SPECIAL SENSES sclera & the retina

AUDIO-VISUAL - it lines most of the sclera & is

DISTURBANCES attached to the
retina but can easily detach from the
sclera
- contains blood vessels that nourishes
the retina
b. CILIARY BODY
- connects the choroid with the iris
- secretes aqueous humor that helps
give the eye
its shape
c. IRIS
- the colored portion of the eye
- extension of the ciliary body,
located in front of
the lens
INTERNAL STRUCTURES OF THE EYE
- it has a central opening called the
pupil
1. EYEBALL ( 3 LAYERS OF THE EYEBALL)
C. INNER LAYER (RETINA)
A.OUTER LAYER
- a thin, delicate structure in which
- fibrous coat that supports the
the fibers of
eye
the optic nerve
are distributed
a. SCLERAE
- bordered externally by the choroid
- Tough, white connective tissue
& sclera
“white of the
and internally by the vitreous
eye”
- contains blood vessels &
- located anteriorly & posteriorly
photoreceptors
(cones & rods)
b. CORNEA
- light sensitive layer
- Transparent tissue through
which light enters
2. FLUIDS OF THE EYE
the eye.
A. AQUEOUS HUMOR
- Located anteriorly
- Clear, watery fluid fills anterior &
posterior
chamber
- produced by the ciliary processes, &
the fluid
drains in the Canal of Sclemm
- serves as refracting medium &
provides
nutrients to lens & cornea
- contributes to maintenance of IOP
B. VITREOUS HUMOR
- Clear, gelatinous/jell-like material
that fill the
posterior cavity of the eye
B. MIDDLE LAYER
- Maintains the form & shape of the eye
a. CHOROID
- Provides additional physical
- a dark brown membrane located
support to the
between the
Eye occipital lobe, and fibers from the left
half of each eye carry impulses to the
3. EYE MUSCLES left occipital lobe.
A. INTRINSIC MUSCLES:
a. IRIS - From the OPTIC CHIASMA, the optic
b. CILIARY BODY nerves continue, as optic tracts, to the
B. EXTRINSIC cerebrum.
a. FOUR STRAIGHT RECTUS - Within the brain, visual impulses are
MUSCLE interpreted as light
- superior, inferior, lateral &
medial REFLEXES OF THE EYE
b. TWO OBLIQUE MUSCLES A. LIGHT REFLEX
- superior & inferior - pupil becomes smaller when light is
flashed in
4. BLOOD VESSELS the eye
A. OPTHALMIC ARTERY B. ACCOMODATION REFLEX
- major artery supplying the - pupil becomes smaller when gaze is
structures in the eye shifted
B. OPTHALMIC VEINS from distant to near object
- venous drainage occurs through
vision PHYSIOLOGY OF BINOCULAR VISION
A. CONVERGENCE OF VISUAL AXES
5. NERVE SUPPLY TO THE EYE -coordinated movement of 2 eyes
toward fixation of same near point
A. CRANIAL NERVE II B. REGULATION OF PUPIL SIZE
- Optic nerve (nerve of sight) -regulating amount of light entering
B. CRANIAL NERVE V eyes by
- Trigeminal (opthalmic) changing pupil sizes
C. MOTOR NERVE ( CN III, CN IV, CN C. REFRACTION OF LIGHT RAYS
VI) - rays are refracted or bent as they
- oculomotor, trochlear, abducens pass thru
varying densities
D. ACCOMMODATION
a. near vision- ciliary muscle
SENSORY PATHWAY FOR VISION contract, lens
- the ROD & CONE receptors, which are bulges /convex
sensitive to light initiate nerve impulse b. distant vision- ciliary muscle
messages which w/c travel over the relaxes, lens
optic nerves flattens

- OPTIC CHIASMA is the crossing point ASSESSMENT OF VISION

for fibers from the medial halves of the VISUAL ACUITY TEST
retinae - measures the client’s distance &
near vision
- that in OPTIC CHIASMA, the optic nerve SNELLEN CHART
fibers from the medial halves of the - simple tool to record visual acuity
retinae cross to the opposite side of the - the client stands 20 ft from the chart
brain while from the lateral halves or & covers 1
the retinae remain uncrossed eye and uses the
- Thus fibers from the right half of each other eye to read the line that
eye carry impulses to the brain’s right appears more
clearly ISHIHARA CHART
- this procedure is repeated for the - consists of nos. that are composed of
other eye colored dots located within a circle
- the findings are recorded as a of colored dots
comparison - client is asked to read the nos. on the
between what the client can read at chart
20 ft and - each eye is tested separately
the no. of feet normally required by an - the test is sensitive for the diagnosis
individual to read the same line of
EXAMPLE: 20/50 red/green blindness but not
- The client is able to read at 20 ft effective for the detection of the
from the chart discrimination
what a healthy eye can read at 50 ft of blue
CONFRONTATIONAL TEST
- Performed to examine visual fields or PUPILS
peripheral - Normal: round & of equal size
vision - Increasing light causes pupillary
- The examiner & the client sit facing constriction
each other Decreasing light causes pupillary
- The test assumes that the examiner dilation
has normal - the client is asked to look straight
peripheral vision ahead while
EXTRAOCULAR MUSCLE FUNCTION the examiner quickly
- tests muscle function of the eyes brings a beam of light ( penlight) in
- tests 6 cardinal positions of gaze from the side
1. Client’s right (lateral position) & directs it onto the side
2. Upward & right (temporal - CONSENSUAL RESPONSE
position)
3. Down & right
4. Client’s left (lateral position)
5. Upward & left (temporal DIAGNOSTIC TESTS FOR THE EYE
position) 1. FLUORESCEIN ANGIOGRAPHY
6. Down & left - detailed imaging & recording of ocular
- client holds head still & asked to circulation by
move eyes & a series of photographs after
follow a small object administration of the
- the examiner looks for any parallel dye
movements PRE-OP NURSING CARE
of the eye or for • Assess for allergies & previous
reactions to dyes
NYSTAGMUS • Obtain informed consent
- an involuntary rhythmic rapid • A mydriatic medication is instilled in
twitching of the eye 1 hr. before the test
the eyeballs • The dye is injected into the vein of the
client’s arm
ASSESSMENT OF VISION • Inform client that the dye may cause
COLOR VISION TEST the skin to appear yellow for several
hrs. after the test & this is gradually
- Tests for color vision which involve eliminated through the urine
picking nos. or letters out of a
complex & colorful picture
• The client may experience N&V, • Explain the procedure to the client.
sneezing, paresthesia of the tongue or • Advise the client about the brightness
pain at the injection site of the light & the need to look forward
• If hives appear, oral or IM at the point over the examiner’s ear
antihistamines such as
Diphenhydramine 4. CORNEAL STAINING
• (Benadryl) are given as prescribed. - installation of a topical dye into the
POST-OP NURSING CARE conjunctival sac
• Encourage rest. to outline the irregularities of the corneal
• Encourage oral fluids. surface
• Remind the client that the yellow skin that are not easily visible
appearance will disappear - the eye is viewed through a blue filter,
• Instruct the client that the urine will and a bright
appear bright green until the dye is green color indicates areas of non-intact
excreted corneal
• Instruct the client to avoid direct epithelium
sunlight for a few hrs after the test. NURSING CARE
• Instruct the client that the • If a client wears contact lenses, they
photophobia will continue until pupil must be removed
size returns to normal • The client is instructed to blink after
the dye has been applied to distribute
2. COMPUTED TOMOGRAPHY the dye evenly across the cornea
- a beam of x-ray scans the skull & orbits
of the eye 5. TONOMETRY
- a cross-sectional image is formed by the - the test is primarily used to assess for
use of a an increase in
computer IOP and potential glaucoma
- contrast material is not usually - NORMAL IOP: 8-21 mm Hg
administered NURSING CARE
NURSING CARE • Each eye is anesthetized.
• No special client preparation or follow- • The client is asked to stare forward at
up care required a point above the examiner’s ear
• Instruct the client that he or she will • A flattened cone is brought in contact
be positioned in a confined space & with the cornea
need to keep the head still during the • The amount of pressure needed to
procedure. flatten the cone is measured
• The client is instructed to avoid
3. SLIT LAMP rubbing the eye following the
- allows examination of the anterior ocular examination if the eye has been
structures anesthetized
under microscopic magnification - the potential for scratching the cornea
- the client leans on a chin rest to stabilize exists
the head
while a narrow beam of light is aimed so OPTHALMIC MEDICATIONS
that it
illuminates only a narrow PARASYMPATHOLYTIC DRUGS
segment of the eye. - used pre-op or for eye examinations to
produce mydriasis

