Prof.
Dr/ Entisar Abdelaleem
Dr/ Nagwa Alkhayat
C.I/ Hoda Gamal Abulmajd
2024 - 2025
Outlines
• Introduction
• Definition
• Structure of eye
• Pathophysiology of cataract
• Causes
• Risk factor
• Types
• Signs and Symptoms
• Complications
• Diagnosis
• Treatment (Medical & Surgical)
• Nursing management
• Patient education after cataract surgery
• Prevention
• References
Introduction
Cataract is an eye condition in which the lens of the eye becomes cloudy due to
the breakdown of proteins in the lens, making the eye appear unclear or less
colored.
This causes vision to worsen, making it especially difficult to see fine details
clearly. Some people’s vision is only slightly affected, whereas others might lose
their Eyesight very quickly. Cataract, the most common cause of blindness and
visual impairment, is often Related to ageing. Occasionally children are born with
the condition, or a cataract May develop following an eye injury, or as a result of
inflammation or other Diseases, such glaucoma and diabetes.
Structure of Human Eye
A human eye is roughly 2.3 cm in diameter and is almost a
spherical ball filled with some fluid. It consists of the following parts:
1. Sclera: It is the outer covering, a protective tough white layer called the sclera
(white part of the eye).
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2. Cornea: The front transparent part of the sclera is called the cornea. Light
enters the eye through the cornea.
3. Iris: A dark muscular tissue and ring-like structure behind the cornea is
known as the iris. The color of the iris actually indicates the color of the eye.
The iris a s also helps regulate or adjust exposure by adjusting the iris.
4. Pupil: A small opening in the iris is known as as a pupil. Its size is controlled
with the help of iris. It controls the amount of light that enters the eye.
5. Lens: Behind the pupil, there is a transparent structure called a lens. By the
action of ciliary muscles, it changes its shape to focus on the , light on the
retina. It becomes thinner to focus on distant objects and becomes thicker to
focus on the nearby objects.
6. Retina: It is a light- sensitive layer that consists of numerous nerve cells. It
converts images formed by the lens into electrical impulses. These electrical
impulses are then transmitted to the brain through optic nerves.
7. Optic nerves: Optic nerves are of two types. These include cones and rods.
8. Cones: Cones are the nerve cells that are more sensitive to bright light. They
help in detailed central and colour vision.
9. Rods: Rods are the optic nerve cells that are more sensitive to dim lights. They
help in peripheral vision.
10.Choroid: the intermediate layer, and brings the blood supply to the eye,
allowing for the exchange of oxygen and nutrients.
11.The macula: it is in the central area of the retina and it provides central vision,
which is the high-resolution, color vision dedicated to the central focus of the
eye any time.
12.Fovea: In the center of the macula, a highly specialized region that provides
extreme detail for the input within the eye’s focus.
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o The anterior part of the eye is divided into two chambers, both filled with
liquid. The anterior chamber is between the cornea and the iris.
o The posterior chamber is between the iris and the lens. In the posterior part
of the eye, the vitreous chamber, between the lens and the retina contains the
vitreous humour.
13.Vitreous chamber: The light from the outside travels through the humour,
before reaching the retina, where it will be finally transformed into an
electrical impulse and delivered to the brain via the optic nerve.
o At the junction of the optic nerve and retina, there are no sensory nerve cells.
So no vision is possible at that point and is known as a blind spot.
o An eye also consists of six muscles. It includes the medial rectus, lateral
rectus, superior rectus, inferior rectus, inferior oblique, and superior
oblique.
The basic function of these muscles provide different tensions and torques that
further control the movement of the muscle.
Definition
cataract is a clouding of the lens of the eye, which is typically clear. For
people who have cataracts, seeing through cloudy lenses is like looking through
a frosty or fogged-up window. Clouded vision caused by cataracts can make it
more difficult to read, drive a car at night or see the expression on a friend's face.
Cataracts develop slowly and can affect one or both eyes.
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Pathophysiology
• The lens contains specialized proteins called crystallins, arranged precisely to
maintain transparency. Crystallins are protected from oxidation by high levels
of reduced glutathione, helping to preserve lens clarity. As we age, oxidative
stress increases, and the lens loses its ability to repair itself, leading to protein
damage and breakdown. This damage causes protein aggregation, which
affects lens transparency, contributing to cataract formation.
