Nursing Care of Patients With Sensory Disorders: Vision and Hearing

Chapter 52 F.A. Davis

Viral Conjunctivitis Treatment

Eye washes/irrigations (goes away in 2–4 weeks)

Bacterial Conjunctivitis Treatment

Antibiotic eye drops/ointments

Causes for Blepharitis (Inflamed Eyelid Edges)

Staph infection, dandruff, rosacea, or gland problems

Seborrheic Blepharitis S/S

Red eyelids, flaky scales at lashes

Ulcerative Blepharitis S/S

Crusts, redness, possible cornea irritation

Blepharitis Treatment

Daily eyelid cleaning with diluted baby shampoo or cleanser. Antibiotic ointments if infection is present. Chronic cases may cause thick eyelids and eyelash loss.

Keratoconjunctivitis Sicca

Not enough quality tears. More common over age 50; Dry eye disease

Keratoconjunctivitis Sicca S/S

Scratchy feeling, burning, redness, blurred vision, watery then dry eyes

Keratoconjunctivitis Sicca Treatment

Avoid smoke, reduce screen time, blink more, warm compresses, special eye drops (artificial tears or meds like Restasis, Xiidra).

Hordeolum

Small staph infection at base of eyelash. Red, raised, tender. Usually heals on its own; sty

Chalazion

Larger bump in eyelid gland. Can press on cornea, cause discomfort. May need drainage surgery if it doesn’t heal.

Keratitis (inflammation of the cornea) Causes

Bacteria, virus (like herpes), fungus, poor contact lens hygiene, dry eyes, weak immune system

Keratitis S/S

Very painful (cornea has lots of nerves), light sensitivity, tearing, redness, blurry vision, eyelid spasms

Keratitis Treatment

Antibiotic/antiviral/antifungal drops, steroids (sometimes), eye patch, warm compresses

Keratitis Complications

Can scar or thin cornea → permanent vision loss if untreated

Visual acuity test

checks how well you see

Amsler grid

checks for blind spots or wavy vision

Ophthalmoscope exam

looks inside and outside the eye

Slit-lamp exam

magnified view of cornea and sclera

Fluorescein sodium

stains eye to show scratches or foreign bodies (bright yellow-orange)

Nursing: Rinse stain after exam (it sticks to tissue)

Topical anesthetics (ex: proparacaine, tetracaine)

numb the eye for painless exams or injury relief

Nursing: Blink reflex is gone → protect eye, keep eyelid closed/moist

Anti-VEGF drugs (ex: pegaptanib)

slow new blood vessel growth in wet macular degeneration

Nursing: Monitor for infection after injection (up to 1 week)

Steroids (ex: dexamethasone, TobraDex combo)

reduce swelling/inflammation from infection, allergy, burns, surgery

NSAIDs (ex: ketorolac, bromfenac)

reduce pain/inflammation after cataract surgery

Miotics (ex: pilocarpine, physostigmine)

shrink pupil & increase outflow of fluid → lowers eye pressure (for glaucoma)

Nursing: Pupils stay small with little reaction to light

Beta-Blockers (ex: timolol, betaxolol)

lower eye pressure by reducing aqueous humor

Nursing: Monitor for bradycardia, heart block, wheezing (systemic side effects)

Mydriatics (ex: atropine)

dilates pupils for exam/surgery

Nursing: Light sensitivity (wear dark glasses until effect wears off)

Cycloplegics (ex: cyclopentolate)

paralyze accommodation muscles (used for exams/surgery)

Nursing: Contraindicated in glaucoma → increases eye pressure

Emmetropia (Normal)

light focuses exactly on the retina

Ametropia (refractive error)

light does not focus correctly on the retina → blurry vision

Myopia

See near objects clearly, but distant objects are blurry (nearsightedness). Eye is too long. Light focuses in front of the retina.

Hyperopia

See far objects clearly, but near objects are blurry (farsightedness). Eye is too short. Light focuses behind the retina.

Astigmatism

Light focuses on two different points, not one. Vision is blurry and distorted.

Presbyopia

age-related trouble seeing up close

Cycloplegic drops

used to dilate pupil & relax the focusing muscle (causes temporary blurry vision & light sensitivity)

Diabetic Retinopathy

Damage to the retina caused by diabetes, due to high blood sugar affecting blood vessels

Background retinopathy

Early stage; microaneurysms may leak blood, causing blurry vision or color changes

Pre-proliferative

Veins swell and twist, slowing blood flow. Usually no symptoms.

Proliferative

New, fragile blood vessels grow; can bleed and cause retinal detachment → permanent vision loss.

