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Chapter 21
Eye and Ear Disorders
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Learning Objectives
 Explaining the difference between ophthalmic and
otic preparations.
 Recognizing ophthalmic and otic medications and
their uses.
 Describing drugs used in the treatment of ototoxicity
and vertigo.
 Describing how to store ophthalmic and otic
preparations to prevent their being inadvertently
interchanged.
 Providing patient education for compliance with
medications used to treat diseases and conditions of
the eye and ear.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye
Figure 21-1 Anatomy of the eye. (From Young AP, Proctor DB: Kinn’s the medical assistant: an
applied learning approach, ed 11, St Louis, 2011, Saunders.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye
Figure 21-2 Aqueous humor passes into anterior chamber through the pupil, where it is drained away by the
ring-shaped canal of Schlemm. (From Thibodeau GA, Patton KT: Anthony’s textbook of anatomy and
physiology, ed 18, St Louis, 2007, Mosby.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye
Miosis: constriction of pupil
Mydriasis: dilation of pupil
Accommodation: lens changing shape to
adjust for viewing objects at a distance
Presbyopia: inability of lens to accommodate
near objects due to lens rigidity caused by
aging
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Eye
Cataract: cloudy lens
Cycloplegia: paralysis of ciliary muscle
Tears lost by evaporation or draining into
the nasolacrimal ducts
Glaucoma: increased ocular pressure
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ear and Eye Disorders
Common Symptoms
Eyes
visual disturbances
eye redness
pain, burning in or
around eyeball
Ears
loss of hearing
vertigo, dizziness
tinnitus
earache, increased
pressure in ear
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye Medications
Ophthalmic preparations are formulated for
the eye.
Systemic medications can cause ocular side
effects.
Eye medications may cause systemic effects
and variation in homeostasis.
Eye preparations are sterile.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye Medications
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye Medications
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Medications
Common Side Effects
Ophthalmic
 changes in intraocular
pressure
 burning, stinging, pain
on administration
 blurred vision,
diplopia
 photophobia
 headache
 increased tears
Otic
 tinnitus
 burning, itching of
ear canal
 dizziness
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ocular Infections
 conjunctivitis (pinkeye)
 hordeolum (stye)
 chalazion—hard cyst in eyelid
 blepharitis—inflammation of eyelids
 keratitis—inflammation of cornea
 uveitis—inflammation of uveal tract
 all treated with antiinfective and antiinflammatory
agents
 both eyes often treated to prevent spread of
infection
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Eye Conditions
Acute conjunctivitis.
From Newell FW (1996): Ophthalmology:
principles and concepts, (8th ed.). St. Louis:
Mosby.
Stye. (hordeolum)
From Kanski J, Nischal KK (1999):
Ophthalmology: clinical signs and differential
diagnosis. London: Mosby International.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Antiinfective and Antiinflammatory
Agents
Ensure sulfa preparations have not darkened
from their light-yellow color.
Action of sulfonamides is inhibited by
ophthalmic anesthetics; administer the two
agents at least 30 to 60 minutes apart.
Sulfonamides are incompatible with
thiomersal and silver preparations.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Antiinfective and Antiinflammatory
Agents
Most states require silver nitrate drops for
newborns to prevent gonococcal infection.
During eye irrigation, turn head toward
affected side to prevent cross-contamination.
Ophthalmic corticosteroids can have systemic
effects if used for prolonged time.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Glaucoma
 characterized by increased intraocular pressure
 90% of glaucoma patients have open-angle
glaucoma
 blindness can occur secondary to optic nerve
damage.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Open-Angle Glaucoma
Ophthalmoscopic image of open-angle glaucoma.