• With age, the lens's metabolic efficiency declines, reducing its ability to
synthesize proteins and maintain cellular structures.
• Oxidative damage, along with protein-related light scattering and
discoloration, leads to cataracts.
• Light and radiation exposure alter the genetic material of lens cells. Damaged
cells may degrade or move to the back of the lens, forming posterior
subcapsular cataracts.
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• This process, over time, leads to clouding of the lens, known as a cataract
Causes
The main causes of cataracts involve changes in the structure of the lens in the
eye. Here’s a detailed breakdown:
1. Protein C lumping in the Lens: The eye’s lens is made mostly of water and
proteins arranged in a precise way to keep the lens clear. As we age, the
proteins can break down and clump together. This clumping causes
cloudiness in the lens, which leads to cataract formation.
2. Oxidative Stress: Oxidative stress, caused by free radicals (unstable
molecules), damages the proteins and lipids in the lens. Over time, this
damage can result in cataracts. Factors like UV light exposure, smoking, and
poor diet increase oxidative stress.
3. Lens Thickening and Hardening (Sclerosis): As people age, the lens
naturally thickens and hardens. This process, called nuclear sclerosis, changes
the transparency of the lens, making it harder for light to pass through, which
can lead to cataracts.
4. Altered Lens Cell Function: The cells in the lens are unable to regenerate
and repair themselves effectively. Damage accumulates over time, especially
due to aging, trauma, or other factors, contributing to cataract development.
These biological processes happen naturally with aging but can be accelerated by
factors like trauma, UV exposure, or other health condition.
Risk factors
Certain factors can increase the risk of developing a cataract as following: -
• Aging
• Diabetes (cataracts can form earlier if you have diabetes)
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• Family history of cataracts at a young age
• Years of excessive exposure to the sun and UV rays
• Smoking
• Obesity
• High blood pressure
• Past eye injury or inflammation
• Previous eye surgery
• Steroid medication use
• Hormone replacement therapy
Significant alcohol consumption
Types
Cataracts can be classified into several types based on their
location and cause:
1. Nuclear Cataracts: Nuclear cataracts are the most common type and
primarily affect the centre of the lens (called the nucleus). These cataracts
usually develop with age. They form deep in the central part of the lens and
increase gradually, causing the centre of the lens to become yellow or brown.
As the cataract progresses, it can significantly impact both near and distance
vision and may become difficult to tell colors apart.
2. Cortical Cataracts: Cortical cataracts develop on the lens cortex which is the
outer edge of the lens. They often start as whitish, wedge-like opacities that
progress inward and can be described as gradually moving into the centre in
a spoke-like manner.This type of cataract may also cause halos around lights.
3. posterior Subcapsular Cataracts: A posterior subcapsular cataract starts As
a small spot that usually forms near the back of the lens, right In the path of
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light. A posterior subcapsular cataract often Affects your reading vision. It
also may reduce your vision inBright light and cause glare or halos.
4. Congenital Cataracts: Some people are born with cataracts or down from
Parents. They also may be associated with an infection or trauma.
5. Secondary Cataracts: Secondary cataracts can develop after surgery for
other eye conditions, such as glaucoma or retinal disease. This type of cataract
occurs when lens cells that were not removed during the initial surgery begin
to cloud over time.
6. Traumatic cataract: it result from an eye injury. The lens can become
clouded either immediately after the injury or a number of years later.
7. Radiation cataracts: Radiation cataracts are a specific type that develop as a
result of exposure to ionising radiation. around lights at night. These types of
cataracts tend to grow faster than others .Each type can affect vision
differently and may require various treatment approaches.
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Signs and symptoms
Symptoms of cataracts include the following:
• Clouded, blurred or dim vision.
• Trouble seeing at night.
• Sensitivity to light and glare.
• Need for brighter light for reading and other activities.
• Seeing "halos" around lights.
• Frequent changes in eyeglass or contact lens prescription.
• Fading or yellowing of colors.
• Double vision in one eye.
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Complications
Complications of untreated cataract
When cataracts are not treated in time, they can lead to a range of complications.
These complications not only affect vision, but can also affect overall health and
quality of life.
1) Gradual loss of vision The quality of vision can gradually decline.
2) Increased risk of falls and accidents Poor vision can increase the risk of falls,
especially in the elderly.
3) Possibility of total blindness Cataracts can lead to complete loss of vision in
severe cases.
4) Development of secondary eye diseases such as glaucoma.
