ua l a n d

Vis r y
Au d it o
rb a n c es
Distu

Jastine Joy V. Beltran - Perez, RN 2022 May - June NCM 106 LEC
Objectives
Review on the anatomy and physiology of the EYES and EARS.
Make a pathophysiology concept map of the following disorders of the eyes and ears
RLE-SL Group 1 – Cataract
RLE-SL Group 2 – Glaucoma
RLE-SL Group 3 – Retinal Detachment
RLE-SL Group 4 – Conductive Hearing Loss vs Sensorineural Hearing Loss vs Mixed Hearing Loss
RLE-SL Group 5 - Meniere’s Syndrome

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anatomy and physiology of the eye

3
external anatomy of the eye

4
internal anatomy of the eye

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3 TYPES OF TEARS
1. BASAL TEARS - continuously secreted to
lubricate cornea
2. REFLEX TEARS
3. CRYING TEARS - d/t emotions- contains
leucinenkephalin (natural painkiller)

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EXTRAOCULAR MUSCLES

1. 4 RECTUS - SUPERIOR, INFERIOR, MEDIAN,

LATERAL
2. 2 OBLIQUE - SUPERIOR, INFERIOR

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LAYERS OF THE EYE

1. OUTERMOST LAYER - FIBROUS LAYER -

PAIN FIBER
2. MIDDLE LAYER - VASCULAR LAYER -
CHOROID
3. INNERMOST LAYER - SENSORY LAYER -
RETINA - CONTAINS PHOTORECEPTOR
( RODS & CONS)

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 i a g n o s t i c
D s
T e s t
 VISUAL ACUITY TEST
determines if the
patient is NEARSIGHTED (14 INCHES) or FARSIGHTED
(20 FEET)

TOOL: SNELLEN'S CHART

NORMAL : 20/20 VISION

20/30 and above - NEARSIGHTED

20/15 and below - FARSIGHTED
20/200 - LEGALLY BLIND
20/400 - LEGALLY BLIND AND NO LIGHT PERCEPTION

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PERIMETRY TEST/CONFRONTATION
TEST

measures the peripheral vision

usually used for GLAUCOMA

TOOL: pen or small object or examiner's finger

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 EXTRAOCULAR MUSCLE
FUNCTION TEST

examines the function of the

eye muscles through 6
cardinal directions of gaze
observes for NYSTAGMUS
(oscillating moveme nt of
the eyeball)

TOOL: examiner’s finger,

pencil, or a pen light

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 OPTHALMOSCOPY

assesses patient's eye on a dark

room

TOOL: opthalmoscope
assesses
1. lens
2. optic nerve
3. optic cap - N 1/3 ; glaucoma 1/2

red reflex - optic disc (red/pinkish)

pale (glaucoma)

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 TONOMETRY
measures the intraocular pressure

TOOL: tonometer

normal IOP - 10-21mmHg

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 GONIOMETRY
measures the angle between iris and
cornea

TOOL: goniolens/gonioscope

normal: 45degrees

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 V i s ua l
r b a n ce s
D i s tu
Cataract
opacity of the lens

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Types of Cataract
1. Senile Cataract - aging
2. . Congenital Cataract - in utero; German Measles
3. Traumatic Cataract - injury to the lens caused by alkaline
material
4. Secondary Cataract/ Metabolically Induced Cataract -
DM,
5. Smoking- Induced Cataract

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Diagnostic Tests
1. Ophthalmoscopy
2. . Slit Lamp -a very bright
source of light shone
through a slit and a
microscope; it allows us to
look at the individual parts
of the eye in detail, in
particular the retina at the
back of the eye

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Surgical Mngt (OPD)
1. Intracapsular Cataract Extraction (ICCE) -
removal of the entire lens
2. Extracapsular Cataract Extraction (ECCE) -
removal of the anterior part of the lens (affected
area)
3. Phacoemulsification - probe ---> ultrasound +
shockwaves = melts the lens ----> removed by
suction
4. Intraocular Lens Implantation

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Pre-Op Nsg Interventions
1. Instruct pt to prevent increase IOP
2. Administer mydriatrics & cytoplegics
3. Topical Anesthesia (Tetracaine Hydrochloride)

