18. Sense Organs - Pathologies Flashcards
Otitis Externa (Swimmer’s Ear): definition
Inflammation of the outer ear
Otitis Externa (Swimmer’s Ear): epidemiology
5x more common in swimmers
Also prevalent in humid cultures, diabetes mellitus, HIV and people with narrow auditory canal
Otitis Externa (Swimmer’s Ear): pathophysiology
Ear wax (cerumen) contains lysozymes and oil that create an acidic, lubricating coat
This coat inhibits bacterial and fungal growth so insufficient wax can predispose to infection
Otitis Externa (Swimmer’s Ear): aetiology
90% associated with bacterial infection
Remaining fungal or allergic
Excess wax (obstruction)
Water in the ear
Frequent use of earplugs/headphones/hearing aids
Acne, eczema, fungal infections following antibiotic use
Otitis Externa (Swimmer’s Ear): signs and symptoms
Pain (especially with movement of pinna)
Discharge - often purulent
Swelling
Itching
Red, swollen auditory canal
Hearing deficit
Otitis Externa (Swimmer’s Ear): allopathic treatment
Hygiene
Avoid water in ears
Syringe ears with saline solution (by GP)
Topical antibiotics
Otitis Media: definition
Inflammation of the middle ear
Otitis Media: epidemiology
Most common cause of earache in children due to horizontal eustachian tube
75% <10 yrs old
Many have food or inhaled allergies
Otitis Media: pathophysiology
Fluid puts pressure on tympanic membrane
Otitis Media: aetiology
Infectious organisms - bacterial/viral
Allergies
Otitis Media: signs and symptoms
Earache/pain
Malaise, fever, nausea
Mild earing loss
Can get bulging of tympanic membrane
Otitis Media: complications
Scar tissue on eardrum (with rupture of tympanic membrane)
Otitis Media: allopathic treatment
Rupture of tympanic membrane
Antibiotics
Secretory Otitis Media: definition
Effusion of the middle ear resulting from incomplete resolution of acute otitis media
What is secretory otitis media also known as?
Glue ear
Secretory Otitis Media: pathophysiology
Gluey fluid dampens the tympanic membrane and ossicle vibrations which leads to hearing impairment
Secretory Otitis Media: signs and symptoms
Hearing loss
Pressure in ear
Mild intermittent ear pain
Secretory Otitis Media: allopathic treatment
Tympanostomy tube (grommet) inserted into eardrum to drain fluid
Tonsils may be removed
Labyrinthitis (Otitis Interna): definition
Balance disorder associated with inflammation of the membranous labyrinth
Labyrinthitis (Otitis Interna): aetiology
Often follows upper respiratory infection
Following head injury, allergy or reaction to medication
Labyrinthitis (Otitis Interna): signs and symptoms
Sudden, severe vertigo
Sudden, unilateral hearing loss
Tinnitus
Nausea, vomiting
Labyrinthitis (Otitis Interna): allopathic treatment
Anti-emetic drugs (anti-sickness)
Meniere’s Disease: definition
Disorder of inner ear, caused by change in fluid volume in labyrinth
Meniere’s Disease: pathophysiology
Progressive distention of the membranous labyrint
Meniere’s Disease: aetiology
Genetics
Viral
Autoimmune links - RA, SLE
Food allergy links
Meniere’s Disease: signs and symptoms
Vertigo Tinnitus Hearing loss Nausea, vomiting Ear pressure Characterised by fluctuating patterns of symptoms
Meniere’s Disease: allopathic treatment
No cure - only symptom minimisation
Tinnitus: definition
Perception of sound originating from within the head rather than outside
Tinnitus: aetiology
Objective - pulsatile (carotid stenosis, valve disease), muscular (spasm of tympanic muscles)
Subjective - ear origin (Meniere’s, ear infection, wax), neurological (head injury, MS, tumour), infections (meningitis), drug related (NSAIDs, loop diuretics), TMJ (jaw) dysfunction
Hearing Impairment: definition (conductive)
Ear canal obstructions, ossicle abnormalities, ruptured tympanic membrane
Hearing Impairment: definition (sensory)
Poor hair cell function due to congenital condition, infection or noise trauma
Mild hearing loss: definition
25-40dB
Moderate hearing loss: definition
41-70 dB
Severe hearing loss: definition
71-90 dB
Profound hearing loss: definition
90 dB+
Hearing Impairment: aetiology
Diseases - measles, meningitis, mumps, rubella, chlamydia, syphilis
Premature birth
Head injuries
Shaken baby syndrome
Hearing Impairment: allopathic treatment
Hearing aid
Cochlear implant
Blepharitis: definition
Inflammation of eyelid margin
Can be acute or chronic
Blepharitis: epidemiology
Most common in adults
Blepharitis: pathophysiology
Often associated with Staphylococcus aureus infection
Dermatitis
Blepharitis: signs and symptoms
Often bilateral
Red eyelid margins
Sore, gritty eyes, scales, flakes
Eyelids may stick together, worse in morning
Itching and burning
Loss of eyelashes
Can block sebaceous glands and cause recurrent styes
Blepharitis: allopathic treatment
Eyelid hygiene - clean with cotton bud
Warm compress
Topical antibiotics
Avoid contact lens use
Stye: definition
Inflammation of sebaceous glands of eyelid
Where is usually affected by a stye?
