Ch. 42 & 43, Caring for clients w/eye disorder & ear disorders

Macular degeneration is the ?

- breakdown of or damage to the macula, the point on the retina where light rays converge for the most acute visual perception. The disorder usually occurs in both eyes but the vision in one eye tends to deteriorate more rapidly

DISORDERS OF THE MIDDLE EAR S/S are?

- client often describes a history of having had a recent upper respiratory infection or seasonal allergies. Signs and symptoms vary widely depending on the type and severity of the inflammation but may include a fever, tinnitus, malaise, severe earache, and diminished hearing.

Eye trauma patho & etiology?

-Eye injuries Cell and tissue injury causes an inflammatory response. Secondary infections may follow the initial injury. -When trauma involves the cornea, scar tissue may affect the refraction of light. If the capsule that contains the lens is damaged- aqueous fluid and vitreous penetrate the lens, causing it to become an opaque cataract. -Penetrating trauma can lead to endophthalmitis a condition in which all three layers of the eye and the vitreous are inflamed* removal of the eye may be necessary.

Ch. 42 Refractive errors are? p665

-It means the shape of your eye doesn't bend light correctly, resulting in blurred image. Some are listed below. -Emmetropic or normal vision means that light rays are bent to focus images precisely on the retina. -Hyperopia is farsightedness People who are hyperopic see objects that are far away better than objects that are close, -Presbyopia is associated with aging and results in difficulty with near. -Astigmatism is visual distortion caused by an irregularly shaped cornea.

GLAUCOMA is what ?

-a major cause of blindness in the United States, is a group of eye disorders caused by an imbalance between the production and drainage of aqueous fluid. When the drainage system is obstructed, the anterior chamber becomes congested with fluid and IOP rises. -Optic nerve damage can occur as a result of the increased IOp. Although there is not a cure for glaucoma, the disease symptoms can be controlled, and optic nerve damage can be prevented.

UVEITIS is?

-an inflammation of the uveal tract which consists of the iris, ciliary body and choroid. patho: -cause is unknown but... -it is detected with some frequency among clients with juvenile rheumatoid arthritis, ankylosing spondylitis, tuberculosis, toxoplasmosis, histoplasmosis, and herpes zoster infection.

KERATITIS AND CORNEAL ULCER is

-is an inflammation of the cornea. A corneal ulcer is erosion in the corneal tissue. patho: Trauma to the cornea (e.g., wearing hard contact lenses for an extended period) and infectious agents (e.g., bacteria, fungi viruses) cause keratitis. Secondary infections are common once the epithelium is damaged.

1-mastoidectomy 2-mastoiditis 3-Meniere's disease

1-surgical procedure performed to remove diseased tissue from the mastoid process. 2-inflammation of any part of the mastoid process. 3-episodic symptoms created by fluctuations in the production or reabsorption of fluid in the inner ear.

1- astigmatism 2- cataract 3-corneal transplantation

1-visual distortion caused by an irregularly shaped cornea. 2-disorder in which the lens of the eye becomes opaque. 3-replacement of abnormal corneaL tissue with healthy donated corneal tissue.

CATARACTS Signs & symptoms are?

Signs & symptoms - is seeing a halo around lights. - Other symptoms include difficulty reading, changes in color vision (colors that look faded or yellow), glaring of objects in bright light, distortion of objects blurred vision, poor night vision, and double vision in one eye. - As the cataract worsens visual acuity is so severely reduced that the client can only read the largest letter on a Snellen chart, count fingers and distinguish movement. - On inspection, a white or gray spot is visible behind the pupil. - Under ophthalmoscopic and slit-lamp examination, the lens appears in varying stages of opacity. - - Some lenses are so cloudy that the examiner cannot see through the cataract to the posterior of the eye. - Tonometry determines whether the cataract is increasing the

DISORDERS OF THE INNER EAR

VERTIGO is the sensation of movement when there is none or a sense of exaggerated motion when moving - The inner ear contains the semicircular canals and otolithic organs which sense the body's motion. - Signals are quickly sent from the inner ear to muscles of the eyes, neck, trunk, and limbs so that stability can be maintained. When a disturbance occurs in the inner ear, vertigo occurs, along with problems with balance and stability. Vertigo is not a disease but a symptom of a disease. - There are two types of vertigo: - objective vertigo, in which a person is stationary and the environment is moving (a sensation of things moving around oneself)- and - subjective vertigo when a person feels motion but the surrounding environment is stationary (a spinning sensation. - "Syncope fainting and loss of consciousness are not forms of vertigo and usually indicate disease in the cardiovascular system. - People experiencing vertigo are most likely to have peripheral vestibular disorder, such as benign paroxysmal positional vertigo, Meniere's disease, and acoustic neuroma. - medications used to treat or manage symptoms related to vertigo. Nursing care focuses on the treatment of symptoms and maintenance of the client safety. - Motion sickness is a form of physiologic vertigo. - Benign Daroxysmal positional vertigo (BPPV) involves brief periods of severe vertigo when clients move their heads, particularly if they move their head back and toward the affected ear.

