jcmendiola_Achievers2013 Care of Clients with Problems In Inflammatory & Immunologic Response, Perception & Coordination (NCM104) Patients With Special Senses Alterations I and II Special Senses We have 5 Special Senses - Smell - Taste - Sight - Hearing - Balance - (Common Sense) WEH LOL They have highly localized receptors that provide specific information about the environment They also transmit external stimuli to the brain so it can interpret it They act also as a protective mechanism Olfaction Sense of smell Response to airborne molecules, called odorants entering the nasal cavity At least 7 (Perhaps 50) primary odors exist o Olfaction neurons have very low thresholds and accommodate rapidly OLFACTION EPITHELIUM and BULB - Olfactory neurons in the olfactory epithelium are bipolar neurons o Distal ends have olfactory hairs - Olfactory hairs have receptors that respond to dissolved substances - Receptors activate G Protein which results in ion channels opening and depolarization NEURONAL PATHWAYS for OLFACTION - Axons from the olfactory neurons extend as olfaction nerves to the olfactory bulbs where they synapse with interneurons - Axons from interneurons from the olfactory tract which connect to the olfactory cortex - Olfactory bulbs and cortex accommodate to odors Taste Sensory structures that detect taste stimuli are taste buds Most taste buds are located in the epithelium of papillae Taste buds are found on the o Tongue MORE! o Palate o Lips o Throat HISTOLOGY of TASTE BUDS - Taste buds consists of : o Taste Cells (50) Topics Discussed Here Are: 1. Special Senses Anatomy and Physiology a. Anatomy and Physiology of the Eye b. Hearing and Balance (Anaphy of Ear) 2. Assessment of Eyes and Ears a. Eyes b. Ears c. Diagnostic Tests 3. Disorders of the Eye a. Impaired Vision b. Infection and Inflammatory Conditions of the Eye c. Disorders of the Cornea d. Retinitis Disorders e. Macular Degeneration f. Glaucoma g. Cataract h. Rehabilitation of a Blind Person 4. Disorders of the Ears and Balance a. Wax b. Foreign Bodies c. Otitis Externa d. Otitis Media e. Cholesteatoma f. Otosclerosis g. Meniere's Disease LOOKY HERE ☺
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jcmendiola_Achievers2013
Care of Clients with Problems In Inflammatory
& Immunologic Response, Perception & Coordination
(NCM104)
Patients With Special Senses Alterations I and II
Special Senses
We have 5 Special Senses
- Smell
- Taste
- Sight
- Hearing
- Balance
- (Common Sense) � WEH LOL
� They have highly localized receptors
that
provide specific information about the
environment
� They also transmit external stimuli to
the
brain so it can interpret it
� They act also as a protective
mechanism
Olfaction
� Sense of smell
� Response to airborne molecules, called odorants entering the nasal cavity
� At least 7 (Perhaps 50) primary odors exist
o Olfaction neurons have very low thresholds and accommodate rapidly
OLFACTION EPITHELIUM and BULB
- Olfactory neurons in the olfactory epithelium are bipolar neurons
o Distal ends have olfactory hairs
- Olfactory hairs have receptors that respond to dissolved substances
- Receptors activate G Protein which results in ion channels opening and depolarization
NEURONAL PATHWAYS for OLFACTION
- Axons from the olfactory neurons extend as olfaction nerves to the olfactory bulbs where
they synapse with interneurons
- Axons from interneurons from the olfactory tract which connect to the olfactory cortex
- Olfactory bulbs and cortex accommodate to odors
Taste
� Sensory structures that detect taste stimuli are taste buds
� Most taste buds are located in the epithelium of papillae
� Taste buds are found on the
o Tongue � MORE!