- C/I in clients with glaucoma because of

NURSING CARE the risk of increased IOP
- Mydriatics are C/I in cardiac PARASYMPATHOMIMETIC
dysrhythmias & cerebral atherosclerosis & A. GROUP I: MIOTIC CHOLINERGIC DRUGS
should be used with caution in the - - reduce IOP by mimicking the action
elderly & in clients with prostatic of acetylcholine
hypertrophy, DM or parkinsonism - act directly on the myoneural junction &
produce strong contractions of the iris (
MYDRIATICS, CYCLOPLEGIC & miosis) & ciliary body musculature
ANTICHOLINERGIC medications ( accommodation)
MYDRIATICS B. GROUP II: CHOLINESTERASE
- dilate the pupils (mydriasis) INHIBITORS
CYCLOPLEGIA - reduce IOP by inhibiting the action of
- relax the ciliary muscles cholinesterase
ANTICHOLINERGICS - action of this drug is difficult to reverse
- block responses of the sphincter
muscle in the ciliary body, MIOTICS
producing mydriasis - reduce IOP by constricting the pupil &
Ex. contracting the
• Atropine sulfate (Isopto-Atropine, Ocu- ciliary muscle, thereby increasing the blood
Tropine, Atropair, Atropisol) flow to
• Scopolamine hydrobromide (Isopto- the retina & decreasing retinal damage &
Hyoscine) loss of
• Cyclopentolate hydrochloride vision
(Cyclogyl, AK-Pentolate, Pentolair) - open the anterior chamber angle &
• Homotropine hydrobromide (Isopto increase the
Homatrine, AK-Homatropine, outflow of aqueous humor
Spectro- - used for chronic open-angle glaucoma or
Homatrine) acute &
• Tropicamide (Mydriacyl, I-Picamide, chronic closed-angle glaucoma
Tropicacyl) - used to achieve miosis during eye surgery
• Phenylephrine hydrochloride (AK- - C/I in clients with retinal detachment,
Dilate, Dilatair, Mydfrin, Ocu-Phrin) adhesions
NURSING RESPONSIBILITIES between the iris & lens, or inflammatory
• Monitor for allergic reactions diseases
• Assess for risk of injury
• Assess for constipation & urinary - used with caution in clients with asthma,
retention hypertension, corneal
• Instruct the client that a burning abrasion,hyperthyroidism,
sensation may occur on installation coronary vascular disease, urinary tract
• Instruct the client not to drive or obstruction,
operate machine for 24 hrs after GI obstruction, ulcer disease, parkinsonism,
installation of the medication unless or
otherwise directed by the physician bradycardia
• Instruct the client to wear sunglasses Ex.
until the effects of the medication wear • Acethylcholine Cl (Miochol)
off • Carbachol (Miostat)
• Instruct to notify MD if blurring of • Pilocarpine HCl (Isopto Carpine,
vision, loss of sight, difficulty in Pilocar)
breathing, sweating or flushing occurs • Pilocarpine nitrate (Pilofrin, Liquifilm,
• Instruct the client to report eye pain to Pilagan)
the physician • Echothiophate iodide (Phospholine
iodide)
• Demecarium bromide (Humorsol) • Instruct the client to notify MD if
• Isoflurophate (Floropryl) shortness of breath occurs
NURSING CARE • Instruct not to D/C medication abruptly
• Assess V/S & risk of injury • Instruct to change positions slowly to
• Assess the client for the degree of avoid orthostatic hypotension
diminished vision • Instruct to avoid hazardous activities
• Monitor for postural hypotension & • Instruct to avoid OTC meds without
instruct the client to change positions the MD’s approval
slowly
• Assess breath sounds for rales & ADRENERGIC EYE MEDICATIONS
rhonchi - Decrease the production of aqueous
- cholinergic meds cause bronchospasms humor & lead
& to a decrease in IOP
increased bronchial secretions - Used to treat glaucoma
• Maintain oral hygiene due to increased ADRENERGIC MEDICATIONS
salivation • Apraclonidine HCl (Iopidine)
• Have Atropine sulfate available as • Brimonidine tartrate (Alphagen)
antidote for Pilocarpine • Dipivefrin HCl (Propine)
• Instruct the client not to stop the meds • Epinephrine borate (Epinal, Eppy)
suddenly • Epinephrine HCl (Epifrin, Glaucon)
• Instruct to avoid activities such as
driving while vision is impaired CARBONIC ANHYDRASE MEDICATIONS
• Instruct clients with glaucoma to read - Interfere with the production of carbonic
labels on OTC meds & to avoid acid
Atropine-like meds which leads to decreased aqueous
- Atropine increase IOP humor
formation & decreased IOP
BETA-ADRENERGIC BLOCKING EYE - Used for long-term treatment of open-
MEDICATIONS angle
- IOP by decreasing sympathetic impulses & glaucoma
decreasing - C/I in the client allergic to sulfonamides
aqueous humor production w/o affecting EX.
accommodation or pupil size • ACETAZOLAMIDE ( DIAMOX)
- Used to treat chronic open-angle glaucoma • DICHLORPHENHAMIDE (DARANIDE,
- C/I in the client with asthma ORATROL)
• ETHOXYZOLAMIDE (CARDRASE,
EX. ETHAMIDE)
• Betaxolol HCl (Betoptic) • METHAZOLAMIDE (NEPTAZANE)
• Carteolol HCl (Ocupress) NURSING CARE
• Levobunolol HCl (Betagan) • Monitor V/S
• Metipranolol (Optipranolol) • Assess visual acuity
• Timolol maleate (Timoptic) • Assess for risk of injury
NURSING CARE • Monitor I&O
• Monitor V/S before administering • Monitor weight
medication esp. BP & PR • Maintain oral hygiene
• If the pulse is below 60 or if systolic BP • Monitor for lethargy, anorexia,
is below 90 mm Hg, withhold the drowsiness, polyuria, N/V
medication & contact MD • Monitor electrolytes for hypokalemia
• Monitor for shortness of breath and • Increase fluid intake unless C/I
I&O • Advise the client to avoid prolonged
• Assess for risk of injury exposure to sunlight
• Encourage the client to use artificial • Be alert to allergic responses to the
tears for dry eyes preservatives in the lubricants
• Instruct not to D/C the medication
abruptly TOPICAL ANESTHETICS FOR THE EYE
• Instruct to avoid hazardous activities - Produce corneal anesthesia
while vision impaired - Used for anesthesia for eye
examinations, surgery,
OSMOTIC MEDICATIONS or to remove foreign bodies from the eye
- Lower IOP EXAMPLES
- Used in emergency treatment of acute • Proparacaine HCl (Ophthaine,
closed- Opthenic)
angle glaucoma • Tetracaine HCl (Pontocaine)
NURSING CARE
- Used pre-op & post-op to decrease vitreous • Assess for risk of injury
humor • Note that the medications should not
volume be given to the client for home use &
EXAMPLES are not to be self-administered by the
• Glycerin (Glyrol, Osmoglyn) client
• Mannitol (Osmitrol) • Note that the blink reflex is
• Urea (Ureaphil) temporarily lost & that the corneal
NURSING CARE epithelium needs to be protected
• Assess V/S, visual acuity & risk for • Provide an eye patch to protect the
injury eye from injury until the corneal reflex
• Monitor weight and I&O returns
• Monitor electrolytes
• Increase fluid intake unless C/I ANTI-INFECTIVE EYE MEDICATIONS
• Monitor for changes in level of ANTIBACTERIAL
orientation • Chloramphenicol (Chloromycetin,
Chloroptic)
EYE LUBRICANTS • Ciprofloxacin hydrochloride (Cipro)
- Replace tears or add moisture to the • Erythromycin (Ilotycin)
eyes • Gentamicin sulfate (Garamycin,
- Moisten contact lenses or an artificial Genoptic)
eye • Norfloxacin (Chibroxin)
- Protect the eyes during surgery or • Tobramycin (Nebcin, Tobrex)
diagnostic • Silver nitrate 1%
procedures ANTIFUNGAL
- Used for keratitis, during anesthesia or • Natamycin (Natacyn Opthalmic)
in a ANTIVIRAL
disorder that results in unconsciousness • Idoxuridine (Herplex-Liquifilm)
or • Trifluridine (Viroptic)
decreased blinking • Vidarabine (Vira-A Opthalmic)
EXAMPLES NURSING CARE
• Hydroxypropyl methylcellulose (Lacril, • Assess for risk of injury
Isopto Plain) • Instruct the client in how to apply the
• Petroleum-based ointment (Artificial eye medication
Tears, Liquifilm Tears) • Instruct the client to continue
NURSING CARE treatment as Rx
• Inform the client that burning may • Instruct the client to wash hands
occur on installation thoroughly & frequently
• Advise the client that if improvement • Instruct the client in the use of the
does not occur, notify the MD cane used for the blind client, which is
differentiated from other canes by its
ANTI-INFLAMMATORY EYE MEDICATIONS straight shape & white color with red
EXAMPLES tip
• Dexamethasone (Maxidex) • Instruct the client that the cane is held
• Diclofenac (Voltaren) in the dominant hand several inches
• Flurbiprofen Na (Ocufen) off the floor
• Suprofen (Profenal) • Instruct the client that the cane
• Ketorolac tromethamine (Acular) sweeps the ground where the client’s
• Prednisone acetate (Predforte, foot will be placed next to determine
Econopred) the presence of obstacles
• Prednisolone Na phosphate (AK-Pred,
Inflamase) 1. CATARACTS
• Rimaxolone (Vexol) - an opacity of the lens that distorts the
image
projected onto the retina & that can
progress to
blindness