CONJUNCTIVITIS Medical Management/ Nursing Management

- Treatment includes antibiotic or antiviral ointment or drops. -Warm soaks or sterile saline irrigations are used to remove purulent drainage, reduce swelling and relieve pain or itching. - If an allergen causes the conjunctivitis, antihistamines and decongestants are prescribed. Nurse: -cleans the eye and instills or applies the prescribed medication. - teach client how to care for themselves & prevent infection cuz this condition is infectious. -'Remain at home and apart from other people as much as possible while contagious. -Use separate towels, linens, and other personal items. -Wash hands often and thoroughly with soap and water. -Jsenew tissue each time when wiping discharge from eye. -Discard eye make-up items and do not use new make-up until conjunctivitis clears. -> Return to physician if discharge becomes thick and yellowish.

Hearing Impairment is?

- is described as mild, moderate, severe, or profound, depending on the intensity of sound required for a person to hear it. - Conductive hearing loss occurs from obstructions in the outer or middle ear, such as an accumulation of cerumen in the external acoustic meatus, or disease such as failure of the tiny ear bones to vibrate. - Sensorineural hearing loss involves damage to the inner ear from conditions that affect the sensory hair cells or the nerves. - Etiologies include atherosclerosis tumors of the vestibulocochlear nerve infections, and drug toxicity. - Presbycusis is hearing impairment that is associated with old age. Clients with a hearing impainnent often have tinnitus in which the client hears buzzing whistling or ringing noises in one or both ears.

HEARING IMPAIRMENT Medical Management

- medical management includes a recommendation for a hearing aid, a battery-operated device that fits behind the ear in the; ear, or in the ear canal and amplifies sound. - Clients with a conductive hearing loss benefit more from the use of a hearing aid because the structures that convert sound into energy and facilitate perception of sound in the brain continue to function. - Some clients with hearing deficits learn American sign language (ASL), a method for communication that uses a hand spelled alphabet and word symbols. Clients also learn speech reading also called lip reading.

Nursing management for patients with refractory error eyes do what for them?

-They are instrumental in teaching clients how to care for their corrective lenses and remove and clean contact lenses. -In addition, nurses provide preoperative and postoperative care and teach clients about postoperative care at home.

KERATITIS AND CORNEAL ULCER S/S & medical/surgical & nursing mng.

-localized pain or the seusation that a foreign body is present. Blinking increases discomfort. Photophobia, blurred vision, tearing, purulent discharge and redness develop. -In addition to flashlight illumination and slit-lamp examination, fluorescein drops or strips provide evidence of corneal tissue erosion. med/surg: -is treated with topical anesthetics, mydriatics (dregs that dilate the pupil) and local and systemic antibiotics. Dark glasses are recommended to relieve photophobia. - Treatment in the early stages of a corneal ulcer is the same as for keratitis. Once corneal scar tissue has formed, the only treatment is corneal transplantation (keratoplasty). nurse: - removes exudate that harbors microbes and instills antibiotic eye medication. He or she follows aseptic principles to avoid transferring microorganisms to the injured corneal tissues. The nurse advises the client who wears contact lenses to stop wearing them temporarily.

1-intraocular lens (IOL) implant 2-iridotomv

1-artificial lens that is inserted in the eye to improve or restore vision. 2-the removal of a portion of the iris; can be a laser or surgical procedure.

MACULAR DEGENERATION Signs & symptoms are?

In dry macular degeneration blurred vision is the first svmo:om of disease which becomes more noticeable when clients try to read or do close work. In wet macular degeneration, clients experience distortion of vision, such as straight lines appearing wavy or letters in words looking broken. A client's perception of color may also be diminished. When the macula becomes irreparably damaged clients compare their vision to a target in which the bull's-eye area of the image is absent. - The peripheral field or side vision is unaffected, but the client cannot see images by looking at them directly.

Pathos for the refractive eyes are?

Refractive errors are inherited or occur as a result of surgical treatment of disorders of the cornea or lens. -Myopia occurs in people with elongated eyeballs. light rays focus in the vitreous body before they reach the retina. -Hyperopia reSults when the eyeball is shorter than normal, causing the light rays to focus at a theoretical point behind the retina. -Presbyopia occurs because of degenerative changes. Presbyopia is caused by the gradual loss of elasticity of the lens, which leads to decreased ability to accommodate, or focus, for near vision.

RETINAL DETACHMENT Surgical Management

Surgical interventions for retinal reattachment include laser surgery, cryopexy, diathermy, retinopexy, and scleral buckling. The method chosen depends on the extent of detachment. - Several procedures are used for small tears or holes. Laser surgery (photocoagulation) involves making small burns around the tear to attach the retina back in place. - Pneumatic retinopexy is a less invasive method used to repair larger retinal tears. A gas bubble is then injected within the vitreous to push the detached retina against the sclera. The gas bubble expands at first but then disappears within 2 6 weeks. A disadvantage of this procedure is that the client may have to position himself or herself in a facedown position for a certain period of ^me each day for 7 to 10 days following the procedure. - Scleral buckling (indenting of the surface of the eye) is a surgical procedure in which a tiny synthetic band is attached outside the eyeball to lightly push the wall of the eye against the detached retina.

DISORDERS OF THE MIDDLE EAR Nursing Management

- After myringotomy, the discharge from the ear is bloody and then purulent. - To remove the drainage the nurse wipes the external ear repeatedly with a dry sterile cotton applicator. An alternative is to insert a loose (not tightly packed) cotton pledget in the external ear to collect drainage. The nurse changes the cotton when it becomes moist.

What are the BCVA Standards? Best corrected vision acuity.

