Opposite constriction of eye when a penlight is used on the

other.
ENT

EYE ASSESSMENT

Exopthalmos

 Proptosis

 Protrusion of the eye

BLEPHARITIS

 Eyelid inflammation.

 “blepharos” -> etelid (greek)

 Manifestation:

(1) Redness (2)Itchy eyelids (3)Dandruff-like scales

Treatment: Baby shampoo scrub

Enophthalmos
Warm moist compress
Sunken appearance of eyeball

Anisocoria
ENTROPION
Difference in size of pupils
 Turning inward of the eyelid.

 Causes eye lashes to rub against the eye.

 Treatment: Surgery

Consensual Reflex
DRY EYE SYNDROME

 Inadequate wetting and lubricant of the eye.

 Cause: Dry enviroment or workplace, Sun exposure

 Treatment: Tears Naturalle

 Red- Green

COLOR BLINDNESS -Most common

 Inability to see certain colors in the usual way.  Blue-Yellow

 Anatomy defect: Cones Treatment:

 Diagnostic: Ishihara Test >Lifelong disorder.

>Special contact lenses & glasses.

CONJUNCTIVITIS

 “Sore eyes”, “Pink eyes”

 Inflammation or infection of the transparent membrane

(conjunctiva)

 Most common ocular disease worldwide.

Causes:

 Bacterial or viral infection

 Allergic reaction
 Etiology:
 Incompletely opened tear duct. (Babies)
-Genetic
 Irritants (Shampoo, Dirt)
-Aging
 Pathophysiology: Subconjunctival blood vessel
-Medical conditions
Hemorrhage
>Diabetes
Manifestation:
>Macular degenaration
 Redness in the white of the or inner eyelid
>Glaucoma
 Unilateral or Bilateral

 Itchiness
COLOR BLINDNESS TYPES
 Scratching or Burning sensation
 Achromacy/Achromatopsia

-”No Color”

-Sees only gray

 LASIK EYE SURGERY

PREVENTION  “Laser-assisted in situ keratomileusis”

 Don’t touch your eyes with your hands.  Treatment for:

 Don’t share personal items such as eye cosmetics. >Astigmatism

 Wash hands regularly. >Myopia

TREATMENT >Hyperopia

 Self Limiting, 2-week course

 Eye drops, or ointment

 Cool water compress LASIK PROCEDURE

 Avoid straining of the eyes

ASTIGMATISM

 Distorted vision

 Cause

1. Irregular shape of the cornea

2. Curvature of the lens inside the eye.

Treament: Glasses, Surgery

COMPARISON: Hyperopia & Myopia

HYPEROPIA MYOPIA HORDEOLUM

Farsightedness Nearsightedness  Localized infection or inflammation of the eyelid margin

Vision condition in which
distant objects are usually
seen clearly, but close ones
do not come into proper
focus.
Parallel Rays of Light
involving hair follicles of the eyelashes.
Vision condition in which
close objects are seen  “Sty or Stye”
clearly, but objects farther
away appear blurred.
Parallel rays if light focus in
front of the retina

Focus behind the retina Tx: Concave lens

Tx: convex lens

  Seeing bright colors as faded or yellow instead

HORDEOLUM  Double vision

 Causative Agent: Staphylococcus aureus.

 Manifestations: Lid is red and edematous with a small

collection of pus in the form of an abscess.

 Management: Warm compress 10 to 15 mins, 3 times a

day

Incision and Draina

ge

Topical antibiotics

DIAGNOSTICS EVALUATION FOR CATARACT

 Slit-Lamp examination

Magnifies 10 to 40 times the real image.

 Ophthalmoscope

 Snellen’s Chart

Pre-operative care of patient for cataract surgery.

 Hold Aspirin and Warfarin

 Administer Anti-cholinergics

 Cycloplegia

 Mydriasis

 Example:

>Atropine Sulfate ointment 0.5%, 1% and 2% solutions.

CATARACT
>Tropicarmide (Mydriacyl) 0.5%, 1% solution.
 Opacity of the lens

 Common Incidence: Age: 70 y/o and above

Intracapsular removal
 2 Types:
Removal of cataract within it’s capsule.
>Senile cataracts

>Non senile cataracts

Extracapsular removal
Manifestation:

 Painless,blurry vision
Removing the eye’s natural lenses while leaving the back of -->Maybe focusedd for near, intermidiate or far distance
the capsule that holds the lens in place.
-->IOL are mostly made of silicone or acrylic

2. Accommodative Lens IOL

Phacoemulsification
-->Allow cillary muscle to move the lens to focus on different
Uses n ultrasonic devce that liquefies the nucleus and the distances.
cortex which are then suctioned out.
3. Toric IOL

-->Designed to correct refractive error

>Decreasing effects of Astigmatism

Posterior Capsulotomy

 Laser is used to make an opening in the cloudy capsule.

Allows light to pass through again for clear vision

GLAUCOMA

 Optic nerve damage associated with Increased IOP.

 Goal of management: Facilitate outflow of aqueous

humor.

Post-Cataract surgery care: PATHOPHYSIOLOGY

 Watch out for Toxic Anterior Segment Syndrome (TASS). Imbalance of inflow (rate of Aqueous production & Outflow
(Aqueous re-absorption)
 Position the patient on unaffected side

 Keep eye patch in place.

Angle Problem
 Avoid UV light exposure-> Wear sunglasses.
>place where outflow occurs
 Avoid activities that can increases IOP.
>Where iris meets the cornea
>Anger >Coughing

>Vasalva maneuver >Eye strain

GLAUCOMA TYPES
>Bending >Heavy lifting
ACUTE CLOSE ANGLE CHRONIC OPEN ANGLE

 Anterior displacement  Local obstruction to the

Nursing Diagnosis
of iris against corner outflow in the
 Disturbed sensory perception (visual) trabecular meshwork
 Severe frontal pain
 Risk for Injury  Dull pain
 Marked elevation in IOP
 Self care deficit  Slow in progress

Lens used in Cataract surgery

1. Monofocal IOL

-->Traditional lens
 Clinical manifestation:

 Shadow or curtain falling across the field of vision.

 No pain

 Burst of black spots or floaters

MEDICAL MGMT

Timolol Maleate (Timolol)

-->Decrease production of Aquesous humor 4 TYPES of Retinal Detachment

-->Increase outflow of Aqueous humor 1. Rhegmatogenous

-Caused by tear

SURGICAL MGMT: -Associated with high myopia/ s/p Cataract surgery

Use of laser to create an opening in the trabecular meshwork -Most common type

2. Tension

Scar formation -Due to scar formation

-Associated with Diabetic Retinopathy

Tightening of meshwork fibers 3. Rhegmotogenous and Tension combination

4. Exudative

Increased outflow of aqueous humor -Production of a serous fluid under the retina

SURGICAL MGMT: ALTERNATIVES -Due to inflammation (Uveitis)

 Trabeculotomy

-->Creation of an opening through which aqueous fluid DIAGNOSTICS EXAM

escapes by loosely suturing of scleral flap.
 Ophtalmoscope
 Iridectomy
 Slit Lamp examination
-->Creation of a new route for the flow of aqueous humor to
 Color vision test
the trabecular meshwork.

SURGICAL MGMT
Avoid the following medications:
1. Scleral Bukling
 A-tropine
-->To place the retina back in contact with the choroid.
 B-enadryl
-->Sclera is depressed by Silastic (rubber like silicone) sponge
 C-ogentin
& an intraocular injection of air or Sulfur Hexafluoride (SF6)
 Cause further obstruction in the excretion of aqueous gas bubble.
humor.

RETINAL DETACHMENT

Separation of the retina from the choroid

 Seal the edges of the tear

2. Pneumatic Retinopexy

-->For upper portion of eye detachment

-->Small gas bubble is injected into the vitreous body.

EYE TRAUMA MANAGEMENT

3. Laser Photocoagulation  Wash hands

-->A laser is used to burn the edges of the tear and halt  Immediate copious flushing of the eye with water when
progression. corrosive substance come in contact with the eye

 If foreign body is lodged, Do not attempt to remove it

 Avoid pressure on the eye, do not touch, do not rub eye

 Surgery required

 Observe for sympathetic ophalmia

-->Granulomatous uveitis

-->Makes cause blindness

-->May develop days to years after injury

-->Treatment:Enucleation, Steroids,
Immunosuppresants.

Cover with dressing or plastic or metal eye shield for

4. Cryopexy
protection, to limit eye movement and prevent further
uses nitrous oxide to freeze the tissue behind the retinal tear trauma

 Avoid activities that increases IOP

Stimulating scar tissue formation  Use sterile technique when treating th eyes
 Consult ophthalmologist immediately KERATITS

EYE SURGERIES  Cornea Inflammation

Enucleation removal of the eyeball  Signs & Symptoms:

-Eye redness

-Eye pain

-Excessive tearing/discharge

-Difficulty opening your eyelid

Evisceration removal of the entire eyeball contents and

cornea, except the sclera

Cause:

-Injury

-Contaminated contact lenses

-Contaminated water

Treatment

-Antibacterial (Tobramycin)

Exanteration removal of the eyelid, eyeball and orbital

contents
 Tympanic Membrane

 “Ear Drum”

 Consists of layers of skin, fibrous tissue & a mucous

membrane

 Transmits sound vibration to the internal ear

EAR

Eustachian Tube

 “Auditory tube”
3 DIVISION OF THE EAR
 Allows the pressure against inner and outer surfaces of
 Inner
the tympanic membrane to equalize, preventing
 Middle rupture.

 External Ossicles (Middle ear’s 3 bones)

 Malleus (Hammer)

Ear Anatomy
Attaches to the tympanic membrane and transfers sound to -->Tympanic membrane incision
the incus

 Incus (Anvil)

Articulate the malleus and the stapes and carries vibration to

the stapes

 Stapes (Stirrup)

Connects vibratory motion from the incus to the

oval window Transmits vibration to the inner ear

A
Hearing Loss

Conduction loss if there is interference wiyh sound reaching

the inner ear.

Indicators of hearing loss  Tympanoplasty

 Inattentivesness or strained facial expression

 Excessive loudness or softness of speech

 Frequent need to clarify contents of conversation or

inappropriate responses

 Titling of head while listening

 Lack of response when spoken to

OTITIS MEDIA

 Inflammation of the middle ear.

 Pedia specific S & S: irritability and pulling of ear (ear

pain) in young children

 General sign and symptoms:

-->Fever

-->Feeling of fullness in the ear

-->Ear pain
IMPACTED CERUMEN

Med Mgmt

 Antipyretics  Accumulation & Impaction by a yellowish waxy

substance from external auditory canal
 Analgesics
 Main manifestation: Otalgia (ear pain)
 Antibiotics
 Treatment: Ceruminolytic agents:

Glyceryl (Debrox)
Surgical Mgmt:

 Myringotomy
VERTIGO Meniere’s Patho:

 Med Dx: Benign Paroxysmal Positional Vertigo

 Manifestation: Endolymphatic hydrops

 Vertigo (dilations in the endolymphatic space)

 Light- headedness

 Balance loss Increased pressure

 Nausea

 Treatment:

1. Epley manuever/ Canalith Reposition Vertigo Tinnitus

Positioning to move “ear rocks” (small crystals of calcium

carbonates)
Menniere’s Disease Mgmt
2. Betahistime (Serc) -> 8-6 mg dose
 Furstenberg diet
3. Get out of the bed slowly
--> Avoid MSG, Adequate fluids, Low salt
4. Sit down when feeling dizzy
 Avoid stimulants (migrane associated vertigo)

MENIERE’S DISEASE

 Abnormal inner ear fluid balance caused by a

malabsorption in the endolymphatic sac.

 Motion sickness medications

 Diuretrics

 Endolymphatic Shunt surgery


 -->Hollow spaces within
The bones of the head
surrounding the nose.

 Preceded by a cold, allergy attack or irritation by

environmental pollutant.

Otosclerosis

 Irregular bone growth around the ossicles.

 Mgmt: Stapedectomy

SINUSES IN THE BODY

Care of a patient:

Stapedectomy

(1) Audograms and tympanograms

 Hearing acuity

(2) Lie on the non-operations ear w/ HOB elevate.

 Reduce edema

 Prevent dislodgment of the prosthesis.

(3) Avoid unnecessary pressure:

 No airplane travel for about a month.

 Sneeze with the mouth open. Types of Sinusitis

SINUSITIS Chronic Sinusutis

 Infection or inflammation of the paranasal sinuses  Symptoms lasting 8 weeks or longer.

 -Use a specially designed to squeeze bottle to rinse nasal
passages
Recurrent Sinusitis
-Ex: Sinus Rinse
 Several attacks within a year.
 If initial and medical treatment fails:

-Functional Endoscopic Sinus Surgery (FESS)

PEOPLE AT RISK & RISK FACTORS OF SINUSITIS
-Involves enlarging the natural openings from the sinuses to
 Anyone with viral URTI that has not improved after 10
allow drainage.
days or worsen after 5 to 7 days

 People with allergic rhinitis

 Patient with decrease immune system

 Immune deficiencies

 With abnormality of mucus secretion or mucus

movement

---Example: Cystic fibrosis

 With disease of abnormal cilia

---Example: Kartagener’s syndrome

SINUSITIS MANIFESTATION

 Yellowish, greenish nasal discharge

 Clogged nose

 Facial pain/pressure

 Reduced sense of smell and taste

 Cough

 Headache

Sinusitis Diagnostic tools

 Physical Manifestations  Caldwell Luc surgery

 Nasal Endoscopy -George Caldwell and Henry Luc

 CT Scan of the Paranasal sinuses -Access point: Through the upper jaw above one of the
second molar teeth to go to Maxillary Sinus.

-Route is created to connect the maxillary sinus with the nose,

Sinusitis Treatment
thus improving drainage.
 Acute sinusitis and initial recommendations

-Decongestants

-Pain relievers

-Antibiotics

 “Nasal Lavage”
Non-pharmacological & surgical interventions for Sinusitis

 Moisten your sinus cavities

-Drape a towel over your head as you breathe in the vapor

from a bowl of hot water

--->Helps ease pain and help mucus drain.

 Sleep with your head elevated

-Help your sinuses drain, reducing congestion.

 Drink plenty of fluids

-Dilute mucoous secretions and promote drainage.