DISORDERS OF THE EYE - intervention is indicated when visual acuity
has been
LEGALLY BLIND reduced to a level that the client finds to
- a person is legally blind if the best visual be
acuity with unacceptable or adversely affecting
corrective lenses in the better eye is 20/200 lifestyle
or less or CAUSES
a visual field of 20 degrees or less in the  Aging process (Senile cataracts)
better eye  Inherited (Congenital cataracts)
NURSING CARE  Injury (Traumatic cataracts)
• When speaking to a client who has  Can occur as a result of another eye
limited sight or blind, the nurse uses a disease (Secondary cataracts)
normal tone of voice ASSESSMENT
• Alert the client when approaching • Opaque or cloudy white pupil
• Orient the client to the environment • Gradual loss of vision
• Use a focal point & provide further • Blurred vision
orientation to the environment from • Decreased color perception
the focal point • Vision that is better in dim light with
• Allow the client to touch objects in the pupil dilation
room • Photophobia
• Use the clock placement of foods on • Absence of red reflex
the meal tray to orient the client MEDICAL MANAGEMENT
• Promote independence as much as - surgical removal of the lens, one eye at
possible a time
• Provide radios, TVs, & clocks that give - a lens implantation may be performed at
the time orally or provide a Braille the time
watch. of surgical procedure
• When ambulating, allow the client to • EXTRACAPSULAR EXTRACTION
grasp the nurse’s arm at the elbow - the lens is lifted out w/o removing the
• Instruct the client to remain one step lens capsule
behind the nurse when ambulating - may be performed with Phacoemulsion
• PHACOEMULSIFICATION
- the lens is broken up by ultrasonic • Contact the MD for any decrease in
vibrations & vision, severe eye pain or increase in
extracted eye discharge
• INTRACAPSULAR EXTRACTION
- the lens is removed within its capsule 2. GLAUCOMA
through as - increased IOP as a result of inadequate
small incision drainage of
PRE-OP NURSING CARE aqueous humor from the canal of
• Instruct measures to prevent or Schlemm or over
decrease IOP production of aqueous humor
• Administer pre-op eye medications - the condition damages the optic nerve
including mydriatics & cycloplegics as & can result
prescribed in blindness
POST-OP NURSING CARE TYPES
• Elevate the head of the bed 30-45 A. ACUTE = a rapid onset of IOP > 50-7- mm
degrees Hg
• Turn the client to the back or un- CLOSED-ANGLE/NARROW ANGLE
operative side GLAUCOMA
• Maintain an eye patch & orient the - results from obstruction to outflow to
client to the environment aqueous humor
• Position the client’s personal B. CHRONIC = a slow progressive, gradual
belongings on the un-operative side onset of IOP>30-50 mmHg
• Use side rails for safety CLOSED-ANGLE GLAUCOMA
• Assist with ambulation - follows an untreated attack of acute
CLIENT EDUCATION AFTER CATARACT close-angled
SURGERY glaucoma
• Avoid eye straining OPEN-ANGLE GLAUCOMA
• Avoid rubbing or placing pressure on - results from an overproduction or
the eyes obstruction to
• Avoid rapid movements, straining, the outflow of aqueous humor
sneezing, coughing, bending,
vomiting, or lifting objects over 5 lbs
• Teach measures to prevent
constipation
• Wipe excess drainage or tearing with a
sterile wet cotton ball from the inner to
the outward canthus
• Use an eye shield at bedtime
• If an eye implant is not performed, the
eye cannot accommodate & glasses
must be worn at all times
• Cataract glasses act as magnifying
glasses & replace central vision only
• Cataract glasses magnify, & objects
appear closer therefore teach client to
judge distance & climb stairs carefully ASSESSMENT
• Contact lenses provide sharp visual  Progressive loss of peripheral vision
acuity but dexterity is needed to insert followed by a loss of central vision
them  Elevated IOP (Normal pressure is 10-
21 mm Hg)
 Vision worsening in the evening with conjuctival spaces by the creation of an
difficulty opening
adjusting to dark rooms
 Blurred vision 3. RETINAL DETACHMENT
 Halos around white lights - occurs when the layers of the retina
 Frontal headaches separate because
of accumulation of fluid between them
 Photophobia
- also occurs when both retinal layers elevate
 Increased lacrimation
away
 Progressive loss of central vision
from the choroid as a result of a tumor
NURSING CARE FOR ACUTE GLAUCOMA
TYPES
• Treat as medical emergency
PARTIAL RETINAL DETACHMENT
• Administer medications as
- becomes complete if left untreated
prescribed to lower IOP
COMPLETE RETINAL DETACHMENT
• Prepare the client for peripheral
- when detachment is complete, blindness
iridectomy
may occur
- allows aqueous humor to flow from the
ASSESSMENT
posterior
 Flashes of light
to anterior chamber
 Floaters
NURSING CARE FOR CHRONIC
GLAUCOMA  Increase in blurred vision
• Instruct the client the  Sense of curtain being drawn
importance of medications  Loss of a portion of the visual field
a. MIOTICS: to constrict the pupils IMMEDIATE NURSING CARE
b. CARBONIC ANHYDRASE • Provide bedrest
INHIBITORS: to decrease • Cover both eyes with patches to
the production of aqueous humor prevent further detachment
c. BETA-BLOCKERS: to decrease the • Speak to the client before approaching
production of • Position the client’s head as prescribed
aqueous humor & IOP • Protect the client from injury
• Instruct the client the need for life-long • Avoid jerky head movements
medication use • Minimize eye stress
• Instruct the client to wear a Medic-Alert • Prepare the client for surgical
bracelet procedure as prescribed
• Instruct the client to avoid anti- MEDICAL MANAGEMENT
cholinergic medications - draining fluid from the subretinal space
• Instruct the client to report eye pain, so that the
halos around eyes & changes of vision retina can return to the normal position
to the physician • SEALING RETINAL BREAKS BY
• Instruct the client that when maximal CRYOSURGERY
medical therapy has failed to halt the - a cold probe applied to the sclera to
progression of visual field loss & optic stimulate an
nerve damage, inflammatory response leading to
surgery will be recommended adhesions
• Prepare the client for • DIATHERMY
TRABECULOPLASTY as prescribed - the use of electrode needle & heat
- to facilitate aqueous humor drainage through the
• Prepare client for TRABECULECTOMY sclera to stimulate an inflammatory
as prescribed response
- allows drainage of aqueous humor into leading to adhesions
the • LASER THERAPY
- to stimulate an inflammatory response because of lack of muscle coordination of
to seal small the
retinal tears before the detachment extraocular muscles
occurs - most often results from muscle
• SCLERAL BUCKLING imbalance or
- to hold the choroid & retina together paralysis of extraocular muscles, but may
with a splint also result
until scar tissue forms closing the tear from conditions such as brain tumor,
• INSERTION OF A GAS OR SILICONE myasthenia
OIL gravis or infection
- to encourage attachment because these - normal in young infant but should not be
agents present
have a specific gravity less than vitreous after about age 4 months
or air & can ASSESSMENT
float against the retina  Amblyopia if not treated early
POST-OP NURSING CARE  Permanent loss of vision if not treated
• Maintain eye patches bilaterally as early
prescribed  Loss of binocular vision
• Monitor hemorrhage as prescribed  Impairment of depth perception
• Prevent N&V and monitor for
 Frequent headaches
restlessness which can cause
 Squints or tilts head to see
hemorrhage
NURSING CARE
• Monitor for sudden, sharp eye pain
• Corrective lenses as indicated
(notify the MD stat)
• Instruct the parents regarding
• Encourage DBE but avoid coughing
patching (occlusion therapy) of the
• Provide bed rest for 1-2 days as
“good” eye ( to strengthen the weak
prescribed
eye)
• If gas has been inserted, position as
• Prepare for botulinum toxin (Botox)
prescribed on the abdomen & turn the
injection into the eye muscle
head so unaffected eye is down
- produces temporary paralysis
• Administer eye medications as
- allows muscles opposite the
prescribed
paralyzed muscle
• Assist client with ADL
to strengthen the eye
• Avoid sudden head movements or
• Inform the parents that the injection of
anything that increases IOP
botulinum toxin wears off in about 2
• Instruct the client to limit reading for
months & if successful, correction
3-5 weeks
occurs
• Instruct client to avoid squinting,
• Prepare for surgery to realign the
straining & constipation, lifting heavy
weak muscles as Rx if nonsurgical
objects &
interventions are unsuccessful
bending from the waist