- 20/20 normal - Past driving test 20/40 one eye is required. - Low vision 20/70 to 20/200. - Blindness is a legal term for a BCVA of 20/200 or less even with corrective lenses. -Visually impaired people fit in the 20/70 to 20/200 they can perceive light & motion. - 20/400 Blind w/no light perception.

CATARACTS Pathophysiology are?

- A cataract is a condition in which the lens of the eye becomes opaque. One or both eyes may be affected. - Cataracts occur as a result of the aging process or are congenitally acquired, caused by injury to the lens, or secondaiy to other eye diseases. - When cataracts occur in response to injury they usually develop quickly. - Most cataracts result from degenerative changes associated with aging and develop slowly. - A high incidence of cataracts occurs among people with diabetes and those with a family history. - Prolonged exposure to ultraviolet rays (e.g., sunlight, tanning lamps) radiation, or certain drugs (e.g., corticosteroids) has been associated with cataract formation. - In all cases vision decreases because light no longer has a transparent pathway to the retina.

1-motion sickness 2-myringoplasty 3-myringotomy

1-a form of physiologic vertigo caused by repeated and constant motion. 2-surgical repair of perforated eardrum. 3-incisional opening of the eardrum to allow drainage, ease pressure and relieve pain.

1-benign paroxysmal positional vertigo (BPPV) 2-cochlear implant 3-labyrinthitis

1-brief periods of severe vertigo when clients move their heads, particularly if they move their head back and toward the affected ear. 2-device that is surgically placed in the inner ear and connected to a receiver in the bone behind the ear to improve hearing. 3-inflammation of the labyrinth of the inner ear.

Nursing Management for eye injury are? 669

- ask patient to move his hand from eye - inspect eye, darkened the room use pen light & look for foreign objects. - If none look up lower the lid inspect the conjunctival sac. Evert upper lid & look down if nothing then do fluorescein dye to check for foreign objects is still present & if the cornea is abraded.

Cataracts Nursing Management

- Cataract surgery is usually performed in an outpatient setting. The client wears a protective eye shield for 24 hours after the procedure and then at night and during naps for about a week. Clients need to wear sunglasses when in bright light for at least 1 week. Eyedrops used several times a day, are prescribed tor at least 1 week to prevent infection. - There may be blurring for several days to weeks following cataract surgery. Clients may experience a small amount of eye discharge, especially when awaking. There could be some redness and a scratchy sensation for a few days. - Clients need to notify the eye surgeon if they experience new floaters in their vision or increased redness, flashing lights, or change in vision. These are symptoms associated with retinal detachment, a complication of cataract surgery. - Healing will be complete within about 8 weeks. - 1 Do not encase in strenuous activity and heavy lifting. • Do not bend or stoop or do other exercise that potentially increases IOP. i Do not immerse the eyes in water (clients may use a clean damp cloth to remove any eye discharge). . Do not engage in any activity that potentially could cause dust or other particles to lodge in the eye.

CATARACTS Surgical management are?

- Cataracts cannot be treated medically and are surgically removed. - Surgery is generally done in outpatient settings with topical and intraocular anesthesia. Clients are awake md able to converse during the procedure. Clients who are highly anxious or agitated can receive intravenous sedation. - For clients who have cataracts in both eyes the surgery is done on one eye and the second one is done at least a few weeks later, and perhaps months later. - The most common surgical procedure is phacoemulujrcation (also referred to as small incision cataract surgery)- With this method, a small portion of the anterior :apsule is removed. A small probe is then inserted in the -ye, and ultrasound waves are emitted through this device. -Suction is used to extract the lens particles. When phacoemulsification is performed, most clients are able to eturn to full activity within a very short period of time. - Extracapsular extraction is another method used to remove the lens. A longer incision is made, and the lens is extracted in one piece. - After surgery, vision is restored with one of three nethods: intraocular lens implant, corrective eyeglasses, or a contact lens. An intraocular lens (IOL) Implant involves insertion of an IOL at the time of cataract surgery and is the most common method for improving vision. IOLs are inserted behind the iris. - Ultrasonography is performed before surgery to determine the size and prescripdon of the IOL. A monofocal (single-vision) or multifocal lens is implanted and reduces the need for corrective glasses. "A combined surgical approach using customized IOLs and refractive surgery for a customized vision correction is now proving beneficial for elderly patients" - When cataract eyeglasses are prescribed, the correcting lens for the aphakic e-ye (the eye without a lens) causes the client to see objects about one-third larger than normal. - A contact lens also can restore vision after cataract extraction. Advantages of the contact lens are that peripheral vision is not lost and objects appear about their actual size. A disadvantage is that the lens must be removed at night. - Clients may experience cloudy vision at some point after cataract surgery involving an IOL. To restore the client's vision, a simple laser procedure is performed to open the membrane.

GLAUCOMA Signs and Symptoms are?

- Clients with open-angle glaucoma may be asymptomatic, and the condition may not be discovered until the client has a routine ophthalmologic examination. - When symptoms do occur, they often are ignored because they are not dramatic. - Clients complain of eye discomfort, occasional and temporary blurred vision, the appearance of halos around lights, reduced peripheral vision, and the feeling that their eyeglass prescription needs to be changed. -In contrast, clients with acute angle-closure glaucoma become symptomatic quite suddenly* - The eyes become rock hard, painful, and sightless. - Nausea and vomiting may occur. - The conjunctiva is red* the cornea becomes cloudy and commonly is described as appearing "steamy." - The attack is self-limiting but with each subsequent attack vision becomes more impaired.