o Palate
o Lips
o Throat
HISTOLOGY of TASTE BUDS
- Taste buds consists of :
o Taste Cells (50)
Topics Discussed Here Are:
1. Special Senses Anatomy and Physiology
a. Anatomy and Physiology of the Eye
b. Hearing and Balance (Anaphy of Ear)
2. Assessment of Eyes and Ears
a. Eyes
b. Ears
c. Diagnostic Tests
3. Disorders of the Eye
a. Impaired Vision
b. Infection and Inflammatory Conditions of the Eye
c. Disorders of the Cornea
d. Retinitis Disorders
e. Macular Degeneration
f. Glaucoma
g. Cataract
h. Rehabilitation of a Blind Person
4. Disorders of the Ears and Balance
a. Wax
b. Foreign Bodies
c. Otitis Externa
d. Otitis Media
e. Cholesteatoma
f. Otosclerosis
g. Meniere's Disease
LOOKY
HERE ☺
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� Have hairs that extend into taste pores
o Basilar Cells
o Supporting Cells
FUNCTIONS of TASTE
- Receptors on the hairs detect dissolved FIVE basic types of taste exist:
o Salty – Sodium Ions
o Sour – Acids
o Sweet – Sugar, some other carbohydrates and some protein
o Bitter – Alkaloids (Base)
o Umami – Elicited by the amino acid glutamate and related compounds
- All taste buds sense FIVE primary tastes, but tend to be more sensitive to ONE
o Sensory to bitter substances in the highest (Poisonous)
- Taste is strongly influenced by olfactory sensation
o Nasal congestion can damper the taste sensation
- Tongue can detect other stimuli besides taste
o Temperature
o Texture
NEURONAL PATHWAY for TASTE
- The FACIAL NERVE carries taste sensation from the ANTERIOR 2/3 of the tongue
- The GLOSSOPHARYNGEAL NERVE carries taste sensation from the POSTERIOR 1/3
of the tongue
- The VAGUS NERVE carry taste sensations from the EPIGLOTTIS
- The neural pathway for taste extends from the Medulla Oblongata to the Thalamus and to
the Cerebral Cortex
Visual System
� Consists of:
o Eye
� Eye Ball
� Optic Nerve
o Accessory Structures
� Eyebrows, eyelids, conjunctiva, lacrimal apparatus and extrinsic eye muscles
o Sensory Neurons
ACCESSORY STRUCTURES
- Eye Brows
o Prevent perspiration from entering the eyes and help shade the eyes
- Eyelids
o Consists of 5 tissue layers
o Protect the eyes from foreign objects
o Help lubricate the eyes by spreading tears over their surface
� Lubricating glands associated with the eyelids
• Meibomian Glands and sebaceous glands
• Ciliary Glands lie between the hair follicles
- Eyelashes
o Project from the free margin of each eyelid
o Initiate blinking reflex
- Conjunctiva
o Covers the inner eyelid and the anterior part of the eye
- Lacrimal Apparatus
o Consists of the lacrimal glands, lacrimal canaliculi and a nasolacrimal duct
o Lacrimal Glands secrete TEARS
� Tears
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• Contains mostly water and with some salts, mucus, and
lysozymes
• Enter the eye via superolateral excretory ducts
• Exit the eye…
•
o Extrinsic Eye Muscles
� Six strap-like muscles
• Enables the eye to follow moving objects
• Maintains the shape of the eyeball
� FOUR Rectus muscles originates from the annular ring
� TWO Oblique muscles move the eye in the vertical plane
Anatomy of the Eye
~ A slightly irregular hollow sphere with anterior and posterior poles
~ The eyeball is composed of 3 layers
o Fibrous Layer
� Sclera
� Cornea
o Vascular Layer
� Choroid
� Ciliary Body
� Iris
o Nervous Layer
� Retina
~ The internal cavity is filled with fluid called humors
FIBROUS LAYER
� Sclera
o Posterior 4/5th of the eye
o White Connection: Tissue that maintains the shape of the eyeball
o Provide a site for muscle attachments
� Cornea
o Anterior 1/5th
o Transparent and refracts light that enters the eye
VASCULAR LAYER
� Choroid
o A vascular network
o May contain melanin-containing pigmented cells
o Appears black in color
o Prevents the reflection of light inside the eye
� Ciliary Body
o Ciliary Ring
� A thickened ring of tissue surrounding the lens
� Composed of smooth muscle bundles (Ciliary Muscles)
� Anchors the suprasensory ligaments that holds the lens in place
� Changes the shape of the lens
o Ciliary Process
� Produces AQUEOUS HUMOR
� Iris
o Smooth muscle regulated by autonomic venous system
� Sphincter Pupillae
• Close vision and bright light: pupils CONSTRICT
� Dilator Pupillae
• Distant vision and dim light: pupils DILATE
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Ciliary Process
Aqueous Humor Flow
Lens
Iridocorneal
Cornea
Trabecular Meshwork
Canal of Schlemm
Veins
� Changes in emotional state: Pupils dilate when the subject matter is…
o Controls the amount of light entering the pupil
o Color is detected by the amount of melanin present
� Large Amount of Melanin: Brown / Black
