PTERYGIUM, CHALAZION & TRACHOMA

GROUP 6

PTERYGIUM�

• Pterygium is a growth that develops on the conjunctiva or mucous membrane that covers the white part of the eye.
• It’s a benign or noncancerous growth that’s often shaped like a wedge.  

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PREDISPOSING FACTORS OF PTERYGIUM�

• Hereditary
• Exposure to ultraviolet light
• Common in people living in warm climates and spend a lot of time in sunny or windy environments
• Irritants like pollen, sand, smoke, and wind
• Light skin and light eyes
• Dry eyes

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CAUSES

• The cause is unclear. It appears to be partly related to long term exposure to UV light and dust. Genetic factors also appears to be involved. It is a benign growth. Other conditions that can look similar include similar include a pinguecula, tumor or Terrien’s marginal corneal degeneration. Pterygia are twice as likely to occur in men than in women.

SIGNS AND SYMPTOMS OF PTERYGIUM�

• Redness of the eye
• Blurred vision
• Eye irritation
• Burning sensation or itching
• Discomfort
• Feel like there is something in the eye

DIAGNOSIS OF PTERYGIUM�

• Physical examination
• Slit lamp examination
• Visual acuity test
• Corneal topography(used to measure curvature changes in the cornea)
• Photo documentation(which involves taking pictures to track the growth rate of the pterygium)

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MANAGEMENT OF PTERYGIUM�

• Surgery
• Using proper protective eyewear
• Prescribed ointment or eye drops that contain corticosteroids are administered to reduce inflammation

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SURGICAL MANAGEMENT OF PTERYGIUM�

• THE BARE SCLERA TECHNIQUE; it involves excising the head and body of the pterygium while allowing the bare scleral bed to re-epithelialize.
• A CONJUNCTIVAL AUTOGRAFT TECHIQUE; it involves obtaining an autograft, usually from the superotemporal bulbar conjunctiva, and suturing the graft over the exposed scleral bed after excision of the pterygium.
• AMNIOTIC MEMBRANE GRAFTING; amniotic membrane is typically placed over the bare sclera, with the basement membrane facing up and the stroma facing down

PREOPERATIVE MANAGEMENT OF PTERYGIUM�

• Explain procedure to patient
• Allow patient to sign a consent form
• Inform them that it does not have a cure but it is to improve vision
• Orient patient to bedside equipment and staff
• Reassure patient that pain will be managed
• Tell patient that after surgery both eyes will be covered for one or two days

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CTN

• Explain post-operative expectations such as blurred vision
• Eyes are irrigated with normal saline
• Ensure that patient avoids aspirin and all medications containing aspirin one week prior to surgery
• Stop all NSAIDs medications three days prior to surgery
• Patient should not take digitalis medication; example digoxin and oral antibiotics medications on the morning of the surgery
• Patient should avoid anything apart from the usual medicines eight hours before the scheduled start of surgery
• All other pre op care is given.

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POST OPERATIVE MANAGEMENT�

• After the surgery a pad is placed over the eye and remained in place until the next day.
• Pain is relieved immediately it sets in by administering prescribed medications
• The eye is cleaned with cool boiled water or saline
• Antibiotic drugs are used initially, then steroid drops are added as the cornea heals
• Do not allow patient to rub the eye

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CTN

• Wash hands before administering eye drops
• Inform patient to always keep the eye dry and closed in the shower for the first few days
• Do not allow patient to lift heavy things
• Allow patient to wear sunglasses outside
• Inform patient to report any persistent pain or sudden change in vision

Prevention��1. prevent eye from environmental factors that cause pterygia��2. wearing of portable sunglasses �that shield the eye from environmental irritants e.g. wind and sunlight.

Prevention ctd’

3. In patients who has undergone surgery, the sunglasses must be able to shield the eye from

i. pollen

Ii. Wind

Iii. Ultraviolet rays and

Iv. Smoke.

This helps to prevent relapse after surgery

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COMPLICATIONS OF PTERYGIUM�

• Distortion and reduction of central vision
• Redness
• Irritation
• Chronic scarring of the conjunctiva and the cornea.

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CHALAZION�

• A chalazion is a small bump that appears on the eyelid because of a blocked oil gland. It can appear as a single granuloma or multiple granulomas in the upper or lower eyelids.

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• CAUSES OF CHALAZION
• Caused by blockage in the meibomian gland (which produces oil in both the upper and lower eyelids) on the eyelid.

PREDISPOSING FACTORS OF CHALAZION�

• Unclean hands
• Hereditary
• Tuberculosis
• Viral infections
• Rosacea, seborrheic dermatitis, other skin conditions

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SIGNS AND SYMTOMS

• A hard lump on the eyelid
• Increased tearing
• Blurry or blocked vision
• Sensitivity to light

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DIAGNOSIS�

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• Physical examination through signs and symptoms
• Lipid analysis
• Visual acuity test and visual field test
• Swab for viral and bacterial culture

MANAGEMENT OF CHALAZION�

• Surgical care
• Corticosteroid injection to the chalazion lesion may be used for smaller lesions.
• Warm compresses applied three to four times a day for 10 to 15 minutes may resolve the inflammation in the early stages.

