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Perano, July Anne B. BSN3A Review of structure and function of the Visual and Auditory Senses 1.

EYES The eye can be divided into 3 layers or coats (i.e., outer, middle, and inner), and the refractive media. o The outer, protective layer  The sclera is the white, opaque, fibrous connective tissue.  The cornea is the anterior continuation of the sclera, which is transparent and avascular. o The middle, vascular layer (i.e., uveal tract)  The choroid is a thin, pigmented membrane containing blood vessels that supply eye tissues.  The ciliary body is the anterior continuation of the choroid containing muscles that change the shape of the lens to focus vision.  The iris is the central extension of the ciliary body, consisting of 2 muscles and a central opening, the pupil, which constricts and dilates to regulate the amount of light entering the eye’s anterior (i.e., constricts with strong light and near vision, dilates with dim light and far vision.) o The inner, neural layer (i.e., retina) contains layer of nerve cells, including rods and cones that translate light waves into neural impulses for transmission to the brain. o Refractive media  The cornea is the transparent layer that forms the external coat of the anterior portion of the eye.  The aqueous humor is watery fluid filling the eye’s anterior chamber that serves as a refracting medium and maintains the hydrostatic intraocular pressure.  The lens is a biconvex crystalline body located behind the pupil that changes shape for accommodation (i.e., focusing)  The vitreous humor is a jelly-like substance filling the posterior cavity behind the lens, acting as a refractive medium and maintaining the shape of the eye. FUNCTION o Vision depends on a complex coordination of ocular structures that mediate passage of light rays reflected from an external object to the retina and transmit visual images to the brain for interpretation. o Normally, light passes through the refractive media to the retina, where an inverted and reversed image forms. o In the retina, rods and cones convert the projected image into nerve impulses and transmit them to the optic nerve. o Impulses travel along the optic nerve to the brain’s optic chiasm and then to the cerebral cortex, where they are interpreted as sight. 2. EARS STRUCTURE o External ear  Structures of the external ear include the auricle, external auditory canal, and tympanic membrane, also called the eardrum.  The auricle and external auditory canal receive and direct sound waves to the tympanic membrane. o Middle ear communicates with mastoid air cells of temporal bone.  Ossicles (i.e., malleus, incus, and stapes) move and conduct sound waves from the external ear to inner ear.  The Eustachian tube connects the middle ear to the nasopharynx and equalizes pressure on both sides of the tympanic membrane. o Inner ear (i.e., labyrinth)

o The acoustic nerve (cranial nerve VIII) connects the cochlea .  Movement in the organ of Corti stimulates the sensory end of the cochlear branch of the acoustic nerve (cranial nerve VIII). receptor end organ of hearing). 2. o Position sense. or other noticeable postural characteristics. These cells transmit impulses through the vestibular branch of the acoustic nerve to the brain for maintenance of balance and equilibrium. Fluid in the semicircular canals of the inner ear responds to body movement by stimulating nerve cells that line the canals. semicircular canals and vestibular receptors with the brain. causing it to vibrate. EYES NURSING HISTORY o Family history of eye disease o Systemic medical conditions o Sports injuries o Laser surgery o Blows to the head o Vit.  Assess the sclera for whiteness. whose stapes transmit the vibrations through the fluid in the inner ear to the cochlea and the organ of Corti. balance and equilibrium).  Inspect eyebrows and eyelashes for distributions of hair growth.  These vibrations trigger movement of the ossicles in the middle ear. shininess and brightness. lesions and edema. where they strike the tympanic membrane. redness.  Semicircular canals contain sensory organs of equilibrium. FUNCTION. smoothness. The ears are involved in hearing and position sense (i.. squinting.  Risk factors assessment and screening procedures 1.  Assess for the blink reflex.  Assess for symmetry in the appearance of the eyes. A deficiency o Certain medications Significant subjective data from client o Decrease visual acuity o Blurred vision o Decreased color perception o Pain in the eye Physical Examination o Inspection  Assess for head tilting.e.  The cochlea contains the organ of Corti (i.- The vestibule contains receptors that respond to the position of the head as it relates to gravity.. which sends impulses to the temporal lobe for interpretation as sound.e. EARS NURSING HISTORY o Age o Heredity o Allergies o Upper respiratory infection o Head trauma o Excessive environmental noise or music o Certain ototoxic medications . o Hearing  Sound waves are directed by the external ear through the external auditory meatus.  Inspect the cornes for transparency.  Inspect eyelid for ptosis.