� Less Amount of Melanin: Light brown, green, or Gray
� Even Less Melanin: Blue
NERVOUS LAYER
� Retina
o The inner layer of the eyeball
o Has over 123 million photoreceptors which respond to light
� Macular (Fovea Centralis)
o Area of greatest sensitivity to light
o Highest concentration of photoreceptors
� Optic Disc
o Located through which nerves exit and blood vessels enter the eye
o No photoreceptor cells
o The “Blind Spot” of the eye
CHAMBERS of The EYE - Composed of 3 Chambers
o Anterior Chamber
� Between the cornea and iris
o Posterior Chamber
� Between the iris and the lens
o Vitreous Chamber
� Much larger than the 2 chambers
� Posterior to the lens
Aqueous Humor
� Fills the Anterior and Posterior chamber
� Supports, nourishes and removes wastes for the cornea, which has no blood vessels
� Produced by the CILIARY PROCESS as a blood filtrate
� Returned to the circulation through the scleral venous sinus
Vitreous Humor
� Fills the Vitreous Chamber � Contributes to the Intraocular Pressure (IOP)
� Helps maintain the shape of the EYEBALL
� Holds the lens and retina in place
� Functions in the refraction of light in the eye
Lens
- A biconvex, transparent, flexible avascular structure that:
o Allows precise focusing of light onto the retina
o Is composed of epithelium and lens fibers
� Lens epithelial anterior cells that differentiates into lens fibers
� Lens fibers: Cell fibers filled with the transparent protein
CRYSTALLIN
o With age, the lenses become more compact and dense and loses its elasticity
(Presbyopia)
Functions of the Complete Eye
- Properties of Light o Electromagnetic Spectrum
� All electrical waves from short gamma rays to long radio waves
Aqueous Humor Production Must be
EQUAL to the EXCRETION
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o Visual Spectrum
� Portion of the electromagnetic spectrum that can be detected by the human eye
- Refraction o Bending of light
o Light striking a CONCAVE SURFACE refracts OUTWARD (Divergence)
o Light striking a CONVEX SURFACE refracts INWARD (Convergence)
o Converging lights rays meet a the focal point and are said to be FOCUSED (***)
o Focusing system of the EYE (Light Refraction)
� Cornea – Person for most of the convergence
� Aqueous Humor
• Lens – Adjusts the convergence by changing the shape
� Vitreous Humor
•
� Distant and Near Vision
• Distant Vision: Looking at the object 20 feet or more
• Near Vision: Looking at the object less than 20 feet from the eye
• Relaxation of the ciliary muscles causes the lens to FLATTEN,
producing the Emmetropic Eye
o Normal Resting condition of the lens
• Far point of vision
o Point at which the lens does not have to THICKEN for
focusing to occur
o Normal: 20 feet / more from the eye
• Near Point Vision
o Closest point an obnject can come to the eye and still be
focused (***)
• When an object is less than 20 feet from the eye, the image falling on
the retina is no longer focused
Three EVENTS MUST Occur to Bring the Image into FOCUS!
1. Accommodation by the Lens
� Contraction of the ciliary muscles causes the lens to
become more spherical
� Change in the lens shape enables the eye to focus on
objects that are less than 20 feet away
2. Constriction of the pupils
� To increase the depth of focus
3. Convergence of the Eye
� Medial rotation of the eye (***)
Structures and Functions of the Retina
- Pigmented layer of the retina
- Provides a black backdrop for increased visual acuity
- Rods and Cones synapse with Bipolar Cells
o Bipolar cells synapse at ganglion cells (***)
� Rods
• Responsible for non-color vision and vision with low illuminate (Night
Vision)
• Rod-shaped photo receptive part of the rods contains about 700 double-
layered membrane discriminating (***)
• Disc containing Rhodopsin RODS:
↑ = DARK
↓ = LIGHT
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o A Purple pigment consisting of little Protein OPSIN
covalently bound to a yellow photosensory pigment called
Retinal (Derived from Vitamin A)
• Exposure to light activates Rhodopsin
o Rhodopsin is split by light into retinal and opsin, eventually
resulting in an action potential
o Light adaptation is caused by a radiation of Rhodopsin
o Dark adaptation is caused by Rhodopsin production
� Cones
• Responsible for color vision and visual acuity
• Three Types (Each with a Different type of Iodopsin Pigment)
o Pigments are most sensitive to blue, red and green light
• Perception of many colors result from mixing the ratio of the different
types of cones that are active at a given moment (***)
• Most visual image are focused on the Fovea Centralis and Macula
o Fovea Centralis has many high concentration of cones
o In the remaining (***)
