Summary
Highlights
Retinal detachment occurs when the retina separates from the underlying choroid tissue, leading to rapid and potentially permanent vision loss if not addressed immediately. It is considered a surgical emergency.
Symptoms of retinal detachment include painless, rapid vision loss, floaters (cobwebs or threads in the visual field), flashes of light, and the photognomonic sign of a 'curtain-like shadow' or 'black curtain' descending over the visual field.
Emergency surgery is required to reattach the retina. Two main procedures are pneumopexy, where a gas bubble is injected into the vitreous cavity to push the retina back, and scleral buckling, which involves placing a silicon band around the sclera to bring the eyewall closer to the detached retina.
Before surgery, the priority is to provide bed and eye rest. This includes covering both eyes with patches to prevent further stimulation, avoiding jerky movements, and minimizing eye stress by instructing the patient not to read or use cellphones.
Post-operatively, maintain eye patches and watch for hemorrhage. Patients should avoid bumping their head, rapid eye movements, driving, limiting reading for 3-5 weeks, wearing dark glasses during the day, and avoiding squinting, straining, heavy lifting, and bending from the waist to prevent increased intraocular pressure and recurrence.
Glaucoma, cataracts, and retinal detachment are common causes of vision loss, often linked to aging and diabetes. Other causes include diabetic retinopathy and macular degeneration affecting central vision. Each condition has distinct key features and treatments.
Glaucoma involves optic nerve damage due to increased intraocular pressure, leading to peripheral or tunnel vision loss. Acute glaucoma is painful with sudden IOP increase, while chronic glaucoma is painless with gradual IOP increase. Treatment includes miotic medications (like pilocarpine) to constrict pupils and improve fluid drainage, and surgery.
Cataracts are age-related clouding of the eye's lens, resulting in painless, progressive vision loss due to lens opacity. The primary treatment is surgery to remove the opaque lens and replace it with a clear artificial one.
Nursing goals for visually impaired patients focus on promoting independence and safety. This includes notifying patients when approaching, orienting them to their environment, placing visual aids and personal items within reach, ensuring a well-lit and clear pathway, assisting with ambulation by offering an arm and walking a step ahead, teaching them to feel for chairs before sitting, and assisting with meals using the clock system to describe food positions.