Eyes and Ears

Disorders

Glaucoma
Increased IOP resulting from inadequate
drainage or overproduction of aqueous
humor (10-20 mmHg)
Damages the optic nerve and causes
irreversible blindness
Risk factors: family history, race, age, DM,
CV disease, eye trauma, prolonged use of
steroids

 Types:
Open angle glaucoma - overproduction of
AH
Close angle glaucoma- obstruction of
outflow of AH
* the more dilated the pupils are, the more
obstruction to the outflow

Open-Angle Glaucoma

Closed-Angle Glaucoma

Assessment for Glaucoma

Progressive loss of peripheral vision (compression
of rods) tunnel vision
Increased IOP
Halos around white lights (corneal edema)
Blurred vision, headaches, eye pain, photophobia,
lacrimation, difficulty adjusting to dark rooms
Chronic (open angle)- persistent dull eye pain
Closed angle- sudden severe pain around eyes and
face, headache or brow pain, n/v, decreased light
perception, dilated, non-reactive pupil, inflammation,
red eye, cloudy cornea

Management for Glaucoma

Instruct patient about lifelong need for
medication
Avoid anti-cholinergic meds
Prepare for surgery
- Laser trabeculoplasty
* avoid activities that increase IOP
* report any acute deep pain in eye,
decreased vision

Management for Glaucoma

Care: Routine post-op care

Eye patch
Position on back or on unoperative side
Assess for signs of increased IOP
Meds: Steroids, Antibiotics and Miotics
(Pilocarpine)
Diuretics, beta-blockers, Epinephrine
(open angle)

Cataracts
Opacity of the lens that distorts the image
projected on the retina
Causes: aging, overuse of steroids, Cushings
disease, DM, overexposure to UV rays
Manifestations: poor night vision, painless blurring
of vision, pupillary color may change to yellow,
gray or white, reduced visual acuity, loss of
central vision

Cataract

Cataracts
Treatment:
Intracapsular Cataract Extractionremoves the entire lens and capsule
*Disadvantage- removes the protective
posterior capsule- greater risk for retinal
detachment-loss of supportive structure of
IOL implant

Extracapsular Cataract Extraction- lens

and anterior capsule removed- capsule
removed then uses phacoemulsification to
break cataractous lens then IOL is
implanted
After lens is removed, the eyes has no
accomodative power and loses its
refractive power (aphakia)
-eyeglasses, contact lenses or IOL implant

Cataracts
NURSING MANAGEMENT
Elevate HOB 30-45 ; place on non-operative
side
Modify the environment- place items on
unaffected side to discourage movements or
positions that would apply pressure to the
operative site or cause increased IOP
Provide sensory stimulation to help
compensate for vision loss; avoid eye
straining

Cataracts
NURSING MANAGEMENT
Protect eye from injury by wearing an eye
shield
Correctly instilling eyedrops
Notify MD if sharp pain occursbleeding/infection
Avoid constipation
Cataract glasses magnify and objects will
appear closer

Retinal detachment
- separation of the retina from the posterior

part of the eye (epithelium); threatens

visual function
trauma, age related degenerative changes
If total detachment, blindness can occur

Retinal Detachment

Retinal Detachment
Manifestations: bright flashing lights, floatersblood and other cells are reflected by the cones
and rods; sensation of a veil in the line of sight,
blurred vision
Treatment:
- Bed rest with area of detachment in dependent
position to promote healing
- Tranquilizers to rest and reduce anxiety
- Cover both eyes with patches to prevent further
detachment
- Minimize eye stress

Retinal Detachment
Surgery:
a.Cryosurgery- supercooled probe causes
retinal scarring to reattach retina
b.Photocoagulation- laser beam thru the
pupil produces a retinal burn causing
scarring
c.Scleral buckling- depressing the sclera to
force the choroid closer to the retina

Scleral Buckling

Retinal Detachment
Post-operative Care
- Keep on bed rest, provide call bell and
answer promptly
- Maintain protective eye patches- 2 weeks
- Instruct to avoid activities that increased
IOP; limit reading for 3-5weeks
- Diminish lights in the room,
- Observe for signs of hemorrhage post-op
(severe pain, restlessness)