o Most rods (***)
• Bipolar and Ganglion cells in the retina can modify information sent
•
Neuronal Pathway of Vision
- Ganglion cell Axons from the optic nerve, optic chiasm and optic tracts
o Extend to the Thalamus and SYNAPSE
o Then the neurons form the Optic Radiation that project to the visual cortex
- Depth Perception
o
o
Hearing and Balance - Three parts of the Ears are:
o External Ear
� Extends from the outside of the head to the Tympanic Membrane
o Middle Ear
� Air-filled chamber, medial to the Tympanic Membrane
o Inner Ear
� Set of fluid filled chambers medial to the Middle Ear
- The external and Middle ear are involved with hearing
- The Inner ear functions in both hearing and equilibrium
AUDITORY STRUCTURES and THEIR FUNCTIONS
EXTERNAL EAR
- Auricle – Fleshy part of the external ear
- External Acoustic Meatus
o Passageway that leads to the tympanic membrane
o Finally with hairs and ceruminous glands
� Ceruminous Glands produce Cerumen (Ear wax)
o Tympanic membrane (Ear Drum)
� Thin connective tissue that vibrates in response to sound
� Transfer sound electrically to the middle ear Ossicles
� Bounding between outer and middle ears
MIDDLE EAR
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- A small, air-filled, mucosa-lined cavity
o Flanked laterally by the eardrum
o Flanked medially by the oval and round windows
- Contains 3 small bones (Malleus – Incus – Stapes)
o Transmit vibratory motion of the eardrum to the oval window
o Pampered by the Tensor tympani and Stapedius muscles
o Auditory Tube (Eustachian Tube)
� Equalizes the pressure within the ear
INNER EAR
- Bony labyrinth
o Interconnected, fluid filled tunnel within the temporal bone
- Contains:
o Vestibule and Semicircular Canals: primarily involved in balance
o Cochlear: Involved in hearing
- Membranous Labyrinth
o Series of membranous sacs with the bony labyrinth
o Filled with Potassium (K+) rich filled called Endolymph (Protein)
o Space between the bony labyrinth and membranous labyrinth is filled Perilymph
- Cochlea
o Spiral shaped canal within the temporal bone
o Divided into the three compartments by the vestibule and vesicular membranes
o Scala Vestibuli and Scala Tympani contains Perilymph
o Cochlear Duct contains Endolymph and the spiral organ
� Spiral organ consists of inner hair cells and outer hair cells with attachments
to the tectorial membrane
� Hair cells have hair-like projections at their apical ends which are very long
called Stereocilia
AUDITORY FUNCTIONS - Pitch is = Frequency of soundwaves
- Volume = Is determined by the amplitude
- Timbre is the resonant quality (Overtones) of sound
Hearing Involves
- Soundwaves funneled by the auricle down the external acoustic meatus causes the tympanic
membrane to vibrate
- Tympanic membrane vibrations pass along the auditory window of the inner ear (***)
-
- Movement of the stapes in the oval window causes the Perilymph, vestibular membrane and
Endolymph to vibrate and produce movement of the basilar membrane
- Movement of the basilar membrane causes bending of the Stereocilia (***)
- Bending of the Stereocilia pulls on gating spring and opens K+ channels
- K+ ions enter the (***)
- Depolarization causes the release of glutamate (?), general action potentials in the sensory
hemoassociated with hair cells
- The round window dissipates soundwaves and protects the inner ear from pressure build up
Neural Pathway
Static Balance
- Evaluates the position of the head relative to gravity and detects live acceleration and deceleration
(***)
- Vestibule Contains
o The Utricle and Saccule in the inner ear
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� Contains maculae of hair cells
� Hairs are embedded in an Otolithic Membrane
• Consists of a gelatinous mass and crystals called otoliths
• Moves in response to gravity
o Evaluates movements of the head
o Semicircular canals
� 3 Semicircular canals at right angles to one another are present in the inner ear
� The Ampulla of each semicircular canal contains the crista ampullaris
• Has hair cells within hair
Assessment
� History Taking (Ocular)
o Blurred, double-vision / distorted vision
o Pain – PQRST
o Itching sensation
o Any eye discharge – Color, consistency, odor
o Onset of problem
o Duration
o Any history of trauma / injury
o How it affects ADLs
o Family history of same symptoms
o History of Chronic Conditions
o Genetic abnormalities
� Eye Examination
o Visual acuity
o Check for the Following
1) Position of the eyelid
2) Lid and eyelash margin
3) Pupillary response
4) Cardinal Gazes
5) Redness / swelling of the mucous membrane
6) Discharge – Watery, purulent
• Corneal Reflex?
