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NEUROSENSORYNEUROSENSORYSYSTEMSYSTEM
NEUROSENSORYNEUROSENSORYSYSTEMSYSTEM
Kenneth P. Veluya, RN, MSNKenneth P. Veluya, RN, MSN
Clinical InstructorClinical Instructor
OBJECTIVES: Describe functions and structures of the eyes and adnexa.
MEDICAL SPECIALTIES:
OPHTHALMOLOGIST: Specializes in diagnosing and treating diseases and disorders of the eye.
OPTOMETRIST: Holds a doctor of Optometry (OD) degree and specializes in measuring the accuracy of vision to determine if corrective lenses or eyeglasses are needed.
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES
EXTERNAL STRUCTURESEXTERNAL STRUCTURES
EYELIDSEYELIDS CONJUNCTIVACONJUNCTIVA
PALBEBRALPALBEBRAL BULBARBULBAR
LACRIMAL APPARATUSLACRIMAL APPARATUS LACRIMAL GLAND, DUCTS & PASSAGESLACRIMAL GLAND, DUCTS & PASSAGES
6 EXTRAOCULAR MUSCLES6 EXTRAOCULAR MUSCLES Levator palpebrae muscleLevator palpebrae muscle
ADNEXA OF THE EYES:
Adnexa oculi Includes:
Orbit Eye muscles Eyelids Eyelashes Conjunctiva Lacrimal apparatus
Adnexa: appendages; or accessory structures of an organ
EYELIDS Upper and lower
eyelids protect eyes from foreign matter, excessive light, and impact.
Canthus: angle where upper and lower eyelids meet.
Inner: nearest the nose
Epicanthus: vertical fold of skin on either side of the nose.
EYEBROWS and EYELASHES
Prevent foreign matter from reaching the eyes.
Edges of eyelids contain cilia (eyelashes) and oil-producing sebaceous glands.
CONJUNCTIVA
Mucous membrane that lines the underside of each eyelid
Continues to form a protective covering over the exposed surface of the eyeball.
Plural: conjunctivae
LACRIMAL APPARATUS
Lacrimal glands: located above the outer corner of each eye; secrete lacrimal fluid (tears) that maintains moisture on the anterior surface of the eyeball.
LACRIMATION:Normal continuoussecretion of tears by the lacrimalglands.
ANATOMY & ANATOMY & PHYSIOLOGYPHYSIOLOGY
EYESEYES ORBITORBIT
EYEBALL : 3 LAYERS: EYEBALL : 3 LAYERS: OUTEROUTER
ScleraSclera CorneaCornea
MIDDLE (Uveal Tract)MIDDLE (Uveal Tract) ChoroidChoroid Ciliary Body Ciliary Body IrisIris
•INNER (Retina)INNER (Retina)–RodsRods
–Sensitive to lightSensitive to light–Peripheral visionPeripheral vision
–CONESCONES–Fine descriminationFine descrimination–Color visionColor vision
Eyeball Layers:Eyeball Layers:
SCLERA Also known as white
of the eye. Fibrous tissue outer
layer of the eye. Maintains eye shape. Protects the delicate
inner layers of tissue. Cornea: transparent
anterior portion of the sclera; provides most of the optical power of the eye.
UVEAL TRACT
Also known as UVEA Vascular layer of the
eye. Includes:
choroidirisciliary body
CHOROID
Also known as choroid layer or choroid coat
opaque middle layer of the eyeball
contains many blood vessels and provides the blood supply for the entire eye
OPAQUE: light cannot pass through the substance
IRIS, PUPIL
IRIS: pigmented (colored) muscular layer that surrounds the pupil
PUPIL: black circular opening in the center of the iris that permits light to enter the eye.
Muscles within the iris control the amount of light allowed to enter the eye
Located within the choroid
Set of muscles and suspensory ligaments that adjust the lens to refine the focus of light rays on the retina.
To focus on nearby objects, these muscles adjust the lens to make it thicker.
To focus on distant objects, these muscles stretch the lens so it is thinner.
CILIARY BODY
ANATOMY & ANATOMY & PHYSIOLOGYPHYSIOLOGY
EYESEYES LENS – FOCUS IMAGELENS – FOCUS IMAGE
FLUIDS OF THE EYE:FLUIDS OF THE EYE: AQUEOUS HUMORAQUEOUS HUMOR
ANTERIOR & POSTERIOR CHAMBERSANTERIOR & POSTERIOR CHAMBERS ANTERIOR EYE CAVITYANTERIOR EYE CAVITY NUTRIENTS TO LENS & CORNEANUTRIENTS TO LENS & CORNEA INTRAOCULAR PRESSURE MAINTENANCEINTRAOCULAR PRESSURE MAINTENANCE
20-25 mmHg20-25 mmHg VITREOUS HUMORVITREOUS HUMOR
POSTERIOR EYE CAVITYPOSTERIOR EYE CAVITY TRANSPARENCY & FORM OF THE EYETRANSPARENCY & FORM OF THE EYE
Lens is also known as thecrystalline lens.
Clear, flexible, and curvedstructure that focuses imageson the retina.
It is held in place by the suspensory ligaments of theciliary body.
Contained within a clear capsule
Located behind the iris andpupil.
LENS
Sensitive inner nerve layer of the eye located between the posterior chamber and the choroid layer at the back of the eye.
RETINA
Contains specialized light sensitive cells: • rods: black & white receptors• cones: colored receptors• both rods and cones receive images and convert them into nerve impulses
RETINA
MACULA LUTEA and FOVEA CENTRALIS
MACULA LUTEA • Clearly defined yellow area in the center of the retina• Area of sharpest central vision.