Usually affects upper lid
Stye: aetiology
Usually a bacterial infection - Staphylococcus
Risks - diabetes mellitus, chronic blepharitis
Related to immune compromise/stress
Stye: signs and symptoms
Red, swollen and/or painful infection of sebaceous glands of eyelid
Stye: complications
Cyst formation can damage the cornea
Stye: allopathic treatment
Usually none necessary
Hot compress 3/4 times a day once burst
Antibiotic ointment if stye doesn’t resolve
Conjunctivitis: definition
Highly contagious inflammation of the conjunctiva
Conjunctivitis: aetiology
Viral
Bacterial
Often linked with allergies
Conjunctivitis: signs and symptoms
Red eye, irritated and uncomfortable
Watery (viral/allergic)
Purulent discharge (bacterial)
Photophobia suggests corneal (deeper) involvement
Conjunctivitis: allopathic treatment
Eye bath with salt water or eye-cleansing solution
Antibiotic eye drops
Uveitis: definition
Inflammation of any part of the uvea
Uveitis: aetiology
Autoimmune links - HLA-B27 eg AS
Trauma to eye (inc contact lenses)
Viral infection, fungal or parasitic
Uveitis: signs and symptoms
Progressive unilateral red eye with pain
Blurred vision
Photophobia
Visual acuity reduced in affected eye
Watery discharge
Uveitis: allopathic treatment
Antibiotics
Cortisone depending on cause
Cataracts: definition
Opacity of the lens
Cataracts: pathophysiology
Healthy lens = transparent
Cataracts = new fibres produced and become disorganised with cytoplasm
Cataracts: allopathic treatment
Surgery
Day surgery - replacing lens with plastic
Cataracts: aetiology
Age-related deterioration of lens
Congenital
Diabetes mellitus
Smoking
Steroids*
Causes breakdown of proteins, which can include collagen
Cataracts: signs and symptoms
Gradual painless loss of vision
Diplopia
Age-Related Macular Degeneration (AMD): definition
Ageing changes that occur in the central areas of the retina (macula)
Age-Related Macular Degeneration (AMD): epidemiology
55 yrs+
Leading cause of vision loss worldwide
Age-Related Macular Degeneration (AMD): aetiology
Advancing age
Smoking
CVD risk factors
Family history
Age-Related Macular Degeneration (AMD): signs and symptoms
Reduced visual acuity
Difficulty with near vision
Gradual and progressive loss of central vision
Age-Related Macular Degeneration (AMD): diagnosis
Ophthalmoscopy
Amsler grid
Muscae Volitantes (Floaters): definition
Opacities floating in field of vision
Shadowy shapes that move with eye movements
Muscae Volitantes (Floaters): aetiology
Shrinkage of vitreous humour causing collagen to become fibrils
Vitreous haemorrhage with haemorrhaging in diabetic retinopathy
Retinal Detachment: definition
Separation of the neurosensory layer of the retina from the pigmented epithelium
Retinal Detachment: pathophysiology
Accumulation of sub-retinal fluid in the potential space
Retinal Detachment: signs and symptoms
Floaters in vision
Flashing lights
Curtains descending over vision
Retinal Detachment: allopathic treatment
Ocular emergency - surgery
Retinal Detachment: complications
Visual impairment
Blindness
Retinal Detachment: epidemiology
Middle-aged
Elderly
Glaucoma: definition
Increased intraocular pressure caused by inadequate drainage
Glaucoma: intraocular pressure levels
IOP should be 10-21 mmHg
>40 = significant damage caused
Glaucoma: pathophysiology
Causes compression of the retina and optic nerve
Glaucoma: aetiology
Congenital
Acquired - uveitis, intraocular haemorrhage
Obstruction of the canal of Schlemm
Smoking
Glaucoma: signs and symptoms (acute)
Mild - pain in eyes
Haloes around lights, relieved by sleep
Severe - rapid deterioration of vision
Intense eye pain
Redness, watering of eye
Sensitivity to bright light
Nausea, vomiting
Glaucoma: signs and symptoms (chronic)
Often no symptoms until permanent damage has occurred
Late symptoms - loss of peripheral vision
Blurring of objects directly in front of person
Loss of night vision
Glaucoma: complications
Damage to optic nerve and retina leads to permanent blindness
Glaucoma: allopathic treatment
Eye drops/tablets to reduce fluid retention
Laser or surgical treatment
Diabetic Retinopathy: definition
Progressive, potentially sight-threatening disease of the retinal microvasculature
Diabetic Retinopathy: pathophysiology
Microvascular damage occurs which occludes branches of the retinal artery causing neovascularisation
The vessel walls become physically weak and leaky, leading to micro-aneurysms, oedema and haemorrhaging
Diabetic Retinopathy: aetiology
Chronic hyperglycaemia
Diabetic Retinopathy: prognosis
May retain normal sight or present as a decline in vision or floaters
Corneal Ulcer:definition
An ulcer (open sore) that develops in the cornea
Corneal Ulcer: aetiology
Bacterial (e.g. gonorrhoea), viral
(e.g. herpes simplex), fungal infection.
Trauma (e.g. contact lens), spread
from blepharitis.
Corneal Ulcer: signs and symptoms
Pain
Reduced vision
Photophobia
Discharge
Corneal Ulcer: treatment
Medical emergency — possible loss of sight
Antibiotics, antifungal or antiviral drugs, keratoplasty
(corneal transplant).
Strabismus: definition
Mis-alignment of the eyes, which means the retinal
image is not in corresponding areas of both eyes
Strabismus: classifications
Esotropia = inward squint
Exotropia = outward squint.
Strabismus: aetiology
Genetic (family history of squint).
Damage to nerves supplying extra-ocular muscles (e.g. stroke, brain tumour).
Strabismus: treatment
Glasses to correct visual problems and patching the normal eye (forces the brain to use the affected eye).
Surgery to tighten muscles around the eye.