Diabetic Retinopathy S/S

Blurred vision, reduced color discrimination; often no symptoms until late stage

Retinal Detachment

Retina separates from the underlying choroid layer, allowing fluid to collect between them

Retinal Detachment Causes

Tear or hole in retina; Fibrous tissue pulling retina; Fluid accumulation

Retinal Detachment S/S

Sudden flashes of light, floaters, “curtain” or veil over vision, loss of peripheral vision; no pain

Retinal Detachment Complications

Increased intraocular pressure, recurrent detachment

Primary Open-Angle Glaucoma (POAG) – Most common

Drainage angle between the iris and sclera stays open, but fluid outflow is blocked. IOP rises slowly, causing gradual vision loss, especially peripheral vision.

Acute Angle-Closure Glaucoma – Less common but urgent

Angle between iris and sclera suddenly closes, causing sudden high IOP. Medical Emergency!

Primary Open-Angle Glaucoma S/S

Slow, mild eye ache, halos around lights, subtle vision changes

Acute Angle-Closure Glaucoma S/S

Severe eye pain, blurred vision, photophobia, nausea, vomiting

Cataracts

Clouding of the lens in the eye that makes vision blurry or dim

Cataracts S/S

Painless, halos around lights, glare sensitivity, blurry or double vision, difficulty reading, decreased color vision, changes in color perception, prescription changes for glasses, red reflex missing

Cataract surgery – Signs of infection / Warning signs to report

Yellow/green drainage, redness, pain, blurry vision, tearing, light sensitivity

Macular Degeneration (AMD)

Damage to the macula (central retina), causing central vision loss; affects reading and color vision

Dry AMD (Atropic)

Slow, progressive; photoreceptors become progressively worse; most common (70–90%)

Wet AMD (exudative)

Sudden, severe; fragile blood vessels leak, causing edema and scarring

AMD Risk Factors

Age >60, family history, diabetes, smoking, UV exposure, Caucasian

Dry AMD S/S

Slow central vision loss; near vision more affected

Wet AMD S/S

Sudden central vision loss, blurred/distorted vision, dark spot in center, color discrimination loss

Dry AMD Treatment

No cure; prevent progression with diet (leafy greens, carotenoids, zinc)

Wet AMD Treatments

Anti-angiogenesis eye injections (e.g., ranibizumab, aflibercept); older laser therapies less common

Foreign bodies (eye trauma)

Pain with movement, tearing
Treatment: Saline flush or removal by HCP

Chemical burns (eye trauma)

Pain, tearing, redness; urgent irrigation needed
Treatment: Immediate 15–20 min irrigation, antibiotics

Heat / UV burns (eye trauma)

Pain, photophobia

Abrasions / lacerations (eye trauma)

Redness, decreased vision, delayed pain

Treatment: Cleanse, antibiotic ointments/drops, patch

Penetrating wounds (eye trauma)

Most serious; high risk for blindness and infection
Treatment: Stabilize protruding object; cover both eyes; HCP treats; may require removal of eye if cannot be treated.\

Conductive Hearing Loss

Sound cannot reach the inner ear due to a mechanical blockage

• Usually treatable by removing the blockage or surgery

Conductive hearing loss causes

Earwax, infections, fluid in the middle ear, trauma, perforated eardrum, tumors, otosclerosis

Sensorineural Hearing Loss

Damage to the inner ear (cochlea) or auditory nerve

• Often permanent, but hearing aids or cochlear implants can help

Sensorineural hearing loss causes

Aging (presbycusis), infections (measles, meningitis), trauma, noise, ototoxic drugs, tumors, arteriosclerosis

Central Hearing Loss

Brain cannot interpret sound signals correctly

• Causes: Stroke, tumors

Functional (Psychogenic) Hearing Loss

No physical cause; triggered by emotional stress

Furuncle/Carbuncle

Infection of hair follicles

Otomycosis

Fungal infection

Perichondritis

Infection of auricle cartilage; may cause necrosis

Impacted Cerumen Causes

Self-cleaning failure, excessive hair, aging, hearing aids, improper cleaning, bony growths

External Ear Masses S/S

Pain, hearing loss, drainage, possible facial paralysis

Trauma of ear S/S

Lacerations, contusions, hematomas, abrasions, cauliflower ear, pain, numbness, itching, decreased hearing

Otitis Media (Middle Ear Infection) Cause

Often starts after a cold or respiratory infection → swelling blocks the eustachian tube → fluid/pus builds up in the middle ear

Acute Otitis Media

infected fluid, pus, pain, fever

Otitis Media S/S

Earache, fever, fullness in ear, hearing loss, nausea/vomiting, bulging/red eardrum, drainage if eardrum bursts

Paracentesis

needle drains fluid

Myringotomy

small incision in eardrum to drain fluid

Transtympanic tubes

keep ear open and prevent fluid buildup

Myringoplasty

surgical patch/graft to repair ruptured eardrum

Mastoidectomy

removes infected mastoid bone

Otosclerosis

New bone grows around the stapes (one of the tiny hearing bones) → it can’t move