 Inspect external canal for lesions. enabling the examiner to bring the cornea. shiny. the room should be darkened. o Palpation  Palpate the area around the ear and palpate the auricle for pain or discomfort. normal findings include an intact.  Nose and throat assessment should accompany ear assessment because infection in these areas may lead to ear problems. The visual field test is a subjective examination.  Inspect ear canal for any bloody drainage. and both should breathe normally. This instrument enables the examiner to see larger areas of the retina. that is their central and peripheral (side) vision. o Ophthalmoscopy  Direct  A direct ophthalmoscope is a hand-held instrument with various plus and minus lenses. requiring the patient to understand the testing instructions. symmetry and angle of attachment to head. lens. The lenses can be rotated into place. The examiner switches to the left hand and left eye when examining the patient’s left eye. The light source is affixed with a pair of binocular lenses. pus or serous fluid. o Slit lamp  - . which are mounted on the examiner’s head. The ophthalmoscope is used with a hand-held.  Tympanic membrane (eardrum) inspection involves straightening the external auditory canal of an adult by pulling the auricle up and back while tilting the client’s head slightly.- - Significant subjective data from client o The client’s reporting “trouble with hearing” o Ear pain or discharge from ear o Tinnitus or “ringing in the ears” o Complaints of dizziness or incoordination Physical Examination o Inspection  Inspect the auricle and surrounding tissue for size. The examiner holds the ophthalmoscope in the right hand and uses the right eye to examine the patient’s right eye. and the patient’s eye should be on the same level as the examiner’s eye. It produces a bright and intense light. dryness. pearly gray and concave membrane that moves with swallowing. Laboratory Examination Non-invasive o Visual acuity  Most health care providers are familiar with the standard Snellen chart. The fraction 20/20 is considered the standard of normal vision. This chart is composed of a series of progressively smaller rows of letters and is used to test distance vision. The patient and the examiner should be comfortable. fully cooperate. cleanliness and redness. The patient is given a target to gaze on and is encouraged to keep both eyes open and steady.  Indirect  The indirect ophthalmoscope is an instrument commonly used by the ophthalmologist. and retina into focus sequentially. Visual field testing actually maps the visual fields of each eye individually. During this examination. cerebrospinal fluid. and complete the entire test in order to provide useful information. although in an unmagnified state. 20-diopter lens. o Visual Field Testing  A visual field test is a method of measuring an individual's entire scope of vision.

and even death from respiratory failure. and allergic reactions. insect bites. It is rarely prescribed now. rashes. when driving could be hazardous.  Anticholinesterase miotics increase the risk of cataract development and are therefore used mostly in patients in whom cataracts have already been removed. or discharge from the vagina or penis. Side effects include:   Teary eyes. audiometry is the single most important diagnostic instrument. blood. Although dipivefrin. Corticosteroids This medication is used to treat swelling. When a hand-held contact lens. Rare side effects include high blood pressure and disturbances in heart rhythm. poison ivy. and allergic reactions. in which the spoken word is used to determine the ability to hear and discriminate sounds and words. Occasionally it can cause anxiety and headaches. in which the sound stimulus consists of a pure or musical tone (the louder the tone before the patient perceives it. saliva. Side effects o This medication may cause burning. mucus. or calorically evoked nystagmus. This should disappear in a few days as your body adjusts to the medication.o The slit lamp is a binocular microscope mounted on a table. or itching of skin conditions such as eczema. also called cholinergic agonists. itching. Vision can also become dim and it may difficult to see in darkened rooms or at night.  Invasive o CT scan  A CT scan of the head can give some information about the eyes. Cataracts may be evaluated by changing the angle of the light. Excessive use of these miotics may cause toxic reactions. breast milk. it still causes problems in the eyes similar to those of epinephrine. reducing the pressure inside the front of the eye. For example. including convulsions. enlarged pupils. and the inner ear. and speech audiometry. is used with the slit lamp. Retinal detachment is an uncommon but dangerous side effect in susceptible individuals. - . o Electronystagmography  Electronystagmography is the measurement and graphic recording of the changes in electrical potentials created by eye movements during spontaneous. or redness when first applied to the skin. pus. such as a three-mirror lens. such as urine. o Ear culture and sensitivity  A culture and sensitivity test is usually done on the sample of fluid. as may the ocular fundus. This instrument enables the user to examine the eye with magnification of 10 to 40 times the real image. the angle of the anterior chamber may be examined. Audiometric testing is of two kinds: pure-tone audiometry. Miotics Miotics. narrow the iris muscles and constrict the pupil. This action pulls the iris away from the trabecular meshwork and allows the aqueous humor to flow out through the drainage channels. by varying the width and intensity of the light. the greater the hearing loss). inflammation.  Epinephrine can produce burning in the eyes. positional. Pharmacology 1. has fewer systemic side effects. allergies and other irritations. brow-aches. Side Effects. stinging. air-filled cavities (sinuses) within the bones around the nose. dermatitis. the anterior chamber can be examined for signs of inflammation. - 2. eye pain. Audiometry  In detecting hearing loss. The illumination can be varied from a broad to a narrow beam of light for different parts of the eye. spinal fluid. facial bones. This medication may also cause skin thinning and discoloration. A culture and sensitivity test may be done on many different body fluids. A miotic narrows the pupil and so can cause nearsightedness. muscular paralysis. the newer form of epinephrine.

