Eye and Ear--MEDSURGE 2

the sensory organ of vision protected by the bony orbital cavity surrounded by a cushion of fat

eye

where is palpebral fissure

elliptical open space between the upper and lower lid

lacrimal apparatus does what

provides constant irrigation through tears, drains through puncta

how do we see?

1. look at an object

2. light rays are reflected from the object to the cornea

3. light rays are bent and focused by the cornea, lens, and vitreous humor, the lens job is to make sure the rays come to a sharp focus on the retina, the resulting image on the retina is upside down

4.the light rays are converted to electrical impulses which are then transmitted though the optic nerve to the brain where the image is translated and perceived in an upright position.

how is the image we perceive flipped upright?

goes from optic nerve to brain occipital cortex, image is translated and then flipped to upright position

aqueous humor

keeps eye lubricated and nourished

vitreous humor

gelatinous substance to minimize trauma to the eye of a pt

IOP should be between

10-21 mm Hg

conjunctiva

clear coating and first response to pathogens

sclera

white of eye

cornea

clear concave prism where light enters

normal physical assessment of visual system

visual acuity 20/20, ho diplopia, external eye without any lesions, lacrimal apparatus non-tender and without drainage, conjunctiva is clear, sclera white, PERRLA, EOMI, optic disc margins sharp, retinal vessel without AV nicking with no hemorrhages or spots

two tools to measure eye pressure

puff test and Tono-pen in clinical setting

myopia def

nearsightedness caused by light rays focusing in front of the retina, elongated eyeball

causes of myopia

excessive light refraction by the cornea or lens, abnormally long eye, lens swelling with hyperglycemia, can increase with growth spurts

hyperopia def

farsightedness caused by light focusing behind the retina, short eyeball

causes of hyperopia

inadequate focusing power, short eyeball

presbyopia

form of hyperopia or farsightedness that occurs as a normal process of aging around age 40 and not able to accommodate for close objects secondary to dec elasticity, hold objects far away to read, wear bifocals

astigmatism

irregular or unequal corneal curvature causing the parallel light rays to bend unequally

corrective lenses can include

glasses, bifocals, multifocal contacts, monovision contacts

monovision

one eye sees more clearly than another and so one eye sees better up close while the other sees better farther, with both open then there are usually clear

LASIK def

a flap of cornea is folded back and then internal layer of the cornea are removed by laser, flap is restored, mostly used for myopia and astigmatism and monovision

LASIK recovery

pt will have immediate 20/20 vision and limited to no pain post procedure

PRK def

reshaping of cornea with laser, geared toward correcting myopia, hyperopia, and astigmatism, better for higher levels of myopia or thin cornea

PRK recovery

takes a week to 10 days to reach 20/20 eyesight and pain is way more post op

what can treat more diopters of myopia? LASIK or PRK

PRK (up to 12)

visual impairment

vision that cannot be fully corrected by lenses, medical treatment or surgery

legal blindness

central vision for distance is 20/200 or worse in better eye, peripheral visual field no greater than 20 degrees in its widest diameter or in the better eye

Hordeolum (sty) def

infection of the sebaceous gland in lid margin, usually staph aureus

Hordeolum sxs

red, swollen, circumscribed and tender area, develops rapidly

Hordeolum tx

warm moist compresses, don't use make up around area, if reoccurs lid scrubs (scrubs 1 tsp baby shampoo/1 pint warm water)

if hordeolum continues past 72 hrs

go get abx from doc

conjunctivitis aka pink eye

infection or inflammation of the conjunctive (thin transparent layer of tissue that lines the inner surface of the eyelid), may be bacterial or viral

Bacterial conjunctivitis

highly contagious, bacterial agents, staph aureus, strep pneumonia, discomfort at site, pruritus, redness, mucopurulent discharge

bacterial conjunctivitis

1. antibiotic drops

2. strict hand washing

3. careful handling of drainage

4. warm compresses in for crustiness

is there discharge with conjunctivitis?