5) Difficulty performing routine tasks and affecting the person’s self-reliance in
meeting his needs.
6) Psychological impact on the person, including depression and social isolation.
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Diagnosis
1) Patient history to determine if vision difficulties are limiting daily activities
and other general health concerns affecting vision.
2) Visual acuity measurement to determine to what extent a cataract may be
limiting clear distance and near vision.
3) Refraction to determine the need for changes in an eyeglass or contact lens
prescription.
4) Eye structure exam: An eye structure exam, also called a slit lamp, allows
your eye doctor to see. The structures at the front of your eye up close. It's
called a slit lamp because it uses an intense line of light, a slit, to light up the
structures in your eye. The slit allows your doctor to view these structures in
small sections. This makes it easier to find anything that may be wrong.
5) Retinal exam: A retinal exam looks at the back of your eyes, called the retina.
To prepare for a retinal exam, your eye doctor puts drops in your eyes to open
your pupils wide, called dilation. This makes it easier to see the retina. Using
a slit lamp or a special device called an ophthalmoscope, your eye doctor can
examine your lens for signs of a cataract
6) Fluid pressure test: This test, also called applanation tonometry, measures
fluid pressure in your eye. There are multiple different devices available to do
this
Treatment
1) Medical Treatment
No medical treatment has been shown to be effective in the treatment or
Prevention of cataract.
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2) Surgical Treatment
There are majorly five types of cataracts treatment. Each one is developed to cater
different eye conditions and are distinct from each other in multiple aspects:
1. Phacoemulsification (Phaco Surgery)
This is the most common type of cataract surgery In this procedure, the surgeon
makes a 2- to 3-millimeter incision and uses a rapidly vibrating ultrasonic probe
tip to break up the cataract. The surgeon then suctions out the lens, as shown in
the image above. The outer layer of the cataract, called the lens capsule, is usually
left in place. After the lens is removed, the surgeon places a lens implant in the
empty space in the capsule where the natural lens once was, as shown in the image
below.
2. Intracapsular Cataract Extraction (ICCE)
Intracapsular Cataract Extraction (ICCE) is an older surgical method
among all the different kinds of cataract surgery. It involves the removal
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of both the cataract-affected lens and the surrounding capsule. This
procedure is rarely performed today, as it is associated with a higher
risk of complications and has been largely replaced by modern
techniques like Phacoemulsification.
3. Extracapsular Cataract Extraction (ECCE)
The risk of complications is higher with this technique than with
phacoemulsification due to the longer incision, but due to its low cost it is still
performed in many areas around the world.
4. Refractive Lens Exchange with Intraocular Lens Implants
Manual microincision cataract surgery, A 2013 study found that both
phacoemulsification and manual microincision cataract surgery had similar long-
term outcomes and complications.
5. Laser-Assisted Cataract Surgery (LACS):
Laser-Assisted Cataract Surgery (LACS) is a more recent and
innovative approach to cataract removal. This technique combines the
precision of lasers with the benefits of Phaco Surgery, offering
improved accuracy and safety.
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Complication of Cataract surgery: -
• Inflammation.
• Infection.
• Bleeding.
• Swelling.
• Drooping eyelid.
• Dislocation of artificial lens.
• Retinal detachment.
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• Glaucoma.
• Secondary cataract.
• Loss of vision
Danger Signs after surgery
If you have one of these symptoms, which are very rare, call your doctor
immediately:
• A sudden decrease in vision
• Infiltration of eye or increase tears of eye or if occur dryness of the eye
• Inflammation of eye
• Hemorrhage of eye
• Redness in or around the eye that persists after two days
• Continued sensitivity to light
• Discharge from the eye
• Pain that continues
• Fever, nausea or vomiting
• Sudden increase in floaters, or flashing lights
• A shadow in your peripheral vision; a shade appearing in your field of
vision; or dark spots.
During your recovery period, it is important to adhere to the following
instructions:
‑ Avoid physical activities and heavy lifting (do not lift anything weighing
more than 25 pounds or 11 kg).
‑ Avoid bending, exercising, and other similar activities that may strain your
eye while it is healing.
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‑ Avoid water that may enter your eye and cause infection. Make sure to keep
your eye closed while showering or bathing. In addition, avoid swimming or
hot tubs for at least two weeks.
‑ Avoid any activity that exposes your eye during the recovery phase to dust,
dirt, or other contaminants that cause infection.