• Corneal Abrasion?
� Diagnostic Assessment
o Snellen’s Chart
� Tests visual acuity
� Normal result is 20/20
o Ishihara Plate
� Tests color vision
o Tonometry
� Indirect measurement of intraocular pressure
� Normal: 10 – 21 mmHg (or 11 – 21) ?
o Perimetry
� Measurement of the peripheral visual field
o Gonioscopy
� A biomicroscopic examination that visualizes the anterior chamber angle
� Diagnostic test of congenital and secondary glaucoma
o Bjerrum Tangent Screen
� Measures central vision
o Ophthalmoscopy
� Examines the fundus of the eye
o Slit Lamp Biomicroscopy
� Assesses the eyes anterior portion under high magnification and in optical
section
o Amsler Grid
RSVP!
R – Redness
S – Swelling
V – Visual Acuity
P – Pain on palpation
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� Tests client for macular problems
� Consists of grid of identical squares with a central fixation
o Ultrasonography
� Evaluates lesions in the globe or the orbit
� MRI / CT Scan
o Optical Coherence Tomography
� Light is used to evaluate retinal and macular disease
o Color Fundus Photography
� Detects and documents retinal lesions
o Fluorescein Angiography
� Evaluates macular edema and macular capillary non perfusion and identify
retinal and vascular neovascularization
o Indocyanine Green Angiography
� Evaluates abnormalities in the choroidal vasculature
� History Taking (Ears)
o Change in the hearing and balance
o Loss of balance
o History of accidents
o Assess for symptoms of ear disorders
o Check for the following
1) External ear
2) Otoscopic Examination
3) Auditory Acuity – Whisper, Weber, Rinne
o Symptoms of Ear Disorders
1) Deafness
• Client has hearing loss which may be mild / severe
• Hearing loss may be conductive, semi-neural / mixed types
• Otitis media (common cause of deadness among children)
Presbycusis (common cause of deafness among adults)
2) Pain
• Ear ache / Otalgia is a very common complaint
• Otitis media for children, Otitis externa for adults
• Pain may arise from the ear itself / from an adjacent site with a shared
nerve supply
• Most common site for referred pain is the throat, where infections of
more rarely malignant tumors are responsible
3) Discharge
• Mucoid, purulent / bloody
• Cause of discharge is Otitis externa or Otitis media
• Perforation will be present in the tympanic membrane
4) Vertigo
• Form of dizziness where the client experiences a spinning sensation
• Common symptom when balance / vestibular system of the inner ear is
diseased
• Accompanied by nausea and vomiting
5) Tinnitus
• Common complaint of noise in the ears
• Its quality varies from high-pitched, whistling to the clanging of bells
or recognizable scratching of music
Assessment / Diagnostic Tests
- Tuning Fork Tests
o Rinne’s Test
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� Compares air conduction from bone conduction; differentiates conductive and
sensorineural hearing loss
� The vibrating tuning fork is placed against the mastoid bone (Bone conduction)
(***)
� Interpretation of Results:
• Normal: Air conduction is better than bone conduction (The tone is
louder in front of the ear)
• Conductive hearing loss: Bone conduction is better than air conduction
(The tone is louder behind the ear)
o Weber Test
� The rounded tip of the handle of the vibrating tuning fork is placed on the
client’s forehead
� Interpretation of Results:
• Normal: Tone heard in center of head / equally in both ears
• Conductive Hearing Loss: Tone heard better in affected ear; e.g.
