Treatments for Diabetic Eye Disease
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Book Excerpts: Treatment of Diabetic Eye Disease
Treatments of Diabetic Eye Disease: Online Medical Books
16 MEDICAL BOOKS ONLINE!
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Hyperglycemia:
Treatment
(In a Page: Signs and Symptoms)
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IV fluids
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Acute treatment includes insulin administration (IV or subcutaneous) or oral hypoglycemic medications
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Remove offending medications if possible
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Treat the underlying etiology
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Acute treatment of diabetic ketoacidosis involves fluid repletion, correction of electrolyte disturbances, insulin administration, and very frequent monitoring of glucose and electrolytes (intensive care admission is often necessary for initial stages of treatment)
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Long-term management includes regular testing of HbA1C, glucose (home readings), blood pressure, lipid profile, renal function, and regular podiatric and ophthalmology examinations
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» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Red Eye:
Treatment
(In a Page: Signs and Symptoms)
-
Ophthalmologic referral for HSV/herpes zoster keratitis or conjunctivitis, acute angle-closure glaucoma, scleritis, corneal ulcer, iritis, penetrating foreign bodies
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Avoid treating patients with steroid eyedrops without ophthalmologic consultation
- Conjunctivitis
–Allergic: Avoid offending agents, cold compresses to eyes, NSAIDs, ocular decongestants, antihistamines
–Viral: Self-limited, good hygiene to avoid spread
–Bacterial: Antibiotic eye drops; avoid neomycin,
because allergic reactions are common
-
Subconjunctival hemorrhage: Reassurance, cool compresses, clears spontaneously in 1–2 weeks
-
Chemical eye injury: Immediate copious irrigation with normal saline for at least 30 minutes
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Preventative measures include proper hygiene and daily cleaning of contact lenses, proper hand-washing techniques before all contact with eyes, eye protection in occupations entailing possible ocular injury
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hyperglycemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Initial management
–Fluid to correct dehydration
–Insulin to correct hyperglycemia and acidosis
–Intravenous therapy required if patient in DKA
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Long-term management: Goal is to normalize blood glucose and HbA1c to decrease risk of acute and chronic complications
-
Type II diabetes
–Absolute daily insulin requirement
–Monitor blood glucose (metabolic control)
–Attention to dietary intake (carbohydrate counting)
-
Type II diabetes
–Weight management via diet changes and exercise
–Most require medication (insulin and/or metformin)
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Prognosis
–Chronic hyperglycemia increases long-term risk of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis and ischemic heart disease) complications
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scleral Injection (Red Eye):
Treatment
(In A Page: Pediatric Signs and Symptoms)
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Intense topical antibiotics for corneal ulcers
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Topical antibiotics for bacterial conjunctivitis (sulfa, fluoroquinolones; avoid gentamicin)
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Consider systemic ceftriaxone if suspect Gonococcus
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Tears, cool compresses, topical and oral antihistamines for allergic conjunctivitis
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Frequent handwashing for viral conjunctivitis
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Oral doxycycline and treatment of partners for chlamydia
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NSAIDs for epi/scleritis
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Oral doxycycline, topical Metrogel, warm compresses for rosacea, chalazia, and blepharitis
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Massage of inner canthus, hot compresses, oral and topical antibiotics for canaliculitis and dacrocystitis
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Check intraocular pressure if suspect angle closure glaucoma (pressure typically over 40 mmHg)
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Frequent lubrication for dry eye
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Eye Discharge:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Blocked tear duct: Supportive care with massage and warm compresses; surgical probe or stent may be indicated if stenosis persists beyond 9 months of age
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Allergic conjunctivitis: Intraocular anti-inflammatory agents, antihistamines, or mast cell stabilizers
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Viral conjunctivitis: Supportive care for most routine viral infections; herpetic lesions should be referred to an ophthalmologist and must be treated with systemic acyclovir and intraocular steroids
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Bacterial conjunctivitis: Usual pathogens are susceptible to polysporin/trimethoprim, may also be treated with quinolones; newborn STD pathogens must be treated systemically
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-
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Foreign body: Removal may require referral to an ophthalmologist
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Corneal abrasion: Routine antibiotics and patching are no longer recommended, but may be used in more severe cases
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Eye pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient's eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to reduce intraocular pressure (IOP). If drug treatment doesn't reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Diabetic complications during pregnancy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of both the newly diagnosed and the established diabetic is designed to maintain blood glucose levels within acceptable limits through dietary management and insulin administration. Many females with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.
For pregnant patients with diabetes, therapy includes:
❑ bimonthly visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester
❑ maintenance of fasting blood glucose levels at or below 100 mg/dl and 2-hour postprandial blood glucose levels at or below 120 mg/dl during the pregnancy
❑ frequent monitoring for glycosuria and ketonuria (ketosis presents a grave threat to the fetal central nervous system)
❑ weight control (gain not to exceed 3 to 3½ lb [1.4 to 1.6 kg] per month during the last 6 months of pregnancy)
❑ high-protein diet of 2 g/day/kg of body weight, or a minimum of 80 g/day during the second half of pregnancy; daily calorie intake of 30 to 40 calories/kg of body weight; daily carbohydrate intake of 200 g; and enough fat to provide 36% of total calories (however, vigorous calorie restriction can cause starvation ketosis)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Be alert for changes in insulin requirements from one trimester to the next and immediately postpartum. Oral antidiabetic drugs are contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Generally, the optimal time for delivery is between 37 and 39 weeks’ gestation, although with reassuring antenatal testing and no evidence of macrosomia, 40 weeks or later is also feasible. The insulin-dependent diabetic may require hospitalization before delivery for frequent monitoring of blood glucose levels and prompt intervention if complications develop.
