Professional Documents
Culture Documents
NURSING DEPARTMENT
Muller’s muscle
Parts Conjunctiva
I. Tarsal/pulpural Conjunctiva
- The part lining in the inner aspect of the eye lid.
- Firmly attached to the underlying tarsal plate.
- Which is highly pink- easily anemic identified
II. Bulbar Conjunctiva
- The part lining the eye ball.
- Loosely attached to the underlying sclera.
III. Fornix
-Part in which the tarsal and bulbar
conjunctivas are continuous.
C. Glands
Glands of zeis and glands of Moll
– Testing vision
Current History
Duration of illness
Family history
Medical history
Ophthalmoscope
External examination
conjunctiva
– multiple sclerosis,
– brain lesions, or
– narcotics use.
Ocular motility test…
Perform cover test
• As you cover the eye, observe the
uncovered eye for movement.
– Hand movement
– Light perception
Accommodation.
eyes.
Visual Fields by Confrontation…
• While you return the patient‘s gaze, place your
hands about 2 feet apart, lateral to the patient‘s
ears.
– Use your right hand and right eye for pt's right
eye, left hand and left eye for the pt‘s left eye
– Disturbance of vision
– Eye discharge
Eye disorders
– Refractive errors
– Myopia
– Astigmatism
– Presbyopia
Hyperopia (far sightedness)
• Mechanism
• Etiology
– * Genetic link
• Diagnosis
– * Ophthalmoscope
Hyperopia (far sightedness)…
•Treatment
–* Convex lens
Myopia (near sightedness)
• Mechanism
• Etiology
– * Genetic link
– Squinting
– Eye rubbing
– Headaches
• Treatment
– *Concave lens
Astigmatism
• Mechanism
– * Genetic link
Astigmatism…
• Symptoms and signs
– * Squinting
– * Eye rubbing
– Headache
Astigmatism…
• Diagnosis
• Treatment
– * Genetic link
• Treatment
– * Convex lens
– Lens transplant
Disorders of the eye lid and eye lashes
• Hordeolum • Ectropion
• Chalazion • Trichiasis
• Blepharitis • Edema
• Entropion
Disorders of the eye lid
• Hordeolum (stye)
– *Inflammation of the hair follicle of the eye lid
• Etiology
– * Staphylococcal infection
* Usually associated with blepharitis
Internal Hordeolum
• It is secondary infection of meibomian glands
caused by staphylococcus
• Non-pharmacological treatment
• Mechanism
• Etiology
• Treatment
• Topical treatment
– Dexamethasone eye drop, 1 drop QID, for 3
to 6 weeks, then taper every 5 to 7 days OR
– Oxytetracycline+ Polymyxin B+Hydrocortisone
suspension TID/4 weeks OR
Ulcerative Blepharitis…
• Topical treatment…
– Generally asymptomatic
• Pharmacological treatment
• Etiology
– Itching, redness
– Visual examination
• Treatment
• Etiology
to cornea
Ectropion…
• Cause: _ Blepheritis
_ Trauma
• Rx: - Epilation
Inflammatory edema
Non-inflammatory edema
Eye lid edema…
Eye lid edema…
Diseases of the conjunctiva
• Conjunctivitis
– Bacterial conjunctivitis
– Viral conjunctivitis
– Allergic conjunctivitis
• Trachoma
Conjunctivitis (pink eye)
• * Is the inflammation of the conjunctiva
Etiology
– * Viral / bacterial
* Irritants (allergies, chemicals, UV light)
Conjunctivitis (pink eye)…
Common symptoms and signs
• Photophobia
• Eye discharge
Conjunctivitis…
• Types
– Bacterial conjunctivitis
– Viral conjunctivitis
– Allergic conjunctivitis
Bacterial conjunctivitis
• Is a bacterial infection of the conjunctiva usually
caused by Staph.auerus, streptococcus,…
Non-pharmacological treatment
Topical antibiotics
– Red eye
– Itching, Photophobia
Treatment
• Steroids if needed
Allergic conjunctivitis
• Inflammation of the conjunctiva caused by
air born allergy contacting the eye.
