Nursing Management of Eye and Ear Disorders

Eye: Anatomy and External Structures

  • Eyelid, Pupil, Sclera, Iris
  • The Eye components: Cornea, Lens, Aqueous Humour, Retina, Choroid, Macula, Optic Nerve, Vitreous Humour
  • Extraocular muscles: Medial Rectus, Lateral Rectus
  • Other structures: Ciliary Muscle

Eye: Examination and Assessment

  • External structures: note irritation, discharge, trauma; assess eyelids and sclera; assess pupils and pupillary response in a dark room; observe gaze and eye position; assess extraocular movements; record Ptosis and Nystagmus

Eye: Examination Sequence (high-level)

  • History → General observations → Visual acuity (best corrected) → Slit-lamp examination → Pupil observations and function → Ancillary testing → Direct ophthalmoscopy → Extraocular movements → Orbital imaging (CT/X-ray) → Blood tests (e.g., FBC, ESR) for assessment

Eye: Visual Acuity and Ophthalmoscopy

  • Snellen Chart for Visual Acuity: typical values include 6/60, 6/36, 6/24, 6/18, 6/12, 6/6
  • Slit Lamp examination
  • Ophthalmoscopy: Direct and Indirect; undilated vs dilated pupil; assess cornea, lens, retina; retina portion visible through undilated or dilated pupil

Eye: Eye Trauma and Infections

  • Eye trauma: physical damage; symptoms include pain, redness, swelling, blurred vision, bleeding
  • Types: blunt, penetrating, chemical exposure
  • Common causes: MVCs, falls, sports, assaults, work injuries
  • Eye infections: conjunctivitis, keratitis, blepharitis

Eye Trauma: Immediate Management

  • Do not press on the eye; cover with dry sterile dressing/eye shield; stabilise foreign objects; manage intraocular pressure (IOP)
  • Medicate to address pain, infection prevention, and inflammation

Eye Trauma: Medication Management (essentials)

  • Antibiotics: e.g., Ciprofloxacin eye drops
  • Anti-inflammatories: e.g., Prednisolone acetate eye drops
  • Cycloplegics: e.g., Atropine
  • Analgesics: e.g., Acetaminophen, Ibuprofen
  • IOP-lowering agents: e.g., Timolol, Acetazolamide

Eye Infections

  • Conjunctivitis: viral/bacterial/allergic; symptoms: redness, itching, discharge; treatment: antibiotic/antiviral drops, antihistamines
  • Keratitis: bacterial/viral/fungal; symptoms: eye pain, blurred vision, photophobia; treatment: antimicrobial drops, antivirals
  • Blepharitis: bacterial or seborrheic dermatitis; symptoms: eyelid redness/itching, dandruff-like scales; treatment: eyelid hygiene, antibiotic ointments

Topical Antibiotic Therapy

  • Chloramphenicol eye drops/gel commonly prescribed; can be OTC in some places; may cause local or systemic effects; sometimes inappropriately prescribed
  • Eye ointments have greasy base and are more stable than drops

Nursing Management: Traumas and Infections

  • History and assessment: mechanism, infection type; primary survey; assess underlying conditions and exposures
  • Pain management; medication administration (antibiotics/antivirals/anti-inflammatories)
  • Ocular irrigation for chemical exposure; regular monitoring for infection signs, IOP changes, response to treatment
  • Elevate head 45°; education and follow-up; reassurance

Correct Application of Eye Drops

  • Wash hands; tilt head back and pull lower lid downward; look upward; hold dropper ~2.5 cm above eye; apply drop; close eye 1–2 minutes; gentle pressure at inner canthus to reduce systemic absorption

The ‘double DOT’ technique / Don’t Open Eyes

  • Digital Occlusion of the Tear Duct to reduce systemic absorption

Eye Disorders

Cataracts

  • Clouding of the lens → blurred vision
  • Symptoms: blurred vision, glare/halos, faded colours, double vision, night vision difficulty
  • Diagnosis: Visual acuity test, Slit-lamp exam, Retinal exam
  • Management: No preventive medical therapy; corrective lenses; better lighting; treat underlying conditions; surgery is the only definitive removal method; success ~95 ext{--}98 ext{ extdegree}
  • Note: After surgery, vision improves with artificial lens replacement

