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Keloid
SYSTEM
ANATOMY & PHYSIOLOGY OF EYES
EXTERNAL STRUCTURES
 EYELIDS
 CONJUNCTIVA
 PALBEBRAL
 BULBAR
 LACRIMAL APPARATUS
 LACRIMAL GLAND, DUCTS & PASSAGES
 6 EXTRAOCULAR MUSCLES
 Levator palpebrae muscle
ANATOMY & PHYSIOLOGY
EYES
 ORBIT
 EYEBALL : 3 LAYERS:
 OUTER
 SCLERA
 CORNEA
 MIDDLE
 CHOROID
 CILIARY BODY
 IRIS
•INNER
–RODS
–SENSITIVE TO LIGHT
–PERIPHERAL VISION
–CONES
–FINE
DESCRIMINATION
–COLOR VSION
EYES
ANATOMY & PHYSIOLOGY
EYES
 LENS – FOCUS IMAGE
 FLUIDS OF THE EYE:
 AQUEOUS HUMOR
 ANTERIOR & POSTERIOR CHAMBERS
 ANTERIOR EYE CAVITY
 NUTRIENTS TO LENS & CORNEA
 INTRAOCULAR PRESSURE MAINTENANCE

20-25 mmHg
 VITREOUS HUMOR
 POSTERIOR EYE CAVITY
 TRANSPARENCY & FORM OF THE EYE
EYES
VISUAL PATHWAYS
RETINA
OPTIC NERVE
OPTIC CHIASM
OPTIC TRACT
OCCIPITAL LOBE
Physical Examination-EYE
 VISUAL ACUITY : SNELLEN’S CHART
 VISUAL FIELDS: PERIMETRY
 EXTERNAL STRUCTURES
 POSITION & ALIGNMENT OF EYES
 PUPILS (PERRLA)
 EXTRAOCULAR MOVEMENTS
 PARALYSIS
 NYSTAGMUS
 CORNEAL REFLEX
DIAGNOSTIC TESTS
 SNELLEN
 OPHTHALMOSCOPE
 BIOMICROSCOPE / SLITLAMP
 EXAMINE THE ANTERIOR SEGMENT OF THE EYE
 TONOMETER
 14-20 mmHg
 BJERRUM’S TANGENT SCREEN
 CENTRAL FIELD OF VISION
 ISHIHARA COLOR PLATE TEST
 IDENTIFY 3 PRIMARY COLORS
 GONIOSCOPY
 ANGLE OF ANTERIOR CHAMBER
PLANNING FOR HEALTH
PROMOTION
CARE OF THE EYES
•PERSISTENT REDNESS
 EYEDROPS,
DISCOURAGED
•CONTINUED DISCOMFORT & PAIN ESP
 PRINTED MATTER:
14 INCHES
AWAY
FOLLOWING
INJURY
•CHILDREN:
CROSSING OF EYES
 TV:
10-12 FT AWAY
•BLURRED
SPOTS BEFORE
EYES
 READ
WITHVISION/
ILLUMINATION:
100-150THE
WATTS
•GROWTH ON THE EYE/ OPACITIES
 LIGHT
FROM
BEHIND
•CONTINUAL DISCHARGE, CRUSTING OR
 TEACH ABOUT
DANGER SIGNALS OF VISUAL
TEARING
DISORDER
•PUPIL IRREGULARITIES
DISORDERS - EYE
 INJURIES & TRAUMA
 GLAUCOMA
 INFECTIONS
 DETACHMENT OF THE
RETINA
 CATARACT
 REFRACTIVE ERRORS
INJURIES & TRAUMA
EMERGENCY:
 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
INFECTIONS
 HORDEOLUM/ STY -Zeis gland in the follicle
 CHALAZION –meibomian glands
 CONJUNCTIVITIS – pink eye
 bacterial infection, allergy, trauma
 UVEITIS - iris
 KERATITIS - cornea
 PTERYGIUM – triangular fold
 From white of the eye to the cornea
Conjunctivitis
Sty
Chalazion
Pterygium
CATARACT
 Opacity of the lens & its capsule which interferes with
transparency
S/SX:
 Dimness in visual acuity
 Rapid & marked refraction error
CLASSIFICATION:
 Primary/ senile
 Secondary/ traumatic
 Congenital
Cataract
Treatment
 Replacement of the intra ocular lens
 Commonly done by phakoemulsification technique
EYE SURGERY
NURSING CARE PRE-OP
 Orient to new environment
 Teach deep breathing & how to close eyes without
squeezing
 Eye antibiotics preop
 Mydiatrics if ordered
EYE SURGERY
NURSING CARE POST-OP
 Reorient patient to his surroundings
 Prevent increase in IOP & stress on the suture line
Contd….
 ACTIVITIES THAT INCREASE IOP:
• Coughing
• Vomiting
• Bending
• Stooping
• Promote comfort of the patient: mild
analgesic to control pain
EYE SURGERY
NURSING CARE POST-OP
COMPLICATIONS:
 Observe
& treat complications
•NAUSEA
& VOMITING
•Antiemetics
•Cold the
compress
• Promote
rehab
of the patient
•HEMORRHAGE
•Encourage
the patient to become
•Sudden pain of
the with
eye him when he first
independentwalk
•PROLAPSE
OF THE IRIS
become ambulatory
•Most common postop complication
•Health
teachings
•Can precipitate glaucoma
EYE SURGERY
HEALTH TEACHINGS:
 1-4 wks : dark glasses; temporary corrective lenses
 6-8 wks: permanent lenses
 It will take time to learn distances & climb stairs
 Color slightly changed
 Use one eye at a time unless with contact lens
 Decreased peripheral vision
GLAUCOMA