FOVEA CENTRALIS • Pit in the middle of the macula lutea.• Color vision is best in this area because of the high concentration of cones.
THE OPTIC DISK and NERVE
OPTIC DISK• Also known as blind spot• Region in the eye where the nerve endings of the retina gather to form the optic nerve.• Also called the blind spot because it does not contain any rods or cones.
THE OPTIC DISK and NERVE
OPTIC NERVE• Also known as II cranial nerve• transmits nerve impulses from retina to the brain.
FUNCTION OF THE EYES: RECEIVE IMAGES AND TRANSMIT
TO THE BRAIN.
VISUAL PATHWAYSVISUAL PATHWAYSRETINARETINA
OPTIC NERVEOPTIC NERVE
OPTIC CHIASMOPTIC CHIASM
OPTIC TRACTOPTIC TRACT
OCCIPITAL LOBEOCCIPITAL LOBE
ACCOMMODATIONCONVERGENCEEMMETROPIA
ACCOMMODATION Process whereby
the eyes make adjustments for seeing objects at various distances.
Include: constriction
(narrowing) dilation
(widening) of the pupil
movement of the eyes
changes in shape of the lens
CONVERGENCE
Simultaneous inward movement of both eyes (toward each other).
Usually in an effort to maintain single binocular vision as an object comes nearer.
EMMETROPIA
EM Normal relationship
between the refractive power of the eye and the shape of the eye that enables light rays to focus correctly on the retina
emmetr: proper measure opia: vision
Refraction: ability of the lens to bend the light rays to help them focus on the retina.
Physical Examination-Physical Examination-EYEEYE
VISUAL ACUITY : VISUAL ACUITY : SNELLEN’S CHARTSNELLEN’S CHART VISUAL FIELDS: VISUAL FIELDS: PERIMETRYPERIMETRY EXTERNAL STRUCTURESEXTERNAL STRUCTURES
POSITION & ALIGNMENT OF EYESPOSITION & ALIGNMENT OF EYES PUPILS (PERRLA)PUPILS (PERRLA)
EXTRAOCULAR MOVEMENTSEXTRAOCULAR MOVEMENTS PARALYSISPARALYSIS NYSTAGMUSNYSTAGMUS
CORNEAL REFLEXCORNEAL REFLEX
VISUAL ACUITY MEASUREMENT Evaluation of the eye’s ability to
distinguish object details and shape. Assessed by the smallest
identifiable object that can be seen at a specified distance (usually 20 ft or 16 in).
REFRACTION
Determine an eye’s refractive error and the best corrective lenses to be prescribed.
Diopter: unit of measurement of lens refractive power.
TONOMETRY
Measures intraocular pressure (IOP).
Abnormally high pressure may be an indication of glaucoma.
MYDRIATIC DROPS
In preparation for an examination of the interior of the eye, it is necessary to dilate the pupils through the use of mydriatic drops.
Produce temporarily paralysis, forcing the pupils to remain wide open even in the presence of bright light.
Undilated pupil
Dilated pupil
Don’t look at me…
PLANNING FOR HEALTH PLANNING FOR HEALTH PROMOTIONPROMOTION
CARE OF THE EYESCARE OF THE EYES
EYEDROPS, DISCOURAGEDEYEDROPS, DISCOURAGED PRINTED MATTER: 14 INCHES AWAYPRINTED MATTER: 14 INCHES AWAY TV: 10-12 FT AWAYTV: 10-12 FT AWAY READ WITH ILLUMINATION: 100-150 WATTSREAD WITH ILLUMINATION: 100-150 WATTS LIGHT FROM BEHINDLIGHT FROM BEHIND TEACH ABOUT DANGER SIGNALS OF VISUAL TEACH ABOUT DANGER SIGNALS OF VISUAL
DISORDERDISORDER
•PERSISTENT REDNESSPERSISTENT REDNESS•CONTINUED DISCOMFORT & PAIN ESP CONTINUED DISCOMFORT & PAIN ESP
FOLLOWING INJURYFOLLOWING INJURY•CHILDREN: CROSSING OF EYESCHILDREN: CROSSING OF EYES•BLURRED VISION/ SPOTS BEFORE THE EYESBLURRED VISION/ SPOTS BEFORE THE EYES•GROWTH ON THE EYE/ OPACITIESGROWTH ON THE EYE/ OPACITIES•CONTINUAL DISCHARGE, CRUSTING ORCONTINUAL DISCHARGE, CRUSTING OR
TEARINGTEARING•PUPIL IRREGULARITIESPUPIL IRREGULARITIES
PLANNING FOR HEALTH PLANNING FOR HEALTH MAINTENANCE & RESTORATIONMAINTENANCE & RESTORATION INSTILLATION OF EYEDROPSINSTILLATION OF EYEDROPS
LOWER CUL-DE-SACLOWER CUL-DE-SAC JUST CLOSE EYES, NOT SQUEEZEJUST CLOSE EYES, NOT SQUEEZE
INSTILLATION OF EYE OINTMENTINSTILLATION OF EYE OINTMENT FROM INNER CANTHUS, OUTWARDFROM INNER CANTHUS, OUTWARD
HOT/ COLD COMPRESSHOT/ COLD COMPRESS EYE IRRIGATIONSEYE IRRIGATIONS
REMOVE CHEMICALS OR SECRETIONSREMOVE CHEMICALS OR SECRETIONS MASSAGE THE EYEBALLMASSAGE THE EYEBALL
