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Keloid
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SYSTEMSYSTEM
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ANATOMY & PHYSIOLOGY OF EYESANATOMY & PHYSIOLOGY OF EYESEXTERNAL STRUCTURES
EYELIDS
CONJUNCTIVAPALBEBRALBULBAR
LACRIMAL APPARATUSLACRIMAL GLAND, DUCTS & PASSAGES
6 EXTRAOCULAR MUSCLES
Levator palpebrae muscle
EXTERNAL STRUCTURES
EYELIDS
CONJUNCTIVAPALBEBRALBULBAR
LACRIMAL APPARATUSLACRIMAL GLAND, DUCTS & PASSAGES
6 EXTRAOCULAR MUSCLES
Levator palpebrae muscle
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ANATOMY & PHYSIOLOGYEYESORBIT
EYEBALL : 3 LAYERS: OUTER
SCLERACORNEA
MIDDLE CHOROIDCILIARY BODY IRIS
•INNER–RODS
–SENSITIVE TO LIGHT–PERIPHERAL VISION
–CONES–FINE DESCRIMINATION–COLOR VSION
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EYESEYES
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ANATOMY & PHYSIOLOGYEYESLENS – FOCUS IMAGE
FLUIDS OF THE EYE:AQUEOUS HUMOR
ANTERIOR & POSTERIOR CHAMBERS ANTERIOR EYE CAVITY NUTRIENTS TO LENS & CORNEA INTRAOCULAR PRESSURE MAINTENANCE
20-25 mmHgVITREOUS HUMOR
POSTERIOR EYE CAVITY TRANSPARENCY & FORM OF THE EYE
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EYESEYES
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VISUAL PATHWAYSRETINARETINA
OPTIC NERVEOPTIC NERVE
OPTIC CHIASMOPTIC CHIASM
OPTIC TRACTOPTIC TRACT
OCCIPITAL LOBEOCCIPITAL LOBE
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Physical Examination-EYEVISUAL ACUITY : SNELLEN’S CHARTVISUAL FIELDS: PERIMETRYEXTERNAL STRUCTURES
POSITION & ALIGNMENT OF EYESPUPILS (PERRLA)
EXTRAOCULAR MOVEMENTSPARALYSISNYSTAGMUS
CORNEAL REFLEX
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DIAGNOSTIC TESTSSNELLENOPHTHALMOSCOPEBIOMICROSCOPE / SLITLAMP
EXAMINE THE ANTERIOR SEGMENT OF THE EYETONOMETER
14-20 mmHgBJERRUM’S TANGENT SCREEN
CENTRAL FIELD OF VISIONISHIHARA COLOR PLATE TEST
IDENTIFY 3 PRIMARY COLORSGONIOSCOPY
ANGLE OF ANTERIOR CHAMBER
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PLANNING FOR HEALTH PROMOTIONCARE OF THE EYES
EYEDROPS, DISCOURAGEDPRINTED MATTER: 14 INCHES AWAYTV: 10-12 FT AWAYREAD WITH ILLUMINATION: 100-150
WATTSLIGHT FROM BEHINDTEACH ABOUT DANGER SIGNALS OF
VISUAL DISORDER
•PERSISTENT REDNESSPERSISTENT REDNESS•CONTINUED DISCOMFORT & PAIN ESP CONTINUED DISCOMFORT & PAIN ESP
FOLLOWING INJURYFOLLOWING INJURY•CHILDREN: CROSSING OF EYESCHILDREN: CROSSING OF EYES•BLURRED VISION/ SPOTS BEFORE THE EYESBLURRED VISION/ SPOTS BEFORE THE EYES•GROWTH ON THE EYE/ OPACITIESGROWTH ON THE EYE/ OPACITIES•CONTINUAL DISCHARGE, CRUSTING ORCONTINUAL DISCHARGE, CRUSTING OR
TEARINGTEARING•PUPIL IRREGULARITIESPUPIL IRREGULARITIES
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DISORDERS - EYEINJURIES &
TRAUMA
INFECTIONS
CATARACT
GLAUCOMA
DETACHMENT OF THE RETINA
REFRACTIVE ERRORS
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INJURIES & TRAUMAEMERGENCY:TREAT THE PATIENT, LEAVE THE EYE
ALONE, EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT
FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEA
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INFECTIONSHORDEOLUM/ STY -Zeis gland in the
follicle
CHALAZION –meibomian glandsCONJUNCTIVITIS – pink eye
bacterial infection, allergy, trauma
UVEITIS - irisKERATITIS - corneaPTERYGIUM – triangular fold
From white of the eye to the cornea
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Conjunctivitis
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Sty
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Chalazion
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Pterygium
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CATARACTOpacity of the lens & its capsule which interferes
with transparency
S/SX:Dimness in visual acuityRapid & marked refraction error
CLASSIFICATION:Primary/ senileSecondary/ traumaticCongenital
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Cataract
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TreatmentReplacement of the intra ocular lens