VIRAL

viral conjunctivitis

itching, burning, redness, mild photophobia, sensation of foreign body, often accompanies URI or post swimming, self limiting, usually patients wait it out but may have to treat with steroid drops if persists

allergic conjunctivitis def

caused by exposure to allergen (IGE response)

sx of conjunctivitis

can be mild and transitory vs severe swollen conjunctiva or ballooning out over the eye, itching, watering, redness

tx of conjunctivitis

remove cause, antihistamines, corticosteroids, artificial tears

Bacterial Keratitis risks (Cornea inflammation)

mechanical or chemical corneal epithelial damage, usually from contact wear, immunological depression, contaminated products (lens solutions, cases, topical medications, cosmetics)

bacterial keratitis tx

if using topical abx, usually two rounds, if not effective may need PO or sub-conjunctival antibiotic injection or IV antibiotics

viral keratitis

most common forms are HSV and cause corneal blindness, HZO caused by varicella zoster virus

Herpes simplex I keratitis def

the cold sore virus, most common infectious cause of viral corneal infection/blindness, patients form dendrite ulcers

herpes simplex I keratitis tx

antiviral eye drops, may include corneal debridement, tropical corticosteroids are typically contraindicated

varicella zoster keratitis def

reactivation of varicella zoster chicken pox virus or HZO, virulent and breaks out in the mucous tissue areas like the eye tissues

varicella zoster keratitis tx

topical corticosteroids and antiviral agents (acyclovir) to dec replication

trauma care for eye issues

if chemical irrigate with saline or sterile water, patch/cover for non-irrigating trauma, stabilize foreign object and dont remove, elevate HOB 45 degrees, analgesics, assurance for patient, NPO status with anticipation of surgery

what actions to avoid/do if experiencing inc IOP, or post LASIK/PRK

sleep with HOB elevated, dont bend over to pick up weights, no coughing or sneezing

cataracts def

opacity within the lens, may be in one or both eyes, age related usually

causes of cataracts

usually age, blunt trauma, radiation, UV, overexposure, long term corticosteroids, DM

presentation of cataracts

decreased vision, abnormal color perception, glare, whitening of lens

glare testing for cataracts

biggest or most common symptom that brings pt in for fixing

dx of cataracts

eye exam and glare testing

tx of cataracts

nonsurgical inc lens prescription, inc lighting, lifestyle adjustments done first and if they are getting worse then move to surgical removal or lens replacement

nursing care of cataracts

dec risk of infection, manage pain, dec pressure on the eye, medications

intraocular lens implantation (Cataract Surgery)

aphakia, congenital or secondary to cataract extraction

*small plastic lens placed in posterior chamber, can be placed for acuity as well, AKA (permanent contacts)

retinal detachment definition

separation of the sensory retina and the underlying epithelial layer with fluid accumulating between the two

retinal detachment sx

while detaching: flashes of light, floaters, ring in the field of vision

once detached: painless loss of vision in the area of the detachment, peripheral or central

risk factors for retinal detachment include

previous eye surgery, diabetic neuropathy, trauma, lattice degeneration with age

dx of retinal detachment

slit lamp microscopy, ultrasound of the eye with sclera bulking naturally toward tear

preop nursing care for retinal detachment and surgeries

• mydriatics

• cycloplegic agents

• surgeries:

  • laser photocoagulation

  • cryopexy

  • scleral buckling

  • vitrectomy

  • intravitreal bubble

post op nursing care for retinal detachment

topical abx and corticosteroids, pain management, medications to dilate pupils

age related macular degeneration def

retinal degeneration process involving the macula and resulting in degrees of central vision loss

dry MD

slow progression and painless vision loss

wet MD

more severe rapid vision loss with abnormal blood vessels forming around the macula