• Instruct the need for follow-up visits
• Instruct the client to wear dark glasses
during the day & an eye patch at night
5. CONJUNCTIVITIS
• Encourage follow-up care because of
- also known as “PINK EYE”
the danger of recurrence or occurrence
- inflammation of the conjunctiva
in the other eye
- usually caused by allergy, infection, or
trauma
4. STRABISMUS
TYPES
- called “SQUINT EYE” or “LAZY EYE”
BACTERIAL OR VIRAL CONJUNCTIVITIS
- a condition in which the eyes are not
- extremely contagious
aligned
CHLAMYDIAL CONJUNCTIVITIS
- is rare in older children & if diagnosed in a
child who
is not sexually active, the child should be
assessed for
possible sexual abuse
ASSESSMENT
 Itching, burning or scratchy eyelids
 Redness
 Edema
 Discharge
NURSING CARE
• Instruct in infection control measures
such as good handwashing & not
sharing towels & washcloths
• Administer antibiotic or antiviral eye
drops or ointment as Rx if infection is
present
• Administer antihistamines as Rx if an
allergy is present
• Instruct the parents that the child
should be kept home from school or
day care until antibiotic eye drops have
been administered for 24 hrs
• Instruct in the use of cool compresses
to lessen irritation & in wearing dark
glasses for photophobia
• Instruct the child to avoid rubbing the
eye to prevent injury
• D/C use of contact lenses & to obtain
new lenses to eliminate the chance of
re-infection
• Instruct the adolescent that eye make-
up should be discarded & replaced
EARS Stapes
(Stirrup)
EXTERNAL EAR
- Embedded in the temporal bone bilaterally - Ossicles are set in motion by sound
at the waves from
level of the eyes malleus to the footplate of the stapes in
- Extends from the auricle through the the oval
external canal window
to the tympanic membrane or eardrum B. EUSTACHIAN TUBE
- Includes the mastoid process, a bony ridge - Connects nasopharynx & middle ear
located - Equalizes pressure on both sides of
over the temporal bone eardrum
A. AURICLE (PINNA)
- Outer projection of ear composed of INNER EAR
cartilage & - Contains the semi-circular canals, the
covered by skin cochlea & the
- collects sound waves distal end of the 8th cranial nerve
B. EXTERNAL AUDITORY CANAL - Maintains sense of balance & equilibrium
- Lined with skin A. SEMI-CIRCULAR CANALS
- Glands secrete cerumen (wax) - Contains fluid & hair cells connected to
- provides protection sensory
- transmits sound waves to tympanic nerve fibers of the vestibular portion of 8th
membrane cranial nerve
C. TYMPANIC MEMBRANE (EARDRUM) B. COCHLEA
- Located at the end of the external canal - Spiral-shaped organ of hearing
- Vibrates in response to sound & transmit - Connects organ of Corti, receptor and
vibrations organ for
to middle ear hearing
- Transmits sound waves from the oval
MIDDLE EAR window &
- Consists of the medial side of the initiates nerve impulses carried by cranial
tympanic nerve
membrane VIII (acoustic branch) to brain ( temporal
- The tympanic membrane is a thick lobe of
transparent sheet cerebrum)
th
of tissue that provides a barrier between C. 8 CRANIAL NERVE
the 1. COCHLEAR BRANCH
external ear & the middle ear - transmits neuro-impulses from the
- The middle ear is protected from the inner cochlea to the
ear by brain where it is interpreted as sound
the round & the oval window membranes 2. VESTIBULAR BRANCH
- The eustachian tube opens into the middle - maintains balance & equilibrium
ear &
allows for equalization of pressure on both HEARING & EQUILIBRIUM
sides of • The external ear conducts sound waves
the tympanic membrane to the middle ear
A. OSSICLES • The middle ear also called the
- Contains 3 small bones: Malleus tympanic cavity conducts sound waves
(Hammer) to the inner ear
Incus (Anvil)
• The middle ear is filled with air which - due to any physical obstruction to the
is kept at atmospheric pressure by the transmission
opening of the Eustachian tube of sound waves
• The inner ear contains sensory SENSORINEURAL HEARING LOSS
receptors for sound & forequilibrium - due to a defect in the organ of hearing, in
• The receptors in the inner ear transmit the 8th
sound waves & changes in body cranial nerve, or in the brain itself
position to the nerve impulses MIXED CONDUCTIVE, SENSORINEURAL
HEARING LOSS
ASSESSMENT OF THE EAR - results in profound hearing loss
OTOSCOPIC EXAM
GUIDELINES VOICE TEST
- the speculum is never blindly • Ask the client to block one external
introduced into the canal
external canal because of the risk of • The examiner stands 1-2 ft away &
perforating quickly whispers a statement
the tympanic membrane • The client is asked to repeat the
- tilt the head slightly away & hold the whispered statement
otoscope • Each ear is tested separately
upside down as if it were a large pen WATCH TEST
- this permits the examiner’s hand to lie • A ticking watch is used to test the
against the high-frequency sounds
head for support • The examiner holds a ticking watch
- pull the pinna up & back to straighten about 5 inches from each ear & asks
the external the client if the ticking is heard.
canal in an adult
- visualize the external canal while slowly TUNING FORK TESTS
inserting A. WEBER TUNING FORK TEST
the speculum • CONDUCTIVE HEARING LOSS = the
NORMAL FINDINGS OF THE EXTERNAL sound is heard in affected ear
CANAL • SENSORINEURAL HEARING LOSS=
 Pink & intact without lesions sound heard in the unaffected ear
 Has various amounts of cerumen & B. RINNE TUNING FORK TEST
fine little hairs NORMAL RESULT: (+) RINNE TEST/
NORMAL FINDINGS OF THE TYMPANIC AC>BC
MEMBRANE • CONDUCTIVE HEARING LOSS
 The tympanic membrane should be If the client is unable to hear the sound
intact without perforations & free from through the ear in front of the pinna,
lesions (-) RINNE TEST/ AC<BC
 The tympanic membrane is
transparent, opaque, pearly gray & VESTIBULAR ASSESSMENT OF THE EAR
slightly concave TEST FOR FALLING
• The examiner asks the client to stand
AUDITORY ASSESSMENT with the feet together & arms hanging
• Sound is transmitted by air conduction loosely at the sides & eyes closed
& bone conduction • The client normally remains erect with
• Air is 2-3x longer than bone slight swaying
conduction ABNORMAL RESULT: (+) ROMBERG SIGN
- presence of significant swaying
CATEGORIES OF HEARING LOSS
CONDUCTIVE HEARING LOSS TEST FOR PAST POINTING
• NORMAL TEST RESPONSE: NURSING CARE
- The client can easily return to the point • All jewelry are removed
of • Lead eye shields are used to cover
reference the cornea to diminish the
FINDINGS radiation dose to the eyes
• The client with vestibular function • The client must remain still in a
problem lacks a normal sense of supine position
position sense and is unable to return • No follow-up care is required
to the extended fingers to the point of
reference, the fingers instead either AUDIOMETRY
goes to the right or left of the reference - measures hearing acuity
point - uses 2 types: PURE TONE
GAZE NYSTAGMUS EVALUATION AUDIOMETRY & SPEECH
• Examine the client’s eyes as they look AUDIOMETRY
straight ahead, 30 degrees to each - after testing, audiogram patterns are
side, upward & downward depicted on a
FINDINGS graph to determine the type & level of
- Any spontaneous nystagmus is a (+) hearing loss
result
- ABNORMAL FINDING PURE TONE AUDIOMETRY
- a constant involuntary cyclic movement - used to identify problems with hearing,
of the speech,
eyeball in any direction represents a music & other sounds in the environment
problem with SPEECH AUDIOMETRY
the vestibular system - the client’s ability to hear spoken words
is measured
HALLPIKE MANEUVER NURSING CARE
• Assesses for positional vertigo or • Inform the client regarding the
induced dizziness procedure
• The client assumes a supine position • Instruct the client to identify the
• The head is rotated to one side for 1 sounds as they are heard
minute
FINDINGS
• (+) test result is presence of ELECTRONYSTAGMOGRAPHY
nystagmus after 5-10 sec - evaluates spontaneous nystagmus
- ABNORMAL FINDING - used to distinguish between normal
- a constant involuntary cyclic movement nystagmus &
of the either medication-induced nystagmus or
eyeball in any direction represents a nystagmus caused by a lesion in the
problem with central or
the vestibular system peripheral vestibular pathway
- records changing electrical fields with
DIAGNOSTIC TESTS FOR THE EAR movement
TOMOGRAPHY of the eye, as monitored by electrodes
- may be performed with or without placed on
contrast the skin around the eye
medium
- assesses the mastoid, middle ear & CALORIC TEST (BI-THERMAL TEST)
inner ear - evaluate dizziness
structures - Nystagmus, N/V or ataxia