INCREASED IOP
PROGRESSIVE LOSS OF PERIPHERAL VISION
CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS
HUMOR
TYPES:
1. CHRONIC/ SIMPLE/ OPEN-ANGLE
2. ACUTE ANGLE CLOSURE
3. Congenital
4. Secondary – trauma, uveitis, postop
5. Absolute – uncontrolled- enucleation
OPEN-ANGLE GLAUCOMA
CANAL OF SCHLEMM
IRIS
ANTERIOR
CHAMBER
CILIARY BODY
LENS
CORNEA
ZONULES
EYES
ACUTE-ANGLE CLOSURE GLAUCOMA
CANAL OF SCHLEMM
IRIS
ANTERIOR
CHAMBER
CILIARY BODY
LENS
CORNEA
ZONULES
EYES
OPEN ANGLE GLAUCOMA
S/SX:
 Loss of peripheral vision (tunnel)
 Difficulty in adjusting to darkness
 Failure to detect changes in color
 Headache, pain behind the eyeball
 Halos
 Nausea & vomiting
OPEN ANGLE GLAUCOMA
MANAGEMENT:
Conservative :
 Miotics : pupillary constriction
draw iris smooth muscle away
from the canal
 Acetazolamide : decrease aqueous production
 Fluid restriction
Definitive management
 Principle: improve drainage of aqueous
• Iridocleisis-anterior chamber & subconjunctival space
• Corneoscleral trephening – junction of cornea & sclera
• Trabeculotomy
• Laser therapy to meshwork
Acute Angle Glaucoma
CAUSE:
 Pupillary dilation by mydiatrics
 Abnormal anterior displacement of iris
S/SX:
 Severe eye pain
 Nausea & vomiting
 Blurred vision
 Colored halos around lights
 Dilated pupils
 Increased IOP
 MANAGEMENT:
• Miotics
• Azetazolamide
• Osmotic agents – glycerol
• Surgery - iridectomy
GLAUCOMA
NURSING CARE – SURGERY
PRE-OP
 Explain that vision lost cannot be restored, but further
loss can be prevented
POST-OP
 Flat 24H- prevent iris prolapse
 Narotics or sedatives
 Liquid diet until 1st dressing
 Turn to unoperative site
 LONG TERM CARE:
• No restriction on the use of the eyes
• No fluid restriction; exercise permitted
• Medical follow up needed for life
RETINA
CHOROID
SCLERA
OPTIC NERVE
RETINAL DETACHMENT
RETINAL DETACHMENT
 Fluid accumulation
 Tumor
CAUSE:
 Myopic degeneration
 Trauma
 Aphakia
S/SX:
 Floating spots or
opacities before the eye
 Casts shadows on the
retina
 BrightFlashes of light
 Progressive constriction
of vision in 1 eye
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- sealing break & reattaching
RETINAL DETACHMENT
POST-OP NURSING CARE:
 Cover eyes
 Area of detachment, dependent
 Mydiatrics
 Discharge instructions:
 No strenuous exercises & acivity x 6mos
 Contact sports restricted
 No sudden jarring head motion
 No restriction with use of eyes
REFRACTIVE ERRORS
REFRACTION – bending of light rays
ACCOMMODATION – ability to adjust from near to far
vision
ADAPTATION – ability to see light from darkness
COMMON ERRORS:
 Myopia
 Hyperopia
 Presbyopia
•Astigmatism
•Blindness
myopia
NEAR-SIGHTED
 Long A-P dimension of the eyeball
 Light rays focus infront of the retina
 Good vision for near distances
 Concave lenses
Myopia
hyperopia
FAR-SIGHTED
 Eyeball A-P dimension too short
 Light rays focus behind the retina
 Good vision for far distances
 Convex lenses
Hyperopia
presbyopia
FARSIGHTEDNESS OF OLD AGE
 Gradual loss of accommodation
 Loss of lens elasticity
 Inability to read without holding the material more
than 13 ft from the eye
 Bifocal lenses
ASTIGMATISM
 Asymmetry or irregular curvature of the cornea
 Cylindrical lenses
BLINDNESS
 Vision: 20/200
ANATOMY & PHYSIOLOGY
EARS
EXTERNAL EAR
 AURICLE
 PINNA
 TYMPANIC MEMBRANE
MIDDLE EAR
 OSSICLES: MALLEOUS, INCUS, STAPES
 EUSTACHIAN TUBE
EAR
ANATOMY & PHYSIOLOGY
EARS
INNER EAR
 ORGAN OF CORTI
 HEARING
 VESTIBULAR APPARATUS
 BALANCE
 3 SEMICIRCULAR CANALS
 UTRICLE
EAR
ANATOMY & PHYSIOLOGY
EARSSOUND WAVES TO TYMPANIC MEMBRANE
OSSICLES IN MOTION
VIBRATION FROM STAPES TO OVAL WINDOW