Surgical: a. Consult your doctor or pharmacist for more details. 3. increased thirst or urination. dizziness. local irritation. it is possible this medication will be absorbed into your bloodstream. This is especially true for children and for those who have used this for an extended period of time and if they also have serious medical problems such as serious infections. systemic toxicity may occur in the very young and the elderly. Do not use if there is an infection or sores present on the area to be treated. oedema and conjunctivitis may occur: contact dermatitis. Procedures 1. even he is feeling well. - Prevent or treat infections caused by pathogenic microorganisms o Interventions    Assess client for allergies and determine whether culture has been obtained. on prolonged administration. This precaution applies for up to one year after stopping use of this drug. halobetasol propionate and augmented betamethasone dipropionate beyond two weeks consecutively is not recommended. and inform them that you use (or have used) this medication. Tell your doctor immediately if any of the following side effects occur: vision problems. Iridectomy  A surgical procedure in which a hole is made in the periphery (outer part) of the iris by removing a full-thickness piece from the iris in order to treat a specific type of glaucoma called narrow-angle glaucoma (or angle-closure glaucoma). 4. - Side Effects o transient stinging and raised intraocular pressure. The most common form of cataract surgery today involves a process called phacoemulsification. - Antibiotics Treat infection of the eyes o Intervention  Be sure to obtain a specimen for culture before use. assess client for super infection. hyperaemia. Instruct client to take medication. . Consult with your doctor before breast-feeding.- Precautions o Do not use this medication near the eyes if you have glaucoma. Small amounts of this medication may appear in breast milk. After multiple doses. injuries or surgeries. b. Treatment with clobetasol. - Mydriatic agents Agents that dilate the pupil (mydriatics) and paralyse accommodation (cycloplegics) are not only used as aids in the examination of the eye and other ophthalmic procedures but also in the management of inflammatory conditions of the eye to treat or prevent the formation of adhesions between the lens and the iris. This may have undesirable consequences that may require additional corticosteroid treatment. Discuss the benefits and risks with your doctor. Though very unlikely. With the use of an operating microscope. unusual weakness or weight loss. Cataract procedure  The standard cataract surgical procedure is performed in a hospital or in an ambulatory surgery center on an outpatient basis. persistent headache. This medication should be used cautiously during pregnancy and only if clearly needed.

