Lecture Notes

Classroom Activity to Accompany Diseases of the Human Body Fifth EditionCarol D. Tamparo Marcia A. Lewis

17Eye and Ear

Diseases and Disorders

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Diseases and Disorders of the Eye

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Life is either a daring adventure or nothing at all.

—Helen Keller

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Common Signs and Symptoms of Eye Diseases and Disorders• Any visual disturbance• Pain or burning in eye, any of its structures

• Eye redness• Photophobia

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Refractive Errors• Description

• Defects in visual acuity and eye’s inability to focus light on surface of retina

• Hyperopia: far-sightedness• Presbyopia: loss of elasticity in the lens, consequence of advancing age

• Myopia: near-sightedness• Astigmatism: variations in the curvature of the lens or cornea

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Refractive Errors• Etiology

• Except for presbyopia cause in not known

• Genetic predisposition is suggested

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Refractive Errors• Signs and symptoms

• Visual disturbances• Squinting• Headaches• Frequent rubbing of the eyes

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Refractive Errors• Diagnostic procedures

• Testing for visual acuity• Snellen chart• Ophthalmoscopic exam• Tests to determine muscle function

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Refractive Errors• Treatment

• Prescription and fitting of corrective lenses

• LASIX surgery• Photorefractive keratectomy• Astigmatic keratectomy• Intrasomal corneal rings to correct myopia

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Refractive ErrorsComplementary therapy

• See the American Academy of Ophthalmology for suggestions

Client communication• Educate about care and use of contacts

• Encourage good postoperative care and follow-up

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Refractive Errors• Prognosis

• Good with corrective lenses/ surgery

• Prevention• None known

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Stye (Hordeolum)• Description

• Localized, purulent, inflammatory infection of one or more sebaceous glands of the eyelid

• Commonly occur on skin surface at edge of lid or the surface of the conjunctiva

• Usually result of staphylococcal bacteria

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Corneal Abrasion• Description

• Painful scrape or scratch on the cornea• Produced by foreign bodies, fingernail scratch, poorly fitting or scratched contact lens, excessive eye rubbing

• Any ulceration of cornea can cause permanent vision loss

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Cataract• Description

• Gradual clouding of eye’s crystalline lens or its surrounding membrane

• Unilateral or bilateral• Affects visual acuity• Common in elderly clients

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Cataract• Etiology

• Change in chemical composition of lens causes loss of transparency

• The result of aging, injuries, some diseases, genetics, birth defects

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Cataract• Signs and symptoms

• Gradual, painless loss, or blurring of vision

• Seeing halos around lights• In mature cataract, eye pupil may appear white

• Diagnostic procedures• Ophthalmoscopy• Penlight or slit-lamp exam

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Cataract• Treatment

• Depends upon degree of visual impairment, age, general health of client

• Surgical removal of lens, replacement with corrective devices

• Surgical implanted artificial lens may be used

• Phacoemulsification

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CataractComplementary therapy

• Protect eyes from ultraviolet light

Client communication• Instruct on postoperative care• Wear sunglasses that block UVB rays

UVB = ultraviolet B.

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Cataract• Prognosis

• Good with corrective surgery• Prevention

• None known

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Glaucoma• Description

• Aqueous humor is produced faster than can be drained from the eye

• Fluid pressure builds within the eye; damages retina, optic nerve

• Often causes blindness

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Glaucoma• Etiology

• Open-angle glaucoma is idiopathic• Genetic factors are possible• Secondary to diseases, toxins, medications

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Glaucoma• Signs and symptoms

• No symptoms until irreparable damage has occurred

• There may be aching in the eyes • Visual disturbances• Seeing halos around lights• Losing peripheral vision

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Glaucoma• Diagnostic procedures

• Tonometry measures eye pressure• Ophthalmoscopy exam• Vision field testing

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Glaucoma• Treatment

• Eye drops decrease intraocular pressure or production of aqueous humor

• Laser or microsurgery to lower eye pressure

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GlaucomaComplementary therapy

•Antioxidant supplements may be beneficial

Client communication•Teach clients how to administer prescribed eye medications

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Glaucoma• Prognosis

• Good with early treatment• Drug therapy is lifelong

• Prevention• Ophthalmoscopy exams every 3 to 5 years after age 20

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Glaucoma• Glaucoma is caused by overproduction of 1. vitreous humor2. tears3. aqueous humor4. lymph fluid

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Retinal Detachment• Description

• Complete or partial separation of retina from choroid layer of eye

• Leads to the loss of retinal function and blindness

• Result of hole or break in retina that allows vitreous fluid to accumulate between the layers