IN GLAUCOMA ESP AFTER OPERATIONSIN GLAUCOMA ESP AFTER OPERATIONS CARE OF CONTACT LENSCARE OF CONTACT LENS
NOT TO WEAR WITH SWIMMINGNOT TO WEAR WITH SWIMMING
DISORDERS - EYEDISORDERS - EYE INJURIES & INJURIES &
TRAUMATRAUMA
INFECTIONSINFECTIONS
CATARACTCATARACT
GLAUCOMAGLAUCOMA
DETACHMENT OF DETACHMENT OF THE RETINATHE RETINA
REFRACTIVE REFRACTIVE ERRORSERRORS
INJURIES & TRAUMAINJURIES & TRAUMA
EMERGENCY:EMERGENCY: TREAT THE PATIENT, LEAVE THE EYE TREAT THE PATIENT, LEAVE THE EYE
ALONE, EXCEPT IN CHEMICAL INJURY ALONE, EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT- FLUSH EYES STAT
FOREIGN BODIES: FLUSH WITH WATER FOR FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; 15 MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEADON’T TOUCH CORNEA
MAY USE CARBONATED DRINKS IF WATER IS MAY USE CARBONATED DRINKS IF WATER IS NOT AVAILABLENOT AVAILABLE
INFECTIONSINFECTIONS
HORDEOLUM/ STY -Zeis glandHORDEOLUM/ STY -Zeis gland in the in the folliclefollicle
CHALAZION –meibomian glandsCHALAZION –meibomian glands CONJUNCTIVITIS – pink eyeCONJUNCTIVITIS – pink eye
bacterial infection, allergy, traumabacterial infection, allergy, trauma UVEITIS - irisUVEITIS - iris KERATITIS - corneaKERATITIS - cornea PTERYGIUM – triangular foldPTERYGIUM – triangular fold
From white of the eye to the corneaFrom white of the eye to the cornea
EYELIDS
BLEPHAROPTOSIS
Drooping of the upper eyelid
blepharo: eyelid ptosis: drooping or sagging
ECTROPION Eversion (turning
outward) of the edge of the eyelid
Ec: out trop: turn ion: condition
ENTROPION Inversion (turning inward)
of the edge of the eyelid. En: in
trop: turn ion: condition
HORDEOLUM Stye Infection of one or more
glands at the border of the eyelid.
CHALAZION Internal hordeolum Localized swelling of the
eyelid resulting from obstruction of one of the sebaceous (oil-producing glands of the eyelid).
DACROCYSTITIS
Inflammation of the lacrimal sac.
Associated with faulty tear drainage.
CONJUNCTIVITIS Also known as pink eye Inflammation of the
conjunctiva
Xerophthalmia is the term used to describe the eye signs of vitamin A deficiency. This is a childhood blinding disease which is caused by a lack of vitamin A in the diet. Often, the first symptom is night blindness followed by Bitot's spots on the conjunctiva. Although Bitot's spots differ somewhat in size, location and shape, they have similar appearance. They are accumulations of foamy, cheesy material on the conjunctiva, often in association with other signs of xerophthalmia
XEROPHTHALMIA
Also known as dry eye Drying of eye surfaces Loss of luster of conjunctiva
and cornea
SCLERITIS Also known as pink eye Inflammation of the
conjunctiva Inflammation limited to the
sclera. Note markedly dilated blood vessels which do not extend onto the underside of the lower lid, helping to distinguish scleritis from conjunctivitis. Associated witha number of autoimmune diseases.
CORNEAL ABRASION Inflammation of the cornea kerat: cornea
kerat/o: also means hardA corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea very
painful.
CORNEAL ULCER
Pitting of the cornea caused by an infection or injury.
These ulcers heal with treatment but with a cloudy scar that impairs vision.
Usually due to injuries with a sharp objects, dust, sand or vegetable matter like thorns, leaves etc.,
IRITIS
Inflammation of the iris. In the majority of cases
there is no specific cause. Occasionally, iritis is just
one symptom of diseases such as rheumatoid arthritis, lupus , scleroderma, anklylosing spondylitis, Crohn's disease, ulcerative colitis.
SYNECHIA
Adhesion that binds the iris to any adjacent structure.
Adhesion: holds structures together abnormally.
Plural: synechiae
ANISOCORIA Condition in which
the pupils are unequal in size.
May be congenital or caused by head injury, aneurysm, or pathology of the central nervous system.
aniso: unequal cor: pupil ia: abnormal
CATARACT Loss of transparency
of the lens. May be congenital or
caused by trauma or injury
Formation of most cataracts are associated with aging.