Three stages defined for dry AMD:

- Early dry AMD-Clients either have small or veiy few drusen and vision may not be impacted. - Intermediate dry AMD-The number of drusen are either increased or there are a few large druserr clients may have a blurred spot in their vision and need more light to do tasks that require close vision such as reading. - Advanced dry AMD-In addition to drusen, there is a breakdown of light-sensitive cells supporting tissue in the macula. -dry AMD does not have any treatment or cure.

RETINAL DETACHMENT Pathophysiology are?

- In retinal detachment the sensory layer becomes separated from the pigmented layer of the retina. - retinal separation is associated with a hole or tear in me retina caused by stretching or degenerative changes. Retinal detachment may follow a sudden blow, penetrating injury, or eye surgery. Tumors, hemorrhage in front of or behind the retina, and loss of vitreous fluid are particularly likely to lead to retinal detachment. Three types of retinal detachment have been identified: - • Rhegmatogenous-Fluid moves under the retina through a tear and separates it from the pigmented layer- this most common form. Tractional-Tension or a pulling force causes scar tissue to form on the retina's surface and eventually the retina separates from the pigmented layer. -'Exudative-Fluid moves under the retina secondary to inflammatory disorders or injury to the eye- there are no tears in the retina macular degeneration, or uveitis.

macular DEGENERATION patho/etiology & nurse care?

- Macular degeneration, which tends to affect older adults, is usually referred to as age-related macular degeneration (AMD). - two main types of AMD are referred to as the dry type and the wet type. In the dry type, which is the most common, the outer layers of the retina break down over a long period ot time, ana characteristic small yellowish deposits (drusen) are apparent under the retina. When drusen are apparent under the retina. When drusen form within the macula, the client gradually experiences blurred vision. Nurse: The nurse helps the client cope with loss of vision. For additional nursing management of the client with permanent visual impairment review the information that accompanies the previous discussion of blindness

RETINAL DETACHMENT S/S are?

- Many clients notice definite gaps in their vision or blind spots. - They describe the sensation of a curtain being drawn over their field of vision, and they often see flashes of light - Seeing spots, "cobwebs," or moving particles in one's field of vision, called floaters, is common. - Complete loss of vision may occur in the affected eye. The condition is not painful but clients usually are extremely apprehensive - When the retina is inspected with an ophthalmoscope, tissue appears gray in the detached area.

DISORDERS OF THE MIDDLE EAR patho, are?

- Otitis media is an acute inflammation or infection in the middle ear. - Clients may have acute or chronic forms of either serous otitis media, also known as secretory or nonsuppurative otitis media, or the purulent or suppurarive type. - Although otitis media is more common among young children, adults can and do develop middle ear infections. - Serous otitis media, a collection of pathogen-free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids. - Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections. - Typical pathogens that cause otitis media include Streptococcus pneumoniae and Haemophilus influenzae. - Adults generally experience otitis media unilaterally (on one side). When fluid or pus collects in the middle ear, pressure increases and causes pain. This causes the eardrum to bulge with the potential of a spontaneous rupture in some cases. - Other potentially serious complications can occur. because the middle ear connects with the mastoid process, a part of the temporal bone, pathogens that are unresponsive to antibiotic therapy can spread, 'Causing mastoiditis, or they can travel deeper in the inner ear, causing labyrinthitis. - Infection also may extend to the meninges, causing meningitis, or brain abscess may result from its extension to the brain. If septicemia occurs, the infection can spread to the large veins at the base of the brain and cause lateral sinus thrombosis.

DISORDERS OF THE MIDDLE EAR Medical and Surgical Manaaement

- Prompt treatment usually prevents rupture of the eardrum. - In some cases the fluid is aspirated by needle. - The overase of antibiotics, has created another problem: Microorganisms are becoming resistant, and, for some infections, the available antibiotics are of limited benefit. - To reduce the consequences of spontaneous rupture of the eardrum, subsequent scarring, and hearing loss, the physician performs a myringotomy tympanotomy, an incisional opening of the tympanic membrane.The incised opening facilitates drainage of the purulent material, eases the pressure, and reheves the throbbing pain. - Plastic surgery (myringoplasty) usually is successful in repairing the perforated eardrum. In one technique, the edges of the perforation are cauterized and a patch of blood-soaked absorbable gelatin sponge (Gelfoam) is used as scaffolding over which new tissue grows until it has filled in the defect. - Chronic infiection are prevented if the eardrum is repaired: In the case of mastoiditis, a mastoidectomy is performed to remove the' diseased tissue; With early and effective antibiotic therapy mastoiditis is rare.

HEARING IMPAIRMENt Surgical Management are?

- Sensorineural hearing loss usually is irreversible. For the client who is profoundly deaf or has severe hearing loss and for whom a hearing aid is ineffective, a cochlear implant may be beneficial. - This device has an external microphone that captures incoming sounds as well as an external sound processor implanted behind the ear that captures the sound, converts it to digital signals, and sends them to an internal implant. - Other implanted hearing devices may also be used. One type is a bone conduction device known as the bone anchored hearing aid (BAHA). It is used as an alternative for clients who have mixed and conductive hearing loss or single-sided hearing loss.