and visual recovery is often slower. Following enucleation. and often no eye patch is required after surgery. An artificial lens is placed in the same capsular bag as with the phacoemulsification technique. Enucleation is only done under drastic circumstances such as to remove a malignant tumor in the eye or to relieve intolerable pain in a blind eye. In this most modern method. This technique requires a larger incision so that the cataract can be removed in one piece without being fragmented inside the eye. no stitches are used to close the wound. Such infection usually resulted from an ear infection that spread to the nearby bone in the skull.  Intracapsular cataract surgery: This surgical technique requires an even larger wound than extracapsular surgery. c. cataract surgery can usually be performed in less than 30 minutes and usually requires only minimal sedation. Tympanoplasty  Surgical repair of the eardrum  Patch the eardrum with a piece of the patient's own tissue taken from a vein or muscle sheath (called tympanoplasty).  The surgery used to be a common way to treat an infection in the mastoid air cells. Numbing eyedrops or an injection around the eye is used and. Keratoplasty  Corneal transplant.your surgeon will make a very small incision in the surface of the eye in or near the cornea. Extracapsular cataract extraction usually requires an injection of numbing medication around the eye and an eye patch after surgery. This procedure will usually take 2 . A thin ultrasound probe. is inserted into the eye and uses ultrasonic vibrations to dissolve (phacoemulsify) the clouded lens. There are three basic techniques for cataract surgery:  Phacoemulsification: This is the most common form of cataract removal as explained above. This method is rarely used today but can still be useful in cases of significant trauma. d. These cells are called mastoid air cells. an artificial lens is placed into the thin capsular bag that the cataract previously occupied. in general. . Enucleation  The surgical removal of an eye. Mastoidectomy  A mastoidectomy is surgery to remove cells in the hollow. This surgical technique requires a various number of sutures to close the larger wound. in front of the iris. Once the cataract is removed. an artificial eye (ocular prosthesis) is implanted as a cosmetic substitute for the real eye. e.3 hours. This lens is essential to help your eye focus after surgery. and the surgeon removes the entire lens and the surrounding capsule together. These tiny fragmented pieces are then suctioned out through the same ultrasound probe. f. This technique requires the intraocular lens to be placed in a different location. air-filled spaces in the skull behind the ear.  Extracapsular cataract surgery: This procedure is used mainly for very advanced cataracts where the lens is too dense to dissolve into fragments (phacoemulsify). which is often confused with a laser by patients.

Fenestration  Literally. were passive funnellike amplification cones designed to gather sound energy and direct it into the ear canal. and is designed to amplify and modulate sound for the wearer. Some foreign objects may be removed from the ear using irrigation alone. Similar devices include the bone anchored hearing aid. Myringotomy  Ear tube insertion involves placing tubes through the eardrums. Hearing aid device  A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear.  Pathophysiology  Cataracts can develop in one or both eyes at any age for a variety of causes. External auditory canal irrigation  Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline.fenestration refers to the creation of a new opening. as if glasses need cleaning. The extent of visual impairment depends on the size. Cataracts rank only behind arthritis and heart disease as a leading cause of disability in older adults. density. b. Special: a. and posterior subcapsular. Ear irrigation is performed in the emergency department as a first-line treatment for a foreign object in the ear canal. Earlier devices. Instillation of otic solution  An ear instillation is a solution of topical medicine prepared for administration into the ear canal. the making of a window -. the ear canal is irrigated to remove the dead insect. Other effects include myopic 2. c. Light scattering is common. The three most common types of senile (age-related) cataracts are defined by their location in the lens: nuclear. h. known as an "ear trumpet" or "ear horn". then.  Clinical Manifestations  Painless. If the object is a live insect. Cataract  A cataract is a lens opacity or cloudiness. but most require a combination of both irrigation and the use of instruments by the physician. Ear irrigation is most commonly performed on those who experience a wax buildup that has impaired hearing and irritated the outer ear canal. The eardrum is the thin layer of tissue that separates the outer and middle ear. Blindness a. . More than one type can be present in one eye. and cochlear implant. It is used to treat patients who complain of foreign body or cerumen (ear wax) impaction.fenestra in Latin (and fenetre in French) is a window -. The patient perceives that surroundings are dimmer. and reduced visual acuity. oil is inserted into the ear to kill the insect.  The purpose of ear irrigation is to remove earwax that is obstructing the ear canal or to remove a foreign object lodged in the ear canal. Disturbance in Visual Perception 1. and location in the lens. Visual impairment normally progresses at the same rate in both eyes over many years or in a matter of months. because it is less invasive than using an instrument. cortical. blurry vision is characteristic of cataracts. sensitivity to glare.g. and the individual experiences reduced contrast sensitivity.