Assessment of Ear and Hearing

Weber test- bone conduction to test lateralization

Rinne test- air conduction audible longer

Major forms of hearing loss

Conductive loss- interrupted passage of
sound from external ear to junction of the
stapes and oval window usually due to
wax or otitis media or externa
Sensorineural loss- impaired cochlea or
acoustic (VIII) nerve dysfunction causing
failure of transmission of sound impulses
within the inner ear or brain- exposure to
loud noises

Menieres Disease or
Endolymphatic Hydrops
Abnormal inner ear fluid balance

inner ear disease that results from

labyrinthine dysfunction- causes severe
vertigo, sensorineural hearing loss and
tinnitus
Affects adults 30-60 years old; males
Unknown; familial, immune disorder, migraine
HA, middle ear infection, head trauma

Menieres Disease or
Endolymphatic Hydrops

Menieres Disease
Perception of sound is also impaired
Also may be a result of ANS dysfunction
that produces temporary constriction of
blood vessels supplying the inner ear.

Menieres Disease
Manifestations:
- sudden severe spinning, whirling vertigo- 10 minsseveral hours ( attacks may occur several times a
year)
- tinnitus- altered firing of sensory auditory neurons
- hearing impairment- sensorineural
- severe n/v, sweating & pallor due to ANS
dysfunction
- loss of balance and falling to the affected side due
to vertigo
- feeling of fullness or blockage in the ear

Menieres Disease
Lying down to minimize head movement and avoiding
sudden movements and reduce dizziness
Promethazine and Prochlorperazine for n/v
Atropine- to control an attack by reducing ANS function
Dimenhydrinate (Dramamine)- to control vertigo and nausea
Antihistamines (meclizine) or diphemhydramine- to reduce
dizziness and vomiting
Vasodilators- dilate BV supplying the inner ear
Sodium restriction- reduce endolymph
Surgical Interventions such as labyrinthectomy- only done if
unresponsive to meds and with incapacitating symptoms
with poor or no hearing- destruction of cochlea- total loss of
hearing in affected ear

SAMPLE QUESTIONS

A patient with Menieres disease is

experiencing severe vertigo. Which
instruction would the nurse give to the
patient to assist in controlling the
vertigo?
a.
b.
c.
d.

increase fluid intake to 3000mL/day

lie still and watch the TV
avoid sudden head movements
increase sodium in the diet

 A patient is diagnosed with a disorder

involving the inner ear. Which of the
following is the most common client
complaint associated with a disorder
involving this part of the ear?
a. hearing loss
b. pruritus

c. tinnitus
d. burning in the ear

 You are planning to instruct a client with chronic

vertigo about home safety and prevention of
exacerbation of symptoms. You should tell your
client to:
A. Drive at times when she does not feel dizzy.
B. Going to the bedroom and lying down during an
attack of vertigo.
C. Removing throw rugs and clutter at home.
D. Turning the head slowly when spoken to.

 A scleral buckling procedure is performed on the

client with retinal detachment. You provide
discharge instructions to the client. Which
statement by the client indicates a need for
further instructions?
A. I need to clean my eyes daily with sterile water
and a clean washcloth.
B. I need to wear an eye shield at night.
C. I need to avoid vigorous activity and heavy
lifting.
D. I need to avoid air travel.

 You are reviewing the doctors orders to a

patient with Menieres disease. Which of the
following dietary measures will you need to
reinforce?
A. Low fiber diet with decreased fluids
B. Low sodium diet with fluid restriction
C. Low fat diet with restriction of citrus fruits
D. Low carbohydrate diet with elimination of red
meats

 You are giving instructions to an elderly client with

glaucoma; you evaluate his understanding of the
use of eye drops. Which statement by the client
would indicate additional teaching is required?
A. I should pull my lower eyelid down and place the
drop/s onto the lower lid.
B. My wife makes sure I do not drive after dark.
C. I am glad I can stop taking this medicine when
my vision improved.
D. I have been careful to avoid being constipated.