May be due to diabetes, exposure to ultraviolet or infrared radiation, malnutrition
CATARACTCATARACT Opacity of the lens & its capsule which interferes with Opacity of the lens & its capsule which interferes with
transparencytransparency
S/SX:S/SX: Dimness in visual acuityDimness in visual acuity Rapid & marked cxs of refraction errorRapid & marked cxs of refraction error
CLASSIFICATION:CLASSIFICATION: Primary/ senilePrimary/ senile Secondary/ traumaticSecondary/ traumatic CongenitalCongenital
TREATMENT:TREATMENT:•Intracapsular extraction – Intracapsular extraction – lens & capsulelens & capsule•Extracapsular extraction – Extracapsular extraction – lens onlylens only•Cryoextraction – Cryoextraction – probe cooled below 0 probe cooled below 0 ooCC•Phacoemulsification – Phacoemulsification – probe vibratesprobe vibrates•Enzymatic zonulysis – Enzymatic zonulysis – alphachemotrypsin: alphachemotrypsin: fibrinolytic & proteolytic, to anterior chamberfibrinolytic & proteolytic, to anterior chamberIntraocular lens – Intraocular lens – synthetic; distant visionsynthetic; distant vision
for aphasic patientfor aphasic patient
EYE SURGERYEYE SURGERY
NURSING CARE PRE-OPNURSING CARE PRE-OP
Orient to new environmentOrient to new environment Teach deep breathing & how to close Teach deep breathing & how to close
eyes without squeezingeyes without squeezing Eye antibiotics preopEye antibiotics preop Mydiatrics if orderedMydiatrics if ordered
EYE SURGERYEYE SURGERY
NURSING CARE POST-OPNURSING CARE POST-OP
Reorient patient to his surroundingsReorient patient to his surroundings Prevent increase in IOP & stress on Prevent increase in IOP & stress on
the suture linethe suture line
ACTIVITIES THAT INCREASE IOP:ACTIVITIES THAT INCREASE IOP:
•CoughingCoughing•Brushing Brushing •Shaving Shaving •Vomiting Vomiting •Bending Bending •Stooping Stooping
•Promote comfort of the patient: Promote comfort of the patient: mild analgesic to control painmild analgesic to control pain
EYE SURGERYEYE SURGERY
NURSING CARE POST-OPNURSING CARE POST-OP
Observe & treat complicationsObserve & treat complicationsCOMPLICATIONS:COMPLICATIONS:•NAUSEA & VOMITINGNAUSEA & VOMITING
•AntiemeticsAntiemetics•Cold compressCold compress
•HEMORRHAGEHEMORRHAGE•Sudden pain of the eyeSudden pain of the eye
•PROLAPSE OF THE IRISPROLAPSE OF THE IRIS•Most common postop complicationMost common postop complication•Can precipitate glaucomaCan precipitate glaucoma
• Promote the rehab of the patientPromote the rehab of the patient•Encourage the patient to become Encourage the patient to become
independent- walk with him when he first independent- walk with him when he first become ambulatorybecome ambulatory•Health teachingsHealth teachings
EYE SURGERYEYE SURGERY
HEALTH TEACHINGS:HEALTH TEACHINGS:
1-4 wks : dark glasses; temporary corrective 1-4 wks : dark glasses; temporary corrective lenseslenses
6-8 wks: permanent lenses6-8 wks: permanent lenses It will take time to learn distances & climb It will take time to learn distances & climb
stairsstairs Color slightly changedColor slightly changed Use one eye at a time unless with contact lensUse one eye at a time unless with contact lens Decreased peripheral visionDecreased peripheral vision
CHOKED DISK Also known as
papilledema. Swelling and
inflammation of the optic nerve at the point of entrance through the optic disk.
Swelling is due to increased intracranial pressure due to a tumor pressing on the optic nerve.
Normal optic nerve (central pinkish disk)
FLOATERS Also known as vitreous floaters. Particles that float in the
vitreous fluid and cast shadows on the retina.
Usually occur with aging or in association with vitreous detachments, retinal tears, or intraocular inflammations.
Harmless They generally look like specks
of various shapes and sizes, or like cobwebs. They are frequently visible when you are looking at a plain-lighted background like a blank light colored wall, a blue sky or the white pages of a book.
NYSTAGMUS
Involuntary, constant, rhythmic movement of the eyeball.
Unintentional jittery movement of one or both eyes
Causes: - drug abuse - brain tumor - stroke - multiple sclerosis - Meniere's disease - labyrinthitis - alcoholism
RETINAL DETACHMENT
Also known as detached retina
Retina is pulled away from its normal position of being attached to the choroid in the back of the eye.
RETINAL DETACHMENT
Retinal tear: occurs if the retina tears (develops a hole) as it is pulled away from its normal position.
RETINARETINA CHOROIDCHOROID
SCLERASCLERA
OPTIC NERVEOPTIC NERVE
RETINAL DETACHMENTRETINAL DETACHMENT
RETINAL DETACHMENTRETINAL DETACHMENT
Fluid accumulationFluid accumulation TumorTumor
CAUSE:CAUSE: Myopic degenerationMyopic degeneration TraumaTrauma Aphakia Aphakia
S/SX:S/SX: Floating spots or opacities Floating spots or opacities
before the eyebefore the eye Casts shadows on the Casts shadows on the
retinaretina BrightFlashes of lightBrightFlashes of light Progressive constriction of Progressive constriction of
vision in 1 eyevision in 1 eye
MANAGEMENT:MANAGEMENT:
Conservative :Conservative :•Quiet in bed with eyes coveredQuiet in bed with eyes covered•Head: positioned so that retinal holes lowerHead: positioned so that retinal holes lower•Photocoagulation – Photocoagulation – small burn to retinasmall burn to retina•Cryotherapy – Cryotherapy – cold probe to freeze retinacold probe to freeze retina
Surgical: Surgical: •Scleral buckling- Scleral buckling- sealing break & reattachingsealing break & reattaching
retinaretina
RETINAL DETACHMENTRETINAL DETACHMENT
POST-OP NURSING CARE:POST-OP NURSING CARE: Cover eyesCover eyes Area of detachment, dependentArea of detachment, dependent MydiatricsMydiatrics Discharge instructions:Discharge instructions:
No strenuous exercises & acivity x No strenuous exercises & acivity x 6mos6mos
Contact sports restrictedContact sports restricted No sudden jarring head motionNo sudden jarring head motion No restriction with use of eyesNo restriction with use of eyes
UVEITIS Inflammation anywhere
in the uveal tract. May affect the choroid,
iris, or ciliary body Many possible causes
including diseases elsewhere in the body.
Can rapidly damage the eye and produce complications including cataracts, detached retina, and glaucoma.
Leading cause of blindness in the U.S.
GLAUCOMA Characterized by increased
intraocular pressure. If untreated, optic nerve is
damaged causing loss of peripheral vision, and eventually blindness.
Leading cause of blindness in US.
Does not produce symptoms until optic nerve is damaged.