GLAUCOMA Medical Management Surgical Management are?

- Treatment is most often begun with a topical medication at the lowest dose and then advanced to increase the dosage until the desired IOP level is reached and maintained. - Clients with open-angle glaucoma use topical beta-blockers, such as timolol (Timoptic). Beta-blockers decrease the flow rate of aqueous humor into the eye. -Prostaglandins such as latanoprost (Xalatan) and bimatoprost (Lumigan) that increase the outflow of the fluid in the eye and reduce IOP are also used to treat glaucoma. - Other medications to control IOP may be given* as many as four topical medications may be used at a time. Miotics such as carbachol (Miostat) and pilocarpine (Pilocar) constrict the pupil. These medications pull the iris away from the drainage channels so that the aqueous fluid can escape. - Other eye medications that are used for lowering IOP include echothiophate iodide (Phospholine Iodide), epinephrine, and dipivefrin (Propine). Acetazolamide (Diamox) and methazolamide (Neptazane), which are carbonic anhydrase inhibitors, sJow the production of aqueous fluid. - Oral medications, including carbonic anhydrase inhibitors such as acetazolamide (Diamox) and dichlorphenamide (Daranide) may be used to supplement or replace topical medications. However side effects are more problematic with the oral preparations. -In an acute attack of angle-closure glaucoma, analgesics are given to relieve pain, and the client is kept at complete rest. Laser surgery is usually performed before medications are prescribed, but clients frequently require medications after surgery. p.676

Medical Management & Surgical mng

- Two types of ocular trauma require quick responses: chemical burns and foreign objects in the eye. - Chemical burns require irrigation with tap water or normal saline. - Foreign bodies should not be removed if they are penetrating. - The eye should be protected from further jarring or movement of the object. - A metal eye shield, if available, or a stiff paper cup can be used to cover the eye following a traumatic injury until treatment is initiated by a qualified physician. - After emergency first aid is performed the eye is anesthetized to ease examination. Antibiotic ointment or drops are instilled, and the eye is patched. -Clients with blunt trauma are hospitalized to reduce the danger of intraocular complications. - To repair a laceration of the eyelid, the physician injects a local anesthetic, and the lid margins are approximated with sutures. A cut on the eyeball, especially the cornea, is serious and requires immediate treatment. Surgery is performed if internal eye structures are damaged.

DISORDERS OF THE EXTERNAL EAR are?

- Various disorders such as impacted cerumen, injury from foreign objects, or otitis externa affect the external acoustic meatus. If these disorders are not treated carefully and adequately they may spread to the middle ear. - Impacted cerumen is accumulated earwax that obstructs the external acoustic meatus. - Impacted cerumen is more common among people who have excessive thick or dry cerumen. - The client reports having a sense of fullness or pain in the ears referred to as otalgia, and diminished hearing. - dried cerumen is hydrated by instilling one or two drops of lf-strength peroxide, warm glycerin or mineral oil, or it is softened with commercial agents such as carbamide peroxide (Debrox) and triethanolamine (Ceramenex). Cerumen is removed mechanically by irrigating the ear if the eardrum is intact or using an instrument called a cerumen spoon or curette. - A rubber-bulb syringe filled with warm water is sometimes used as well as microsuction devices by specially trained practitioners.

GLAUCOMA Surgical Management are?

- When compliance is poor One of several procedures that create accessory drainage channels can be performed. - These procedures include laser or surgical Iridotomy laser trabeculoplasty and corneal trephine. - Laser iridotomy, in which holes are burned into the iris to increase areas for drainage is performed first. If this procedure is unsuccessful, it is followed by a standard sur gical iridotomy> in which a section of the iris is removed. - Either a peripheral or sector iridotomy is used. - In a peripheral iridotomy a small section of iris is removed at the outer margin of the iris. - In a sector or keyhole iridotomy a larger segment of the iris is removed in the direction of the pupil. - A laser trabeculoplasty is an alternative to a surgical iridotomy. In this procedure, the laser beam is directed at the trabecular network, which lies near the canal of Schlemm, creating multiple openings for drainage. - A corneal trephine is similar to a trabeculoplasty in that it produces a small hole at the junction of the cornea and sclera to provide an outlet for aqueous fluid. The opening is then covered by a flap of the conjunctiva.

ENUCLEATION Medical and Surgical Management

- When enucleation is performed, a metal or plastic ball is buried in the capsule of connective tissue from which the eyeball is removed. - A A pressure dressing is applied to control hemorrhage, a complication of enucleation. After the tissues have healed, a shell-shaped prosthesis is placed over the buried ball - The shell is painted to match the client's remaining eye. The shell is the only portion that is removed for cleaning.

UVEITIS S/S, medical mng. & nursing mng. is?

- blurred vision and photophobia. Eye pain is experienced in varying degrees. The eye appears red and congested and the pupil reacts poorly to light. In severe cases, a hypopyon can occur, which is an accumulation of pus in the anterior chamber behind the cornea. Medical mng: -Treatment includes oral and topical corticosteroids, mydriatic (dilating) eyedrops such as atropine, and antibiotic eyedrops. Analgesics are prescribed for pain. Sunglasses reduce the discomfort of photophobia. nursing mng: - instructs the client on the medication regimen and drug administration technique and stresses compliance with therapy- Failure to follow the medication regimen can result in serious complications. The nurse also emphasizes the importance of close follow-up during treatment..

GLAUCOMA Nursing Management are?

- nurse determines the client's history of symptoms the medications that have been prescribed, and whether the client is adhering to the prescribed medication schedule. It is also is important to ask when the client was first diagnosed with glaucoma. - Acute angle-closure glaucoma is an emergency- The nurse refers the client for medical treatment immediately because vision can be permanently lost in 1 to 2 days. Severe pain requires analgesics. To promote the maximum effect from analgesic drug therapy, it is essential to limit sensory stimulation such as loud noise, activity, and movement. - The nurse informs the physician immediately if the client states that the pain has worsened despite treatment. While clients are incapacitated by their pain or if the disease results in loss of vision, the nurse assists with meeting basic needs. - Mydriatics (drags that dilate the pupil) must never be administered to clients with glaucoma. The nurse consults physician if drugs with anticholinergic properties, such atropine sulfate, are prescribed because dilation of the pupil can further obstruct drainage of aqueous fluid, raise IOP, and damage whatever vision remains. - Because glaucoma tends to run in families, the nurse advises adults to be examined regularly- Early diagnosis and treatment are essential for preventing loss of vision. - Clients who already are diagnosed with glaucoma are encouraged to maintain close follow-up and comply with the medication regimen. - The nurse explains drug-instillation techniques. Besides eyedrops, some clients insert an ocular therapeutic system under the upper lid. - An ocular therapeutic system is a small, thin film that contains eye medication. The film, which is replaced weekly continuously releases the medication and eliminates the need for frequent eyedrop instillation.

DISORDERS OF THE EXTERNAL EAR Nursing Management are?

- nurse inspects the ears and implements measures to remove excessive cerumen. Ear drops can be warmed by holding the container in the hand for a few moments or placing it in warm water. - If irrigation or instillation of liquids is ordered, the nurse warms the liquid to body temperature. - Cold or hot liquids cause dizziness, and the potential for injury exists if the liquid is hot. - The nurse avoids inserting the irrigating syringe too deeply so as to close off the auditory canal. - He or she directs the flow toward the roof of the canal rather than the eardrum. - It is important to teach clients not to clean the external auditory canal with objects such as cotton-tipped swabs or toothpicks because it is traumatic to the surface and can harm the tympanic membrane.

HEARING IMPAIRMENT Nursing Management are?

- nurse observes for signs of hearing impairment such as leaning forward, turning and cupping the ear to hear better, and asking that words be repeated. - assesses gross hearing using the techniques described earlier. - determines the clarity of the client's speech and may recommend a referral for the diagnosis and subsequent treatment of a hearing impairment as well as speech therapy. - Many people reject the idea that their hearing is impaired. Some consider it a sign of aging and deterioration. If the client fears that wearing a hearing aid is a stigma, the nurse describes the various types of hearing aids that are available, some of which fit almost unnoticeably in the ear. - The nurse also stresses the importance of avoiding the purchase of a hearing aid from a mail-order catalogue or a company salesperson.

ENUCLEATION Nursing Management

- nurse observes the client after surgery for signs and symptoms of bleeding or infection. - The client usually is allowed out of bed the day after surgery. When healing is complete in about 2 to 4 weeks, the nurse teaches the client how to insert and remove the prosthetic shell. - The prosthesis is typically is removed before going to bed and inserted the next morning. - The nurse instructs the client to hold the head over a soft surface such as a bed or padded table when removing or inserting the prosthesis to avoid damage if the prosthetic eye falls. - The client should clean the shell after removal and keep it in a safe place where it will not become scratched or broken.

ENUCLEATION is what?

- the surgical removal of an eye. It is necesary when the eye is destroyed by injury or disease, when i malignant tumor develops (rare), or to relieve pain if the .eye is severely damaged and sightless.

GLAUCOMA what is the patho?

-4 types of glaucoma: open-angle or chronic glaucoma, angle-closure or acute glaucoma, congenital glaucoma, or secondary glaucoma. - Open-angle glaucoma is the most common form. Its onset is slow, and the client may not experience noticeable symptoms for several years. - Angle-closure glaucoma is less common, but the onset is very sudden, and immediate recognition and treatment are required to prevent blindness. - Congenital glaucoma is seen early in life and is familial. - Secondary glaucoma occurs following administration of some medications such as steroids, following ophthalmic infections, or as the result of systemic diseases or ocular trauma. -It most commonly occurs as a primary disease among adults older than 40 years of age. It is more prevalent among those who have a family history of the disorder. The incidence is higher among African Americans who are four to eight times more likely to develop blindness from glaucoma than are other ethnic groups. -Open-angle glaucoma occurs when structures in the drainage system (i.e., trabecular meshwork and canal of Schlemm) degenerate and the exit channels for aqueous fluid become blocked. -Angle-closure glaucoma occurs in people who have an anatomically narrow angle at the junction where the iris meets the cornea.

Nurse managment for the blind are?

-Introduce yourself each time you enter the room because many voices sound similar. -Call the client by name during group conversations because the blind client cannot see to whom questions or comments are directed. -Speak before touching the client. -'Tell the client when you are leaving the room. -Ask client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes his or her control over the environment. -Keep personal care items in the same location at alt times. Doing so provides client with the ability to locate toiletries easily, -Move food items from the tray to a larger surface area. Doing so facilitates locating food and eating utensils without accidental spilling or dropping. -At mealtimes describe where food is on the plate using the positions on the face of a clock. This measure assists the client to identify the location of food. -Offer to open containers, butter bread and so forth. Allowing the client a choice facilitates independence. -Orient client to the physical environment Orientation assists the client to remain familiar with the environment and to avoid injury. -Indicate the location of the signal cord for obtaining nursing assistance. Doing so facilitates the client's ability to get help. -Keep doors fully open rather than ajar. This measure helps maintain a safe environment. -Help client to feel where the door to the bathroom is located. This intervention promotes independence and prevents injury. - Remove chairs or objects that are in the client's walking pathway- Doing so maintains a safe environment. -Instruct client to grasp your elbow and walk slightly behind and to the side when ambulating. This positioning helps the client to feel secure and ensures safety.

Signs & symptoms of people w/refractive error eyes?

-People with refractive errors experience blurred vision. -Some seek help for recurrent headaches caused by straining to see clearly. -detected with the Snellen and jae'ger charts. -During retinoscopy, the vision of myopes improves when concave trial lenses correct the focusing power of the eyes. -Hyperopes experience improvement when convex lenses are used.

Medical Management & surgical management of Refractive error eyes?

-Refractive enrors usually are corrected with eyeglasses or contact lenses. surgery: -'Incisional radial keratotomy (RK): the eye surgeon reshapes the cornea by making incisions. It It is made flatter for clients with myopia and more cone-shaped for clients with hyperopia, enabling light rays to converge directly at the back of the retina. -• Laser-assisted in situ keratomileusis (LASIK): uses a laser called a femtosecond laser or a surgical blade to create a thin corneal flap, which is gently folded back to expose the inner cornea. -* Photorefractive keratectomy (PRK): the removal of the epithelial layer (top surface) of the cornea. -* Intrastromal corneal ring segments (ICRSs): surgeon implants these semicircular pieces of plastic through a small incision in the cornea to correct mild myopia. -' Phakic intraocular lenses (IOLs) clients who do not have cataracts can have phakic IOLs surgically implanted in front of their natural lenses. - Conductive keratoplasty (CK) procedure, used only for clients with presbyopia, involves the application of heat to the periphery of the cornea to make it tighter and steeper.

Diagnostic Tests for eye injuries are?

-Staining the surface with fluorescein dye identifies a minute foreign body or abrasion to the cornea. -A slit-lamp examination provides magnification and light to visualize structures in the anterior and posterior segments. -X-rays, computed tomography (CT) and possibly magnetic resonance imaging (MR!) help find a penetrating foreign body. -An x-ray or CT confirms an orbital fracture.

The wet type has two classifications. of AMD

-The first is called classic choroidal neovascularization. It has a more abrupt onset and is characterized by enlarged drusen. -- -The underlying problem stems from an opening between one of the membranous layers of the retina and the choroid. -Serous fluid seeps into the separation and elevates an area of the retina like a blister. One or more blood vessels grow into the defect and produce a subretinal hemorrhage. After the bleed, scar tissue forms. The damage almost always is confined to the macular area and vision loss can be severe. -second form of wet-type macular degeneration is termed occult choroidal neovascularization- it differs from the clasik form in that the new vessel growth and leakage is less pronounced resulting in vision loss that is less severe.

Medical Management for the blind are?

-Vision is improved to its maximum extent with corrective lenses. -severely visually impaired or blind are referred to a rehabilitation center or other resource for supportive services. -Blind or nearly blind events are taught skills for independent living how to use a cane for mobility and how to read and write Braille, a system that uses raised dots to form letters of the alphabet and numbers. -Some individuals use trained guide dogs.

Signs and Symptoms of injured eye?

-injured eye is painful or described as feeling "gritty." There is tearing and the client usually tries to relieve discomfort by squeezing the eyelids closed. -The effort helps control eye movement and reduces the light entering the eye. Vision may be blurred. -If the bony orbit is fractured, the eyes may appear asymmetrical and the client has diplopia (double vision). -Blows to or near the eye usually result in swelling and bleeding into soft tissues with ultimate discoloration (black eye) of the area. On inspection, hemorrhage may be observed in the subconjunctival tissue. The eye may appear to recede into the orbit, and there may be a change in the normal size or shape of the iris or pupil. -Adjacent lid structures may be lacerated, bloody and swollen. Shining a penlight obliquely across the eye detects an obvious or obscured foreign body. -Sometimes the upper lid must be everted to detect an object trapped beneath If treatment has been delayed. there may be purulent drainage in the conjunctival sac. A rust ring is seen in retained foreign bodies that contain iron.

CONJUNCTIVITIS Pathophysiology and Etiology /Signs & symtoms

-is an inflammation of the conjunctiva. It commonly is called pinkeye because of hemorrhage of the subconjunctival blood vessels which cause the pink appearance. Some forms are highly contagious. patho: -Conjunctivitis results from a bacterial, viral, or rickettsial infection. The microorganisms most often are introduce! by air transmission, direct contact with sources on the fingers, a contaminated face towel or washcloth, or transmission from infected lesions near the eye. S/S: - redness, excessive tearing swelling, pain, Miming or itching and, possibly purulent drainage from one or both eyes. Clients may complain of photophobia (sensitivity to light). Conjunctivitis generally starts in one eye but spreads to the other eye through hand contact. - In infections with the herpes simplex virus, lesions appear on or near the lid margins, In severe cases, lymph nodes in the neck or throat area are enlarged.

