Risk for dry eye

Risk for dry eye

Domain 11. Safety-protection
Class 2. Physical injury
Diagnostic Code: 00219
Nanda label: Risk for dry eye
Diagnostic focus: Dry eye

Introduction to Nursing Diagnosis: Risk for Dry Eye

Dry eye syndrome, also known as keratoconjunctivitis sicca (KCS), is a condition of the eyes in which there is an insufficient amount of tears produced. Symptoms include itching, excessive redness, blurry vision, burning sensation and foreign body sensation in the eye. Nurses should be aware of the risk factors, at-risk population and associated conditions which could lead to dry eye diagnosis, as well as evidence-based suggested interventions and nursing activities to provide care and management of the condition.

NANDA Nursing Diagnosis Definition

The NANDA International (NANDA-I) defines Risk for Dry Eye as ‘the state in which an individual has an increased possibility of developing dry eye’. The NANDA-I lists risk factors including certain chemicals and drugs, ageing, decreased blinking rate, environment with wind, dust and/or smoke exposure, living or working in a dry environment, menopause, diabetes, rheumatoid arthritis, Sjögren’s Syndrome, long-term contact lens use, vitamin A deficiency and decreased tear production from chronic eyelid inflammation.

Risk Factors

The following are some of the common risk factors associated with dry eye syndrome:

  • Ageing: As we age our eyes produce less tears, making us more prone to developing dry eye syndrome.
  • Decreased Blinking Rate: Staring at screens or moving objects for an extended period of time can cause our eyes to blink less which reduces the amount of tear spread across the eyes.
  • Environmental Factors: Wind, dust and/or smoke exposure can irritate the eyes, causing it to produce less tears.
  • Living or Working in a Dry Environment: Low humidity levels or living in a colder climate can irritate the eyes and reduce tear production.
  • Certain Chemicals and Drugs: Antihistamines, decongestants, certain antidepressants, and oral contraceptives can interfere with tear production.
  • Menopause: Estrogen is a factor in tear production, and during menopause levels decrease, leading to an increased risk of dry eyes.
  • Chronic Diseases: Certain chronic diseases such as diabetes and rheumatoid arthritis can lead to dry eye syndrome.
  • Sjogren’s Syndrome: This autoimmune disorder causes glandular obstruction, which can result in reduced tear production.
  • Long-term Contact Lens Use: Constant wear of contact lenses may mitigate tear production over time.

At Risk Population

Many at-risk populations may be affected by dry eye syndrome including:

  • Older adults: As people age, their tear production decreases. Therefore, older adults have a higher risk of experiencing dry eye syndrome.
  • Women who are pregnant or recently had a baby: The hormonal changes associated with pregnancy and childbirth can cause a reduction in tear production, creating a higher risk for dry eye syndrome.
  • People with chronic illnesses: Certain chronic illnesses and conditions, such as diabetes and rheumatoid arthritis, can increase a person’s susceptibility to dry eye syndrome.
  • Wearing contact lenses: Long-term contact lens wear can be a factor in dry eye syndrome.
  • Living in a dry environment: Low humidity levels can be a risk factor for dry eye syndrome.

Associated Conditions

Dry eye syndrome can cause a range of symptoms and side effects, including:

  • Itching: A major symptom of dry eyes, itching occurs due to the lack of moisture on the surface of the cornea.
  • Excessive Redness: Dry eyes can cause inflammation of the cornea, resulting in red, bloodshot eyes.
  • Blurry Vision: Dry eyes can lead to poor vision due to lack of tear film over the cornea.
  • Burning Sensation: A frequent symptom of dry eyes, burning sensations are caused by irritants and lack of moisture.
  • Foreign Body Sensation: This is a sensation of something foreign, such as sand, in the eyes due to the lack of lubrication.

Suggestions of Use

Nurses should be educated on the risk factors, at-risk populations and associated conditions of dry eye syndrome in order to effectively assess and treat patients who may be affected by this condition. Nurses should identify individuals at risk for developing dry eye syndrome, use preventative strategies when applicable and collaborate with other healthcare professionals to properly manage the condition.

Suggested Alternative NANDA Nursing Diagnosis

The following are alternative NANDA nursing diagnoses for dry eyes:

  • Deficient Fluid Volume: This nursing diagnosis focuses on the decreased volume of fluids present in a patient’s eyes due lack of tear production.
  • Impaired Skin Integrity: This nursing diagnosis recognizes the damage that dry eye syndrome can cause to the skin around the eyes such as itching, irritation and redness.
  • Impaired Vision: This nursing diagnosis addresses how dry eyes can cause blurred vision, difficulty seeing, pain and discomfort.
  • Risk for Delayed Development: If dry eyes are left untreated, the patient may experience delayed or impaired vision development.

