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Diseases » Vision Impairment » Treatments

Treatments for Vision Impairment

Contents

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Book Excerpts: Treatment of Vision Impairment

Treatments of Vision Impairment: Online Medical Books

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Diplopia: Treatment
(In a Page: Signs and Symptoms)

Treat the underlying etiology

Patch one eye (usually the involved eye) as necessary
–In children <10 years old, avoid patching and monitor for development of amblyopia

Document magnitude of ocular deviation and/or diplopia to determine improvement or stability between exams (measured with prisms by ophthalmologist)
Prisms in glasses for small stable deviations
Strabismus surgery for symptomatic diplopia in primary and reading positions if deviation is stable for more than 6 months, for manifest head tilt, or for improving appearance

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Source: In a Page: Signs and Symptoms, 2004

Papilledema: Treatment
(In a Page: Signs and Symptoms)

Pseudotumor cerebri may be self-limited with weight loss, discontinuation of offending medications; diuretics may be used (e.g., acetazolamide) to decrease CSF production, lumboperitoneal shunting or optic nerve sheath decompression may be indicated in some cases
Intracranial tumors may require resection
Hydrocephalus: Surgical correction of anatomic abnormalities, with or without VP shunt
Intracranial hemorrhage: Conservative management versus surgical evacuation depends on size and location
–Acute subdural hematoma: Control elevated ICP with osmotic and loop diuretics and mild hyperventilation; emergent craniotomy for evacuation of hematomas that result in significant mass effect
–Epidural hematoma: Usually does not require surgery; hyperventilation and mannitol to decrease ICP
Intracerebral infections require appropriate antibiotics
Encephalitis: Control ICP by hyperventilation, diuresis
Malignant hypertension: Aggressive IV pressure control

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Source: In a Page: Signs and Symptoms, 2004

Vision Loss: Treatment
(In a Page: Signs and Symptoms)

Treat underlying causes (e.g., brain tumor, carotid stenosis, cardiac valvular vegetations, hypotension)
Temporal arteritis: Systemic steroids
Nonarteritic ischemic optic neuropathy: Aspirin
Optic neuritis: Systemic steroids
Glaucoma: Topical antiglaucoma medications; peripheral iridotomy for angle closure
Retinal detachment: Surgical repair
Cataracts: Surgical removal
AV fistula: Embolize
Cavernous sinus thrombosis: Antibiotics, anticoagulation
Mucormycosis: Amphotericin B, debridement
Pituitary apoplexy: Systemic steroids, neurosurgical intervention
Herpes zoster: Systemic acyclovir
Tolosa-Hunt: Systemic steroid
Keratoconus/corneal hydrops: Cycloplegic, hypertonic (5%) NaCl ointment, corneal transplant

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Source: In a Page: Signs and Symptoms, 2004

Diplopia: Treatment
(In A Page: Pediatric Signs and Symptoms)

If monocular, first consider a refractive cause or an ocular media compromise
If binocular, critical to find the underlying cause
Assess control of diabetes and other systemic concerns and remedy
If diagnosis of myasthenia, manage systemically with Mestinon
Neurologic or neurosurgical intervention may be necessary depending on cause
Relatively benign causes resolve on their own in 3 months, but patching or prism in glasses may be necessary
Prism in glasses or interventive strabismus surgery may be necessary in recalcitrant cases

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Vision Loss: Treatment
(In A Page: Pediatric Signs and Symptoms)

Transient symptoms are usually due to migraine, stroke, or increased intracranial pressure; appropriate therapy for these disorders
Manage any underlying systemic disease
If angle closure glaucoma, stat consult for immediate medical and surgical intervention
Retinitis or uveitis: Management of underlying cause; NSAIDs and steroids
If hemorrhage in the macula from macular degeneration or histoplasmosis, laser therapy or intravitreal steroids may save the vision
Vitreous hemorrhage may be evacuated after establishing and treating cause
Macular edema may be treated with topical steroids, Diamox, intravitreal steroids, NSAIDs
Retinal vascular occlusion: Intraocular surgery or laser therapy may alleviate symptoms

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Papilledema (Optic Disc Swelling): Treatment
(In A Page: Pediatric Signs and Symptoms)

Condition-dependent: Treatment of underlying systemic disease is often the only treatment
Pseudotumor cerebri and other causes of intracranial hypertension: Weight loss, Diamox or Lasix, planned recumbency, LP shunt or optic nerve sheath fenestration if loss of visual function
Space-occupying lesion or hemorrhage: Neurosurgical intervention
Meningoencephalitis: IV antibiotics
Infectious optic neuropathy: Treat underlying cause and consider systemic steroids (controversial)
Optic neuritis: IV (not oral) steroids
Optic nerve glioma treatment controversial: Observation if slowly progressive, resection if only one nerve involved, radiation if chiasm involved, shunts if increased ICP
Toxic or nutritional: Stop offending toxin or supply nutritional supplementation

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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.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Hemianopsia: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))

Explain to the patient the extent of his defect so that he can learn to compensate for it. Advise him to scan his surroundings frequently, turning his head in the direction of the defective visual field so that he can directly view objects he would normally notice only peripherally.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

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.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

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.

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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Vision loss: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Any degree of vision loss can be extremely frightening. To ease the patient’s fears, orient him to his environment and make sure that it’s safe. Announce your presence each time you approach him. If the patient reports photophobia, darken the room and suggest that he wear sunglasses during the day. Obtain cultures of any drainage, and instruct him not to touch the unaffected eye with anything that has come in contact with the affected eye. If necessary, prepare him for surgery.

Patient teaching

Discuss safety measures to prevent injury. Emphasize the importance of frequent hand washing and to avoid rubbing the eyes. If the loss is progressive or permanent, refer the patient to the appropriate social service agencies, community support services, and related associations for assistance with adaptation and equipment.

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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Diplopia: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Discuss safety measures with the patient and his family. Stress the importance of ambulating with assistance. Explain all diagnostic tests and procedures to the patient. Encourage the patient to express his concerns regarding diplopia. If necessary, orient the patient to his room and his meal tray.

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