A Partial Fulfillment of the Requirements in NCM 116-n RLE
CATARACT
Submitted by:
PRECIOUS PULMONES
Submitted to:
FRANCISCO CAMPOS, RN
MARCH 2025
TABLE OF CONTENTS
Cover Page.............................................................................................................................. i
Introduction............................................................................................................................ 3
Signs and Symptoms.............................................................................................................4
Pathophysiology.................................................................................................................... 5
Diagnostic Test.......................................................................................................................6
Treatment................................................................................................................................ 7
Nursing Intervention.............................................................................................................. 9
References............................................................................................................................10
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INTRODUCTION
Cataract refers to an eye disorder in which the normally transparent lens
becomes cloudy, hence blocking light from traversing through to the retina. Clouding
or opacification of the lens or the capsule surrounding it leads to vision impairment
and, in extreme cases, blindness. Cataracts can occur at any age, including infancy,
but they predominantly occur among the elderly. The disorder may occur in one or
both eyes and is variable in severity. It might not have much influence on day-to-day
life in its initial years, but as it advances—particularly after the fourth or fifth
decade—it can cause total lens opacity, compromising vision and day-to-day activity
considerably. Cataracts remain among the prevalent causes of blindness across the
globe (Nizami, Gurnani, & Gulani, 2024).
From 1990 to 2019, the global cataract burden, in terms of disability-adjusted
life years (DALYs), increased by 91.2%, crude rates went up by 32.2%, and
age-standardized rates decreased by 11.0%. The maximum age-standardized
prevalence and DALY rates occurred in 2017 and 2000 with a prevalence rate of
1,283.53 per 100,000 population and a DALY rate of 94.52 per 100,000. These rates
are expected to fall slightly to 1,232.33 and 91.52 in 2050. The rate of blindness due
to cataract was the highest in Southeast Asia in 2019 at an age-standardized DALY
rate of 99.87. Disparities by gender have been seen since 1990, with a greater
burden in women. This pattern continues with increasing age and differs among
Global Burden of Disease (GBD) super regions. Moreover, gender variations in
age-standardized DALY and prevalence rates were inversely correlated with the
Socio-Demographic Index (SDI) using linear regression analysis (Fang et al., 2022).
In the Philippines, cataracts are still a significant cause of vision impairment
that affects about 1.18 million individuals, or 1.06% of the population. Of persons
with visual conditions, about 423,000 have uncorrected refractive errors, 300,000
(0.27%) have glaucoma, and 223,000 (0.2%) have maculopathy or diabetic
retinopathy (Montemayor, 2022).
Cataracts develop due to multiple factors, including congenital causes linked
to maternal nutrition, infections, and oxygen deprivation. Age-related (senile)
cataracts are the most common, while subcapsular, nuclear sclerotic, cortical, and
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Christmas tree cataracts have distinct characteristics affecting vision. Trauma, such
as blunt or perforating injuries, electric shock, radiation, and chemical exposure, can
also cause cataracts. Systemic diseases like diabetes, myotonic dystrophy, atopic
dermatitis, neurofibromatosis type 2, and endocrine disorders contribute to cataract
formation. Secondary cataracts may arise from chronic anterior uveitis, acute
angle-closure glaucoma, high myopia, hereditary fundus dystrophies, or prolonged
corticosteroid use. Poor nutrition, smoking, and excessive alcohol intake further
increase the risk (Nizami, Gurnani, & Gulani, 2024).
SIGNS AND SYMPTOMS
●​ Blurry vision or haze – Items appear blurry, as if through dirty glasses.
●​ Patches of fuzziness – Irregular patches of blurred vision or missing spots.
●​ More light needed – Greater eye strain in low light.
●​ Dim or yellow hues – Colors become washed out or yellow.
●​ Light sensitivity – Greater squinting or discomfort in bright light.
●​ Glare or halos – Rings or glare around lights, typically at night.
●​ Regular changing of prescriptions – Sudden degeneration of sight that
necessitates new glasses constantly.
●​ Double vision in one eye – Seeing several images in an eye.
●​ Blurry vision – Objects seem like looking through mist.
●​ Night vision issues – Increasing trouble seeing during the night.
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PATHOPHYSIOLOGY
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DIAGNOSTIC TEST
Visual Acuity Test
A visual acuity test assesses the sharpness or clarity of your vision at varying
distances. The most widely used is the Snellen chart, which is a series of rows of
letters that get progressively smaller. You will be asked to stand 20 feet away and
read the smallest line you can, one eye at a time. If you cannot read the letters, the
physician can use a phoropter to calculate the proper prescription for glasses or
contact lenses. In other situations, a different test, such as the Jaeger chart for near
vision or a pinhole test, is performed. This test is crucial in identifying refractive
errors like nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.
Poor scores may also reveal underlying eye illnesses, such as cataracts or macular
degeneration.
Pupillary Response Test
The pupillary response test evaluates how your pupils respond to light and
darkness to help determine the health of your eyes and nervous system. The
physician holds a bright light in front of each eye and sees how rapidly the pupils
constrict (get smaller) and then dilate (get larger) when the light is taken away. Under
normal circumstances, both pupils should respond equally and symmetrically. If one
pupil is more sluggish to respond or is fixed, this could be a sign of neurological
problems, including optic nerve injury, brain trauma, or even conditions like Horner's
syndrome. This test also comes in handy when identifying cataracts since a clouded
lens will likely scatter light, hence an unusual response. Marcus Gunn Pupil (a
situation where the pupil dilates rather than getting smaller upon exposure to light)
can also point toward optic nerve or retina damage.