Usage Tips

Nurses should be mindful of the environmental and lifestyle factors that can contribute to dry eyes, such as low humidity levels, contact lens wear and long periods of time focused on screens. Nurses can help reduce the risks by using a humidifier, using artificial tears and engaging in activities that encourage blinking.

NOC Outcomes

The nurse’s role in managing dry eye syndrome involves patient assessment, implementing prevention and treatment measures, monitoring treatment progress and providing patient education. The following are NOC outcomes for nurses evaluating a patient for dry eye syndrome:

  • Vision Process: This outcome measures a patient’s post-treatment visual acuity, focusing ability and contrast sensibility.
  • Tissue Integrity: Skin and Mucous Membranes: This outcome evaluates the patient’s ability to protect and heal their skin from external damage or injury.
  • Knowledge: Disease Process: This outcome assesses the patient’s knowledge and understanding of dry eye syndrome and its risk factors, treatment and management.
  • Health Maintenance: This outcome monitors the patient’s ability to employ health maintenance techniques and behaviors to prevent further damage to the eyes.
  • Coping: This outcome evaluates the patient’s mental ability to effectively manage their dry eye symptoms and lifestyle modifications.

Evaluation Objectives and Criteria

The assessment and management of dry eye syndrome depends on the ability of the nurse to evaluate and interpret data obtained from the patient. This includes evaluating patient history, physical and psychological assessments, vision test results and laboratory tests. Evaluation objectives and criteria for nurses include determining the type of dry eye syndrome, identifying the underlying cause, and assessing for potential complications.

NIC Interventions

In order to effectively manage dry eyes, nurses must implement evidence-based interventions. The following interventions are recommended for patients with dry eye syndrome:

  • Eye Care: Defaciating the eyelids and using a warm compress can reduce inflammation and encourage lubrication.
  • Tear Supplementation: Using artificial tears can help reduce symptoms, improve ocular comfort and restore vision.
  • Oral Supplements: Consuming vitamins, antioxidants and omega-3 fatty acids can help reduce inflammation and improve tear production.
  • Therapeutic Lenses: Some patients may require specialized contact lenses to decrease blinking and promote tear production.
  • Surgery: In severe cases, patients may require surgery to improve tear production.

Nursing Activities

Nurses have many responsibilities when it comes to assessing, treating and managing dry eyes. These activities may include:

  • Assessing: Assessment and evaluation of symptoms, risk factors and patient knowledge of condition.
  • Managing: Administering medication and treatments for the management of dry eye syndrome.
  • Providing Education: Instructing patients on lifestyle modifications, medication use, and self-care techniques.
  • Monitoring Progress: Monitoring patient progress and providing supportive care.
  • Collaborating: Collaborating with other healthcare providers including ophthalmologists and physical therapists.

Conclusion

Nurses play a significant role in the evaluation and management of dry eyes. It is the nurse’s responsibility to assess and recognize the risk factors and at-risk populations, determine the severity of the condition, provide patient education and employ appropriate interventions. With preventative measures and collaborative care, nurses can help reduce the risk of developing dry eyes in patients.

5 FAQs

  1. What are common risk factors for dry eye syndrome? Ageing, decreased blinking rate, environmental factors, living or working in a dry environment, certain chemicals and drugs, hormones, chronic diseases such as diabetes, Sjögren’s Syndrome, and long-term contact lens use are all common risk factors for developing dry eye syndrome.
  2. What at-risk populations should be aware of dry eyes? Older adults, women who are pregnant or recently had a baby, people with chronic illnesses, contact lens wearers and those living in a dry environment should all be aware of the risk of dry eyes.
  3. What lifestyle modifications can help reduce the risk of dry eyes? Regularly using a humidifier and taking frequent breaks from screens can reduce the risk of dry eyes. Additionally, engaging in activities to encourage blinking, such as drinking water and eating, can help protect against eye strain.
  4. What interventions are available to manage dry eye syndrome? Various interventions are available to manage dry eyes, including eye care, tear supplementation, oral supplements, therapeutic lenses and surgery.
  5. What is the role of the nurse in assessing and treating dry eyes? Nurses are responsible for assessing patient symptoms and risk factors, implementing interventions to manage dry eyes, monitoring patient progress and providing education on how to prevent and manage the condition.

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