Retinal & Vitreous Problems
Bleeding into the vitreous
- trauma, sickle cell disease, hypertension, diabetic retinopathy, retinal tear or detachment, intraocular lens displacement, and clotting abnormalities.
- It causes decrease or loss of vision in affected eye.
- The underlying cause is treated and surgery to repair the retina may include photocoagulation, cryotherapy, scleral buckle, or vitrectomy.
- Assist the patient with visual deficit and activity pnd position restrictions before surgery.
- Maintain eye patchès, activity restriction, pain medication administration after surgery.
Central Retinal Artery Occlusion
- Sudden occlusion of the central retinal artery causes painless loss of vision in one eye with loss of light perception.
- It may have been preceded by episodes of transient monocular blindness (amaurosis fugax) for 10 to 15 minutes.
Cause: an embolus, usually from the ipsilateral carotid artery. Treatment
Central retinal artery occlusion is a medical emergency. Vision may be salvaged (recovered) if treated within 24 hours of onset.
Massaging the globe in an attempt to break up the embolus or move it distally,
Carbogen therapy (5% C02, 95% 02): CO2 dilates retinal arterioles, and 02 increases oxygen delivery to ischemic tissues. Perform for 10 minutes every 2 hours for 48
I.V. infusion of hyperosmotic agents like acetazolamide to lower intraocular pressure.
Place the patient in Trendelenburg's position and monitor vital signs as directed.
Offer reassurance and assist with additional testing and treatment as indicated.
Central Retinal Vein Occlusion
- Occlusion of the central retinal vein or a branch causes sudden (over several hours) painless decrease in visual acuity.
- Usually occurs in people with hypertension or other vascular disorders.
- Urgent ophthalmologic evaluation is needed.
- Photocoagulation may be used to prevent local hemorrhage and promote neovascularization.
- Corticosteroids are used to treat retinal edema, and an aspirin or anticoagulant may be used to -prevent further occlusive disease,
- Encourage regular screening for glaucoma in follow-up as a complication from scar tissue formation after photocoagulation.
Branch retinal vein occlusion
- Some patients are symptom free/ complain of a sudden loss of vision if the macular area is involved.
- A more gradual loss of vision on examination, the ocular fundus appears similar to that found with central retinal vein occlusion; however, only those portions of the retina affected by the obstructive veins have what is known as a "blood and thunder" appearance.