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INDICATION FOR SURGERY�

• A large chalazion
• Chalazion that does not respond to conservative management
• Multiple chalazia
• A chalazion causing significant astigmatic refractive error due to mechanical effects on the cornea.

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CONTRAINDICATIONS �

• Inflamed chalazion (hordeolum internum) is an absolute contraindication.
• COMPLICATIONS AFTER SURGERY
• bleeding
• Recurrences
• Lid notching due to incision to lid margin
• Inadvertent ocular trauma
• Tarsal plate instability due to too large incisions

PREOPERATIVE MANAGEMENT�

• Explain procedure to patient.
• Allow patient to sign a consent form.
• Orient patient to bedside equipment and staff
• Reassure patient that pain will be managed

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CTN

• Tell patient that after surgery both eyes will be covered for one or two days
• Place eye pack to prevent robbing the eye.
• Explain post-operative expectations such as blurred vision
• Eyes are irrigated with normal saline.
• Administer eye drops.

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POSTOPERATIVE MANAGEMENT�

• Administer prescribed medications e.g. Antibiotics and steroid drop or ointment and lubricants.
• Apply cold compresses for 48hours and then warm compresses are continued several times a day.
• Encourage regular lid hygiene measures and control of meibomitis.
• In recurrent or multiple chalazia, a course of oral tetracycline is prescribed for 1 month.

CTN

• Administer analgesia to control pain.
• Do not allow patient to rub the eye.
• Maintain patient safety by using bedside rails.
• If the patient is a child they must be restraint.
• Inform patient to report any persistent pain.
• Wash hands before administering eye drops.

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TRACHOMA�

• Is a contagious bacterial infection which affects the conjunctiva covering of the eye, the cornea and the eyelids. It is often associated with poverty and lack of proper hygiene.
• It is responsible for the visual impairment of 2.2 million people, of whom 1.2 million are irreversibly blind according to world health organization.
• CAUSES OF TRACHOMA
• Caused by a bacteria called chlamydia trachomatis.

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PREDISPOSING FACTORS OF TRACHOMA�

• Poor sanitation
• Unclean water supply
• Reduced personal and community hygiene
• Shared towels
• Poverty
• Age
• Sex

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SIGNS AND SYMPTOMS�

• Pink eye
• Mild itching
• Irritation of the eyes and eyelids
• Discharge from the eyes
• Eye pain
• Blurred vision
• Scarring

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DIAGNOSIS�

• Through signs and symptoms
• Physical examination
• Slit lamp examination
• Visual acuity test
• Eye swab for culture and sensitivity test

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MANAGEMENT OF TRACHOMA�

• Surgical care
• Antibiotics
• Facial cleanliness
• Environmental improvement

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PREOPERATIVE MANAGEMENT OF TRACHOMA�

• Explain procedure to patient
• Allow patient to sign a consent form.
• Orient patient to bedside equipment and staff
• Reassure patient that pain will be managed.
• Eye drops are instilled.
• All prescribed medications are administered.
• Eyes are irrigated with normal saline.
• Eyelids should be cleaned with sterile cotton wool swabs or gauze.
• Explain to the patient the role of anesthesia

POSTOPERATIVE MANAGEMENT OF TRACHOMA�

• Administer prescribed medications.
• Administer analgesia to control pain.
• Eyes are covered with eye patches after surgery.
• If the patient is a child they must be restraint.
• Maintain patient safety by using bedside rails.
• Clean wound using gauze and normal saline.
• Wash hands with soap and water, carefully and gently remove the patch.

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CTN

• Advice patient to keep the wound clean and avoid frequent contact with unwashed hands.
• Avoid exposing the operated eyelid to dust for few days.
• Inform patient to avoid rubbing and touching the eye.
• Advice patient to report any signs of infection or bleeding or discomfort and excessive tearing in the eye.

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NURSING MANGEMENT

• Encourage patient and family to prevent the disease.
• Isolate patient because the disease spread through direct contact
• Encourage personal hygiene
• Carry out antibiotic treatment as prescribed by the physician
• Observe nonverbal reactions of the discomfort since swelling of the lymph nodes, photophobia and inflammation may be present
• Performa comprehensive pain assessment which includes the location, characteristics, duration, frequency
• Determine the visual acuity, note whether one or both eyes are involve ( for cornea damage )

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NURSING CONT.

• Utilize good washing wash hands before contact with patients and between procedure with patients
• Observe for signs and symptoms in disorientation
• Oriented the patients on the environment, other in the are.( provides increased comfort and familiarity

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REFERENCES:�

• Ang, L. et. Cornea 1991; 10: 196-202
• Bailey, R.L., P. Arullendran, H.C. Whittle, and D.C. Mabey. “Randomized Controlled Trial of Single Dose Azithromycin in Treatment of Trachoma”. Lancet 342.8869 Aug. 21, 1993:453-456
• Hirst, L. W. Ophthalmology 2008; 115 (10):1663-1672
• Krachmer, J.H.et al. Cornea, 2^nd ed. (Phidelphia: Elsevier Mosby, 2005), 1481
• Lam, D. S. et al. Ophthalmology 1998; 105: 901-904
• Stark, T. et al. Cornea 1991; 10: 196-202

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