Depending on fetal status and maternal history, the obstetrician may induce labor or perform a cesarean delivery. During labor and delivery, the patient with diabetes should receive continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor. The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Eye pain [Ophthalmalgia]:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s eye pain results from a chemical burn, remove contact lenses (if present) and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Eye discharge:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Inform patients with bacterial or viral conjunctivitis that these disorders are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people for 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and not to wear contact lenses until the conjunctivitis resolves. Tell patients with allergic conjunctivitis that this type of inflammation isn’t contagious.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diabetic complications during pregnancy:
Treatment
(Handbook of Diseases)
Both the newly diagnosed and the established diabetic need dietary management and insulin administration to maintain blood glucose levels within acceptable limits. Most women with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.
For pregnant patients with diabetes, therapy includes:
❑ frequent visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester, an internist may be consulted as necessary.
❑ maintenance of blood glucose levels at or below 95 mg/dl during the third trimester
❑ frequent monitoring for glycosuria and ketonuria (Ketosis presents a grave threat to the fetal central nervous system.)
❑ a high-protein diet of 2 g/day/kg of body weight (a minimum of 80 g/day during the second half of pregnancy), a daily calorie intake of 30 to 40 calories/kg of body weight, a daily carbohydrate intake of 200 g, and enough fat to provide 36% of total calories (However, vigorous calorie restriction can cause starvation ketosis.)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Oral antidiabetic agents are generally contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Delivery
Generally, the optimal time for delivery is no different from a normal pregnancy, as long as blood sugars are controlled and no fetal compromise is present.
Depending on fetal status and maternal history, labor may be spontaneous induced or a cesarean section performed. During labor and delivery, the patient with diabetes should receive a continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor.
The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Eye pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes. Prepare him for diagnostic studies, including tonometry and orbital X-rays. Prepare to irrigate the eye, as ordered.
Patient teaching
Tell the patient that it’s important to seek medical help for eye pain and stress the importance of meticulous compliance with drug therapy to prevent an increase in IOP.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Eye discharge:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inform patients that bacterial and viral conjunctivitis are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people until 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and to stop wearing contact lenses until conjunctivitis resolves. Tell patients with allergic conjunctivitis that this isn’t a contagious type of inflammation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Eye pain:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient’s eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient needs laser iridotomy or surgical peripheral iridectomy to save vision.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Doll's eye sign, absent [Negative oculocephalic reflex]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Don't attempt to elicit doll's eye sign in a comatose patient with suspected cervical spine injury; doing so risks spinal cord damage.
▪ Monitor vital signs and neurologic status.
▪ Discuss end-of-life issues with the patient's family, if appropriate.
▪ Provide emotional support to the family.
Patient teaching
▪ Explain to the patient the underlying cause and its treatment.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Eye pain [Ophthalmalgia]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes.
▪ Prepare the patient for diagnostic studies, including tonometry and orbital X-rays.
Patient teaching
▪ Stress the importance of following instructions for drug therapy.
▪ Teach the patient about ways to protect the eyes.
▪ Tell that the patient that he should seek medical attention for any eye pain.
▪ Explain the underlying cause of the patient's eye pain and its treatment.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Raccoon eyes:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Keep the patient on complete bed rest.
▪ Perform frequent neurologic evaluations to reevaluate the patient's LOC.
▪ Check the patient's vital signs frequently; be alert for such changes as bradypnea, bradycardia, hypertension, and fever.
▪ To avoid worsening a dural tear, instruct the patient not to blow his nose, cough vigorously, or strain.
▪ If otorrhea or rhinorrhea is present, don't attempt to stop the flow; instead, place a sterile, loose gauze pad under the nose or ear to absorb drainage.
▪ Monitor the amount of drainage and test it with a glucose reagent strip to confirm or rule out CSF leakage.
▪ To prevent further tearing of the mucous membranes and infection, never suction or pass a nasogastric tube through the patient's nose.
▪ Observe the patient for signs and symptoms of meningitis, such as fever, photophobia, and nuchal rigidity, and expect to administer a prophylactic antibiotic.
▪ Prepare the patient for diagnostic tests, such as skull X-ray and a computed tomography scan.
▪ If the dural tear doesn't heal spontaneously, prepare the patient for contrast cisternography to locate the tear, possibly followed by corrective surgery, as ordered.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Explain the signs and symptoms of neurologic deterioration that require immediate medical attention.
▪ Explain activity limitations.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Eye discharge:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply warm soaks to soften crusts on the eyelids and lashes, then gently wipe the eyes with a soft gauze pad.
▪ Carefully dispose of all used dressings, tissues, and cotton swabs to prevent the spread of infection.
Patient teaching
▪ Teach the patient to avoid contaminating the unaffected eye and to refrain from sharing pillows, wash cloths, eyedrops, or eye makeup with others.
▪ Discuss ordered diagnostic tests, including culture and sensitivity studies to identify infectious organisms.
▪ Explain the underlying cause of the patient's eye discharge and its treatment.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Setting-sun sign [Sunset eyes]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs and neurologic status.
▪ Elevate the head of the crib to at least 30 degrees, and monitor intake and output.
▪ Monitor ICP, restrict fluids, and insert an I.V. catheter to administer a diuretic.
▪ For severely increased ICP, prepare for ET intubation and mechanical hyperventilation to reduce serum carbon dioxide levels and constrict cerebral vessels.
▪ Anticipate therapy to induce a barbiturate coma or hypothermia therapy to lower the metabolic rate.
▪ Maintain a calm environment.
▪ Perform nursing duties judiciously because procedures may further increase ICP.
▪ Encourage the parents' help in calming the infant, and offer them emotional support.
Patient teaching
▪ Explain the underlying condition and its treatment to the patient's parents.
▪ Prepare the child and his family for surgical management of increased ICP and hydrocephalus, as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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