Otosclerosis
• Sensorineural Hearing Loss: Tone heard best in unaffected ear
•
� The examiner covers one ear with the palm of the hand, then whispers softly
from a distance of 1 – 2 feet from non occluded ear (***)
o Audiometry
� It is the single most important diagnostic instrument in detecting hearing loss
� Types of Audiometry
• Pure Tone Audiometry
o The louder the tone before the client perceives it, the greater
the hearing loss
• Speech Audiometry
o Speech word is used to determine the ability to hear and
discriminate sounds and words
o Oculovestibular Test / Caloric Ice Water Test
� Irrigate the ear with cold water
� Normal: Lateral Conjugate Nystagmus of the eyes towards the area of
stimulation
� Abnormal: Dysconjugate Nystagmus of the eyes
o Electronystagmography
� It helps to diagnose conditions such as Meniere’s disease and tumor on the
internal auditory canal / Posterior Fossa
o Platform Posturography
� Used to investigate postural control capabilities such as vertigo
o Sinusoidal Harmonic Acceleration
� Rotary Rotation
• Assess the vestibulocochlear system by analyzing compensatory eye
movement
o Middle ear Endoscopy
� The ear can be examined by an Endoscopic specialized in otolaryngology
Classifications of Hearing Loss
1. Conductive Hearing Loss
� Involves interference with conduction of sound impulses through the external auditory
canal, the ear drum or the middle ear
2. Sensorineural Hearing Loss
� *** from the disease or trauma to the inner ear / acoustic nerve
3. Mixed Hearing Loss
� Involves both conductive and sensorineural loss
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Assessment of Clients with Hearing Loss - Irritable, hostile / hypersensitive in interpersonal relationships
- Difficulty in following directions
- Complains about people mumbling
- Turns up the volume of the Television
- Asks for frequent repetition
- Answers questions inappropriately
- Leans forward to hear better, face looks serious and straight
- Flat affect
- Loses sense of humor, becomes grim and lonely
- Experiences social isolation
- Develops suspicious attitude
- Has abnormal articulation
- Complains of ringing in the ears
- Has unusually soft / loud voice
- Dominates conversation
Guidelines for Communicating with Patients with Hearing Impairment � Talk directly to the person facing him/her
� Speak in clearly enunciated words using normal tone of voice, DON’T SHOUT
� Use gestures with speech
� Do not whisper to anybody in front of the hearing impaired client
� Do not avoid conversations with a person who has hearing loss
� Do not show annoyance by careless facial expressions
� Move closer to the person or towards the better ear if he/she does not hear you
� Do not smile, do not chew gum/cover the mouth when talking to the person
� Encourage the use of hearing aid if the client has
Disorders of the Eye � Impaired Vision
o Refractive Errors
� Vision is impaired because of a shortening / elongated eyeball prevents light
from focusing sharply on the retina
� Can be corrected by wearing corrective eye glasses (***)
� Myopia: Near sightedness
� Hyperopia: Far sightedness
� Astigmatism: Irregularity in the curve of the cornea
� Presbyopia: Due to aging, inability to accommodate / adjust
Vision Protection and General Eye Care - Regular ocular exam and physical examinations
- Avoid dangerous items
- Early identification and treatment of strabismus in children
- Routine eye assessment programs in schools
- Early treatment when eye symptoms occur
- Routine instillation of appropriate drops in the eyes of every newborn
- Blood test during pregnancy to identify syphilis
- Inoculation against rubella
- Regulation of O2 concentration administered to premature infants
- Avoid habitual rubbing of the eyes
- Have adequate lighting when reading
- Periodically rest eyes during prolonged periods of close works, reading / watching television
- Use glasses and wear protective goggles
- Keep eye glasses clean, protected from scratching and breakage and properly aligned
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- Do not use eye masks or any medications in the eyes unless prescribed by a doctor
- Do not use soiled clothes for rubbing the glasses / eyes
- Use care when using aerosol spray
- Maintain a state of good healthy and eat a well balanced diet with adequate Vitamin A, B, C and E
- Use care when using solvents, lye solutions , ammonia, caustive solutions to avoid splashing or
spilling into eyes
Common Ocular Medications
- Local anesthetics
- Parasympathomimetic Drugs
o Used as MIOTICS
� Pilocarpine HCl 0.5 – 10%
� Carbachol – 1.5 – 3%
� Acetylcholine Cl 1%
- Parasympatholytic Drugs
o Used as Mydriatics
� NeoSynephrine 2.5 / 10%
� Atropine SO4 0.5, 1.4%
� Schophonium Hydrobromide 0.25% � MALI ._.