macular degeneration sx

yellowish exudate beneath the epithelium of the retina

blurred vision/distorted vision

appearance of an area occluded central vision

dx of macular degeneration

vision changes, internal eye exam and Amsler grid testing

tx to slow macular degeneration

lasers to destroy abnormal blood vessels around macula

meds into vitreous cavity to dec endothelial growth factor t slow vision loss

vitamins like green leafy veggies and vitamins c, e, beta carotene, and zinc

Glaucoma def

a condition characterized by increased IOP causing nerve atrophy and peripheral visual field loss

glaucoma types

primary open angle glaucoma and acute angle closure glaucoma

first change in patients with glaucoma notice

peripheral visual loss

primary open angle glaucoma def

most common form of glaucoma, the outflow of aqueous humor decreased in the trabecular meshwork and the drainage becomes clogged resulting in increased IOP

primary open angle glaucoma is __________ with gradual loss of vision and if untreated develops ____________ ____________

painless, tunnel vision

main tx purpose of POAG is to

keep IOP LOW

surgical tx for POAG

ALT and trabeculectomy

medications for POAG aim to:

decrease aqueous humor production or increase aqueous humor outflow

what are meds for POAG

beta adrenergic blockers

alpha adrenergic agonists

miotics

carbonic anhydrase inhibitors

prostaglandins agonist

whats important to do when giving eye drops/meds

SPACE out your drops when you take multiple drops wait 5-10 mins between each med

acute angle closure glaucoma def

the angle between the iris and the cornea closes, aqueous cannot reach outflow pathway and accumulates in eye resulting in rapid increasing IOP, ophthalmic emergency

acute angle closure glaucoma sx

sudden SEVERE pain, n/v, blurred vision, ocular redness, colored halos around lights

acute angle closure glaucoma tx

laser iridectomy to allow the fluid to drain quickly, surgical iridectomy an incision is emergently to iris to allow the fluid to drain quickly

acute angle closure glaucoma medication

topical cholinergic agents, hyperosmotic agents

outer ear

filtering, sound collection and transmission

middle ear

air filled cavity that contains the malleus, incus, and stapes, conduct sound

inner ear

contains the bony labyrinth and semicircular canals and cochlea (hearing and equilibrium

external otitis def

inflammation or infection of the epithelium of the auricle and ear canal, swimming may alter the flora bc of contaminants or chemicals in water, may be bacterial or fungal, pseudomonas most frequent

external otitis sx

ear pain is first sx, swelling of the ear canal, muffled hearing, discharge, fever occurs with infection

external otitis prevention and tx

abx drops for infection, corticosteroid drops for inflammation, good hygiene when giving ear drops, keep ear dry, warm moist external compresses

Otitis media def

inflammation/infection of the tympanum ossicles and space of the middle ear

otitis media sx

redness, swelling and bulging of tympanic membrane, fluid and or pus trapped under eardrum, nasal congestion, muffled hearing, pain in ear/neck, sore throat, fever

complications of otitis media

perforated ear drum, mastoiditis, chronic otitis media, meningitis

otitis media tx

PO ABX for 10 days, monitor meds for ototoxicity, antihistamines if allergies are root cause, adult myringotomy

otosclerosis def

genetic problem where spongy bone develops from the bony labyrinth, preventing movement of the footplate of the stapes

otosclerosis sx

fixed stapes bone=conductive hearing loss

Rinne test=good bone conduction, poor air conduction

otosclerosis tx

hearing aids

vitamin D and calcium carbonate

surgical stapedotomy shows significant hearing improvement after surgery then hearing level dec and then improves again gradually (fine within 3 days)

otosclerosis nursing care

cotton ball in ear canal, cover ear, manage nausea and vomiting post op, temporary dizziness, avoid actions that can inc inner ear pressure like bending, lifting, sneezing, coughing, staining

Meniere Disease def

unknown etiology abnormal accumulation of endolymph/fluid in the inner ear, usually between ages 30-60

Meniere's disease sx

sudden attacks of vertigo, n/v, sweating/pallor, tinnitus, fluctuating sensorineural hearing loss, aural fullness

Meniere's disease tx acute care

•Antihistamines, anticholinergics, sedatives, benzodiazepines, antiemetics, antivertigo meds

•Bed rest