– Cold compress
Allergic conjunctivitis…
• There are various forms of allergic conjunctivitis
– Conjunctival swelling
• Non-pharmacological treatment
– Cold compress
• Pharmacological treatment
– Eyelid edema
– Cold compresses
• Pharmacological treatment
– Allergen avoidance
– Cold compress
• Pharmacological treatment
is a disease of poverty
Poverty
Poor hygiene
on upper tarsus
• Represent prior/old
• Likely to develop
progressive corneal
scarring, needs surgical
treatment
Corneal opacity (CO)
• Corneal opacity
affecting central
cornea
• Goal of treatment
– Prevent complications
• Non-pharmacological treatment
• Systemic treatment
• Cataract
• Glaucoma
Keratitis
• It is inflammation and ulceration of the cornea
– * Trauma
– lid abnormalities
– Immunosuppression
• Sign and symptoms
Photophobia
Blurred vision
– * Medical history
• Treatment
• Maintenance therapy
– * Foreign bodies
* Trauma (fingernail, contact lenses)
– Lid abnormalities
– Immunosuppression
– Dry eye
Corneal abrasion or ulcer…
Symptoms and signs
– Pain
– Redness
– Tearing
– Something constantly in eye
– Whitish opaque cornea
– Vision impairment
Corneal abrasion or ulcer…
Corneal abrasion or ulcer…
• Diagnosis
– * Visual examination
– *Tonometry (IOP)
• Etiology
– Autoimmune disorders
– * Rheumatoid arthritis
- Watering, photophobia
– * Ophthalmic examination
* Blood work to uncover underlying cause
• Treatment
• Etiology
– Photophobia
– Reduction of vision
– Watery discharge
– * Familial or * congenital
– * Uveitis
• Clinical
• Visual examination
– Eyeglass
• Advanced age
• Refractive error
– Acute or Chronic
– Primary or Secondary
• Mechanism
– Hemi-cranial headache
• Goal of treatment
– Elevated IOP
Chronic open-angle glaucoma…
• Diagnosis
• Prostaglandin analogues
• Adrenergic Agonists
• Para sympathomimetic
Prostaglandin analogues
Adrenergic Agonists
Para sympathomimetic:
• Surgery
– Trabeculectomy
– Ridotomy or Iridectomy
– Tube-shunt implant
– * Ophthalmoscopy
* Fluorescein angiography
* Patient history
Macular degeneration…
• Treatment
– * No known cure
* Laser photocoagulation
• MECHANISM
• ETIOLOGY
- Trauma
Retinal detachment…
Retinal detachment…
– * Visual floaters
– * Light flashes
* Dark/opaque shadow
– * Ophthalmoscopy
• Treatment
– Pneumatic retiopexy
– Vitrectomy
Retinal detachment…
Disease of the lacrimal apparatus
Dacryocystitis
• It is an inflammation of the lacrimal sac
Tympanic membrane
Middle ear
Inner ear
equilibrium
• Inspection
• Palpitation
• Otoscopic examination
Palpitation
• Assess the auricle, tragus and mastiod process
for tenderness
– Whisper Test
– Weber Test
– Rinne Test
Physical examination of the Ear…
• Whisper Test
patient‘s head
is heard equally in
both ears
Weber Test…
Rinne Test
• Used to compare air conduction (AC) and bone
conduction (BC)
• Radiographic examinations
– Foreign bodies
– External otitis
Cerumen impaction
Decreased hearing
• Suctioning, or Instrumentation
• Management…
• N.B: Syringing and manual irrigation should be
done by;
• Diagnosis
Causes
≠ Common causative agents being Pseudomonas
A., Staphylococcus aureus and others
Topical antibiotics
Mastoiditis
Otosclerosis
Tympanic Membrane Perforation
– Decreased hearing.
• Risk factors:
– Crowed conditions
– day care
– passive smoking
– bottle feeding
– low economy
Acute otitis media…
Causes
• Usually caused by Streptococcus pneumoniae
• Other bacterias :- Haemophilus influenzae,
Moraxella catarrhalis, influenzae A and B,…
• Viral causes :- RSV, Rhinovirus, Adenovirus,…
• Inflammation of surrounding structures and
allergic reactions ( E.g. sinusitis, rhinitis )
Pathophysiology
and bulging
auricle
Diagnosis
• Otoscopic examination
– Bulging TM
– Opacification of eardrum
– Squamous exudate
Medical management
• AOM spontaneously resolves (40 - 60%)
• Non pharmacologic
• Pharmacologic treatment
Pharmacologic treatment
• Tuberculosis
Clinical manifestation
• Fever, pain
– Surgery / Mastoidectomy/
Nursing interventions
Relive pain and reduce anxiety
Preventing infection
Improving hearing and communication
Assisted ambulation after surgery/balance
Instruct to avoid heavy lifting, straining, exertion,
and nose blowing for 2-3wks post-op
o Prevents dislodging of TM graft or prosthesis .
Otosclerosis
• Hearing aids
otosclerosis.
hearing loss)
Nursing management
• Operative ear up
• Ear plug for asepsis
• Treat N/V
• Safety measures
• Don‘t dislodge prosthesis
– No cough, sneeze, blowing of nose, vomiting,
flying, lifting, showering
–If gets a cold: consult physicians