which manifests as an acute condition with pain. Repeated attacks of nongranulomatous anterior uveitis can cause anterior synechia (ie. In this condition. If severe. It tends to be chronic. b.  Clinical Manifestations  Patients may report the sensation of a shade or curtain coming across the vision of one eye. photophobia. double vision).  Medical Management  No nonsurgical treatment cures cataracts. accumulation of pus in the anterior chamber) may occur. color shift (ie. and there may be vitreous clouding. Retinal Detachment  Retinal detachment refers to the separation of the RPE from the sensory layer.  The most common type of uveitis is the nongranulomatous type. although this increases glare. In a severe . monocular diplopia (ie. The pupil is small or irregular. There are two types of uveitis: nongranulomatous and granulomatous. d. The obstruction results in an increased IOP. Ongoing studies are investigatin ways to slow cataract progression. Mydriatics can be used as short-term treatment to dilate the pupil and allow more light to reach the retina. cell and flare). Open. There may be small. The four types of retinal detachment are rhegmatogenous. vitamin C. People at risk for this type of detachment include those with high myopia or aphakia after cataract surgery. or magnifying lenses may improve vision. but one eye may be more severely affected than the other. and vision is blurred. brunescens (ie. color values shift to yellow-brown). such as intake of antioxidants (eg. 2001).Angle Glaucoma  Usually bilateral. The keratic precipitate may be large and grayish. Granulomatous uveitis can have a more insidious onset and can involve any portion of the uveal tract. vitamin E) (Age-Related Eye Disease Research Study Group. strong bifocals. the ciliary body. a hole or tear develops in the sensory retina. cobwebs. The development of posterior synechia (ie. the aging lens becomes progressively more absorbent at the blue end of the spectrum). Vision is markedly and adversely affected. a hypopyon (ie. adherence of the iris and lens blocks aqueous outflow from the posterior chamber. Symptoms such as photophobia and pain may be minimal. Cataracts may also occur as a sequela to uveitis. or the choroid. especially around the cornea. The condition may be unilateral or bilateral and may be recurrent. and exudative. Rhegmatogenous detachment is the most common form. Closure-Angle Glaucoma  Obstruction in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of the peripheral iris to the trabecula. bright flashing lights. and a pattern of conjunctival injection. Iritis/Uveitis  Inflammation of the uveal tract is called uveitis and can affect the iris. traction. and reduced light transmission. glasses. fine precipitates on the posterior corneal surface and cells in the aqueous humor (ie. allowing some of the liquid vitreous to seep through the sensory retina and detach it from the RPE. astigmatism. contact lenses.shift. Reducing glare with proper light and appropriate lighting can facilitate reading. c. a combination of rhegmatogenous and traction. Conjunctival injection is diffuse. In the early stages of cataract development. or the sudden onset of a great number of floaters. Inflammatory Disturbance a. 2. Secondary glaucoma can result from either anterior or posterior synechia. beta-carotene. peripheral iris adheres to the cornea and impedes outflow of aqueous humor). Patients do not complain of pain.

The word "blepharitis" is derived from the Greek word blepharos. antinuclear antibodies (ANA). such as chorioretinitis. When looking at a person's eye. herpes zoster virus. a medical workup should be initiated to discover any underlying causes. and Lyme disease titer. patients should wear dark glasses outdoors. and photophobia. ocular candidiasis. including a complete blood cell count. or unattractive. and diagnostic tests. It is characterized by a pink appearance (hence the common term pink eye) because of subconjunctival blood vessel hemorrhages. It affects people of all ages. itchy eyelids. Local corticosteroid drops. irritated. The cornea bends light rays as a result of its curved shape and accounts for approximately two-thirds of the eye's total optical power. complete systems review. itching.1%. The condition can be difficult to manage because it tends to recur. and syphilis. scratching or burning sensation. posterior uveitis. d. erythrocyte sedimentation rate. cylopentolate (Cyclogyl) and atropine are commonly used. with the lens of the eye contributing the remaining one-third. which means "eyelid. as well as intravitreal corticosteroids. such as Pred Forte 1% and Flarex 0. may be used. If the uveitis is recurrent. Blepharitis  Blepharitis is the medical term for inflammation of the eyelids. Ciliary spasm and synechia are best avoided through mydriasis.. Clinical Manifestations  General symptoms include foreign body sensation. Only the very thin tear film lies between the front of the cornea and our environment. redness. Keratitis is the medical term for inflammation of the cornea. In very severe cases. one can see the iris and pupil through the normally clear cornea. Angular blepharitis is a term used to describe blepharitis which primarily affects the outer corners of the eyelids. herpes simplex virus. VDRL. Inflammation is a general term used to describe the process by which white blood cells and chemicals produced in the body protect us from foreign substances. blepharitis is not contagious and generally does not cause any permanent damage to eyesight. Blepharitis is an inflammation of the eyelids. systemic corticosteroids. Keratitis  c. Although it may be uncomfortable. b. injury. It is a very common eye disorder with a wide variety of causes. pain. and change in function. Conjuctivitis  Conjunctivitis (ie. causing red. Underlying causes include toxoplasmosis. inflammation of the conjunctiva) is the most common ocular disease worldwide. This evaluation should include a physical examination. Management  Because photophobia is a common complaint. there may be retinal and choroidal hemorrhages." and the Greek suffix itis. The cornea is the domeshaped window in the front of the eye. Conjunctivitis may be unilateral or  . or infection. annoying. The normal body response of inflammation involves varying degrees of swelling. tuberculosis. histoplasmosis. instilled four to six times a day are also used to decrease inflammation. warmth. and the formation of dandruff-like scales on the eyelashes. Another term for blepharitis is granulated eyelids. which is typically used to denote an inflammation in English.