� Cyclopentolate HCl (Cyclogyl) – 1% - 2%
� Tropicamide (Mydriacyl) 0.5 – 1%
- Antibiotic Agents
o Gentamicin 0.3%
o Neosporin
o Chloroptic Eye Drops
- Steroids
- Carbonic Anhydrase Inhibitors – Reduce aqueous humor production
o (Diamox) Acetazolamide
- Beta Blockers – Also used to reduce aqueous humor production
o Timolol Maleate (Timoptic)
Infection and Inflammatory Conditions of the Eye � Conjunctivitis
o Inflammation which results from bacterial / viral infections
o Redness, swelling, Lacrimation, pain, itching, discharge from the eye
Types of Conjunctivitis
- Bacterial – Purulent discharge
- Viral – Tearing
- Allergic – Allergies to pollen
- Toxic – Due to toxic agents
MEDICAL MANAGEMENT
1. For Trachoma – Broad spectrum antibiotic
� Surgical Management for correcting Trichiasis to prevent conjunctival
scarring
2. Antibiotic for 1 week
3. Vasoconstricting Agents
4. Saline irrigation for toxic conjunctivitis
ASSESSMENT
1. Evaluate for type of discharge
2. Conjunctival reaction
3. Presence of Lymphadenopathy
4. Burning sensation
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5. Itching
6. Photophobia
7. Unilateral, bilateral
- Health teaching on ways on how to prevent the spread of infection
- Hand hygiene
- Avoid sharing of towels, face towels, clothing, eye drops
- Application of cold compress as ordered
- Application of antibiotic as orders
� Uveitis
o Inflammation of the uveal tract
o Uveal Tract – Middle vascular layer of the eye, contributing to the retina’s blood supply
o It is composed of the iris, ciliary body, and choroid
Uveitis Can AFFECT
- Iritis – Inflammation of the iris
- Iridicylitis – Inflammation of the iris and the ciliary body
- Choroiditis – Inflammation of the choroid
- Chorioretinitis – Inflammation of the choroid and the retina
Causes:
- Local / Systemic disease
- Injury
- Unidentified case
MEDICAL MANAGEMENT
- Collaborative Management
o Mydriatics (Atropine SO4 1% or 0.25%, Scopolamine)
o To dilate the pupils
o To prevent adhesion between anterior capsule of the lens and the iris
o To relieve pain and photophobia
o To reduce congestion
o To rest the iris and the ciliary body
� Steroids (Local / systemic)
� Dark glasses (To relieve photophobia)
� Analgesics (Aspirin, Acetaminophen)
� Enucleation (Removal of the EYEBALL)
• Done if with perforation of sclera and ciliary body
NURSING RESPONSIBILITY Assessment
- Pain in the eyeball radiating to the forehead and temple
- Blurred vision
- Photophobia
- Redness of eyes without purulent discharge
- Small pupil
- Lacrimation
- Complete physical examination
- Complete history
- Review diagnostic tests like CBC, ESR
- Review client history for repeated Uveitis
- Inflammation of the injured / previously operated eye (Exciting eye) followed by the other eye
(Sympathizing eye)
- Photophobia
- Blurring of vision
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Disorders of the Cornea
Corneal Ulcerations
- Medical Emergency
- May result to corneal perforation, scarring or intraocular infection, permanent impairment of
vision
Causes:
� Trauma
� Exposure to toxic agents
� Allergy
� Vitamin deficiency
� Lowered resistance
� Bacterial, viral, fungal infections
Corneal Opacity
- Lack of corneal transparency due to inflammation, ulceration or injury
MEDICAL MANAGEMENT
- Treatment
o Trifluridine (Viroptic), Idoxuridine (IDU), Adenine Arabinoside (Vira-A)
o Mechincal Chemical Debridement
- Corneal Transplantation (Keratoplasty)
o To repair corneal opacity, perforation of the corneal ulcer
o Ideally a donated eye is transplanted immediately or is removed from the body
within 2 – 4 hours of death
o Corneal may still be viable within 12 hours, after death if the body has been
refrigerated; may be transplanted up to 48 hours after death if it is kept in a sterile
container on a piece of gauze soaked in NSS at 4°C
o Clear vision will appear after 6 – 12 months of surgery)
NURSING RESPONSIBILITY
- For corneal surgery
o Position the client in supine for 1 hour and remain supine until the 1st post op day
o Teach the client signs graft failure (RSVP)
1) Blurring of vision
2) Discomfort
3) Tearing
4) Redness of the EYE
o Medications Post Op
� Pain medications
� Corticosteroids
Retinitis Disorders
Retinitis - Often associated with disease of the choroid
- Caused by bacteria, fungi, toxoplasmosis, cytomegalovirus
- Assess through Ophthalmoscopy
MEDICAL MANAGEMENT
- Collaborative Management
o Rest the eye
o Protect the eyes from light
o Atropine SO4
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NURSING RESPONSIBILITY
