ear and eye disorders

outer ear contains

auricle, external aduitory canal, tympanic membrane

auricle

collects and directs sound into ear canal

external auditory canal

carries sound to the eardrum and amplifies it

tympanic membrane

vibrates with sound, transfers energy to middle ear

middle ear includes

ossicles, eustachian tube, oval window o

ossicles

mallelus, incus,stapes, that amplify and transmit sound

eustachian tube

equalizes pressure between the middle ear and throat

oval window

connects to the inner ear, transmitting vibrations to cochlea

inner ear contains

cochlea, vestibular system, auditory nerve, CN VIII

vestibular system

mantains balance

presbycusis

progressive hearing loss associated with aging

conductive hearing loss

blockage or damage in outer or middle ear

ex: cerumen impaction, otitis media, otoscleorsis

sensorineural hearing loss

damage to inner ear or auditory nerve

carbamide peroxxide otic

debrieding agent for cerumen softening / removal

releases oxygen to soften and remove cerumen, weak antibacterial

pregnancy C category

acute otitis externa

inflammation in the external ear caused by bacteria staphylococcus, pseudomonas, or fungal infection for aspergillus

otitis externa signs

pain and tenderness

discharge

edema

erythema

pruritus

hearing loss

otalgia

corisporin ortic

neomycin, polymixin B, hydrocortisone

ciprodex otic

ciprofloxacin with dexamethasone

acute otitis media

infection from s. pyogenes, s. pneumoniae, HIB

s/s of otitis media

ear pain, erythema or bulging, otorrhea, fever

treatment for otitis media

amoxicillin - 1000 mg x 10 days TID

amoxicillin clavulante - 875/125 mg bid x 10 days

cephalosporins

menieres disease

vertigo with n/v, tinnitus, fluctuating hearing loss

non pharmacological ear disorder management

low sodium diet, low sugar, limit caffeine, limit alcohol, increase fluids, safe position changes, cognitive therapy, med safety, avoid aspirin

meclizine

non selectric central/peripheral h1 RA, anticholinergic effects

meclizine uses

menieres disease, vertigo, motion sickness

meclizine contraindications

hypersensitivity, glaucoma, CNS/renal/hepatic impairment, BPH

dry eye syndrome

insufficient tear production - redness, discomfort

cataracts

clouding of the lens

hyperopia

difficulty focusing on near objects

farsightedness

myopia

difficulty seeing distant objects

nearsightedness

macular degeneration

deteroriation of the central part of the retina causing central vision loss

wet and dry types

diabetic retinopathy

damage to vessels in retina due to diabetes

glaucoma

increased intraocular pressure causing optic nerve damage, leading to vision loss

open angle glaucoma

most common, caused by decreased aqueous humor, slow and often without early signs

angle closure glaucoma

caused by increased aqueous humor due to locked drainage angle - severe eye pain, nausea, vomitting

keep IOP beloq ___ mmHg for glaucoma

20

normal tension glaucoma

optic nerve damage occurs despite normal IOP, possibly due to poor blood flow

congenital glaucoma

present at birht due to developmental drainage issues

secondary glaucoma

caused by eye injury, disease, medications

open angle glaucoma symptoms

headache, mild eye pain, loss of peripheral vision, decreased accomodation, elevated IOP over 20

closed angle glaucoma symptoms

sudden acute eye pain or redness, n/v, headache, decreased/blurred vision, pupils nonreactive, rapid increase in IOP, photophobia, halos around lights

advanced stages of glaucoma

loss of contrast sensitivity and visual field defects

xalantan

reduces iop with open angle glaucpma and ocular HTN, enhances ourflow

pregnancy category C

timolol

miotic, beta adrenergic blocking agent

lowers iop by reducing formation of aqueous humor

pregnancy category C

pilocarpine

cholinergic agonist, direct acting mascarinic

constricts pupil, contracts ciliary muscle to lower IOP

pregnancy category C

caronic anhydrase inhibitors

block carbonic anhydrase, reduces HCO and Na via the cotransporter to decrease water absorption

lowers iop and prevent optic nerve damage

acetazolamide

inhibits carbonic anhydrase in proximal renal tubule, causes increased excretion of Na and HCO

acetazolamide adrs

hypokalemia, metabolic acidosis, n/v/d, dizziness

pregnancy category c

interacts with tcas, amphotericin b and corticosteroids

mannitol

osmotic diuertic, high intracranial or IOP, glomerulus filter, decreases h2o/na reabsorption

mannitol contraindications

anuria, HF, shock, intracranial bleeding