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Age-Related Macular Degeneration (AMD)• Description

• Slow, progressive changes that occur in pigmented cells of retina and macula

• Result is loss of fine vision in one or both eyes

• Leading cause of new blindness in the United States

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Age-Related Macular Degeneration (AMD)• Description

• Two types• Dry, non-neovascular: 90% of cases; begins in middle-age; progresses slowly

• Wet, neovascular: may be abrupt onset; vessels leak, hemorrhage, and form scars, causing central vision loss; leading cause of legal blindness in the United States

• Affects persons age 60 and older

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Age-Related Macular Degeneration (AMD)• Etiology

• Risk factors• Advancing age, hyperopia, familial tendencies

• Smoking, hypertension, light iris color

• Wet form may be inherited or result from injury or infection

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Age-Related Macular Degeneration (AMD)• Signs and symptoms

• Appearance of drusen, spots on the retina

• Painless vision loss and/or distortion

• Diagnostic procedures• Retinal exam using Amsler chart• Fluorescein angiography

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Age-Related Macular Degeneration (AMD)• Treatment

• No treatment for dry form• Nutritional intervention may prevent progression to wet form

• Laser therapy

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Age-Related Macular Degeneration (AMD)Complementary therapy

• Foods high in vitamins E and C, lutein found in dark, leafy vegetables are beneficial

Client communication• Stress regular eye examinations• Suggest magnifiers and reading devices

• Encourage support systems

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Age-Related Macular Degeneration (AMD)• Prognosis

• Loss of vision is certain• Early diagnosis and treatment is essential

• Prevention• Ingestion of antioxidants and zinc

• Regular eye examinations

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Conjunctivitis• Description

• Highly infectious infection of conjunctiva

• Most common eye disease worldwide• Usually lasts 2 weeks

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Conjunctivitis• Etiology

• Bacterial or viral infection• Transmitted by hands, contaminated washcloths

• May be caused by irritation from heat or cold, chemicals, allergies, or exposure to UV light

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Conjunctivitis• Signs and symptoms

• Red, swollen conjunctivae• Itching, burning, tearing• Light sensitivity

•Diagnostic procedures• Eye exam• C&S test determines organism

C&S = culture and sensitivity.

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Conjunctivitis• Treatment

• Causative agent determines treatment

• Antibiotic therapy• Warm compresses applied to eye 3 to 4 times a day for 10 to 15 minutes

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ConjunctivitisComplementary therapy

• Boric acid compress• Ingestion of vitamins A and C, and zinc

Client communication• Teach eye protection, cleanliness• Do not share towels, makeup

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Conjunctivitis• Prognosis

• Good if degeneration of conjunctiva does not occur

• Prevention• Careful hygiene, hand washing prevent spread of infection

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Conjunctivitis• The conjunctiva is the _________ of the eye.1. white2. mucous membrane3. colored portion4. refractive structure

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Diseases and Disorders of the Ear

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Of one thing I am certain, the body is not the measure of healing —

peace is the measure.

—George Melton

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Common Signs and Symptoms of Ear Diseases and Disorders• Hearing loss• Tinnitus• Ear pressure• Loss of balance• Pain• Dizziness

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Impacted Cerumen• Description

• Cerumen: soft, brown, wax-like secretion found in external ear canal accumulates abnormally

• Cerumen should not be removed unless impacted

• Impaction can cause temporary hearing loss

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External Otitis (Swimmer’s Ear)• Description

• Inflammation of the external ear canal

• Result of fungal infection from swimming, from a scratch, or eczema

• May result from bacterial infection

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Otitis Media• Description

• Fluid accumulates in the middle ear

• Acute or chronic• Most common in children• Two forms

• Serous fluid: clear and sterile• Suppurative fluid: product fluid—product of pus-producing bacteria

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Otitis Media• Etiology

• Acute serous form: occurs spontaneously or follows URI, rapid changes in atmospheric pressure

• Serous chronic form: follows acute infection, overgrowth of adenoidal tissue, or chronic sinus infections

URI = upper respiratory infection.

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Otitis Media• Etiology (cont.)

• Suppurative form caused by pyogenic microorganisms in the middle ear

• Follows flu, colds• Those with short, wide, more horizontally placed Eustachian tubes are at greater risk

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Otitis Media• Signs and symptoms

• Vary with severity of infection• Sensation of fullness or pressure in ear

• Pain, symptoms of infection• Dizziness• Varying degree of hearing impairment

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Otitis Media• Diagnostic procedures

• Otoscopic exam of affected ear• Red discoloration of eardrum• Fluid bubbles behind eardrum• Elevated WBC in suppurative otitis media

WBC = white blood cell count.