1-visually impaired 2-acoustic neuroma 3-American sign language

1-condition in which visual acuity is between 20/70 and 20/200 in the better eye with the use of glasses. 2-a benign Schwann cell tumor that progressively enlarges and adversely impacts cranial nerve VII, which consists of the vestibular and cochlear nerves. 3-

1-otosclerosis 2-ototoxicity 3-presbycusis

1-disorder characterized by a bony overgrowth on the stapes that is a common cause of hearing impairment among adults. 2-detrimental effect of certain medications on the eighth cranial nerve or hearing structures. 3-hearing loss associated with aging.

1-endophthalmitis 2-enucleation 3-glaucoma

1-disorder in which all three layers of the eye and the vitreous are inflamed. 2-surgical removal of an eye, 3-eye disorder caused bv an imbalance between the production and drainage of aqueous fluid.

1-retinal detachment 2-trabeculoplasty 3-uveitis

1-disorder in which the sensory layer becomes separated from the pigmented layer of the retina. 2-procedure in which a laser beam is directed at the trabecular network in the eye. 3-inflammation of the uveal tract.

1-tympanotomy 2-vertigo

1-incisional opening of the tympanic membrane. 2-the sensation of movement when there is none, or a sense of exaggerated motion when moving. When a disturbance occurs in the inner ear, vertigo occurs, along with problems with balance and stability. Vertigo is not a disease but a symptom of a disease.

1-hordeolum 2-hyperopia 3-hypopyon

1-inflammation and infection of the Zeis or Moll gland, a type of oil gland at the edge of the eyelid. 2-farsightedness- people who are hyperopic see objects that are far away better than objects that are close. 3-

1-Keratitis 2-keratoplasty 3-macular degeneration

1-inflammation of the cornea. 2-corneal transplantation. 3-breakdown of or damage to the macula, the point on the retina where light rays converge for the most acute visual perception.

1-myopia 2-photophobia 3-presbyopia

1-nearsightedness; people who are myopic hold things close to their eyes to see them well. 2-sensitivity to light. 3-condition in which visual accommodation the ability to focus an image on the retina, gradually declines with aging as a result of lens inelasticity.

1-speech reading 2-stapedectomy 3-tinnitus

1-perception 0f conversation by following the movements of a speaker's lips. 2-surgical procedure to improve hearing loss in which all or part of the stapes is removed and a prosthesis is inserted. 3-disorder in which a client hears buzzing, whistling, or ringing-noises in one or both ears.

1-otalgia 2-otitis externa 3-otitis media

1-sense of fullness or pain in the ears. 2-inflammation of the tissue within the outer ear. 3-inflammation or infection in the middle ear.

1-corneal trephine 2-diplopia 3-emmetropia

1-surgical procedure in which a small hole is produced at the junction of the comea and sclera to provide an outlet for aqueous fluid. 2-double vision. 3-normal vision in which light rays are bent to focus images precisely on the retina.

Common causes of conductive & sensorineural hearing loss are?

Conductive Hearing Loss: • External ear conditions ' Impacted earwax or foreign body »Otitis externa . Middle ear conditions ' Trauma ' Otitis rnedia • Otosclerosis •Tumors Sensorineural Hearing Loss: 'Trauma 'Head injury • Noise • Central nervous system infections (e.g. meningitis) • Degenerative conditions • Presbycusis • Vascular conditions 'Atherosclerosis • Ototoxic drugs »Tumors ' Meniere's disease Mixed Conductive and Sensorineural Hearing Loss: »Middle ear conditions • Temporal bone fractures

MACULAR DEGENERATION Medical Management

There are several treatment options for wet AMD: 1. Angiogenesis inhibitors-used to inhibit the development and progression of abnormal blood vessel formation (angiogenesis)' - Drugs include ranibizumab (Lucentis), pegaptanib (Macugen), bevacizumab (Avastin), and aflibercept (Eylea). These drugs are injected every 4 to 8 weeks. A transient loss of vision related to increased intraocular pressure (IOP), burning sensation, eye pain and floaters may occur. 2. Photodynamic therapy-uses an intravenous injection of a photosensitizing drug and a nonthermal laser application to reduce proliferation of abnormal blood vessels and eliminate the risk to the retina 3. Laser photocoagulation-seals the serous leak and destroys the encroachment of blood vessels in the area. It must be performed early to prevent progression of the disorder. 4. Macular translocation-this is a surgical procedure for wet AMD. A retinal detachment is created, moving the retina to a healthier spot so that the macula is a slight distance from the area of choroidal neovascularization. 5. Implantable miniature telescope (IMTH tiny telescope inserted in one eye allows for central vision whereas the other eye provides peripheral vision. 6. Vitamin and mineral formulation-a combination of vitamin C, vitamin E, beta-carotene (vitamin A), zinc oxide, and cupric oxide (copper) has been found to reduce the risk of developing advanced AMD and severe vision. 7. Diet-clients with AMD are instructed to eat a healthy diet that includes two to three servings of cold-water fish per week and daily servings of leafy green vegetables and a variety of fruits and other vegetables.