Assessment and Management of patients with Eye Diseases and Disorders
The ability to see the world clearly can easily be taken for granted.The eye is a sensitive,highly specialized sense organ subject to various disorders,many of which lead to impaired vision.Impaired vision may affect a person's independence in self-care,work and lifestyle choices,sense of self esteem,safety,ability to interact with society and environment and overall quality of life.
Careful fitting with corrective lenses could help more than 80% of the 14 million Americans who are visually impaired(Bressler,Quigley & Schein,2008).2/3rd of the population with impaired vision is older than 65 years of age.Younger people are also at risk for eye disorders,particularly traumatic injuries.
Assessment of the Eye
Anatomic and Physiologic Overview
The eyeball or globe,sits in a protective bony structure known as the orbit.Lined with muscle and connective and adepose tissues,the orbit is about 4cm high,wide and deep,surrounded on 3 sides by sinuses.The optic nerve and the ophthalmic artery enter the orbit at its apex through the optic foramen.The eyeball is moved through all fields of gaze by the extraocular muscles.
Normally,the movements of the 2 eyes are coordinated,and the brain perceives a single image.
Tears are vital to eye health.Tears are secreted in response to reflex or emotional stimuli.
The conjunctiva,a mucous membrane,provides a barrier to the external environment and nourishes the eye.
The sclera,commonly known as the white of the eye,is a dense,fibrous structure that makes up the posterior 5/6th of the eye maintains the shape of the eyeball and protects the intraocular contents from trauma.
The cornea is a transparent,avascular structure and is the main refracting surface of the eye.
Behind the cornea lies anterior chamber filled with aqueous humor which nourishes the cornea.
The aqueous humor is anterior to the lens,posterior to the lens is vitreous humor.
The ocular fundus is the largest chamber of the eye and contains vitreous humor.
The innermost surface of the fundus is the retina.The retina has consistency of wet tissue paper.
The lens enables focusing for near vision and refocusing for distance vision.
The following questions assist in diagnosis of an eye and vision problem:
1. What does the person perceive to be the problem?
2. Does the patient experience blurred,double,or distorted vision?
3. Is there pain;is it sharp or dull;is it worse when blinking?
4. Is the discomfort an itching sensation or more of a foreign body sensation?
5. Are both eyes affected?
6. Describe the onset of the problem(sudden,gradual).Is it worsening?
7. What is the duration of the problem?
8. Is this the recurrence of a previous condition?
9. What makes the symptoms improve or worsen?
10. How has the patient self-treated?
11. Have other family members had the same symptoms or condition?
Several eye and vision disorders are associated with genetic abnormalities.Some examples are:
- Color blindness
- Retinitis pigmentosa
- Isolated familial congenital cataracts
- Marfan syndrome
- Leber hereditary optic neuropathy
Following health history patients visual acuity is assessed.This is an essential part of eye examination.
The Snellen chart,which is composed of a series of progressively smaller rows of letters,is used to test distance vision.The fraction 20/20 is considered the standard of normal vision.Most people can see the letters on the line designated as 20/20 from a distance of 20 feet.A person whose vision is 20/200 can see an object from 20 feet away that a person with 20/20 vision can see from 200 feet away.The patient is positioned usually at 20 feet,and is asked to read the smallest line that he or she can see.The patient should wear distance correction(eyeglasses or contact lenses) if required.
Assessment and Diagnostic Testing
The assessment of low vision includes a thorough history and examination of distance and near vision acuity,visual field,contrast sensitivity,glare,color perception and refraction.
Activities affected by Visual impairment and suggestions for low vision aids
Arrange paper money in wallet compartments
High power spectacle,bifocals
Lighting,high contrast print,large print
Using a computer
High contrast color,large print
Watching sporting event
Lightweight hand held monoscopes
Sit in front row
Eye disorder- Glaucoma
Glaucoma refers to an ocular condition by optic nerve damage.
Increased intraocular pressure (IOP-pressure on eyes) is the reason for damage of optic nerve.IOP is caused by congestion of aqueous humor in eye.
Risk factors for Glaucoma
People may be having family history of glaucoma.
Cornea may be thin
Race may be African American
Prolonged use of corticosteroids.
Prevent optic nerve damage.
Many eye disorders do not require treatment or can be managed by ourselves.There are many products which are available over the counter(OTC).Among them are ointments,artificial tears,ocular decongestant.They help with itching,dryness,excessive watering of eye.However,there are instances,when it may look like a small eye problem,but it may be severe leading to blindness type of condition.In such cases,consulting a doctor is necessary.A physician should be consulted immediately if the problem is of the eyeball.
If after using the eye care product for 72 hours there is no improvement or the condition worsens,see a octor immediately.
If you are having eye pain,blurred vision,double vision see an ophthalmologist as soon as possible.
If you are preferring self treatment,you should know the cause of disorder,know the OTC eye care products available and where and when they are useful,structure of eye should be known,which disorders are safe treating and which require consultation with physician.
We can protect ourselves from eye diseases & disorders by eating more fruits and vegetables.
Our eye will remain healthy if we eat food rich in minerals and vitamins.These type of minerals and vitamins are called antioxidants.Antioxidants keep our tissues and cells healthy.
Antioxidant rich foods
carrots,sweet potatoes,green leafy vegetables,eggs
Vitamin A and Beta Carotene
Essential fatty acids
eggs,turnip greens,broccoli,zucchini,,Brussel sprouts
Lutein & zeaxanthin
gooseberry,kiwi,red & green bell peppers,broccoli,tomatoes,spinach
Vegetable oils,nuts,whole grains
red meat,oysters & other sea food,dried beans,milk & other dairy products,whole grains,breakfast cereals