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Otitis Media• Treatment

• Analgesics• Antibiotics; but only in severe cases

• Decongestants• Myringotomy, tympanoplasty, inserting tubes into tympanic membrane

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Otitis MediaComplementary therapy

• None

Client communication• Take all antibiotics if prescribed• Stress proper preoperative and postoperative care as needed

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Otitis Media• Prognosis

• Good with prompt treatment• Chronic otitis media may lead to scarring and hearing loss

• Prevention• Prompt treatment of URIs

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Otitis Media• The fluid in the serous type of otitis media appears1. bloody2. cloudy3. thick4. clear

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Motion Sickness• Description

• Nausea, vomiting, vertigo induced by irregular or rhythmic movements—plane, boat, auto travel

• Etiology• Any motion that disturbs equilibrium of semicircular canals in ear

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Motion Sickness• Signs and symptoms

• Loss of equilibrium• Nausea, vomiting• Dizziness, diaphoresis

• Diagnostic procedures• History and complaints

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Motion Sickness• Treatment

• Antihistamines, antiemetics, sedatives

• Transdermal patch

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Motion SicknessComplementary therapy

• Fresh ginger tea, slices of candied ginger

Client communication• Avoid exposure to offending motion• Focus on distant object

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Motion Sickness• Prognosis

• Can be severe and debilitating, but disappears with restoration of equilibrium

• Prevention• CDC produces a Traveler’s Health Yellow book with suggestions to prevent motion sickness

CDC = Centers for Disease Control and Prevention.

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Ménière Disease• Description

• Chronic inner ear syndrome marked by vertigo, progressive deafness, tinnitus, and a sensation of fullness in the ear

• Usually appears in persons between ages 40 and 50

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Ménière Disease• Etiology

• Cause not known• Appears to destroy hair cells in the cochlea

• Rupture of the membranous labyrinth allows endolymph to mix with perilymph that may cause symptoms

• Other possible causes: noise pollution, viral infections, biological factors

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Ménière Disease• Signs and symptoms

• Classic symptoms• Severe vertigo• Tinnitus• Sensorineural hearing loss

• Other symptoms• Nausea and vomiting• Sweating• Loss of balance

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Ménière Disease• Diagnostic procedures

• Diagnosis by classic symptoms• Audiometry• Radiographs of the internal meatus

• MRI

MRI = magnetic resonance imagining.

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Ménière Disease• Treatment

• No cure• Salt-free diet, diuretics• Antihistamines, mild sedatives• Labyrinthectomy; sacrifices hearing

• Vestibular neurectomy• Gentamicin to the middle ear space to control vertigo

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Ménière DiseaseComplementary therapy

• None

Client communication• Instruct clients on how to maintain a low-sodium diet

• Educate about side effects of medication

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Ménière Disease• Prognosis

• Varies, but recurrent attacks lead to residual tinnitus and hearing loss

• Prevention• None

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Hearing Loss/Deafness• Description

• Involves one or both ears• Mild, moderate, severe• More commonly in elderly clients

• Etiology• Congenital, trauma, infections, otosclerosis, damage to nerves, idiopathic

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Hearing Loss/Deafness• Signs and symptoms

• Difficulty hearing in large group• Tinnitus• Noticed by family members

• Diagnostic procedures• Audiologic exam to evaluate hearing loss

• Determine cause• Weber and Rinne tuning fork tests

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Hearing Loss/Deafness• Treatment

• May include hearing aids, tympanoplasty, or stapedectomy

• Cochlear implants

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Hearing Loss/Deafness

Complementary therapy• None

Client communication• Teach proper use of hearing devices• Help others understand the imperative of facing the person when speaking

• Encourage lip reading or sign language if there is total hearing loss

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Hearing Loss/Deafness• Prognosis

• Dependent upon cause• Conductive hearing loss easily treated with hearing devices

• Sensorineural loss has no cure

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Hearing Loss/Deafness• Prevention

• Eliminate exposure to loud noises• Wear ear protection• Prompt treatment of ear infections

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Hearing Loss/Deafness• The Weber and Rinne tests are done using a(n) 1. tuning fork2. audiometer3. otoscope4. tympanometer

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CreditsPublisher: Margaret BiblisAcquisitions Editor: Andy McPheeDevelopmental Editor: Yvonne Gillam, Julie MundenBackgrounds: Joseph John Clark, Jr.Production Manager: Sam RondinelliManager of Electronic Product Development: Kirk PedrickElectronic Publishing: Frank MusickThe publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation.