A client who states that he was walking in a densely wooded area and was struck in the eye with a pine tree branch arrives in the eye clinic. He tells you that his right eye feels like it is scratched because it is burning and very irritated. As the nurse, you prepare the client for which of the following examinations?

As adults age, changes in the lens and ciliary muscles reduce the eye’s ability to accommodate, or adjust focus between near and distant objects. This condition, called presbyopia, makes it harder to see clearly up close and may cause blurred vision. Although other eye changes can occur with age, a slower accommodation of the lens best explains why vision is not as sharp. This is a normal part of the aging process and not necessarily a sign of disease.

Rationale for correct answer:
3. ‘‘The lenses in an older adult’s eyes accommodate more slowly’’: This describes presbyopia, a normal age-related change that reduces near vision. It best explains the client’s concern about decreased sharpness of vision.

Rationale for incorrect answers:
1. ‘‘It is not unusual for older clients to have dry eyes’’: Dry eyes are common in aging but do not explain the gradual loss of visual sharpness. Therefore, this is not the best response to the client’s concern.
2. ‘‘Older adults are more prone to eye infections’’: Older age does not directly increase infection risk, and infections cause acute symptoms rather than gradual blurring. This is not the best response.
4. ‘‘Vision in older adults gradually worsens with age’’: This is too vague and non-specific, offering no explanation of the underlying cause. Thus, it is not the best response.

Take home points

• Presbyopia is a normal age-related change due to slower lens accommodation.
• It results in blurred near vision and reduced sharpness.
• Nurses should provide specific, accurate explanations rather than vague reassurance.

After a trabeculectomy, the client must avoid activities that increase intraocular pressure, such as bending, lifting, or straining, to allow proper healing of the surgical site. Engaging in strenuous housekeeping tasks may put pressure on the eye and compromise surgical success. Therefore, limiting housekeeping activities is a crucial part of postoperative teaching to promote recovery and prevent complications. Education focuses on lifestyle adjustments that protect the surgical site and vision during the healing phase.

Rationale for correct answer:
4. You need to limit your housekeeping activities: Housekeeping tasks often involve bending, lifting, and straining, which can increase intraocular pressure and compromise the healing of the surgical site. Teaching the patient to limit these activities promotes proper healing and reduces the risk of postoperative complications.

Rationale for incorrect answers:

1. You may resume playing golf: Golf requires significant bending and exertion, which may elevate intraocular pressure and endanger healing after trabeculectomy. It is not safe until cleared by the ophthalmologist.
2. You need to tilt your head back when washing your hair: Tilting the head back can cause water or shampoo to enter the eye, increasing the risk of infection or irritation. This practice is not recommended for patients after eye surgery.
3. You may continue driving to and from work: Driving may not be safe immediately after trabeculectomy due to potential blurred vision, discomfort, or risk of increased eye strain. It is unsafe until the patient is cleared by their eye specialist.

Take home points

• Patients must limit strenuous activities such as housekeeping after trabeculectomy.
• Golf, driving, and improper head positioning when washing hair are not safe until cleared by the provider.
• Protecting the eye from strain and pressure is essential for healing and preventing complications.