorders. Requires early treatment to prevent permanent vision loss.
5. Traumatic Cataract
Results from eye injury (blunt oorr penetrating). May develop immediately or years after trauma.
Severity varies based on injury.
6. Secondary Cataract
Occurs due to another condition like diabetes, or after eye surgery. May also result from steroid
use. Posterior capsule opacification (PC
(PCO) is a common post-surgery
surgery condition, sometimes
called 'secondary cataract'.
7. Radiation Cataract
Caused by prolonged exposure to radiation. Seen in patients with excessive UV or occupational
radiation exposure.
Flow of Pathophysiology:
1. Normal Lens Structure
Structure: The lens is made up of water and proteins (mainly crystallins)
arranged in a highly organized manner. This transparency allows clear passage of light to
the retina.
2. Triggering Factors:
• Aging (senile • Metabolic • Long-term
Long
cataract) disorders (e.g., corticosteroid
• UV radiation diabetes) use
• Oxidative stress • Eye trauma or
surgery
3. Biochemical
ochemical and Structural Changes:
• Oxidative damage leads to the denaturation and aggregation of lens proteins.
• The lens fibers swell, rupture, and are replaced by abnormal protein deposits.
• Calcium influx and reduced ATP activity disrupt lens meta
metabolism.
• The orderly arrangement of proteins is lost.
4. Lens Opacification:
• Accumulated protein aggregates scatter incoming light.
• The lens becomes cloudy, blocking or distorting light entering the eye.
5. Visual Impairment:
• Light cannot properly reach the retina.
• Results in blurred vision, glare sensitivity, faded colors, and poor night vision.
• Progresses gradually and can lead to blindness if untreated.
Clinical Features:
- Painless, progressive vision loss
- Blurred or cloudy vision - Glare and halos around lights
- Poor night vision
- Faded or yellowed colors
- Frequent prescription changes in glasses
- Double vision in a single eye
Diagnosis:
- Visual acuity test
- Slit-lamp examination
- Tonometry (to check intraocular pressure) : Tonometry is a medical procedure used
to measure intraocular pressure (IOP), the fluid pressure inside the eye. The normal
IOP range is 10 to 21 mm Hg.
Management:
Non-Surgical:
- Use of glasses in early stages
- Improved lighting
Surgical:
Phacoemulsification: Most common procedure using ultrasound to break and
remove the lens
• Cataract Removal:
Phacoemulsification addresses cataracts, which are clouding of the eye's natural
lens, leading to blurred vision.
• Ultrasound Technology:
An ultrasonic probe is inserted through a small incision in the cornea, emitting
sound waves that break down the lens into smaller pieces.
• Suction and Replacement:
The fragmented lens is then suctioned out, and a new artificial intraocular lens
(IOL) is implanted to restore clear vision.
• Minimally Invasive:
This procedure is considered minimally invasive due to the small incision
required, reducing complications and promoting faster recovery.
Extracapsular Cataract Extraction: For advanced cataracts
Extracapsular Cataract Extraction (ECCE) is a surgical procedure used to remove
advanced cataracts, specifically those that are too hard or dense for phacoemulsification
Procedure:
The procedure involves making an incision in the eye to access the lens, creating an
opening in the lens capsule (capsulorhexis), and removing the cloudy lens.
IOL Implantation:
An artificial IOL is inserted into the remaining capsule to replace the natural lens and
restore vision.
Intraocular Lens (IOL) Implantation: Replaces the removed lens
Intraocular lens (IOL) implantation is a surgical procedure where a small, artificial lens is
placed inside the eye to replace or supplement the natural len
lens.
Pre-operative Nursing Care:
• Explain the procedure to the patient
• Administer prescribed eye drops (antibiotic, mydriatic)
• Monitor vital signs
• Ensure patient is NPO as advised
• Obtain informed consent
Post-operative
operative Nursing Care:
• Monitorr for complications (infection, increased IOP, pain)
• Instruct patient to avoid rubbing eyes, bending, lifting heavy objects
• Administer prescribed medications
• Educate about proper eye care and follow
follow-up visits
• Use protective eye shields if advis
advised
• Sleep on the unoperated side and wear eye protection.
• Complication Awareness:
Awareness:Educate
Educate to report immediately if symptoms like:
o Severe eye pain,
o Sudden vision loss,
o Increased redness or discharge,
o Flashes of light or floaters appear.
o
Complications:
• Infection
• Posterior capsule opacification
• Retinal detachment
• Secondary glaucoma
Nursing Care Plan:
Assessment:
- Assess vision impairment level
- Monitor for eye discomfort, glare, or blurred vision
- Check patient history for systemic diseases or medication use
Nursing Diagnosis:
- Disturbed Sensory Perception (visual) related to lens opacity ( pre-op)
- Acute Pain ( Post Op )
- Risk for Injury related to visual impairment
- Anxiety related to upcoming surgery or vision changes
- Knowledge Deficit related to disease process and post-op care
Interventions:
- Educate patient on avoiding eye strain, rubbing, and exposure to dust
- Administer prescribed eye drops pre- and post-operatively
- Ensure safe environment to reduce fall risk
- Monitor for signs of infection or increased intraocular pressure
- Support patient emotionally and answer questions regarding surgery