Commonly done by phakoemulsification technique
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EYE SURGERYNURSING CARE PRE-OP
Orient to new environment
Teach deep breathing & how to close eyes without squeezing
Eye antibiotics preop
Mydiatrics if ordered
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EYE SURGERYNURSING CARE POST-OP
Reorient patient to his surroundings
Prevent increase in IOP & stress on the suture line
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Contd….ACTIVITIES THAT INCREASE IOP:ACTIVITIES THAT INCREASE IOP:
• CoughingCoughing• Vomiting Vomiting • Bending Bending • Stooping Stooping
• Promote comfort of the patient: mild Promote comfort of the patient: mild analgesic to control painanalgesic to control pain
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EYE SURGERYNURSING CARE POST-OP
Observe & treat complicationsCOMPLICATIONS:COMPLICATIONS:•NAUSEA & VOMITINGNAUSEA & VOMITING
•AntiemeticsAntiemetics•Cold compressCold compress
•HEMORRHAGEHEMORRHAGE•Sudden pain of the eyeSudden pain of the eye
•PROLAPSE OF THE IRISPROLAPSE OF THE IRIS•Most common postop complicationMost common postop complication•Can precipitate glaucomaCan precipitate glaucoma
• Promote the rehab of the patientPromote the rehab of the patient•Encourage the patient to become Encourage the patient to become
independent- walk with him when he first independent- walk with him when he first become ambulatorybecome ambulatory•Health teachingsHealth teachings
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EYE SURGERY HEALTH TEACHINGS:
1-4 wks : dark glasses; temporary corrective lenses
6-8 wks: permanent lensesIt will take time to learn distances & climb
stairsColor slightly changedUse one eye at a time unless with contact lensDecreased peripheral vision
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GLAUCOMA INCREASED IOP PROGRESSIVE LOSS OF PERIPHERAL VISION
CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMOR
TYPES:1. CHRONIC/ SIMPLE/ OPEN-ANGLE2. ACUTE ANGLE CLOSURE3. Congenital4. Secondary – trauma, uveitis, postop5. Absolute – uncontrolled- enucleation
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EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
OPEN-ANGLE GLAUCOMAOPEN-ANGLE GLAUCOMA
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EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
ACUTE-ANGLE CLOSURE GLAUCOMAACUTE-ANGLE CLOSURE GLAUCOMA
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OPEN ANGLE GLAUCOMAS/SX:
Loss of peripheral vision (tunnel)Difficulty in adjusting to darknessFailure to detect changes in colorHeadache, pain behind the eyeballHalosNausea & vomiting
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OPEN ANGLE GLAUCOMAMANAGEMENT:
Conservative :Miotics : pupillary constriction
draw iris smooth muscle away from the canal
Acetazolamide : decrease aqueous production
Fluid restriction
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Definitive managementPrinciple: improve drainage of aqueous
• Iridocleisis-anterior chamber & subconjunctival space
• Corneoscleral trephening – junction of cornea & sclera
• Trabeculotomy
• Laser therapy to meshwork
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Acute Angle GlaucomaCAUSE:Pupillary dilation by mydiatricsAbnormal anterior displacement of iris
S/SX:Severe eye painNausea & vomitingBlurred visionColored halos around lightsDilated pupilsIncreased IOP
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MANAGEMENT:
• Miotics• Azetazolamide• Osmotic agents – glycerol• Surgery - iridectomy
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GLAUCOMANURSING CARE – SURGERY
PRE-OPExplain that vision lost cannot be restored,
but further loss can be prevented
POST-OPFlat 24H- prevent iris prolapseNarotics or sedativesLiquid diet until 1st dressingTurn to unoperative site
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LONG TERM CARE:
• No restriction on the use of the eyes• No fluid restriction; exercise permitted• Medical follow up needed for life