which can increase bleeding. Prop the child's head with an extra pillow at night. This will help the body reabsorb the leakage of blood and may help reduce discoloration.bilateral. A visit to the doctor or an eye specialist may be required to rule out serious injury. but it can also appear when there is significant eye injury or head trauma. 3. Call immediately if any of the following symptoms are noted:        increased redness drainage from the eye persistent eye pain any changes in vision any visible abnormality of the eyeball visible bleeding on the white part (sclera) of the eye. Hyphema  Hyphema is usually caused by trauma to the eye. Blunt contusion  A black eye is often a minor injury. but the infection usually starts in one eye and then spreads to the other eye by hand contact. Call your doctor. follow up by investing in an ounce of prevention — protective goggles or unbreakable glasses are vitally important. Other causes of bleeding in the front chamber of the eye include:  Blood vessel abnormality  Cancer of the eye  Severe inflammation of the iris Symptoms  Bleeding in the front portion of the eye  Eye pain  Light sensitivity  . make sure it's covered with a towel or sock to protect the delicate skin on the eyelid. particularly if you're not certain of the cause of the black eye.  Use cold compresses for 24 to 48 hours. especially near the cornea If the injury occurred during one of your child's routine activities. give acetaminophen — not aspirin or ibuprofen. Eye Trauma a. and encourage him or her to sleep on the uninjured side of the face (pressure can increase swelling).  For a black eye:  Apply cold compresses intermittently: 5 to 10 minutes on. If you use ice. then switch to applying warm compresses intermittently. b. such as a sport.    If the child is in pain. who may recommend an in-depth evaluation to rule out damage to the eye. 10 to 15 minutes off.

The lens of the eye is normally clear. d. zygomatic or tripod. Eyeglasses with a cylinder correction or rigid or soft toric contact lenses are appropriate for these patients. an irregularity in the curve of the cornea. orbital apex. o The depth of the eyeball is important in determining refractive error. midfacial. Vision abnormalities Orbital Fracture  Orbital fractures are detected by facial x-rays. They have deeper eyeballs. Because astigmatism causes a distortion of the visual image. the eyes are shallower and are called hyperopic. Congenital Cataract  A congenital cataract is a clouding of the lens of the eye that is present at birth. 5. Blurred vision from refractive error can be corrected with eyeglasses or contact lenses. acuity of distance and near vision can be decreased. Depending on the orbital structures involved. which may cause purulent infection. Patients for whom the visual image focuses precisely on the macula and who do not need eyeglasses or contact lenses are said to have emmetropia (normal vision). orbital fractures can be classified as blow-out. and vegetable materials such as those from plants or trees. or short of. . the visual image focuses beyond the retina. The appropriate eyeglass or contact lens is determined by refraction. Refractive errors o In refractive errors. and orbital roof fractures. 4. except for copper. c. the distant visual image focuses in front of. the retina. People with hyperopia are farsighted. When people have a shorter depth to their eyes. o Another important cause of refractive error is astigmatism.  Causes  Congenital cataracts often occur as part of the following birth defects:             Chondrodysplasia syndrome Congenital rubella Conradi syndrome Down syndrome (trisomy 21) Ectodermal dysplasia syndrome Familial congenital cataracts Galactosemia Hallerman-Streiff syndrome Lowe syndrome Marinesco-Sjogren syndrome Pierre-Robin syndrome Trisomy 13 . Pediatric visual disturbance a. maxillary. People who have myopia are said to be nearsighted. Blow-out fractures result from compression of soft tissue and sudden increase in orbital pressure when the force is transmitted to the orbital floor. It focuses light that comes into the eye onto the retina. vision is impaired because a shortened or elongated eyeball prevents light rays from focusing sharply on the retina. These patients experience near vision blurriness. whereas their distance vision is excellent. Myopic people experience blurred distance vision. Refraction ophthalmology consists of placing various types of lenses in front of the patient’s eyes to determine which lens best improves the patient’s vision. the area of least resistance. iron. Foreign body  Foreign bodies that enter the orbit are usually tolerated.