Tonometry Test
Tonometry measures intraocular pressure (IOP), or eye pressure. This is an
important test to diagnose glaucoma, a disease resulting from elevated eye pressure
that, if left untreated, can cause optic nerve damage and blindness. There are
various forms of tonometry tests:
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●​ Applanation Tonometry (Goldmann Tonometry) – A tiny probe lightly
touches the cornea following the administration of numbing drops. This is
regarded as the most accurate measurement for IOP.
●​ Non-Contact (Air-Puff) Tonometry – Air is blown on the eye to record
resistance. It is a routine, rapid screening test but less accurate than
applanation tonometry.
●​ Tono-Pen – A portable device for measuring eye pressure, frequently in
children or bedridden individuals.
Normal eye pressure is 10 to 21 mmHg. Any reading above this could be
glaucoma or other ocular disease, whereas below normal might indicate conditions
like ocular hypotony. If elevated IOP is found, further testing (like optical coherence
tomography or visual field testing) would be advised.
Slit-Lamp Examination
Slit-lamp examination gives an enlarged, close-up view of the eye's front
structures such as the eyelids, conjunctiva, cornea, iris, lens, and anterior chamber.
It is a key test for conditions like cataracts, corneal ulcers, retinal detachments, and
macular degeneration. While you sit at a machine, the doctor employs a binocular
microscope and a thin, concentrated beam of light to view various areas of the eye.
Fluorescein dye is sometimes employed to illuminate abnormalities, especially in the
cornea, to identify scratches, foreign particles, or infections. Physician applies
dilating eye drops to open up the pupils for a better look at the retina and optic nerve.
Dilation does, however, result in temporary light sensitivity and blurry vision for
several hours. The test is an important aid to early diagnosis of glaucoma, diabetic
retinopathy, and cataracts because it enables the physician to observe changes in
the internal structures of the eye over time.
MEDICAL TREATMENTS
●​ Phacoemulsification - Phacoemulsification is the most frequently used
cataract surgery procedure today. It is a method of making a small incision in
the cornea, through which an ultrasonic probe is passed to break up the
cloudy lens. The broken-up lens material is suctioned out, and an intraocular
lens (IOL) is placed in its position. This is a minimally invasive procedure that
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takes less than 30 minutes, needs only minimal sedation, and does not
usually require stitches or an eye patch after surgery.
●​ Extracapsular Cataract Extraction (ECCE) - ECCE is used mainly for more
mature cataracts that are too dense for phacoemulsification. In ECCE, a
larger incision is made in the cornea to take out the cloudy lens in one piece,
leaving the elastic capsule partially intact to allow for the insertion of an IOL.
Because the incision is larger, sutures must be used to close the wound, and
recovery of vision can be slower than with phacoemulsification.
●​ Intracapsular Cataract Extraction (ICCE) - ICCE is not as frequently utilized
a method these days, except in certain instances like severe trauma. ICCE is
a technique where the entire lens and the surrounding capsule are removed
via a big incision. The IOL is implanted in front of the iris. Because of the
invasiveness of this method and improvements in surgical methods, ICCE is
no longer practiced in contemporary cataract surgeries.
●​ Monofocal Intraocular Lenses (IOLs) - Monofocal IOLs are the most
frequently implanted lenses in cataract surgery. They have one focusing
distance, usually designed for clear distance vision. Monofocal IOL patients
generally need glasses for near activities, like reading or writing. Toric lenses
do not correct astigmatism; thus, people with this condition might still need
corrective lenses for best vision.
●​ Toric Intraocular Lenses - Toric IOLs aim to correct astigmatism by being of
varied powers in certain meridians of the lens. They enhance the quality of
vision by minimizing distortions resulting from irregularly shaped corneas.
Toric lenses are produced in monofocal, multifocal, and extended depth of
focus models, which can be tailored to suit the patient's visual requirements.
●​ Multifocal Intraocular Lenses - Multifocal IOLs offer several focusing
distances, allowing patients to see at near, intermediate, and far distances.
These lenses minimize the need for glasses for different activities. Some
patients might develop visual disturbances like glare or halos around lights,
and these lenses are not appropriate for all.
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NURSING INTERVENTIONS
Preoperative:
●​ Assess visual impairment and functional limitations.
●​ Educate the patient about the surgical procedure and expected outcomes.
●​ Withhold anticoagulants as per physician’s order.
●​ Ensure informed consent is signed.
●​ Provide emotional support to reduce anxiety.
●​ Instruct on preoperative fasting if required.
●​ Administer prescribed preoperative eye drops.
Postoperative:
●​ Monitor for pain, swelling, or signs of infection.
●​ Educate on proper eye protection.
●​ Instruct on correct administration of prescribed eye drops.
●​ Advise against activities that increase intraocular pressure.
●​ Encourage adherence to follow-up appointments.
●​ Teach the patient to recognize signs of complications.
●​ Promote a safe home environment to prevent falls or injury.
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Behrens, A. (2021). Cataract surgery. Johns Hopkins Medicine. Retrieved from
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Boyd, K. (2024). IOL implants: Lens replacement after cataracts. American Academy
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Byrd, T. (2023). Types of IOLs - Which is best? Byrd and Wyandotte Eye Clinic.
Retrieved
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Fang, R., Yu, Y. F., Li, E. J., Lv, N. X., Liu, Z. C., Zhou, H. G., & Song, X. D. (2022).
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https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-1449
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Khazaeni, L. M. (2022). The eye examination. Merck Manual. Retrieved from
https://www.merckmanuals.com/home/eye-disorders/diagnosis-of-eye-disorde
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Montemayor, M. T. (2022, August 25). [Article title]. Philippine News Agency.
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Nizami, A. A., Gurnani, B., & Gulani, A. C. (2024). Cataract. National Center for
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