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RETINARETINA CHOROIDCHOROID
SCLERASCLERA
OPTIC NERVEOPTIC NERVE
RETINAL DETACHMENTRETINAL DETACHMENT
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RETINAL DETACHMENTFluid accumulationTumor
CAUSE:Myopic
degenerationTraumaAphakia
S/SX: Floating spots or
opacities before the eye
Casts shadows on the retina
BrightFlashes of light
Progressive constriction of vision in 1 eye
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Management
Conservative :• Quiet in bed with eyes covered• Head: positioned so that retinal holes lower• Photocoagulation – small burn to retina
• Cryotherapy – cold probe to freeze retina
Surgical: • Scleral buckling- Scleral buckling- sealing break & reattachingsealing break & reattaching
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RETINAL DETACHMENTPOST-OP NURSING CARE:Cover eyesArea of detachment, dependentMydiatricsDischarge instructions:
No strenuous exercises & acivity x 6mosContact sports restrictedNo sudden jarring head motionNo restriction with use of eyes
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REFRACTIVE ERRORSREFRACTION – bending of light raysACCOMMODATION – ability to adjust from near to
far visionADAPTATION – ability to see light from darkness
COMMON ERRORS:MyopiaHyperopiaPresbyopia
•Astigmatism•Blindness
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myopiaNEAR-SIGHTED
Long A-P dimension of the eyeballLight rays focus infront of the retinaGood vision for near distancesConcave lenses
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Myopia
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hyperopiaFAR-SIGHTED
Eyeball A-P dimension too shortLight rays focus behind the retinaGood vision for far distancesConvex lenses
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Hyperopia
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presbyopiaFARSIGHTEDNESS OF OLD AGE
Gradual loss of accommodationLoss of lens elasticityInability to read without holding the material
more than 13 ft from the eyeBifocal lenses
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ASTIGMATISM
Asymmetry or irregular curvature of the cornea
Cylindrical lenses
BLINDNESS
Vision: 20/200
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ANATOMY & PHYSIOLOGYEARSEXTERNAL EARAURICLEPINNATYMPANIC MEMBRANE
MIDDLE EAROSSICLES: MALLEOUS, INCUS, STAPESEUSTACHIAN TUBE
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EAREAR
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ANATOMY & PHYSIOLOGYEARSINNER EARORGAN OF CORTI
HEARING
VESTIBULAR APPARATUSBALANCE3 SEMICIRCULAR CANALSUTRICLE
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EAREAR
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ANATOMY & PHYSIOLOGYEARS
SOUND WAVES TO TYMPANIC MEMBRANESOUND WAVES TO TYMPANIC MEMBRANE
OSSICLES IN MOTIONOSSICLES IN MOTION
VIBRATION FROM STAPES TO OVAL WINDOWVIBRATION FROM STAPES TO OVAL WINDOW
COCHLEA : ORGAN OF CORTICOCHLEA : ORGAN OF CORTI
CRANIAL NERVE 8 TO TEMPORAL LOBECRANIAL NERVE 8 TO TEMPORAL LOBE
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HEARINGHEARING
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AUDITORY ASSESSMENTEXTERNAL EAR EXAMINATION
Inspection & palpation of auricleVisualization: straighten the auditory canal:
PULL AURICLE UP, & BACK
NORMAL EARDRUM: slightly conicalShinypearly gray in color
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AUDITORY ASSESSMENTHEARING TEST:
Tests for acuteness of hearing or degree of deafness:
Whisper or spoken voice testAudiometer :
Pure tone – mx loudness in decibelSpeech – ability to understand & descriminate
Watch tick testTuning fork test
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AUDITORY ASSESSMENTHEARING TEST:
Test to localize cause of deafness:
Rinne’s
Weber’s
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Auditory assessmentWEBER’S