May be detected through regular eye check-ups (tonometry/visual field testing)
Open-angle glaucoma Closed-angle glaucoma:
Normal vision
Vision of a person with glaucoma
GLAUCOMAGLAUCOMA INCREASED IOPINCREASED IOP PROGRESSIVE LOSS OF PERIPHERAL VISIONPROGRESSIVE LOSS OF PERIPHERAL VISION
CAUSE: CAUSE: OBSTRUCTION TO CIRCULATION OF OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMORAQUEOUS HUMOR
TYPES:TYPES:1.1. CHRONIC/ SIMPLE/ OPEN-ANGLECHRONIC/ SIMPLE/ OPEN-ANGLE2.2. ACUTE ANGLE CLOSUREACUTE ANGLE CLOSURE3.3. CongenitalCongenital4.4. Secondary – trauma, uveitis, postopSecondary – trauma, uveitis, postop5.5. Absolute – uncontrolled- enucleationAbsolute – uncontrolled- enucleation
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
OPEN-ANGLE GLAUCOMAOPEN-ANGLE GLAUCOMA
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
ACUTE-ANGLE CLOSURE GLAUCOMAACUTE-ANGLE CLOSURE GLAUCOMA
OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA
S/SX:S/SX:
Loss of peripheral vision (tunnel)Loss of peripheral vision (tunnel) Difficulty in adjusting to darknessDifficulty in adjusting to darkness Failure to detect changes in colorFailure to detect changes in color Headache, pain behind the eyeballHeadache, pain behind the eyeball HalosHalos Nausea & vomitingNausea & vomiting
OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA
MANAGEMENT:MANAGEMENT:
Conservative :Conservative : Miotics : pupillary constrictionMiotics : pupillary constriction
draw iris smooth muscle away draw iris smooth muscle away from the canalfrom the canal
Given early amGiven early am Acetazolamide : decrease aqueous Acetazolamide : decrease aqueous
productionproduction Fluid restrictionFluid restriction
Aggressive: Aggressive:
Principle: improve drainage of aqueousPrinciple: improve drainage of aqueous
•Iridocleisis-Iridocleisis-anterior chamber & subconjunctival spaceanterior chamber & subconjunctival space
•Corneoscleral trephening – Corneoscleral trephening – junction of cornea & sclerajunction of cornea & sclera
•Trabeculotomy Trabeculotomy •Laser therapy to meshworkLaser therapy to meshwork
Acute Angle GlaucomaAcute Angle Glaucoma
CAUSE:CAUSE: Pupillary dilation by mydiatricsPupillary dilation by mydiatrics Abnormal anterior displacement of irisAbnormal anterior displacement of iris
S/SX:S/SX: Severe eye painSevere eye pain Nausea & vomitingNausea & vomiting Blurred visionBlurred vision Colored halos around lightsColored halos around lights Dilated pupilsDilated pupils Increased IOPIncreased IOP
MANAGEMENT:MANAGEMENT:
•MioticsMiotics•DiamoxDiamox•Osmotic agents – glycerolOsmotic agents – glycerol•Surgery - iridectomySurgery - iridectomy
GLAUCOMAGLAUCOMA
NURSING CARE – SURGERYNURSING CARE – SURGERY
PRE-OPPRE-OP Explain that vision lost cannot be restored, Explain that vision lost cannot be restored,
but further loss can be preventedbut further loss can be preventedPOST-OPPOST-OP Flat 24H- prevent iris prolapseFlat 24H- prevent iris prolapse Narcotics or sedativesNarcotics or sedatives Liquid diet until 1Liquid diet until 1stst dressing dressing Turn to unoperative siteTurn to unoperative site
LONG TERM CARE:LONG TERM CARE:
•No restriction on the use of the eyesNo restriction on the use of the eyes•No fluid restriction; exercise permittedNo fluid restriction; exercise permitted•Medical follow up needed for lifeMedical follow up needed for life
MACULAR DEGENERATION Gradually progressive
condition that results in the loss of central vision but not in total blindness.
Age-related macular degeneration: affects older people.
Dry-type: 90% of cases; caused by atrophy of the macula
Wet-type: associated with formation of new blood vessels that produce small hemorrhage.
DIPLOPIA Also known as double vision Perception of 2 images of a single
object. The two images may be vertically
separated (one on top of the other) or
horizontally separated (side by side) or both
(oblique). It generally occurs when the eyes,
which have previously worked together as a
pair, are no longer able to do so because a
squint has developed and the eyes are now
out of alignment with each other.This may
happen suddenly or over a period of time. Double vision is normally the resulting
symptom when one or more of the eye muscles or nerves have been weakened or damaged. This weakness or damage can be caused by a number of conditions.
HEMIANOPIA
Blindness to one side of the visual field.
Whoever may be at risk for stroke is also at risk for hemianopia.
People with high blood pressure or those with an abnormal heart rhythm, which is associated with blood clots in the heart, may be at risk for stroke.
This is how a street scene looks with normal vision.
This is how the same scene looks with right hemianopia.
MONOCHROMATOSIS Also known as color blindness Lack of the ability to distinguish
colors. True color blindness is
extremely rare. World appears in black, gray, or
white only. Inherit the disorder from the
genes of both parents. Less severe forms are those
whose colors visions are not normal.
They may have difficulty differentiating reds and greens (most common) or blues and yellows.
All humans are born color blind and begin to see colors at 4 months.
NYCTALOPIA Also known as night blindness Difficulty seeing at night. The outer area of the retina is
made up of more rods than cones. The rod cells are the cells that enable us to see in poor lighting. This is the reason why loss of side vision often results in night blindness.
They not only see poorly at night, but also require some time for their eyes to adjust from brightly lit areas to dim ones. Contrast vision may also be greatly reduced.