- multiple x-rays of the head are done
- indicate a pathological condition of the MEDICATIONS THAT AFFECT HEARING
labyrinth ANTIBIOTICS
system, whereas a decreased response • Amikacin (Amikin)
may • Chloramphenicol
indicate that the vestibular system is - Chloromycetin
affected - Chloroptic
NURSING CARE - Ophthoclor
• Warm water causes a greater • Erythromycin
response than cold water - E-Mycin
• Warm water caloric testing (irrigation) - ERYC
precedes cool water caloric testing - Ery-Tab
(irrigation) - PCE Dispertabs
• The character & duration of the eye - Ilotycin
movements are measured • Gentamicin (Garamycin)
• The client must assume a supine • Streptomycin sulfate
position with eyes closed & head (Streptomycin)
elevated to 30 degrees • Tobramycin sulfate (Nebcin)
• After the procedure, the client begins • Vancomycin (Vancocin)
taking clear fluids slowly & cautiously DIURETICS
because N & V may occur • Acetazolamide (Diamox)
• Assistance with ambulation may also • Furosemide (Lasix)
be necessary following the procedure • Ethacrynic acid (Edecrine)
OTHERS
OTIC MEDICATIONS • Cisplatin (Platinol, Platinol-AQ)
ADMINISTERING EAR DROPS • Nitrogen mustard
ADULT • Quinine (Quinamn)
• Pull the pinna up & back to straighten • Quinidine
the external canal to instill ear drops - Cardioquin
CHILD - Quinaglute
• Pull the pinna down & back for infants - Quindex
& children younger than 3 years of age
• Pull the pinna up & back for children ANTI-INFECTIVE MEDICATIONS
for children more than 3 years EXAMPLES
IRRIGATION OF THE EAR • Amoxicillin (Amoxil)
• Irrigation of the ear needs to be • Ampicillin trihydrate (Polycillin)
prescribed by MD • Cefaclor (Ceclor)
• Ensure that there is direct visualization • Clindamycin HCl (Cleocin)
of the tympanic membrane • Trimethoprim (TMP) &
• Warm irrigating solution to 100° F Sulfamethaxazole (SMZ)
- solutions not close to the - Bactrim, Cotrim, Septra
client’s body temp • Erythromycin (Ilotycin, E-Mycin)
will cause ear injury, nausea & • Penicillin V potassium (Pen V)
vertigo • Loracarbef (Lorabid)
• Irrigation must be done gently to • Clarithromycin (Biaxin)
avoid damage to the eardrum • Polymyxin B sulfate (Aerosporin)
• When irrigating, don’t direct • Tetracycline HCl (Achromycin)
irrigating solution directly toward • Acetic acid and Aluminum acetate
the eardrum (Otic Domeboro)
• If perforation of the eardrum is
suspected, irrigation is not done ANTI-HISTAMINES & DECONGESTANTS
- Produce vasoconstriction
- Stimulate the receptors of the • Moisten a cotton plug with medication
respiratory mucosa before insertion
- Reduce respiratory tissue hyperemia & • Keep the container tightly closed &
edema to away from moisture
open obstructed eustachian tubes • Avoid touching the ear with the
- Used for acute otitis media dropper
• 30 minutes after installation, gently
irrigate the ear as Rx with warm water
SIDE EFFECTS using a rubber bulb ear syringe
 Drowsiness • Irrigation may be done with hydrogen
 Blurred vision peroxide sol’n as Rx
 Dry mucous membranes • For chronic cerumen impaction, 1-2
NURSING CARE gtts of mineral oil will soften the wax
• Inform the client that drowsiness, • Instruct the client to notify MD if
blurred vision, & dry mouth may occur redness, pain or swelling persists
• Instruct the client to increase fluid
intake unless C/I & to suck on hard
candy to alleviate dry mouth
• Instruct the client to avoid hazardous DISORDERS OF THE EAR
activities if drowsiness occurs
EXAMPLES 1. CONDUCTIVE HEARING LOSS
• Tripolidine & pseudoephedrine (Actifed) - occurs when sound waves are blocked to
• Naphazoline HCl (Allerest, Albalon) the inner ear
• Chlorpheniramine (Chlor-Trimeton, fibers because of external ear or middle ear
Teldrin) disorders
• Brompheniramine (Bromphen, - disorders can often be corrected with no
Dimetane) damage to
• Terfenadine (Seldane) hearing, or minimal permanent hearing
• Clemastine (Tavist) loss
• Cetirizine (Zyrtec) CAUSES
• Astemizole (Hismanal) • Any inflammatory process or
obstruction of the external or middle
LOCAL ANESTHETICS ear
MEDICATION : • Tumors
Benzocaine (Americaine Otic; • Otosclerosis
Tympagesic) • A build-up of scar tissue on the
SIDE EFFECTS ossicles from previous middle ear
 Allergic reaction surgery
 Irritation
2. SENSORINEURAL HEARING LOSS
NURSING CARE
- a pathological process of the inner ear or
• Monitor for effectiveness if used for
of sensory
pain relief
fibers that lead to the cerebral cortex
• Assess for irritation or allergic reaction
CAUSES
• Damage to the inner ear structures
CERUMINOLYTIC MEDICATIONS
• Damage to the cranial nerve VIII
EXAMPLES
• Prolonged exposure to loud noise
• Carbamide peroxide (Debrox)
• Medications, trauma, infections,
• Boric acid (Ear-Dry)
surgery
NURSING CARE
• Inherited disorders
• Instruct the client not to use drops
• Metabolic & circulatory disorders
more often than prescribed
• Meniere’s syndrome • Using telephone amplifiers
• Diabetes mellitus • Facing lights that are activated by
• Myxedema ringing of the telephone or doorbell
• Specially trained dogs that help the
3. MIXED HEARING LOSS client to be aware of sound & to alert
- also known as conductive-sensorineural the client of potential dangers
hearing loss COCHLEAR IMPLANTATION
- client has both sensorineural & conductive - used for sensorineural hearing loss
hearing - a small computer converts sound waves
loss into
electrical impulses
SIGNS OF HEARING LOSS : GENERAL - electrodes are placed by the internal ear
 Frequently asking people to repeat with a
statements computer device attached to the
 Straining to hear external ear
 Turning head or leaning forward to - electronic impulses directly stimulate
favor one ear nerve fibers
 Shouting in conversations HEARING AIDS
- used for the client with conductive
 Ringing in the ears
hearing loss
 Failing to respond when not looking in
- can help the client with sensorineural
the direction of the sound
loss,
 Answering questions incorrectly
although it is not as effective
 Raising the volume of the television or - a difficulty that exists in its use is the
radio amplification
 Avoiding large groups of background noise as well as voices
 Better understanding of speech when CLIENT EDUCATION: HEARING AID
in small groups • Encourage to begin using the hearing
 Withdrawing from social interactions aid slowly to develop an adjustment to
the service
FACILITATING COMMUNICATION • Adjust the volume to a minimal
• Use of written words hearing level to prevent feedback
• Provision of light in the room squeaking
• Getting the attention of the client • Teach the client to concentrate on the
before you begin to speak sounds that are to be heard & to filter
• Facing the client when speaking out background noise
• Talking in a room without distracting • Instruct the client to clean ear mold
noises with mild soap & water
• Moving close to the client & speaking • Avoid excessive wetting of the hearing
slowly & aid, and try to keep the hearing aid dry
clearly • Clean the ear cannula of the hearing
• Keeping hands & other objects away aid with a toothpick or pipe cleaner
from the mouth when talking to the • Turn off the hearing aid & remove the
client battery when not in use
• Talking in lower tones, because • Keep extra batteries on hand
shouting is not helpful • Keep the hearing aid in a safe place
• Rephrasing sentences & repeating • Prevent hair sprays, oils, or other hair
information & face products from coming into
• Validating contact with the receiver of the hearing
• Reading lips aid
• Using sign language
 Plugged feeling in the ear
 Redness & edema
 Exudate
 Hearing loss
4. PRESBYCUSIS NURSING CARE
- associated with aging • Apply heat locally for 20 minutes 3x a
- leads to degeneration or atrophy of the day
ganglionic • Encourage rest to assist in reducing
cells in the cochlea & a loss of elasticity pain
of the • Administer analgesics such as aspirin
basilar membranes or acetaminophen (Tylenol) for the pain
- leads to compromise of the vascular as prescribed
supply to the • Instruct the client that the ears should
inner ear with changes in several areas be kept clean & dry
of the ear • Instruct the client to use earplugs for
structure swimming
ASSESSMENT • Instruct the client that cotton-tipped
• Hearing loss is gradual & bilateral applicators should not be used to dry
• Client states that he/she has no ear because their use can lead to
problem with hearing but can’t trauma to the canal
understand what the words are • Instruct the client that irritating agents
• Client thinks that the speaker is such as hair products or headphones
mumbling should be discontinued