‑ Avoid driving until your doctor tells you when it is safe to resume driving.
‑ Avoid rubbing your eye, as rubbing the eye can cause infection.
‑ Avoid wearing makeup, you can use face cream after surgery, but avoid it
around the eye.
‑ Avoid flying for two weeks.
‑ Commit to medicated eye drops to be used several times each day for several
weeks after cataract surgery.
‑ A protective eye patch should be worn while sleeping or napping for about a
week after surgery.
‑ Protect your eyes from sunlight and other bright lights while your eyes are
healing. Be sure to wear sunglasses.
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Nursing interventions
If nursing care is provided in the patient’s home, structure the environment with
conducive lighting and reduce fall hazards.
1. Suggest magnifying glasses and large-print books.
2. Explain that sunglasses and soft lighting can reduce glare.
3. Improve the lighting in your home with more or brighter lamps
4. When you go outside during the day, wear sunglasses or a Broad-brimmed
hat to reduce glare
5. Limit your night driving
6. Adequate intake of antioxidants (such as vitamins A, C, and E) Has been
thought to protect against the risk of cataracts
7. Check visual acuity
8. Teach patient about cataracts and their treatment
9. Regular eye examinations. Eye examinations can help detect Cataracts and
other eye problems at their earliest stages and Ask your Doctor how often you
should have an eye examination.
10. Quit smoking. Ask your doctor for suggestions about how to Stop
Medications, counseling and other strategies are available to Help you.
11. Manage other health problems. Follow your treatment plan if You have
diabetes or other medical conditions that can increase Your risk of cataracts.
12. Assist the patient with the actions of daily living as needed to remedy any
self-care deficit.
13. Encourage the patient to verbalize or keep a log on his or her fears and
anxiety about visual loss or impending surgery.
14. Help plan events to solve the problems with social isolation.
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Prevention
• Getting regular eye exams: your eye doctor can detect problems early, As a
general rule, the American Academy of Ophthalmology recommends a
comprehensive eye exam based on age:
‑ Every 5 to 10 years if you are younger than 40
‑ Every 2 to 4 years if you are 40 to 54
‑ Every 1 to 3 years if you are 55 to 64
‑ Every 1 to 2 years if you are older than 65
• Do not smoke. Ask a member of your health care team how to stop smoking.
Medicines, counseling and other strategies are available to help you.
• Manage other health problems. Follow your treatment plan if you have
diabetes or other medical conditions that can increase your risk of cataract
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• Maintaining a healthy body weight and avoiding obesity by following a
healthy diet and exercising regularly (you can exercise for half an hour a
day or 150 minutes a week, and reviewing the appropriate exercise pattern
with your doctor)
• Maintaining blood sugar levels if you have diabetes, as your lens swells if
your blood sugar remains too high for too long. Your lens also works to
change blood sugar into sorbitol. When this substance collects in your eye
lens, you see less clearly, and cataracts may form, To effectively manage
diabetes, it is important to follow a healthy diet, engage in regular physical
activity, monitor blood sugar levels, and take prescribed medications as
directed by your health care provider.
• Maintaining blood pressure, Managing high blood pressure, lifestyle
modifications such as reducing salt intake, maintaining a healthy weight,
exercising regularly, and taking prescribed. Medications can help keep your
blood pressure under control
• Avoid using cortisone medications without consulting and ordering a
doctor, especially eye drops
• Wear eye protection,Serious eye injuries can lead to cataracts. Therefore,
wear eye protection when using power tools or playing sports.
• Wear sunglasses. Ultraviolet light from the sun may cause cataracts. Wear
sunglasses that block ultraviolet B rays when you're outdoors.
• Reduce alcohol use. Drinking too much alcohol can increase the risk of
cataracts.
Diet
You can't do anything about your age or family history, but you can:
• Change your diet, Healthy nutrition plays an important role in maintaining
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eye health and protecting it from Many health problems, including vitamins
E, C, A, and a group of B vitamins, in addition to For other nutrients, such as
zinc, omega-3 fatty acids, and others.
• Good sources of vitamin C include, citrus fruits, oranges, grapefruit, lemons,
etc. In addition to that, tomatoes and tomato juice, red and green hot peppers,
kiwi, broccoli, strawberries, Cantaloupe, melon, potatoes, guava, parsley and
spinach.
