Cataract: Presented By: Homipal

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CATARACT

Presented By:
Homipal
INTRODUCTION
Cataract refers to the opacification of crystalline
lens, which impedes the passage of light
reaching the retina leading to impaired vision.
Although related to age related oxidative damage
of the lens in most cases, it may also be present
congenitally in children or develop after an
injury, inflammation or long-term steroid use.
Clinical Features

Symptoms:
• Gradual painless progressive loss of vision in one/both eyes
• Excessive glare
• Monocular diplopia or polyopia
• Colored halos around lights
• Diurnal variation in vision
• Fixed black spots before eyes

Signs:
• Greyish white or whitish lenticular opacity on torch light examinations
INVESTIGATION
 Visual Acuity (VA), Intra Ocular Pressure
(IOP)
 Blood Pressure (BP), Random Blood Sugar
(RBS)
 Prior to Surgery: ECG, Urine routine, A-
scan, Xylocaine sensitivity test.
Management:

Screening for cataract:

• All individuals aged 30 years and above should routinely


be screened for cataract with the help of a torch.
• In normal cases, the pupils get constricted and appear jet
black.
• However, in patients suffering from cataract, due to the
opacity of the lens, light gets reflected and the pupil
appears to be white (as depicted in the image). 
 
 .
Treatment for cataract:

• There are no medicines which can cure


cataract.
• Surgery is the primary method of
treatment.
• All suspected cases of cataract should
be referred to eye camps.
Role of CHO in Cataract management
Support the Medical Officer at AB-HWC-PHC/UPHC in-
 Screening all individuals 30 years and above for cataract
 Making a list of all vision centres/ eye surgeons/eye
specialists in the area
 Linking patients with suspected cataracts to these vision
centres for treatment
 Inform your clients that the Intra Ocular Lens (IOL)
insertion of cataract is done free in all Govt. Institutions
 Follow up all post – op cases to ensure that they follow
proper eye care post cataract surgery and do not develop
any complications
 Long term follow- up of all cataract cases for vision
acuity
Patient Care cycle/ referral pathway for cataract patients:
1. Patient presents with symptoms (painless loss of vision)

Ask for: Assess for:

1. Onset and progression of 1.Age of the patient


vision loss whether associated 2.General examination: BP, RBS
with pain 3.Ophthalmic examination:
2. Uni / bilateral loss of vision  Check for any uncorrected
3. Known case of Diabetes refractive errors
Mellitus (DM)/Hypertension  Torch examination to look for
(HTN) opacity of lens
4. Any other medicine use
5. Previous eye surgery
2. Probable case of cataract if:
 Gradual painless loss of vision
 Bilateral (although one may be more affected than the
other)
 Age of patient 30 years and above
 Known case of DM/HTN
 Opacity of lens observed during torch examination

3. Referral to District Hospital (DH)/ or to a facility with eye surgeon


specialist/ any near-by eye camp

4. After treatment at the referral centre (surgery in cases of cataract), patient


is referred back to AB-HWC-SHC/PHC/UPHC for follow up
5. Follow-up care through AB-HWC-SHC/PHC/UPHC
a) Instilling antibiotic eye drops as prescribed by the surgeon/eye specialist
b) Check for post-operative complication such as watering from the eyes, continued redness
and pain in the eye
c) Counselling the patient about:
i. Importance of follow-up visits to surgeon after 24 hours/ as advised by surgeon.
ii.Need for using protective eye wear such as dark glasses during day time
iii.Procedure of cleaning the eyes and instillation of eye drops.
iv.Avoid splashing water into the operated eye during face wash/bathing. Head bath can be
resumed only after a period of 3-4 weeks.
v. Lifting heavy objects/ exercises should be avoided for 4-6 weeks.
vi.Avoid applying kajal/mascara for at least 4 weeks.
vii.Warning symptoms such as increasing redness, pain or decreased vision, needing re-
referral to the surgeon.
6. Follow-up at community level through ASHA/ANM/MPW

a)Visit the patient on Day 1, Day 3 and Day 7 after surgery.


b)Check if the patient is able to use the eye drops correctly
and has understood the dosage of his medicines.
c)Re-enforce the post-operative care and pre-cautions to be
undertaken.
d)Ask if the patient is suffering from any of the warning
symptoms such as increasing redness, pain or decreased
vision, needing URGENT referral to the surgeon.

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