5. EXTERNAL OTITIS
- infective inflammatory or allergic
responses 6. OTITIS MEDIA
involving the structure of the external - infection of the middle ear occurring as a
auditory result of a
canal or the auricles blocked eustachian tube, which prevents
- an irritating or infective agent comes into drainage
contact - a common complication of an acute
with epithelial layer of the external ear respiratory
- this leads to either an allergic response infection
or S/S of ASSESSMENT
infection • Fever
- the skin becomes red, swollen, & tender • Irritability, restlessness & loss of
to touch appetite
on movement
• Rolling of head from side to side
- the excessive swelling of the canal lead
• Pulling on or rubbing the ear
to
• Earache or pain
conductive
• Signs of hearing loss
hearing loss due to obstruction
• Purulent ear drainage
- more common in children & termed as
• Red, opaque, bulging or retracting
“SWIMMER’S
tympanic membrane
EAR”
NURSING CARE
- occurs more often in hot, humid
• Encourage oral fluids
environments
• Teach the parents to feed infants in an
ASSESSMENT
upright position
 Pain • Instruct the child to avoid chewing
 Itching during the acute period
- chewing increases the pain • Instruct the client to report excessive
• Provide local heat & have the child lie ear drainage to the physician
with affected ear down
• Instruct the parents in the appropriate
procedure to clean drainage from the 7. CHRONIC OTITIS MEDIA
ear with sterile cotton swabs - a chronic infective, inflammatory, or
• Instruct in the administer of analgesics allergic
or antipyretics such as Acetaminophen response involving the structure of the
(Tylenol) to decrease fever & pain middle ear
• Instruct the parents in the - surgical treatment is necessary to restore
administration of prescribed antibiotics, hearing
emphasizing that the 10-14 day period - the type of surgery can vary & include a
is necessary to eradicate positive simple
organisms reconstruction of the tympanic
• Instruct the parents that screening for membrane, a
hearing loss may be necessary myringotomy, or replacement of the
MYRINGOTOMY ossicles
- temporary incision of tympanic within the middle ear
membrane to TYMPANOPLASTY
decompress the membrane and promote - a reconstruction of the middle ear may
drainage be
of effusion attempted to improve conductive
- insertion of tympanoplasty tubes in the hearing loss
middle ear PRE-OP NURSING CARE
to equalize pressure & keep the ears • Administer antibiotic ear drops as Rx
dry • Clear the ear of debris as Rx & irrigate
POST-OP NURSING CARE ear with a solution of equal parts of
• Keep the ears dry vinegar & sterile H2Oas Rx
• Earplugs should be worn during • Instruct to avoid persons with URTI
bathing, shampooing & swimming • Instruct client to obtain adequate rest,
• Diving & submerging under water are eat a balanced diet & drink adequate
C/I fluids
Client education post myringotomy • Instruct in DBE & coughing but forceful
• Avoid strenuous exercise coughing avoided.
• Avoid rapid head movements, - increases pressure in the middle ear esp.
bouncing or bending post-op
• Avoid straining on bowel movement POST-OP NURSING CARE
• Avoid drinking through a straw • Inform client that initial hearing after
• Avoid traveling by air surgery is diminished & hearing will
• Avoid forceful coughing improve after the ear canal packing is
• Avoid contact with persons with colds removed
• Avoid washing hair, showering or • Keep dressing clean & dry
getting the head wet for a week as Rx • Keep client flat with operative ear up
• Instruct the client that if she/he needs for at least 12 hours
to blow the nose, blow one side at a • Administer antibiotics as Rx
time with wide mouth open • Instruct the client that he/she may
• Instruct the client to keep ears dry by return to work in approximately 3
keeping a ball of cotton coated with weeks post-op
petroleum jelly in the ear & to change
cotton ball daily 8. OTOSCLEROSIS
- disease of the labyrinthine capsule of - removal of the stapes with a small hole
the middle drilled in
ear that results in a bony overgrowth of the footplate & a prosthesis is connected
the tissue between the incus & footplate
surrounding the ossicles - sounds cause the prosthesis to vibrate in
- causes the dev’t of irregular areas of the
new bone same manner as the stapes
formation & causes fixation of the COMPLICATIONS:
bones - Complete hearing loss
- stapes fixation leads to CONDUCTIVE - Prolonged vertigo
HEARING - Infection
LOSS - Facial nerve damage
- if it involves inner ear, PRE-OP NURSING CARE
SENSORINEURAL HEARING • Instruct the client in measures to
LOSS prevent middle ear or external ear
infections
ASSESSMENT • Instruct the client to avoid excessive
 Slowly progressing conductive hearing nose blowing
loss • Instruct not to clean the ear canal with
 Bilateral hearing loss cotton-tipped applicators
 A ringing or roaring type of constant • Instruct the client to remove the
tinnitus hearing aid 2 weeks before surgery to
 Loud sounds heard in the ear when ensure the integration of local tissue
chewing POST-OP NURSING CARE
• Inform the client that hearing is initially
 Pinkish discoloration (SCHWARTZ’S
worse after the surgical procedure & no
SIGN) of the tympanic membrane
- indicates vascular changes in the ear noticeable improvement in hearing
may occur for as long as 6 weeks
 (-) Rinne test
• Inform the client that the Gelfoam ear
 Weber test shows lateralization of the
packing interferes with hearing but is
sound to the ear with the most
used to decrease bleeding
conductive hearing loss
• Assist with ambulating during the first
1-2 days after surgery
- it is not uncommon to have bilateral
• Provide side rails when the client is in
involvement, although hearing loss
bed
may be
• Administer antibiotics &
worse in one ear
antivertiginous & pain meds as Rx
- nonsurgical intervention promotes the
• Assess for facial nerve damage,
improvement of hearing through
weakness, changes in taste sensation,
amplification
vertigo, nausea & vomiting
- surgical intervention involves removal
• Instruct to move head slowly when
of the
changing positions
bony growth that is causing the
• Instruct to avoid showering & getting
hearing loss
the head & wound wet
- a PARTIAL STAPEDECTOMY or
• Instruct to refrain from using small
COMPLETE
objects to clean the external ear canal
STAPEDECTOMY WITH
• Instruct to avoid rapid, extreme
PROSTHESIS
changes in pressure caused by quick
(FENESTRATION) may be surgically
head movements, sneezing,nose
performed
blowing, straining & changes in altitude
FENESTRATION
• Instruct to avoid changes in the middle - sometimes so intense that even when
ear pressure lying down,
- it could dislodge the graft prosthesis the client holds the bed or ground in
an attempt
MENIERE’S SYNDROME to prevent the whirling
- a syndrome also called • Nausea & vomiting
ENDOLYMPHATIC HYDROPS • Nystagmus
(- refers to dilation of the • Severe headaches
endolympathic system by
either overproduction or decreased NON-SURGICAL MANAGEMENT
reabsorption of • Preventing injury during vertigo
endolymphatic fluid) attacks
- characterized by tinnitus, unilateral • Providing bed rest in a quiet
sensorineural environment
hearing loss, & vertigo • Provide assistance with walking
- symptoms occur in attacks & last for • Instruct the client to move the head
several days, slowly
& the client becomes totally - to prevent worsening of vertigo
incapacitated • Initiate Na & fluid restrictions as Rx
- initial hearing loss is reversible, but as • Instruct to avoid smoking
the • Administer Nicotinic acid (Niacin) as
frequency of attacks continues, hearing Rx
loss - promote vasodilating effect
becomes permanent • Administer antihistamines as Rx
- repeated damage to the cochlea caused - reduce the production of histamine
by &
increased fluid pressure leads to the inflammation
permanent • Administer antiemetics as Rx
hearing loss • Administer tranquilizers & sedatives as
CAUSES Rx
• Any factor that increases - to calm client & allow rest, control
endolymphatic secretion in the the vertigo,
labyrinth N&V
• Viral & bacterial infections SURGICAL MANAGEMENT
• Allergic reactions - performed when medical therapy is
• Biochemical disturbances ineffective &
• Vascular disturbances producing the functional level of the client has
changes in the microcirculation in the decreased
labyrinth significantly
ASSESSMENT • ENDOLYMPHATIC DRAINAGE &
• Feelings of fullness in the ear INSERTION OF THE SHUNT
• Tinnitus, as a continuous low-pitched - may be performed early in the course of
roar or humming sound - is present the disease
most of the time but worsens just to assist with the drainage of excess
before & during severe attacks fluids
• Hearing loss is worse during an attack • RESECTION OF THE VESTIBULAR
• Vertigo NERVE
- periods of whirling which might cause • LABYRINTHECTOMY
the client - removal of the labyrinth may be
to fall to the ground performed
POST-OP NURSING CARE
• Assess packing & dressing on the ear
• Speak to the client on the side of the
unaffected ear EAR CARE
• Perform neurological assessments EAR PROTECTION
• Maintain side rails Protecting and Caring For Your Ears
The ears are delicate and irreplaceable
• Assist with ambulating
instruments.
• Encourage the use of bedside Once hearing is damaged, it often can't be
commode restored.
• Administer antivertiginous& antiemetic So give your ears – and your hearing – the
medications as Rx same level of care and attention as you do
other vital parts of your body.
CERUMEN & FOREIGN BODIES General Nursing Care Tips
- Have your ears and hearing checked
CERUMEN/EAR WAX
periodically
- the most common cause of impacted - Know the warning signs of hearing loss
canals - See a medical professional right away
FOREIGN BODIES if you:
- can include vegetables, beads, pencil - injure your ears,
erasers & - experience ear pain, or
insects - notice changes in your ears or sense
of hearing
ASSESSMENT
• Sensation of fullness in the ear with or Warning Signs of Hearing Loss
without hearing loss - Difficulty hearing conversations,
• Pain, itching or bleeding especially in the presence of background
CERUMEN noise
NURSING CARE - Frequently asking others to repeat
• Removal of the wax by irrigation is a what they’ve said
- Misunderstanding what people say
slow process
- Difficulty hearing on the telephone
• Irrigation is C/I in clients with a hx of - Requiring the TV or radio volume to be
tympanic membrane perforation louder than others in the room prefer
• To soften cerumen, add 3 gtts of - Feeling that people are mumbling
glycerin to the ear @ hs & 3 gtts of when they are talking
hydrogen peroxide BID - Difficulty hearing certain
environmental sounds, such as birds chirping
• After several days the ear is irrigated
- Agreeing or nodding your head during
-50-70 ml of solution is the maximal conversations when you’re not sure what’s
amount a client can tolerate during an been said
irrigation sitting - Removing yourself from conversations
FOREIGN BODIES because it’s too difficult to hear
NURSING CARE - Reading lips so you can try to follow
• If the foreign matter is vegetable, what people are saying