Post - Op Nsg Interventions

1. eyepatch/eyeshield
2. eyeglasses/sunglassess
3. position client 30-45degrees
4. wipe excess drainage
5. avoid rapid movements
6. report eyepain

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GLAUCOMA
- a group of eye diseases
- increase IOP resulting to
compression of microcirculation
leading to permanent blindness
- overproduction of aqeuos
humor
- aka SILENT KILLER OF THE
NIGHT

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 Risk Factors
1. Family Hx - glaucoma, thick iris
2. .Aging
3. HTN
4. DM
5. Trauma

Classification
1. Primary & Secondary
primary - family & aging
secondary - DM & HTN
2. Acute & Chronic
acute - sudden onset ---> IOP = 50-70mmHg
chronic - slow onset ---> IOP = 30-50mmHg
3. Open & Closed
open - >45degree
closed- <45degree
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Clinical Manifestation
1. tunnel vision
2. loss of central vision
3. halos around the light/ rainbows
4. sudden n/v, headache
5. severe sharp eye pain

Diagnostic Tests Medical Mngt

1. Miotics - constrict the pupil e.g pilocarpine
1. perimetry (Pilocar)
2. tonometry 2. Carbonic Anhydrase Inhibitor - decrease AQ
3. goniometry humor production e.g acetazolamine (Diamox)
3. Beta-blockers - e.g Timolol
4. opthalmoscopy
4. Osmotic Diuretic - mannitol (Osmitrol)
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Nsg Mngt
1. lifetime medication
2. medical alert bracelet
3. avoid mydriatics
4. report eye pain, changes in vision or halos

Surgical Mngt
1. laser trabeculoplasty
2. trabeculectomy
3. peripheral iridectomy
4. cyclocryotherapy

2
Retinal Detachment
CAUSES
1. Aging
2. Previous Retinal Detachment
3. DM
4. Trauma
5. Tumor - retinoblastoma

2
Clinical Manifestations

1. Bleeding
2. Floaters
3. Black spots
4. Curtains falling
5. Shadows falling
6. Flashes of light
7. Painless blurring of vision
8. Loss of portion of virtual field

2
Immediate Nsg Interventions
1. Bedrest - to prevent further detachment
2. Cover and patch both eyes
3. Avoid jerky head movements
4. Prepare for surgery

Surgical Mngt
1. Laser photocoagulation
2. Cryotherapy
3. Diatherapy
4. Rheumatic retinopexy - injects air to the cornea C/I: never go AIR TRAVEL
5. Scleral buckling - most effective sugical mngt
2
Post-op Nsg Interventions
1. Bedrest
2. Semi- fowler's - NO lying at operated side
3. Monitor increase IOP
4. Avoid activities that can increase IOP
5. Eyeglasses/patches
6. Antibiotics
7. Anti-inflammatory
8. Carbonic Anhydrase Inhibitor

2
Refractive Errors
1. Myopia - nearsightedness ---> mngt CONCAVE
LENS
2. Hyperopia - frasightedness ---> mngt CONVEX
LENS
3. Astigmatism - abnormal curvature of the
cornea ---> mngt lens that is flat on one side
and bulging on the other
4. Presbyopia - age-related vision loss; lens losses
its elasticity; decrease accomodation of light
5. Anisometropia - 2 eyes have different
refractive errors

2
 EYE INJURIES
Penetrating Objects Chemical Burns
- never remove the object - if at the scene of injury, flush eyes with water
- cover the eye for 15 - 20mins
- avoid bending - at hospital, use NSS or opthalmic irrigating
- don't put pressure on the eye sol'n
- call the physician - obtain a sample of the chemical
- antibiotic meds if prescribed
- cover eyes
Foreign Objects
- look upward
Contusion
- expose lower eyelid - black eye
- wet a cotton tip applicator with NSS - ice on the eyes immediately
- gently twist a swab over the particle - eye examination
and remove

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anatomy and physiology of the ears