Normal vision
Slow adjustment
PRESBYOPIA Changes in the eyes that
occur with aging. With aging, the lens becomes
less flexible and muscles of the ciliary body become weaker.
Result: eyes are no longer able to focus the image properly on the retina.
Neither a disease or defect. Natural condition that
everyone has to face. Those who are far-sighted,
live in tropical climates and at sea level develop the condition earlier.
Normal vision
Slow adjustment
STRABISMUS Squint Disorder in which the eyes cannot be directed in a parallel
manner toward the same object. Esotropia: strabismus characterized by an inward deviation
of one eye in relation to the other. Exotropia: walleye; strabismus characterized by the
outward deviation of one eye relative to the other.
ExotropiaEsotropia
Condition in which the lens and cornea do not bend light so that it can focus properly on the retina.
REFRACTIVE ERRORSREFRACTIVE ERRORS
REFRACTION – bending of light raysREFRACTION – bending of light raysACCOMMODATION – ability to adjust from near to ACCOMMODATION – ability to adjust from near to
far visionfar visionADAPTATION – ability to see light from darknessADAPTATION – ability to see light from darkness
COMMON ERRORS:COMMON ERRORS: MyopiaMyopia HyperopiaHyperopia PresbyopiaPresbyopia
•AstigmatismAstigmatism•Blindness Blindness
NORMAL VISION1. Light enters the eye
through the cornea, the clear, dome-shaped surface that covers the front of the eye.
2. From the cornea, the light passes through the pupil. The amount of light passing through is regulated by the iris, or the colored part of your eye.
3. From there, the light then hits the lens, the transparent structure inside the eye that focuses light rays onto the retina.
NORMAL VISION1. Next, it passes through the
vitreous humor, the clear, jelly-like substance that fills the center of the eye and helps to keep the eye round in shape.
2. Finally, it reaches the retina, the light-sensitive nerve layer that lines the back of the eye, where the image appears inverted.
3. The optic nerve carries signals of light, dark, and colors to the area of the brain (the visual cortex), which assembles the signals into images (our vision).
AMETROPIA
Error of refraction in which only objects located at a finite distance from the eye are focused on the retina.
Occurs when eyes with visual defects such as astigmatism, myopia, and hyperopia are unable to properly focus light rays into a clear image.
Typically require corrective lenses or eye surgery.
ASTIGMATISM Condition in which the eye does not
focus properly because of unequal curvatures of the cornea.
Cornea is oval like a football instead of spherical like a basketball.
Objects up close and at a distance appear blurry.
May cause eyestrain and may be combines with both near and farsightedness.
ASTIGMATISMASTIGMATISM
Asymmetry or irregular curvature Asymmetry or irregular curvature of the corneaof the cornea
Cylindrical lensesCylindrical lenses
BLINDNESSBLINDNESS
Vision: 20/200Vision: 20/200
HYPEROPIA Farsightedness Defect in which light rays
focus beyond the retina. Caused by a flatter retina or
shorter eye. Occurs most commonly
after age 40. Uncommon in children.
hyperopiahyperopia
FAR-SIGHTEDFAR-SIGHTED
Eyeball A-P dimension too shortEyeball A-P dimension too short Light rays focus behind the retinaLight rays focus behind the retina Good vision for far distancesGood vision for far distances Convex lensesConvex lenses
MYOPIA
Nearsightedness Defect in which light rays focus in
front of the retina. Condition occurs most commonly
in school-aged children. May be inherited.
myopiamyopia
NEAR-SIGHTEDNEAR-SIGHTED
Long A-P dimension of the eyeballLong A-P dimension of the eyeball Light rays focus infront of the retinaLight rays focus infront of the retina Good vision for near distancesGood vision for near distances Concave lensesConcave lenses
presbyopiapresbyopia
FARSIGHTEDNESS OF OLD AGEFARSIGHTEDNESS OF OLD AGE
Gradual loss of accommodationGradual loss of accommodation Loss of lens elasticityLoss of lens elasticity Inability to rad without holding the Inability to rad without holding the
material more than 13 ft from the material more than 13 ft from the eyeeye
Bifocal lensesBifocal lenses
AMBLYOPIA Dimness of vision or the
partial loss of sight without detectable disease of the eye.
Condition where central visual acuity of an apparently healthy eye is reduced because of lack of use during early childhood, from birth up to the age of seven.
Sometimes known as "lazy eye", it is usually due to an eye muscle problem or due to an inequality between the two eyes.
Often it occurs because the "good" eye is preferred.
What happens if amblyopia goes untreated?If not treated early enough, an amblyopic eye may never develop good vision and may even become functionally blind.
BLINDNESS Inability to see. “Legal blindness” refers to a
best-corrected vision of 20/200 or less.
Leading causes of blindness: cataract glaucoma corneal scarring diabetes
SCOTOMA Also known as blind spot An abnormal area of absent
or depressed vision surrounded by an area of normal vision.
A ring or donut shaped scotoma is an area of reduced vision that forms a shape similar to a ring or donut - the patient can see fine in the center and off-center a little bit but then there is an area of reduced vision followed by another area or normal vision.
In age-related macular degeneration, the center part of the eye and retina known as the macula dies-off, leaving a black hole or "scotoma" right at the center.