Rarely.Streptococcus pneumoniae and various other organisms. e. drooping eyelids may be barely noticeable or quite prominent. Scarring and detachment of the retina in a premature baby in the past was called Retrolental Fibroplasia. They are the same condition. Ptosis  c.notably the herpes simplex virus. However. it is referred to as acquired ptosis. Neisseria gonorrhoeae. 6. Depending upon the severity of the condition. It may also occur as a reaction to chemical irritants. Its importance lies in the fact that it is potentially sight-threatening and may cause systemic complications.1 It is most commonly infective in origin: bacterial causes include Chlamydia trachomatis. In divergent strabismus. Less often viral causes . or exotropia. More often nowadays it is known as Retinopathy of Prematurity. The latter is a self-limiting condition lasting no more than 24 to 36 hours but infections need treatment. tumors of the brain or eye area are the cause of drooping eyelids. when it develops later. Retinal detachment is when the thin retinal film peels off from the back of the eye. in which case it is more easily noticed. forcing the weaker eye to do enough work to catch up. Drooping eyelids may occur on both sides (bilateral) or on one side only (unilateral). Retrolental fibroplasias  In a premature baby (born before their expected due date) the retina at the back of their eyes may scar and detach. If the visual axes converge. leading to amblyopia (blindness) in that eye. it is called convergent strabismus or esotropia.  The classic treatment for mild-to-moderate strabismus has long been an eyepatch. The danger with strabismus is that the brain cones may come to rely more on one eye than the other and that part of the brain circuitry connected to the less-favored eye fails to develop properly. Some sagging of the skin and connective tissues occurs during the normal aging process. This leads to visual impairment. Retinoblastoma  A malignant eye tumor in children. covering the stronger eye with a patch.b. the visual axes diverge. Staphylococcus aureus. eyedrops can work as well as an eyepatch in correcting moderate lazy eye and preventing the development of amblyopia (blindness). potentially leading to drooping of the eyelids. Atropine eyedrops are instilled daily in the stronger (dominant) eye. Congenital ptosis is eyelid drooping that is present at birth. Ophthalmia neonatorum  This is a conjunctivitis occurring in the first 28 days of life. Other causes include conditions that affect the muscles and nerves of the eyelid as well as conditions that affect the skin and connective tissues of the eyelid. A drooping or sagging of the eyelid is medically known as ptosis or blepharoptosis. The atropine works by blurring rather than blocking vision in the stronger eye. that arises in cells in the developing retina containing cancer-predisposing mutations in both copies of the gene . usually under age 5. d. Neoplastic disturbances a. Strabismus  A condition in which the visual axes of the eyes are not parallel and the eyes appear to be looking in different directions.

Disturbances in Auditory Perception 1. industrial machinery. Meniere’s disease  a. but up to half of presbycusis is genetically determined. b. These RB-related tumors usually are diagnosed in adolescence or adulthood. people with presbycusis may not realize that their hearing is diminishing. Otosclerosis usually affects both ears. Presbycusis is common. and iris. especially among young women. soft tissue sarcomas. affecting a third of people between 65 and 75 years and up to a half of people 75 and over. Presbycusis  Age-related hearing loss with gradually progressive inability to hear. causing progressive loss of hearing. The hearing loss can usually be corrected with a hearing aid. Pregnancy may trigger it.  When RB is detected at an early stage. The most common site of metastasis is the liver.RB1. It is due to acquired (somatic) mutations in both RB1 genes. it can sometimes be treated locally but often requires removal of the eye (enucleation). Otosclerosis  The abnormal formation of new bone in the middle ear that gradually immobilizes the stapes (stirrup bone) and prevents it from vibrating in response to sound. osteosarcomas. Strabismus (a "lazy eye") is the second most common sign. power tools. Environmental exposures (such as to guns. It tends to occur after age 40. It is a common disorder. The most common sign of retinoblastoma (RB) is a white pupillary reflex to light (leukocoria).  The sporadic form of retinoblastoma has later onset and typically leads to a single tumor in only one eye. and melanomas. Deafness a. It is due to the transmission of an RB1 (germline) mutation followed by an acquired (somatic) RB1 mutation. 2. ciliary body. One is hereditary while the other is sporadic:  The inherited form of RB is usually present at birth as multiple tumors (multifocal) in both eyes. Presbycusis most often occurs in both ears.  There are two forms of RB. especially high frequency sounds. Because the loss of hearing is so gradual. Ocular melanoma  A malignant melanoma arising from a structure within the eye.  Patients with hereditary RB are also at increased risk of developing tumors outside the eye. or very loud music) contribute significantly to presbycusis. Inflammatory Distrbances Otitis Externa . Meniere's disease is a disorder of the flow of fluids of the inner ear. Early diagnosis and treatment of RB and RBrelated tumors can reduce morbidity and increase longevity. The most common sites of origin are the choroid. They may have trouble distinguishing and understanding conversation in a noisy setting. b. c. The tumor may metastasize from the eye. including pinealomas (in the pineal gland of the brain).