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 i a g n o s t i c
D s
T e s t
Otoscopic Examination
- visualization of the tympanic
membrane
- normal color: pearly- gray
- red & bulging - infxn - otitis
media
- pinkish orange - otosclerosis
- dark, irregular holes -
perforation - most common
cause: earbuds, cotton buds

2
Whisper Test
- stand 1-2ft at the side of the
patient
- cover the unexamined ear
- say a phrase and ask the
patient to repeat
- normal : able to repeat
phrase at a distance of 1-2ft

2
Watch Test
- uses analog watch
- occlude one ear
- out of patient's sight, place a
ticking watch 2-3cm away
from unoccluded ear
- ask what can the patient hear
and repeat to the other ear

2
Weber & Rinne's Test
- test for hearing loss
( conductive or
sensorineural)

2
Romberg Test
- test for balance
- patient stands for
20sec, feet close,
hands on the side or
across the chest,
eyes closed
2
Types
of
Hearing
Loss
2
Clinical Manifestations
of Hearing Loss
1. Frequently asking to repeat a question/s
2. Tilting head when listening
3. Excessively loud voice/ speech
4. Rasing volume of TV or radio
5. Avoiding large groups
6. Failure to respond to oral communication
2
 Facilitate
Communication
1. Use of written words
2. Face client when speaking
3. Reading lips
4. Speak slowly and clearly
5. Repeat information
6. Ask client to validate
7. Use of sign language
2
 Medical Mngt

1. Cochlear Implantation
2. Hearing aids - behind the
ear, in the ear, in the canal

2
Otosclerosis
- abnormal bone growth
in the stapes/stirrups

CAUSE : unknown, familial

tendency

2
Clinical Manifestations
1. Gradual hearing loss
2. Tinnitus
3. Schwartze's Sign -
pathognomonic sign :
pinkish-orange
discoloration of the
Surgical Mngt
tempanic membrane 1. STAPEDECTOMY
WITH
FENESTRATION

2
Post- op Nsg Mngt
1. Safety
2. Avoid changes in ear pressure - swimming, showering,
shampoo
3. Antibiotics
4. Pain Meds
5. Avoid strenous activities
6. Avoid using straw

2
Menìere's Disease
- increase
endolymphatic fluid
at the vestibule/
endolymphatic sac
- causes hearing loss
and balance
- cause : UNKNOWN

2
Clinical Manifestations
1. TRIAD - sensorineural hearing
loss, vertigo, tinnitus
2. Feeling of fullness in the ear
3. Nausea & vomiting
4. Dizziness

2
Nsg Care : SAFETY
1. Bedrest
2. Quiet or non-stimulating environment
3. Assist patient in walking
4. Stand up slowly
5. Move head slowly

Nsg Mngt Surgical Mngt

1. Fluid restriction 1. Endolymphtic drainage
2. Low Na+ diet
2. Labyrithectomy - drains excess
3. Diuretics
endolymphatic fluid
4. Antivertigo meds - meclizine (Antivert)
5. Sedative - diazepam Complicxn: permanent/irreversible
6. antiemetics - metoclopramide hearing loss

2
Otitis Media
- infection in the
middle ear

CAUSE: URTI

2
Clinical Manifestations
1. Pulling or rubbing of the
ear Nsg Mngt
2. Earache 1. Increase fluid
3. Purulent ear drainage 2. Bedrest
4. Red, bulging eardrum 3. Analgesics
5. Fever 4. Antipyretics
5. Manage the respi
infxn
2
Medical/Sx Mngt
1. Myringotomy - tube at
tympanic membrane
(Tympanostomy Tube)

Post -op Mngt

1. Keep dressing clean and dry
2. Avoid use of straw, avoid shaking of head
3. Do not allow to drive immediately post-
op
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Impacted Cerumen
MNGT: Irrigation (Boric
Acid + Glycerin +
Foreign
Hydrogen Peroxide)
Objects
Perforated Ear Drum MNGT: Irrigation
MNGT: (diluted alcohol)
1. Protect air from water
2. Tympanoplasty
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 Th a n k y o u
for l i ste n i n g!
Jastine Joy V. Beltran-Perez, RN 2022 May-June NCM106 LEC