- Straining to hear or keep up with
irrigation is used with care
conversations
• Insects are killed before removal - Tinnitus
unless they can be coaxed out by
flashlight or a humming noise Preventing Hearing Loss
• Mineral oil or alcohol is instilled to - Avoid loud or prolonged exposure to
suffocate the insect which is then noise.
removed with ear forceps - When you can't avoid noise, wear ear
protection.
• Use small ear forceps to remove the
- If your ears produce excessive earwax,
object & avoid pushing the object have your ears cleaned periodically by a
farther into the canal & damaging the health care professional. (Do not use cotton
tympanic membrane swabs, as you will lodge more earwax even
deeper into the ear canal than the small - Stop smoking.
amount of wax you will remove.) - Some studies have found that adults
- Avoid ototoxic drugs. If taking one who smoke are more likely to develop
already, talk with your doctor and see if hearing loss than nonsmokers.
there's a less-ototoxic alternative. - Smoking can also aggravate existing
- Stay healthy and be mindful of risk conditions, such as tinnitus
factors, such as hypertension. - Blowing of the nose
A study conducted by a team of
Noise researchers from the University of
- Avoid exposure to loud noise. Virginia and the University of Aarhus in
- best action: get rid of the noise or Denmark, revealed that blowing your
leave the noisy area. nose may actually cause mucus to
- Follow this simple rule of thumb: if you be propelled back into the sinus
need to shout to be heard over noise, it's cavities.
potentially damaging
- When you can’t avoid noise, always Also, blowing the nose creates a huge
wear ear protection (earplugs or earmuffs) amount of pressure in the nose -- over seven
- Be aware that repeated or prolonged times more pressure than is produced by
exposure to lower noise levels may cause sneezing or coughing.
hearing damage Proper blowing of the nose
- Protect the ears of children who are Blow your nose gently.
too young to know the dangers that noise Blowing too hard creates even more
can pose pressure that can force infectious
mucus into your ears and sinuses.
Cleaning of Ears Avoid the "both-nostrils-open" blow.
- Clean ears with extra care. Instead ...
- Wipe the outer ear with a washcloth or Press a finger over one nostril.
tissue. Gently blow the nose into a paper
- Never put anything into your ear that’s tissue thru the one open nostril.
smaller than an adult finger covered with a Switch your finger to close the opposite
washcloth. nostril, and repeat.
- Using cotton swabs or other small Proper blowing of the nose
object may damage the sensitive structures Drink plenty of fluids.
of your inner ear Makes it easier for mucus to be
- Earwax is usually removed by the removed by blowing gently.
ear’s own cleaning mechanism. Blowing your nose after taking a steamy
- If there is build-up of excess earwax, shower can also help.
have it removed by a physician or medical
professional. Proper blowing of the nose
Use paper tissues rather than cloth
Illness and Medications handkerchiefs.
- Reduce the risk of ear infections by A used handkerchief is a breeding ground for
treating upper respiratory tract infections germs -- and when you reuse it you're
promptly spreading those germs around your face and
- Some illnesses and medical conditions hands.
can affect hearing. Proper blowing of the nose
- If experiencing sudden hearing loss or Only use a paper tissue once, then throw it
persistent noise in your ears or head away.
(tinnitus), have it seen by a health care Minimizes the risk of putting germs
provider/physician right away back onto your face and hands.
Wash your hands when you're finished,
Illness and Medications Microbes from your nose and tissue will
- Be aware that certain medications are be transferred to your fingers while you
ototoxic and may damage your hearing. blow.
- Take medications only as directed, and Prevents spread of germs to other
refer to you health care provider/physician people or back to yourself.
immediately if you experience unusual
symptoms Ear Examination
Includes an assessment of:
Hearing, and Look for wax or other obstructions (e.g.
appearance of the ear foreign bodies – tips of cotton buds!)
Ear Examination Ear wax
Ear Examination Inspecting the Tympanic Membrane
History Move the otoscope in order to see several
Look for classic symptoms of ear different views of the drum.
disease: deafness, tinnitus, discharge Normal tympanic membrane should appear
(otorrhia), pain (otalgia), and vertigo pearly grey, concave, & roughly circular
Previous ear surgery, or head injury (~1cm in diameter).
Family history of deafness Inspecting the Tympanic Membrane
Systemic disease (for example stroke, 1=Attic (pars flaccida)
multiple sclerosis, cardiovascular 2= Lateral process of malleus
disease) 3=Handle of malleus
Ototoxic drugs (antibiotics: 4=End of the malleus
gentamicin), diuretics, cytotoxics) 5=Light reflex
Exposure to noise (pneumatic drill or Inspecting the Tympanic Membrane
shooting, for example) Look for signs of inflammation
History of atopy and allergy in children Acute otitis media
Inspecting the Tympanic Membrane
Ear Examination
Inspecting the External Ear Look for signs of perforation.
Inspect the external ear before examination Perforation of ear drum
with an otoscope/auriscope. Ear Examination
Slowly retract the otoscope/auriscope from
Swab any discharge, and remove any wax. the ear.
Inspecting the External Ear Change the speculum on the
Look for obvious signs of abnormality: otoscope/auriscope and examine the other
Size and shape of pinna ear.
Extra cartilage tags/pre-auricular Finally document what was seen in both ears,
sinuses or pits the condition of the tympanic membrane and
Signs of trauma to pinna the external auditory meatus
Suspicious skin lesions on the pinna Basic hearing tests
including neoplasia Detailed hearing tests are usually performed
Skin conditions of the pinna and in audiology clinics.
external canal
Infection/inflammation of external ear A patient with normal hearing should hear
canal with discharge equally as well in both ears.
Signs/scars of previous surgery
Tuning fork tests: Weber test and Rinne test
PALPATION OF THE EXTERNAL EAR
Gently pull on the pinna to test for pain (If Free field voice testing (whisper from 40 cm)
painful this may suggest external ear
disease). Weber test
The vibrating fork is placed anywhere on the
Palpate for any lymph nodes (e.g. The midline of the patient's skull. The patient has
parotid or postauricular nodes ~ this may to say where they hear the vibration.
also be suggestive of external ear disease) Interpretation of results is as follows:
INSPECTION OF THE EXTERNAL Normal hearing: vibration will be heard on
AUDITORY MEATUS the midline or equally in both ears
Examine the ‘good ear’ first. With prior Perceptive loss: sound is heard better by the
warning to the patient, gently pull the pinna intact ear
upwards and outwards (Directly down and Conductive loss: sound is heard better by the
back in children). affected ear
Inspecting the Ear Canal and Ear Drum Weber Test
Slowly insert the otoscope/auriscope, looking Weber Test
at the skin of the canal while entering. Rinne Test
Check skin for normality or signs of Should be performed on each ear in turn.
inflammation. The base of the fork is placed against the
Inspecting the Ear Canal and Ear Drum patient's mastoid process on one side.
When the patient can no longer hear the when light is bright and opens when light is
vibration, the tuning fork is placed next to dim.
their ear on the same side. Sclera: the tough white sheet that covers
Rinne Test the outside of the eye
Interpretation of results is as follows: The Eye
If the sound is now heard, the Rinne Eye also has a focusing lens, which focuses
test is positive, meaning that air images from different distances on the
conduction is better than bone retina.
conduction and there is:
- no hearing loss The Eye
- perceptive hearing loss. - Ciliary muscles in ciliary body control
Conductive hearing loss may be the focusing of lens automatically.
diagnosed if the test is negative (i.e. - Image formed on the retina is
bone conduction is better than air transmitted to brain by optic nerve.
conduction) - The image is finally perceived by
Rinne Test brain.
Rinne Test Three Layers
The whispered voice test of the Eyeball
Has the advantage of not needing any Sclera: outer fibrous layer, helps keep the
equipment. shape of the eye
Patients are told that they will be asked to Choroid: middle blood rich layer supplying
repeat three numbers. nutrition to the eye structures
The examiner stands out of view of the Retina: inner colored (pigmented) nerve
patient (to prevent lip reading) while layer of the eye.
covering one of the patient's ears and
rubbing the external auditory meatus with a Eye Care Practitioners
gentle circular motion. Eye Care Practitioners
This serves to mask sound input from the Ophthalmologist
non-test ear. a medical doctor who specializes in eye
The examiner then fully exhales (which care.
reduces voice volume) and standing 0.75 m Optometrist
(arm's length) from the ear being tested optometric doctor trained to provide
whispers 3 numbers. refractive correction and diagnose/treat
It is very important to pay attention to the common issues.
loudness of the whispering. Ophthalmic medical practitioner
Failure to repeat 50% or more of the numbers Similar to an optometrist (in the UK).
on two trials is considered a fail and suggests Oculist
a 30 dB+ hearing loss. Older term for either an
Whispered voice test ophthalmologist or optometrist.
Stand 1-2 feet behind client so they can not Ocularist
read your lips. specializes in the fabrication and fitting
2) Instruct client to place one finger on of ocular prostheses for people who
tragus of left ear to obscure sound. have lost eyes due to trauma or illness.
3) Whisper word with 2 distinct syllables Optician
towards client's right ear. also called Optical Dispenser
4) Ask client to repeat word back. specializes in the fabrication and
5) Repeat test for left ear. fitting of
6) Client should correctly repeat 2 syllable spectacles. Prescription for the
word. spectacles must
The eye is like a camera. be supplied by an ophthalmologist
The external object is seen like the camera or
takes the picture of any object. optometrist.
The Eye Orthoptist
Light enters the eye thru a small hole called specializes in ocular motility, which is
the pupil and is focused on the retina, the movement of the eye controlled by
which is like a camera film. the extraocular muscles.
Iris (colored ring of the eye) controls the Vision therapist
amount of light entering the eye; closes work with patients that require therapy,
such as low vision patients.
Ophthalmic medical personnel - photophobia (iridocyclitis, Iritis)
popularly called "OMP"
is a collective term for allied health Keratitis
personnel in ophthalmology. Glaucoma
often used to refer to non-specialized Eye Health Promotion
personnel (unlike ocularists or Nutrition
opticians). Ensure proper intake of nutrients necessary
for optimum vision health in the daily diet