Pre-Operative Care for Cataracts

  • Usual ambulatory surgery prep; antibiotic eye drops day before and morning of surgery; fasting
  • Pupil dilation with Mydriatics (phenylephrine) or Cycloplegics (tropicamide, cyclopentolate); possibly anti-anxiety meds

Post-Operative Care for Cataracts

  • Check: visual acuity, anterior chamber depth, corneal clarity, IOP
  • Home care: signs of concern; same-day discharge; antibiotics and corticosteroid drops; avoid strenuous activity and keep eye clean; avoid activities that raise IOP
  • Eye shield at night; vision rehabilitation; final glasses prescription may take weeks

Glaucoma

  • Definition: increased IOP damaging optic nerve; symptoms: peripheral vision loss, blurred vision, eye pain, halos, redness
  • Diagnosis: Tonometry (IOP), Ophthalmoscopy (optic nerve), Perimetry (visual field)
  • Management: reduce IOP by ~30\% initially; maintain safe IOP range; pharmacologic therapy to decrease production or increase outflow
  • Medications: \beta-blockers, \alpha-receptor agonists, carbonic anhydrase inhibitors, prostaglandin agonists, prostamides, miotics

Nursing Management: Glaucoma

  • Medication management: educate on proper drops administration and adherence; monitor side effects and effectiveness
  • Follow-up: regular eye exams to monitor IOP and optic nerve; lifestyle adjustments; community supports for vision loss

Age-Related Macular Degeneration (ARMD)

  • Definition: deterioration of the central retina (macula); affects central vision
  • Symptoms: central blur/distortion, difficulty reading, recognizing faces, dark/empty central areas, colour perception changes
  • Diagnosis: Fundoscopy, Amsler Grid Test, Optical Coherence Tomography (OCT)
  • Management: preserve vision and quality of life; primary treatment is Anti-VEGF injections to reduce abnormal vessel growth; laser therapy for some types; nutritional supplements (high-dose vitamins/minerals)

Nursing Management: ARMD

  • Medication management: explain injections and side effects; monitor response and adverse effects
  • Vision support: low vision aids, referrals to low-vision clinics, magnifiers, large-print materials, talking devices
  • Education: handouts; promote independence and safety

Low Vision and Blindness

  • Low vision: BCVA 6/18 to 6/60; needs devices/strategies beyond corrective lenses
  • Blindness: BCVA 6/120 to no light perception; legal blindness criteria
  • Impairment often accompanies functional limitations

General Strategies for Low Vision

  • Support coping, environment adaptation (item placement, clock method), communication strategies, collaboration with low-vision specialists/OT
  • Use Braille, audio resources, and service animals as needed

Communication Tips for Low Vision

  • Identify yourself; describe actions; ask before helping; keep noise low; speak clearly; face the person; get closer; speak into the less-impaired ear; restate when needed
  • Ask about preferred methods; encourage use of vision aids; provide written or alternative formats; be patient

Ear: Anatomy and External Structures

  • Outer ear, Middle ear, Inner ear
  • Key components: Eardrum (tympanic membrane), Ossicles, Eustachian tube, Cochlea, Semicircular canals, Vestibular nerve, Auditory nerve, Mastoid bone

Looking in the Ear: Otoscope Technique

  • Use largest comfortable speculum; pull outer ear up and back to straighten canal; look during examination; insert ~2 cm; angle forward; ear canals are sensitive

External Ear & Canal Problems – Trauma

  • Haematoma; damage to ossicles in middle ear; perforation of tympanic membrane

Management of External Ear Trauma

  • Immediate care: assess bleeding, pain, foreign bodies; control bleeding with gentle pressure
  • Medical management: analgesics; antibiotics if infection risk; ear drops for infection/inflammation
  • Surgical intervention for severe cases (e.g., TM perforation or foreign body removal)

External Ear & Canal Problems: Otitis Externa and Cerumen Impaction

  • Symptoms: ear pain, itching, discharge, hearing loss, redness, swelling
  • Diagnosis: physical exam, otoscopy, history

Medical Management: Otitis Externa & Cerumen Impaction

  • Otitis externa: antibiotic ear drops (e.g., Ciprofloxacin, Ofloxacin); antifungal drops (Clotrimazole); corticosteroids (Hydrocortisone)
  • Cerumen impaction: ear drops (hydrogen peroxide, cerumenolytics); manual removal by clinician; irrigation with saline/water