Severus, 42y.o, is receiving Severus, 42y.o, is receiving cryotherapy for repair of a cryotherapy for repair of a detached retina. When taking detached retina. When taking history from him, which symptom history from him, which symptom would the nurse expect him to would the nurse expect him to have?have?
a.a. DiplopiaDiplopiab.b. Severe eye painSevere eye painc.c. Sudden blindnessSudden blindnessd.d. Bright flashes of lightBright flashes of light
ANATOMY & ANATOMY & PHYSIOLOGYPHYSIOLOGY
EARSEARSEXTERNAL EAREXTERNAL EAR AURICLEAURICLE PINNAPINNA TYMPANIC MEMBRANETYMPANIC MEMBRANE
MIDDLE EARMIDDLE EAR OSSICLES: MALLEOUS, INCUS, STAPESOSSICLES: MALLEOUS, INCUS, STAPES EUSTACHIAN TUBEEUSTACHIAN TUBE
EAREAR
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS
INNER EARINNER EAR ORGAN OF CORTI ORGAN OF CORTI
HEARINGHEARING
VESTIBULAR APPARATUSVESTIBULAR APPARATUS BALANCEBALANCE 3 SEMICIRCULAR CANALS3 SEMICIRCULAR CANALS UTRICLEUTRICLE
EAREAR
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS
SOUND WAVES TO TYMPANIC MEMBRANESOUND WAVES TO TYMPANIC MEMBRANE
OSSICLES IN MOTIONOSSICLES IN MOTION
VIBRATION FROM STAPES TO OVAL WINDOWVIBRATION FROM STAPES TO OVAL WINDOW
COCHLEA : ORGAN OF CORTICOCHLEA : ORGAN OF CORTI
CRANIAL NERVE 8 TO TEMPORAL LOBECRANIAL NERVE 8 TO TEMPORAL LOBE
HEARINGHEARING
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
EXTERNAL EAR EXAMINATIONEXTERNAL EAR EXAMINATION
Inspection & palpation of auricleInspection & palpation of auricle Visualization: straighten the auditory canal: Visualization: straighten the auditory canal:
PULL AURICLE UP, & BACKPULL AURICLE UP, & BACK
NORMAL EARDRUM: NORMAL EARDRUM: slightly conicalslightly conical ShinyShiny pearly gray in colorpearly gray in color
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
HEARING TEST:HEARING TEST:
Tests for acuteness of hearing or degree of Tests for acuteness of hearing or degree of deafness:deafness:
Whisper or spoken voice testWhisper or spoken voice test Audiometer :Audiometer :
Pure tone – mx loudness in decibelPure tone – mx loudness in decibel Speech – ability to understand & descriminateSpeech – ability to understand & descriminate
Watch tick testWatch tick test Tuning fork testTuning fork test
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
HEARING TEST:HEARING TEST:
Test to localize cause of deafness:Test to localize cause of deafness:
Schwabach’sSchwabach’s Rinne’sRinne’s Weber’sWeber’s
SCHWABACH’SSCHWABACH’S
•Bone conduction vs normal hearingBone conduction vs normal hearing•Tuning fork @ px’s mastoid until the patientTuning fork @ px’s mastoid until the patient
hears no sound.hears no sound.•TF transferred to examiner’s earTF transferred to examiner’s ear•N = no sound heardN = no sound heard•ABN = ABN = sensorineural hearing losssensorineural hearing loss
RINNE’S TESTRINNE’S TEST
•Sound heard better: air vs boneSound heard better: air vs bone
•N = positive; air conduction is betterN = positive; air conduction is better•ABN: negative: bone conduction betterABN: negative: bone conduction better
conductive hearing lossconductive hearing loss
WEBER’SWEBER’S
•TF top midline of the headTF top midline of the head•Sound heard: normal ear vs affected earSound heard: normal ear vs affected ear•Better in affected ear: Better in affected ear: conductiveconductive•Better in normal ear : Better in normal ear : sensorineuralsensorineural
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
TEST FOR VESTIBULAR FUNCTONTEST FOR VESTIBULAR FUNCTON
CALORIC TESTCALORIC TEST Check direction of nystagmusCheck direction of nystagmus COWS ( cold-opposite; warm-same side of stimulated ear)COWS ( cold-opposite; warm-same side of stimulated ear)
ROTATION (BARANY) TESTROTATION (BARANY) TEST Rotating chairRotating chair Nystagmus is opposite to the direction of rotationNystagmus is opposite to the direction of rotation
HEALTH PROMOTIONHEALTH PROMOTION
EAR PROTECTIONEAR PROTECTION
Noise over 70 decibels is potentially damaging Noise over 70 decibels is potentially damaging to hearingto hearing
Most common & impt type of occupational Most common & impt type of occupational hearing is caused by LOUD NOISEhearing is caused by LOUD NOISE
GENERAL EAR CAREGENERAL EAR CARE
Ear is self-cleaningEar is self-cleaning Cerumen-lubricant; traps dirtCerumen-lubricant; traps dirt Keep eyes, mouth & both nostrils while Keep eyes, mouth & both nostrils while
blowing the noseblowing the nose Cleanse the external ear reached by vision Cleanse the external ear reached by vision
NURSING INTERVENTIONSNURSING INTERVENTIONS
EAR DROPSEAR DROPS WarmWarm After adm’n, head should remain tiltedAfter adm’n, head should remain tilted
SOFTENING & REMOVING IMPACTED SOFTENING & REMOVING IMPACTED CERUMENCERUMEN
Few drops of hydrogen peroxide/ warm glycerineFew drops of hydrogen peroxide/ warm glycerine Irrigate the earIrrigate the ear
NURSING INTERVENTIONSNURSING INTERVENTIONS
EAR IRRIGATIONEAR IRRIGATION
To clean the external canalTo clean the external canal Remove impated cerumenRemove impated cerumen Caloric testCaloric test Apply antiseptic solutionsApply antiseptic solutions Remove foreign bodiesRemove foreign bodies
COMMON EAR PROBLEMSCOMMON EAR PROBLEMS
1.1. OTOSCLEROSISOTOSCLEROSIS
2.2. MENIERE’S DSEMENIERE’S DSE
3.3. HEARING IMPAIRMENTHEARING IMPAIRMENT