Assess
- Reduced visual acuity
- Changes in the visual field
- Alterations in the shape of objects
- Discomfort in the eyes
- Photophobia
Retinal Detachment - Separation of the 2 primitive layer of the retina (Outer pigment epithelium and the inner rod and
cones layer)
- Elevation of both retinal layers away from the choroid because of the presence of a tumor
- Related to tumors (Trauma)
Causes:
- Myopic degeneration
- Trauma
- Aphakia (Absence of crystalline lens)
- Hemorrhage
- Exudates that occur in front / behind the retina
- Sudden, severe physical exertion especially in persons who are debilitated
Assessment:
- Floating spots or opacities before the eyes, these are blood and retinal cells that are freed
at the time of the tear and cast shadows on the retina as they seem to drift about the eye
- Flashes of light – the light that enters (***)
- Progressive constriction of vision in one area – When detachment is extensive and occurs
*** there is a sensation that a curtain has been drawn before the eyes or as if looking over
a fence
- If upper portion is detached, the visual field loss is inferior
- On opthalmoscopy, visual field is (***)
MEDICAL MANAGEMENT
- The head is positioned *** that the retinal hole is in the lowest part of the eye (Dependent
position)
- Early surgery is required to reattach the retina
o Scleral Buckling – To produce indentation
o Photocoagulation
o Cryopexy
o Vitrectomy
NURSING MANAGEMENT
- Keep the client quiet in bed with eyes covered to prevent further detachment
RETINAL DETACHMENT � PreOp Care
o Mydriatics (OU) as ordered
� PostOp Care
o Position dependents on the extent and location of retinal detachment. The area (***)
- Ambulation and activity will be prescribed by the surgeon
- Pressure patch over the eye
- Rest the eyes and head immediately post op
- Avoid straining, nausea and vomiting, coughing, Valsalva maneuver
- Change dressing daily
- Note: Hemorrhage is common complication of the surgery
Retinitis Pigementosa - Rods Problem
- Night blindness
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- Sedentary activity resumed after 3 weeks
- Activity / Occupation that requires heavy physical exertion may not be prescribed
Macular Degeneration (Age-Related)
- Clear vision is the most affected rather than peripheral vision
- Two Types
1) Dry – Outer layer of the retina break down (65 years old) [70%]
2) Wet – Proliferation of abnormal blood vessels growing under the retina [30%]
MEDICAL MANAGEMENT
- No known cure for dry type if AMD, it can only slow the progression of the disease
- Administration of high doses of antioxidants like Vitamin C, E, A and beta carotene, zinc
NURSING MANAGEMENT
- Encourage client to use Amsler Grid
- The client should be encouraged to look at the grids, one eye at a time several times each week
- Any changes in the grid must be informed to the physician immediately
Glaucoma
- Group of ocular conditions characterized by optic nerve damage
- There is no cure but can be controlled
- Acute and chronic
- Primary and Secondary (Alone / with conditions)
- Open (Wide) – No obstructions; Closed (Narrowed)
- Secondary to ↑ IOP, optic nerve damage, and structural changes in the canal of Schlemm /
Trabecular meshwork
CLASSIFICATION of Glaucoma
- Open Angle
- Angle Closed
Acute Glaucoma
- Eye disease characterized by suddenly impaired vision due to intraocular tension
caused by an imbalance in production and excretion of aqueous humor
- It is a result of an abnormal displacement of the iris (***)
Chronic Glaucoma
- Eye disease characterized by impaired vision due to intraocular tension caused by an
actual obstruction in the excretion of aqueous humor
- It develops slowly, at first no symptoms
- Vision is lost first before diagnosed with Glaucoma
GLAUCOMA IS IRREVERSIBLE
- This is due to the compression and damage of the retina and optic nerve
- The blockage to the circulation of the aqueous humor may be secondary to:
• Infection (Uveitis) (Acute glaucoma)
• Injury (Acute Glaucoma)
- Hereditary
NURSING RESPONSIBILTY
- Assess
• Tunnel Vision
• General discomfort
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• Loss of peripheral vision can progress until the person is legally blind
• Usually begins with one eye, if left untreated, both eyes become affected
• Persistent dull eye pain in the morning
• Frequent change of eye glasses, difficulty adjusting to darkness
• Failure to detect changes in color accurately
MEDICAL MANAGEMENT
- Objectives: To reduce intraocular pressure and keep it at a safe level