Middle Ear & Mastoid Problems

  • Conditions: otitis media, mastoiditis
  • Symptoms: ear pain, fever, hearing loss, discharge, swelling behind ear
  • Diagnosis: otoscopy, tympanometry, audiometry, imaging (CT/MRI)

Acute Otitis Media (+/- Effusion, AOM ± E)

  • Common in infancy/early childhood; linked with colds, sore throat, Eustachian tube blockage
  • Guidelines: First-line amoxicillin for uncomplicated AOM; Watchful waiting in mild cases
  • Presentation in children: tugging ear, fever, sleep disruption, decreased responsiveness, speech delay concerns

Mastoiditis (Chronic Otitis Media)

  • Result of repeated AOM; symptoms: purulent discharge, hearing loss, ear pain, dizziness, facial palsy, vertigo

Medical Management of AOM/Mastoiditis

  • Broad-spectrum antibiotics; analgesics (paracetamol, NSAIDs); decongestants
  • If no response: myringotomy to release pressure/exudate; tympanostomy tubes may be placed

Grommets (Tympanostomy Tubes)

  • Small tubes inserted in tympanic membrane to aerate middle ear and prevent fluid accumulation

Middle Ear Complications and Surgical Options

  • Perforation; cholesteatoma; sensorineural hearing loss; facial nerve dysfunction; risk of brain abscess or meningitis
  • Surgical options: myringoplasty (TM repair); tympanoplasty (reconstruction); ossiculoplasty (ossicular reconstruction); mastoidectomy

Preoperative Care

  • Health history and ear disorder specifics; ensure no infection; general anesthesia; limit head movement post-op; antiemetics/analgesia; avoid sneezing/coughing with open ear
  • Hair washing prior to surgery

Postoperative Care

  • Head elevation; monitor vitals and pain; monitor nausea/vertigo; wound and dressing checks; bedrest for 24 hours then gradual ambulation; avoid showering
  • Possible temporary hearing reduction; prepare patient for limited hearing
  • Discharge around day 3–4; dressings/sutures removed after 7–10 days

Discharge Education

  • Medication instructions (analgesics, anti-vertigo meds, complete antibiotic course)
  • Follow surgeon instructions: avoid water in ear; activity restrictions; gentle nose blowing with mouth open; air travel considerations
  • Report excessive drainage or ear pain; safety due to vertigo; follow-up care as directed

Inner Ear Problems

  • Conditions: Labyrinthitis, Menière"s disease
  • Symptoms: dizziness, vertigo, nystagmus, hearing loss, tinnitus, balance issues, nausea
  • Diagnosis: Audiometry, ENG, MRI, patient history

Medical Management: Inner Ear Conditions

  • Labyrinthitis: antiviral or antibiotic therapy based on cause; corticosteroids (e.g., Prednisolone); antiemetics
  • Menière's Disease: diuretics (e.g., Hydrochlorothiazide); low-sodium diet; anti-vertigo meds (e.g., Prochlorperazine)
  • Intratympanic injections: Gentamicin or corticosteroids

Nursing Management: Ear Problems

  • External Ear & Canal: monitor symptoms; inspect canal; ensure correct use of drops; educate about side effects; emphasize completing antibiotic/antifungal courses; hygiene; avoid inserting objects; follow-up care
  • Middle Ear & Mastoid: monitor symptoms, infection signs, fever; assess hearing; ensure antibiotic adherence; avoid water exposure if advised; follow-up care
  • Inner Ear: monitor symptoms, hearing/balance; ensure medication adherence; safety measures to prevent falls; diet and stress management; follow-up care

Hearing Loss

  • Statistics: about 1 in 6 Australians affected
  • Risk factors: age, inherited loss, noise exposure, illness-related loss, medications, head trauma, tumours
  • Types: Conductive, Sensorineural, Mixed

Manifestations and Impact

  • Early symptoms: tinnitus, difficulty hearing in group settings; volume-increase behavior; gradual or unrecognized impairment
  • As loss progresses: speech difficulties, fatigue, social withdrawal

Communication Tips for Hearing Loss

  • Use a low-tone, normal voice; speak slowly and clearly; reduce background noise; face the person; get closer; speak into the better ear; restate, ask preferences, and offer to write or sign
  • Encourage use of hearing aids; reading lips if helpful; use gestures; provide resources; be patient

References

  • (Selected references and resources as listed in the transcript)