• The most important sources of vitamin E are: vegetable oils such as
sunflower oil and olive oil, nuts. Seeds such as almonds and sunflower seeds,
leafy greens such as spinach and kale, fruits such as avocados Kiwi and mango,
whole grains, some types of fish such as salmon, goose meat, green tea and
Dates.
• Vitamin A: Vitamin A is one of the most important vitamins that maintain the
health of the cornea, which is responsible for vision Clear, light-sensitive cells
in the eye, known as photoreceptors, so foods can be reduced, food Rich in
vitamin A, it reduces the risk of many problems affecting the eye,You can get
what you need.
The body gets vitamin A from a number of food sources, the most
important of which are: liver, egg yolk, dairy products,Sweet potatoes,
cabbage, spinach, carrots, mango, red bell pepper.
• Vitamin B3: Known as niacin, it is an antioxidant that may play a Important
role in preventing glaucoma, a health condition that affects the eye and causes
damage to the optic nerve,Food sources: beef, poultry, fish, mushrooms,
peanuts and legumes.
• Vitamin B2: Also known as Riboflavin, it is an antioxidant. Which can reduce
oxidative stress in the eyes, thus protecting them from a number of problems
including cataracts. Eye lens, and its common sources are: oats, milk, dairy
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products, beef and fortified cereals.
• Vitamin B1: Vitamin B1, also known as thiamine, may help reduce the risk of
Cataracts, and can be used as a treatment option in the early stages of
retinopathy ,Diabetes, and its food sources include the following: whole grains,
meat, fish, and some fortified foods, including breakfast cereals, bread and
pasta.
• Sources of Vitamin B6 or Pyridoxine: Poultry, fish, meat, potatoes, and in
the rule of wisdom
• Sources of Vitamin B9 or Folic Acid: (Beef liver, asparagus, and sprouts,
Brussels sprouts, green leafy vegetables such as spinach, fruits and their juices
such as oranges, and nuts, Peanuts and beans).
• Sources of Vitamin B12 or Cobalamin: (Fish, meat, poultry, Eggs, milk and
other dairy products, some breakfast cereals, nutritional yeast, and fortified
foods).
• Zinc: Sources of zinc include the following (seafood, including oysters, crab,
and lobster Seafood, lean red meat, poultry, beans, chickpeas, nuts, pumpkin
seeds, grains Whole, milk, fortified cereals).
• Omega-3 fatty acids: Foods rich in omega-3 fatty acids include the following
(oily fish, sardines, tuna, herring, salmon, flax seeds, walnuts, chia seeds)
If you find it difficult to fit all of this into your daily diet, consider a multivitamin
or Nutritional supplements But always talk to your doctor first.
Exercise
should be gentle and focused on maintaining overall health while minimizing the
risk of falls or injury. Here are some suitable types of exercise:
1. Walking: A simple, low-impact activity that helps improve cardiovascular
health and mobility.
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2. Stretching: Gentle stretching can improve flexibility and prevent stiffness.
3. Balance Exercises: Activities like tai chi or yoga can enhance balance and
coordination, reducing fall risk.
4. Strength Training: Light resistance training with bands or light weights can
help maintain muscle strength.
5. Water Aerobics: Exercising in water can reduce strain on the body while
providing resistance.
6. Low-Impact Aerobics: Classes designed for older adults can improve fitness
without high impact.
Always consult with a healthcare provider before starting any new exercise
regimen, especially for those with vision impairments or other health concerns.
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References:
American Academy of Ophthalmology. (2024). Aao.org.
https://www.aao.org/eye-health/diseases/what-are-
WHO EMRO | Cataract | Health topics. (n.d.). World Health Organization –
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https://www.emro.who.int/health-topics/cataract/
Mayo Clinic. (n.d.). Www.mayoclinic.org.
https://www.mayoclinic.org/diseases-
Diseases & Conditions - American Academy of Ophthalmology. (2024).
Aao.org. https://www.aao.org/eye-health/diseases/what-are-
Fang, R., Yu, Y.-F., Li, E.-J., Lv, N.-X., Liu, Z.-C., Zhou, H.-G., & Song,
X.-D. (2022). Global, regional, national burden and gender disparity
of cataract: findings from the global burden of disease study
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cataracts/?lang=ar
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National Eye Institute. (2023, November 15). Cataracts. Nih.gov.
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diseases/cataracts
Boyd, K. (2018, November 20). What Are Cataracts? American Academy of
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