COCHLEA :
CRANIAL NERVE 8
ORGAN OF CORTI
TO TEMPORAL LOBE
HEARING
AUDITORY ASSESSMENT
EXTERNAL EAR EXAMINATION
 Inspection & palpation of auricle
 Visualization: straighten the auditory canal:
 PULL AURICLE UP, & BACK
 NORMAL EARDRUM:
 slightly conical
 Shiny
 pearly gray in color
AUDITORY
ASSESSMENT
HEARING TEST:
Tests for acuteness of hearing or degree of deafness:
 Whisper or spoken voice test
 Audiometer :
 Pure tone – mx loudness in decibel
 Speech – ability to understand & descriminate
 Watch tick test
 Tuning fork test
AUDITORY ASSESSMENT
HEARING TEST:
Test to localize cause of deafness:
 Rinne’s
 Weber’s
Auditory assessment
WEBER’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
AUDITORY ASSESSMENT
TEST FOR VESTIBULAR FUNCTON
 CALORIC TEST
 Check direction of nystagmus
 COWS ( cold-opposite; warm-same side of stimulated
ear)
 ROTATION (BARANY) TEST
 Rotating chair
 Nystagmus is opposite to the direction of rotation
HEALTH PROMOTION
EAR PROTECTION
 Noise over 70 decibels is potentially damaging to
hearing
 Most common & impt type of occupational hearing is
caused by LOUD NOISE
GENERAL EAR CARE
 Ear is self-cleaning
 Cerumen-lubricant; traps dirt
 Cleanse the external ear reached by vision
NURSING INTERVENTIONS
EAR DROPS
 Warm
 After adm’n, head should remain tilted
SOFTENING & REMOVING IMPACTED CERUMEN
 Few drops of hydrogen peroxide/ warm glycerine
 Irrigate the ear
NURSING INTERVENTIONS
EAR IRRIGATION
 To clean the external canal
 Remove impated cerumen
 Caloric test
 Apply antiseptic solutions
 Remove foreign bodies
COMMON EAR PROBLEMS
1.
OTOSCLEROSIS
2.
MENIERE’S DISEASE
3.
HEARING IMPAIRMENT
OTOSCLEROSIS
 Normal bone is replaced by spongy bone
 Ankylosis of the footplate of the stapes
 Impaired vibration system
OTOSCLEROSIS
ASSESSMENT
 Gradual hearing loss
 Difficulty hearing a whisper
 Own voice is loud
 Paracusis : hear better in loud environment
 Rinne’s test: bone conduction better
OTOSCLEROSIS
PLANNING & IMPLEMENTATION
 Hearing aid
 Surgery – primary form of tx
 Stapedectomy
 Stapes mobilization operation
 Fenestration operation : new window is created
EAR SURGERY
PRE-OP CARE;
 Hair shampoo
 Inform client:
 Head still during surgery
 Post op: get out of bed with assistance
avoid nose blowing until 1 week
EAR SURGERY
POST OP
 Promote comfort & safety
 Promote psychological well-being
 Prevent complications
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
MENIERE’S DSE
 Chronic
 Increase in endolymphatic pressure
ASSESSMENT:
 Tinnitus
 Unilateral hearing loss
 Vertigo
MENIERE’S DSE
PLANNING & IMPLEMENTATION
 CONSERVATIVE: palliative
 Bed rest
 Meds
 Sedative :Phenobarbital
 Antihistamine
 Antiemetics
 Low salt diet
MENIERE’S DSE
PLANNING & IMPLEMENTATION
 SURGERY- delayed until client’s hearing below the
serviceable level
 Destruction of the labyrinth
 Decompression of endolymphatic sac
 Sectioning of the vestibular nerve
 Cryosurgery of the labyrinth
HEARING IMPAIRMENT
TYPES OF HEARING LOSS

CONDUCTIVE
Damage to the conducting system
Hearing aid is useful



SENSORINEURAL

1.
2.
3.
Damage to the:
Organ of Corti
Cochlear nerve
Acoustic branch of the auditory nerve
COMMUNICATING WITH HEARINGIMPAIRED CLIENTS
 Avoid use of gestures without speech
 Do not shout
 Speak distinctly & as close to the client
 Use short phrases
 Do not communicate with someone else in front of
a hearing-impaired client
 Hearing impairment goes with visual problems in
elderly
SOUND AMPLIFICATION
TYPES OF HEARING AIDS;
 Post-auricular
 Body-type
 In-the ear model
Select hearing aid that has cotrollable volume & is
properly fitted