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Introduction ⬇

A cataract is a lens opacity or cloudiness. More than half of all Americans have cataracts by 80 years of age; cataracts are the leading cause of blindness in the world.

Pathophysiology ⬆ ⬇

Cataracts can develop in one or both eyes and at any age. Cigarette smoking; long-term use of corticosteroids, especially at high doses; sunlight and ionizing radiation; diabetes; obesity; and eye injuries can increase the risk of cataracts. The three most common types of senile (age-related) cataracts are defined by their location in the lens: nuclear, cortical, and posterior subcapsular. The extent of visual impairment depends on the size, density, and location in the lens; more than one type can be present in one eye.

Clinical Manifestations ⬆ ⬇

Assessment and Diagnostic Findings ⬆ ⬇

Medical Management ⬆ ⬇

No nonsurgical treatment (medications, eye drops, eyeglasses) cures cataracts or prevents age-related cataracts. Optimal medical treatment is prevention, including patient education regarding risk reduction strategies such as smoking cessation and wearing sunglasses outdoors.

Surgical Management

In general, if reduced vision from cataract does not interfere with normal activities, surgery may not be needed. The decision regarding when cataract surgery is to be performed should include the patient's functional and visual status as a primary consideration. Surgical options include phacoemulsification (method of extracapsular cataract surgery) and lens replacement (intraocular lens [IOL] implants [most common], contact lenses, and aphakic eyeglasses [used in conjunction with contacts, rarely used alone]). Cataracts are removed under local anesthesia on an outpatient basis. When both eyes have cataracts, one eye is treated first, with at least several weeks (preferably months) separating the two procedures. IOL implants are contraindicated in patients with recurrent uveitis, proliferative diabetic retinopathy, neovascular glaucoma, or rubeosis iridis.

Nursing Management ⬆

Providing Preoperative Care!!navigator!!

  • Provide the usual preoperative care for ambulatory surgical procedures, with specific preoperative testing indicated by patient's medical history.
  • Obtain a careful medication history, including the use of alpha-agonists (particularly tamsulosin [Flomax] used for treatment for an enlarged prostate).
  • Administer dilating eye drops prior to surgery.
  • Educate patient regarding use of postoperative eye medications (antibiotic, corticosteroid, and anti-inflammatory drops) that will need to be self-administered to prevent infection and inflammation.

Providing Postoperative Care!!navigator!!

  • Provide patient with verbal and written instructions regarding eye protection, administration of eye drop medications, recognition of complications, activities to avoid, and obtaining emergency care.
  • Educate the patient about the expectation of minimal discomfort and availability of mild analgesic agents (e.g., acetaminophen) as needed.
  • Review medications prescribed including antibiotic medications and anti-inflammatory and corticosteroid eye drops or ointments.

Promoting Home, Community-Based, and Transitional Care!!navigator!!

Educating Patients About Self-Care

  • Educate the patient about postoperative care, including wearing a protective eye patch for the first 24 hours after surgery, followed by eyeglasses during the day and an eye shield at night. Sunglasses should be worn at all times outdoors owing to the eyes' increased sensitivity to light.
  • Slight amount of discharge in the morning, some redness, and a scratchy feeling in the operated eye is to be expected in the first few days; gently wiping with a damp washcloth to remove discharge may be suggested.
  • Educate patient to notify surgeon if new floaters, flashing lights, decreased visual acuity, pain, or increased redness occur.

Continuing and Transitional Care

  • If an eye patch is worn, it is removed at the first follow-up visit, usually 48 hours after surgery.
  • Educate patient regarding the importance of keeping follow-up appointments, monitoring visual status, and seeking prompt intervention for postoperative complications to enhance a good visual outcome.
  • Visual acuity will stabilize after eye is completely healed, usually 6 to 12 weeks, when the final visual correction will be assessed for any remaining refractive errors.
  • Advise patients with multifocal IOL implants that there may be an increased night glare and contrast sensitivity.

For more information, see Chapter 63 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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