• Tuning fork top midline of the head• Sound heard: normal ear vs affected ear• Better in affected ear: conductive• Better in normal ear : sensorineural
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AUDITORY ASSESSMENTTEST FOR VESTIBULAR FUNCTON
CALORIC TESTCheck direction of nystagmusCOWS ( cold-opposite; warm-same side of
stimulated ear)ROTATION (BARANY) TEST
Rotating chairNystagmus is opposite to the direction of
rotation
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HEALTH PROMOTIONEAR PROTECTION
Noise over 70 decibels is potentially damaging to hearing
Most common & impt type of occupational hearing is caused by LOUD NOISE
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GENERAL EAR CAREEar is self-cleaning
Cerumen-lubricant; traps dirt
Cleanse the external ear reached by vision
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NURSING INTERVENTIONSEAR DROPSWarmAfter adm’n, head should remain tiltedSOFTENING & REMOVING IMPACTED
CERUMENFew drops of hydrogen peroxide/ warm
glycerineIrrigate the ear
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NURSING INTERVENTIONSEAR IRRIGATION
To clean the external canalRemove impated cerumenCaloric testApply antiseptic solutionsRemove foreign bodies
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COMMON EAR PROBLEMS
1. OTOSCLEROSIS
2. MENIERE’S DISEASE
3. HEARING IMPAIRMENT
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OTOSCLEROSISNormal bone is replaced by spongy bone
Ankylosis of the footplate of the stapes
Impaired vibration system
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OTOSCLEROSISASSESSMENT
Gradual hearing loss Difficulty hearing a whisperOwn voice is loudParacusis : hear better in loud
environmentRinne’s test: bone conduction better
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OTOSCLEROSISPLANNING & IMPLEMENTATION
Hearing aidSurgery – primary form of tx
StapedectomyStapes mobilization operationFenestration operation : new window is
created
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EAR SURGERYPRE-OP CARE;
Hair shampooInform client:
Head still during surgeryPost op: get out of bed with assistance
avoid nose blowing until 1 week
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EAR SURGERYPOST OP
Promote comfort & safety
Promote psychological well-being
Prevent complications
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Complications
• Facial nerve involvement• Facial paralysis, facial weakness• Inability to show teeth, wrinkle forehead, raise eyebrows or close eyes
• Meningitis – bacterial• Report signs & symptoms
• Bleeding
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MENIERE’S DSEChronic Increase in endolymphatic pressure
ASSESSMENT:TinnitusUnilateral hearing lossVertigo
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MENIERE’S DSEPLANNING & IMPLEMENTATION
CONSERVATIVE: palliativeBed restMeds
Sedative :Phenobarbital Antihistamine Antiemetics
Low salt diet
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MENIERE’S DSEPLANNING & IMPLEMENTATION
SURGERY- delayed until client’s hearing below the serviceable levelDestruction of the labyrinthDecompression of endolymphatic sacSectioning of the vestibular nerveCryosurgery of the labyrinth
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HEARING IMPAIRMENTTYPES OF HEARING LOSS
CONDUCTIVE Damage to the conducting system Hearing aid is useful
SENSORINEURAL Damage to the:1. Organ of Corti2. Cochlear nerve3. Acoustic branch of the auditory nerve
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COMMUNICATING WITH HEARING-IMPAIRED CLIENTSAvoid use of gestures without speechDo not shoutSpeak distinctly & as close to the clientUse short phrasesDo not communicate with someone else in
front of a hearing-impaired clientHearing impairment goes with visual
problems in elderly
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SOUND AMPLIFICATIONTYPES OF HEARING AIDS;
Post-auricularBody-typeIn-the ear model
Select hearing aid that has cotrollable volume & is properly fitted
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