OTOSCLEROSISOTOSCLEROSIS
Normal bone is replaced by spongy boneNormal bone is replaced by spongy bone
Ankylosis of the footplate of the stapesAnkylosis of the footplate of the stapes
Impaired vibration systemImpaired vibration system
OTOSCLEROSISOTOSCLEROSIS
ASSESSMENTASSESSMENT
Gradual hearing loss Gradual hearing loss Difficulty hearing a whisperDifficulty hearing a whisper Own voice is loudOwn voice is loud Paracusis : hear better in loud environmentParacusis : hear better in loud environment Rinne’s test: bone conduction betterRinne’s test: bone conduction better
OTOSCLEROSISOTOSCLEROSIS
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
Hearing aidHearing aid Surgery – primary form of txSurgery – primary form of tx
StapedectomyStapedectomy Stapes mobilization operationStapes mobilization operation Fenestration operation : new window is createdFenestration operation : new window is created
EAR SURGERYEAR SURGERY
PRE-OP CARE;PRE-OP CARE;
Hair shampooHair shampoo Inform client:Inform client:
Head still during surgeryHead still during surgery Post op: get out of bed with assistancePost op: get out of bed with assistance
avoid nose blowing until 1 weekavoid nose blowing until 1 week
EAR SURGERYEAR SURGERY
POST OP POST OP
Promote comfort & safetyPromote comfort & safety Promote psychological well-beingPromote psychological well-being Prevent complicationsPrevent complications
COMFORT & SAFETYCOMFORT & SAFETY
•24h bed rest24h bed rest•No TVNo TV•Pain relieverPain reliever•Gradual ambulation with assistanceGradual ambulation with assistance
PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING
•Reassurance about decreased hearing from Reassurance about decreased hearing from swelling & dressingswelling & dressing
•Slushing within the ear- report to physicianSlushing within the ear- report to physician
COMPLICATIONS;COMPLICATIONS;
•Facial nerve involvementFacial nerve involvement•Facial paralysis, facial weaknessFacial paralysis, facial weakness•Inability to show teeth, wrinkle forehead,Inability to show teeth, wrinkle forehead,
raise eyebrows or close eyesraise eyebrows or close eyes•Meningitis – bacterialMeningitis – bacterial
•Report signs & symptomsReport signs & symptoms•Bleeding Bleeding
EAR SURGERYEAR SURGERY
DISCHARGE PLANNINGDISCHARGE PLANNING
Discharged with dressingDischarged with dressing Sudden head movement, avoidedSudden head movement, avoided No elevatorsNo elevators No hair washing at least 2 weeksNo hair washing at least 2 weeks Avoid people with URTIAvoid people with URTI
MENIERE’S DSEMENIERE’S DSE
Chronic Chronic Increase in endolymphatic pressureIncrease in endolymphatic pressure
ASSESSMENT:ASSESSMENT: TinnitusTinnitus Unilateral hearing lossUnilateral hearing loss Vertigo Vertigo
MENIERE’S DSEMENIERE’S DSE
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
CONSERVATIVE: palliativeCONSERVATIVE: palliative Bed restBed rest MedsMeds
Sedative :PhenobarbitalSedative :Phenobarbital Antihistamine Antihistamine AntiemeticsAntiemetics
Low salt dietLow salt diet
MENIERE’S DSEMENIERE’S DSE
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
SURGERY- delayed until client’s hearing SURGERY- delayed until client’s hearing below the serviceable levelbelow the serviceable level Destruction of the labyrinthDestruction of the labyrinth Decompression of endolymphatic sacDecompression of endolymphatic sac Sectioning of the vestibular nerveSectioning of the vestibular nerve Cryosurgery of the labyrinthCryosurgery of the labyrinth
HEARING IMPAIRMENTHEARING IMPAIRMENT
TYPES OF HEARING LOSSTYPES OF HEARING LOSS
CONDUCTIVE CONDUCTIVE Damage to the conducting systemDamage to the conducting system Hearing aid is usefulHearing aid is useful
SENSORINEURALSENSORINEURAL Damage to the:Damage to the:1.1. Organ of CortiOrgan of Corti2.2. Cochlear nerveCochlear nerve3.3. Acoustic branch of the auditory nerveAcoustic branch of the auditory nerve
COMMUNICATING WITH COMMUNICATING WITH HEARING-IMPAIRED CLIENTSHEARING-IMPAIRED CLIENTS
Avoid use of gestures without speechAvoid use of gestures without speech Do not shoutDo not shout Speak distinctly & as close to the clientSpeak distinctly & as close to the client Use short phrasesUse short phrases Do not communicate with someone else in front of a Do not communicate with someone else in front of a
hearing-impaired clienthearing-impaired client Hearing impairment goes with visual problems in Hearing impairment goes with visual problems in
elderlyelderly
SOUND AMPLIFICATIONSOUND AMPLIFICATION
TYPES OF HEARING AIDS;TYPES OF HEARING AIDS;
Post-auricularPost-auricular Body-typeBody-type In-the ear modelIn-the ear model
Select hearing aid that has cotrollable volume & is Select hearing aid that has cotrollable volume & is properly fittedproperly fitted
Albus, 62 yo, has a stapedectomy. Which Albus, 62 yo, has a stapedectomy. Which of the following is the most important for of the following is the most important for the nurse to include in the post-op care the nurse to include in the post-op care plan?plan?
a.a. Checking the gag reflexChecking the gag reflex
b.b. Encouraging independenceEncouraging independence
c.c. Instruct not to blow noseInstruct not to blow nose
d.d. Position on the operative sidePosition on the operative side
““that’s that’s allallfolks”folks”
““that’s that’s allallfolks”folks”