Ensure intake of different vitamins, minerals,

and herbal supplements
shown by research as essential for
good vision health and the prevention
Danger signs of Visual Disorders for of potentially blinding vision conditions
referral

- loss or distortion of central vision, or Vitamin A

marked difference of acuity between eyes
- sudden loss of peripheral vision - absolutely essential for eye and vision
- flashes of light or floaters (ischemia), health.
sudden cobweb or stringy floaters - required by the retina for its proper
(detachment) functions
- curtain across eyes (ischemia) - recommended for those with poor
- halos about lights (glaucoma) night vision
- intermittent dimming of vision - Helps eyes adjust to light changes
- strabismus - Moistens the eyes, which can enhance
- cornea > 11 mm in newborn visual acuity
(congenital glaucoma) - has been shown to prevent the
- red eye with Red Eye Danger Signs forming of cataracts
- helps prevent blindness from macular
Red Eye Danger Signs degeneration
- blurred vision (keratitis, glaucoma, - Sources: sweet potatoes, carrots,
Iritis) mangoes, spinach, and cantaloupe, yellow
- ciliary flush - perilimbal conjunctival squash.
injection (Iritis)
- corneal opacification or epithelial Vitamin C
disruption (bacterial keratitis) - An antioxidant
- abnormal pupil: nonreactive, - Linked to the prevention of cataracts
small/irregular. (glaucoma, iridocyclitis, Iritis) - One study has shown that taking 300
- proptosis to 600 mg supplemental vitamin C reduced
Iritis cataract risk by 70 percent, delay of
Proptosis macular degeneration, and eye pressure
- Also called Exophthalmos reduction in glaucoma patients.
- forward displacement of the eye in the - Sources: orange juice, citrus fruits and
orbit. broccoli, cauliflower, cabbage, and
- caused by swelling of the soft tissues strawberries.
or bones of the orbit.
Causes:
inflammation, infection and tumor, Vitamin E
hyperthyroidism - Use as an antioxidant
CONTINUED :Red Eye Danger Signs - Helps protect against cataracts and
- increased intraocular pressure age-related macular degeneration.
- colored halos (acute angle-closure - A clinical study has showed that taking
glaucoma) vitamin E can cut the risk of developing
- pain (glaucoma, Iritis, bacterial cataracts in half.
keratitis) - Another study also showed that the
- Au’s sign: sharp pain in covered (red) combination of vitamins C and E had a
eye when uncovered eye is illuminated (Iritis) protective effect against UV rays.
- Sources: wheat germ, dark green leafy Eyewear should provide 99 to 100
vegetables (such as spinach), sweet percent of UV-A and UV-B
potatoes, avocado, asparagus protection.
Prevention of Eye Injury
Zinc Regular eyeglasses do not provide
- Our eyes actually contain the greatest enough safety protection.
concentration of zinc in our body. Protect your eyes with proper safety
- an essential element required for the glasses.
conversion of beta-carotene into vitamin A. Injuries can be prevented if proper
- Sources: Oysters, red meat and eye protection is used at home, in
poultry the workplace and playing sports.
Use appropriate lighting.
Chromium Proper lighting can help improve
- plays a large role in muscle safety at home and prevent eye
contraction including eye muscles injuries.
- low levels of chromium are a major
risk factor for increased intraocular Prevention of Eye Injury
pressure Keep your children safe.
- Sources: beef, liver, eggs, chicken, - Pay special attention to where
oysters, wheat germ, green peppers, sharp items are placed.
broccoli, apples, bananas, and spinach. - Items such as cosmetics, kitchen
utensils and desk supplies can
Glutathione cause eye damage.
- An amino acid that protects the tissues - Avoid flying or projectile toys and
surrounding the lens of the eyes any with sharp points and
- Helps prevent cataracts, glaucoma, dangerous edges.
retinal disease, and diabetic blindness. - Visit eye doctor
- Sources: garlic, eggs, asparagus, and (ophthalmologist) regularly.
onions, watermelon, asparagus, and - Recommended regular eye exam
grapefruits. at least every 2 years.
- Early detection of problems is key
Lutein and zeaxanthin to treatment and prevention.
- Accumulate within the retina and
imbue a yellow pigment that helps protect Specific Prevention of Eye Injury
the eye At home or outside:
- Protects photoreceptors of the retina
from light damage Wash your hands after using household
- Act like sunglass filters to protect the chemicals.
eye
- Lower the risk of cataracts and Wear chemical safety goggles when using
macular degeneration hazardous solvents and detergents, and do
- Are also antioxidants not mix cleaning agents around or near a
- Sources: dark, leafy greens , corn, child.
oranges, papaya and squash. Specific Prevention of Eye Injury
Ginkgo Biloba At home or outside:
- Increases blood flow to the retina.
- Can slow retinal deterioration which Turn spray nozzles away from your face and
results in an increase of visual acuity. the faces of others.
Read and follow directions when opening
Prevention of Eye Injury bottle-tops (such as wine, carbonated
Protect your eyes from the sun. beverages).
Ultraviolet radiation can harm your Read and follow directions when playing
eyes. games and operating equipment.
Use a wide-brim hat and UV-
absorbing eyewear to protect your Specific Prevention of Eye Injury
eyes from harmful effects of the At home or outside:
sun. - Provide lights and handrails to improve
safety on stairs.
- Keep paints, pesticides and fertilizers - Position the video display terminal
properly stored in a secure area. (VDT) slightly further away than where you
- Be sure to wear recommended normally hold reading material.
protective goggles, helmets, and safety gear - Position the top of the VDT screen at
during the appropriate activities. or slightly below eye level.
- Use guards on all power equipment. - Place all reference material as close to
- Protect eyes from the sun with either the screen as possible to minimize head and
by a wind-brimmed hat or by wearing eye movements and focusing changes.
ultraviolet (UV)-protective sunglasses - Minimize lighting reflections and glare.
- Never look directly at the sun - Keep the VDT screen clean and dust-
(especially during an eclipse). free.
- Schedule periodic rest breaks to avoid
Specific Prevention of Eye Injury eye fatigue.
At play: - Keep the eyes lubricated (by blinking)
- Recommended protective eyewear to prevent them from drying out.
should be worn during the appropriate sports - Keep the VDT screen in proper focus.
and recreational activities. - Consult ophthalmologist
- A helmet with a polycarbonate face - some individuals who normally do not
mask or wire shield should be worn during need glasses may need corrective
the appropriate sports. lenses for computer work.
- Fireworks should be handled with care
and only be used by adults.
- Appropriate protective eyewear should
be worn during sporting and recreational
activities.
- Protective eyewear should be worn
when using lawnmowers, as debris may be
projected into the air.
- At school, it is important to wear
protective eye wear when performing science
or lab experiments.

Prevention of Eye Strain

- Most common symptoms of eye strain,
which may be attributed to prolonged
computer screen or tv viewing.
Symptoms may include:

 red, watery, irritated eyes

 tired, aching, or heavy eyelids

 problems with focusing

 muscle spasms of the eye or eye

lid

 headache

 backache
Symptoms of eye strain are often relieved by:
- resting the eyes
- changing the work environment
- wearing the proper glasses.
- Using proper lighting when using a
computer
Prevention of Eye Strain when Using a
Computer