usually lasting less than 6 weeks. and systemic conditions. Before the discovery of antibiotics. Some of the items that are commonly found in the ear canal include the following:  . The primary cause of acute otitis media is usually Streptococcus pneumoniae. either stuck in the lobe from infection or placed too deep during insertion. The most commonly identified viral causes are mumps. Haemophilus influenzae. rubella. Foreign bodies in the ear canal can be anything a child can push into his/her ear. Ramsay Hunt syndrome) also cause labyrinthitis. The infection can enter the inner ear by penetrating the membranes of the oval or round windows. Cerumen or earwax protects the ear from various bacterial infections. or allergic reactions (eg. rubeola. Objects usually found in the ear lobe are earrings. adenoid hypertrophy). Impacted cerumen  Impacted cerumen is another name for impacted earwax. permitting entrance of organisms into the tissues. such as vitamin deficiency and endocrine disorders. Chronic infections of the middle ear damage the tympanic membrane. Acute Otitis Media  Acute otitis media is an acute infection of the middle ear. and influenza. allergic rhinitis). Labyrinthitis  Labyrinthitis. bacterial labyrinthitis usually occurs as a complication of otitis media. A purulent exudate is usually present in the middle ear. infections of the mastoid were life-threatening. trauma to the skin of the ear canal. which enter the middle ear after eustachian tube dysfunction caused by obstruction related to upper respiratory infections. which clears when the offending agent is removed. destroy the ossicles. Even allergic reactions to hair spray.3. Although rare because of antibiotic therapy. refers to an inflammation of the external auditory canal. eczema. can be bacterial or viral in origin. External otitis is often caused by a dermatosis such as psoriasis. resulting in a conductive hearing loss. sinusitis. helps in cleaning and lubrication and also protects the sensitive skin of the ear canal. Chronic Otitis Media  Chronic otitis media is the result of repeated episodes of acute otitis media causing irreversible tissue pathology and persistent perforation of the tympanic membrane. swimmer’s ear). an inflammation of the inner ear. Viral labyrinthitis is a common medical diagnosis. Bacteria can enter the eustachian tube from contaminated secretions in the nasopharynx and the middle ear from a tympanic membrane perforation. hair dye. b. Obstructive problems a. External otitis. The most common fungus isolated in both normal and infected ears is Aspergillus. Viral illnesses of the upper respiratory tract and herpetiform disorders of the facial and acoustic nerves (ie. or seborrheic dermatitis. and permanent wave lotions can cause dermatitis. Causes include water in the ear canal (ie. The production of earwax depends upon person to person. inflammation of surrounding structures (eg. The most common bacterial pathogens associated with external otitis are Staphylococcus aureus and Pseudomonas species. b. and involve the mastoid. d. but little is known about this disorder. Foreign bodies in the ear canal  Foreign bodies can either be in the ear lobe or in the ear canal. or otitis externa. The use of medications in acute otitis media has made acute mastoiditis a rare condition in developed countries. and Moraxella catarrhalis. Earwax is produced when there is a mixture of shed layers of skin along with natural dust particles in the air and secretions from the glands present inside the ear. which affects hearing and balance. Excess production of earwax is a condition referred to as cerumen impaction which can cause many hearing problems as well can create an unwanted pressure against the eardrum causing a lot of pain. cerumen being another name for earwax. c. Bacterial or fungal infections are most frequently encountered. http://search.      4. SOURCES: Brunner’s & Suddarth’s Textbook of Medical-Surgical Nursing 10 Edition Lippincott’s review series Medical-Surgical Nursing 4 Edition http://www. food insects toys buttons pieces of crayon small batteries Ear trauma th th .medicinenet. Tympanic membrane perforation  A ruptured eardrum is an opening or hole in the thin layer of tissue (eardrum) that separates the outer and middle ear.nih.