Retinal Detachment
Results from separation of the sensory layer of the retina containing the rod and cones from the pigmented epithelial layer beneath. - It may occur spontaneously because of degenerative changes in the retina (as in diabetic retinopathy) or vitreous humor, trauma, inflammation, tumor, or loss of a lens to a cataract.
- It is rare in children, the disorder most commonly occurs after age 40.
- Untreated retinal detachment results in loss of a portion of the visual field.
Assessment:
- Initially, the patient complains of flashes of light, floating spots or filaments in the vitreous, or blurred, “sooty” vision. Most of these phenomena result from traction between the retina and vitreous.
- If detachment progresses rapidly, the patient may report a veil-like curtain or shadow obscuring portions of the visual field. The veil appears to come from above, below, or from one side; the patient may initially mistake the obstruction for a drooping eyelid or elevated cheek.
- Straight-ahead vision may be unaffected in early stages but, as detachment progresses, there will be loss of central as well as peripheral vision.
Diagnostic Evaluation:
- Ophthalmoscopy or slit-lamp examination with full pupil dilation shows retina as gray or opaque in detached areas. The retina is normally transparent.
Surgical Interventions:
- Surgical intervention aims to reattach the retinal layer to the epithelial layer and has a 90% to 95% success rate.
Techniques include:
a.
Photocoagulation, in which a laser or xenon are “spot welds” the retina to the pigment epithelium.
b. Electrodiathermy, in which a tiny hole is made in the sclera to drain subretinal fluid, allowing the pigment epithelium to adhere to the retina.
c. Cryosurgery or retinal cryopexy, another “spot weld” technique that uses a super cooled probe to adhere the pigment epithelium to the retina.
d. Scleral buckling, in which the sclera is shortened to force the pigment epithelium closer to the retina; commonly accompanied by vitrectomy.
Nursing Interventions:
1. Prepare the patient for surgery.
- Instruct the patient to remain quiet in prescribed (dependent) position, to keep the detached area of the retina in dependent position.
- Patch both eyes.
- Wash the patient’s face with antibacterial solution.
- Instruct the patient not to touch the eyes to avoid contamination.
- Administer preoperative medications as ordered.
2. Take measures to prevent postoperative complications.
- Caution the patient to avoid bumping head.
- Encourage the patient no to cough or sneeze or to perform other strain-inducing activities that will increase intraocular pressure.
3. Encourage ambulation and independence as tolerated.
4. Administer medication for pain, nausea, and vomiting as directed.
5. Provide quiet diversional activities, such as listening to a radio or audio books.
6. Teach proper technique in giving eye medications.
7. Advise patient to avoid rapid eye movements for several weeks as well as straining or bending the head below the waist.
8. Advise patient that driving is restricted until cleared by ophthalmologist.
9. Teach the patient to recognize and immediately report symptoms that indicate recurring detachment, such as floating spots, flashing lights, and progressive shadows.
10. Advise patient to follow up.