From Apple DJ, Rabb MF (1998): Ocular pathology (5th ed.). St. Louis: Mosby.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Glaucoma
beta-blockers (Betoptic, Ocupress)
cholinergic agents or miotics—constrict pupil
(Carboptic, IsoptoCarpine)
sympathomimetic agents—dilate pupil
(Propine)
carbonic anhydrase inhibitors (Diamox,
Daranide, Trusopt)
prostaglandin agonist (Xalatan, Rescula)
osmotic diuretics (Osmoglyn, Isonate)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Drugs Used for Treating Glaucoma
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Drugs Used for Treating Glaucoma
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Mydriatics and Cycloplegics
Adrenergic agonists mimic mydriasis or
pupillary dilation.
Cycloplegic agents cause paralysis of ciliary
muscles and prevent accommodation.
Over-the-counter adrenergic agonists may
cause vasoconstriction.
Anticholinergic agents cause dilation; are
used to reduce inflammation.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Drugs Used as Mydriatics or
Cyclopegics
Insert Table 21-5
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Local Ophthalmic Anesthetic
Agents
eliminate blink reflex and pain associated with
ophthalmic procedures
used for:
 tonometry
 foreign object removal
 suturing
 radial keratotomy
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ocular Anesthetics
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Artificial Tears and Lubricants and
Immunomodulators
 produce eye lubrication when tear production is
decreased
 lubricate artificial eyes
 moisten contact lenses
 remove debris from eye
 balanced with normal saline
 typically used 3 to 4 times daily
 examples: Lacrisert, Lacri-lube, Duratears,
HypoTears, Tearisol
 Immunomodulators increase tear production
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ophthalmic Antiallergic Agents and
Decongestant Agents
used for allergic eye disorders to prevent
tearing, itching, redness, discharge
can produce stinging, burning sensation,
redness, headaches, blurred vision
examples: Opticrom, Livostin, Alomide,
Zaditor, Patanol, Alamast
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ophthalmic Staining Agents
Chief agent is fluorescein sodium
Used to diagnose corneal epithelial defects
and to locate foreign bodies of the eye
 Stains corneal lesions green
Also used when fitting contact lens, as a dye
for retinal studies, and for ophthalmic
angiography
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Ear
Sensory organ for hearing and equilibrium
Three major parts—external ear, middle ear,
inner ear
Figure 21-4 Anatomy of the ear. (From Thibodeau GA, Patton KT: Anthony’s textbook of
anatomy and physiology, ed 18, St Louis, 2007, Mosby.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Typical Ear Conditions
ear wax accumulation
furuncles from infected hair follicles
inflammation from seborrheic dermatitis,
psoriasis
otitis media (middle ear infection)
tympanic membrane perforation
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Otic Preparations
Drying agents
Antiinfective agents
 inhibit or kill bacterial growth
 reduce swelling and promote drainage of
external ear infections
Corticosteroids
 suppress symptoms associated with inflammation,
edema, pruritus
Cerumenolytics
 soften hardened cerumen (ear wax)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Otic Preparations
Ear analgesics
 relieve pain
 warmed mineral oil, sweet oil, glycerin
Do not instill ear medications if ear is not
draining
For child, pull ear down and back; for adult,
pull ear up and back
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Otic Preparations
Never occlude external ear with tight-fitting
plug; may cause eardrum to rupture.
Use cotton plugs.
Warm ear medications to room temperature
before instilling.
Never use otic medications in the eye.
Medications for vertigo may cause
drowsiness.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Vertigo and Ototoxicity
Caused by detrimental effect on cranial nerve
VIII or organ of hearing from medications
Affects hearing, balance
Tinnitus is most common sign (ringing in
ears)
Might lead to severe headache, nausea,
vomiting, dizziness, ataxia, difficulty with
equilibrium, hearing loss
Mimics Menieres disease
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Storage of Eye and Ear
Preparations
Ophthalmic and otic preparations are easily
confused.
Ophthalmic medications require sterility.
Otic medications do not require sterility.
Do not store in same area or shelf.
Check name of medication and route of
administration more than the usual 3 times,
especially checking for ophthalmic or otic
labeling.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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