Chapter 5 - Eye and Ear Diseases

Question 1

Refractive errors
(1) Hyperopia problem and correction
(2) Myopia problem and correction
(3) Astigmatism

Answer 1

(1) Light rays focus behind retina. Vision of close objects is impaired. Solution: convex lens
(2) Light rays focus in front of retina. Vision of far away objects is impaired. Solution: concave lense
(3) Irregular focusing of light rays entering the eye. Usually caused by cornea not being spherical. Causes some images to be blurred

Question 2

Refractive error - Presbyopia
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 2

(1) Inability of internal lense of eye to focus on near objects due to loss of elasticity related to aging
(2) Blurred vision and eye fatigue
(3) Related to aging; some may be predisposed due to genetics or prolonged close work
(4) Eyeglasses or corrective surgery

Question 3

Nystagmus
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 3

(1) Repetitive, involuntary, rhythmic movements of one or both eyes
(2) Involuntary movement of eyes, blurred or decreased vision
(3) May be caused by lesions on the brain or inner ear from tumors, drugs, or abnormal development
(4) Treat underlying cause, such as removing tumor or correcting developmental abnormality

Question 4

Strabismus
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 4

(1) Misalignment of the eyes
(2) Diplopia can be a symptom if the condition is acquired. When congenital, there are usually no symptoms
(3) If acquired, usually related to another disease or condition. If congenital, it is usually related to amblyopia (lazy eye) in which the brain and one eye are not properly communicating
(4) Corrective glasses or surgery to restore eye muscle balance may be used. For amblyopia, the good eye is often covered to force the child to use the weaker eye

Question 5

Hordeolum (stye)
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 5

(1) Painful abscess of the eyelash follicle
(2) Pain, swelling, redness, formation of pus
(3) Often result from staphylococcus infection that may be secondary to blepharitis
(4) Warm compresses, topical antibiotics, surgical drainage

Question 6

Chalazion
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 6

(1) Small, firm, non-mobile, painless, subcutaneous nodule on margin or body of eyelid
(2) May vary in size; can become infected, producing redness, swelling, and pain
(3) Caused by blockage of fluid originating from one of the meibomian glands, which lubricate the eyelid
(4) Often resolve spontaneously. Warm compresses. Antibiotics if infected. Larger ones may need to be removed surgically

Question 7

Keratitis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 7

(1) Inflammation or infection of the cornea
(2) Decreased visual acuity, irritation, tearing, photophobia, redness of conjunctiva. A severe sign is numbness or pain of the cornea
(3) Often caused by herpes simplex virus. Can also be caused by some bacteria and fungi. Contact lens wear, and improper care thereof, may increase risk of bacterial keratitis. Trauma, dry air, and intense light may also cause keratitis.
(4) Antibiotics or antiviral medications, eye drops, eye patch to relieve photophobia (unless infection is fungal or patient wears contact lenses)

Question 8

Blepharitis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 8

(1) Inflammation of the margins of eyelids involving follicles and glands
(2) Most often a bilateral condition. Redness and crusting in and around eyelids, itching, burning, foreign body sensation, eyelashes fall out and irritate eyes
(3) Ulcerative form may be caused by S. aureus. Non-ulcerative can be allergies, smoke, dust, or other irritant
(4) Apply warm, wet compresses; clean eyelids, antibiotics if appropriate

Question 9

Entropion
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 9

(1) Margin of eyelid turns inward
(2) Foreign body sensation, tearing, itching, redness; can cause conjunctivitis
(3) Loss of tissue elasticity that comes with age
(4) Minor surgical procedure

Question 10

Ectropion
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 10

(1) Eyelid everts from eyeball, exposing part of eyeball and inner eyelid which causes them to be dry and irritated
(2) Tearing and feeling of dryness
(3) Decreased elasticity of eyelid that comes with age
(4) Minor surgical procedure

Question 11

Blepharoptosis (commonly ptosis)
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 11

(1) Permanent drooping of upper eyelid
(2) Usually unilateral but can be bilateral; varies in severity and can fluctuate throughout the day, can obscure vision
(3) Weakness of the third cranial nerve or weakness of the muscle that raises the eyelid. Weakness can be congenital or caused by trauma or disease
(4) If severe, an operation may be done to elevate the eyelid

Question 12

Corneal ulcer or abrasion
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 12

(1) An abrasion is a loss of surface epithelium of the cornea. An ulcer-infection may be secondary to this as an abrasion makes the cornea vulnerable
(2) Pain, redness, sensation of foreign body, vision impairment
(3) Foreign body getting lodged between cornea and eyelid, ocular trauma, contact lenses that don’t fit correctly or are dirty
(4) Depending on cause: removal of foreign body, antibiotic ointment to prevent infection, eye dressing; ulcers need broad-spectrum antibiotics

Question 13

Episcleritis and scleritis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 13

(1) Episcleritis - inflammation of the surface of the sclera; Scleritis - inflammation of the deeper sclera
(2) Episcleritis - usually unilateral; red, irritated, isolated area of eye. Scleritis - unilateral or bilateral, intense redness of one or more areas, pain, blurred vision
(3) Episcleritis is of unknown etiology; scleritis is often related to autoimmune diseases, crohn’s, or ulcerative colitis
(4) Topical steroid eye drops, artificial tears, certain eye ointments, immunosuppressive agents

Question 14

Conjunctivitis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 14

(1) Inflammation of conjunctiva (mucous membrane that covers anterior portion of eye)
(2) Can be unilateral or bilateral and is very common (pinkeye). Redness, swelling, foreign body sensation, itching, tearing, photosensitivity, watery to hyperpurulent discharge may be present if infectious.
(3) Infection (mostly viral or bacterial), irritation from allergies or chemicals
(4) Varies depending on causative agents. Reduce discharge with cold compress, antibiotics for bacterial infections

Question 15

Cataract
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 15

(1) Opacification of the lense of the eye
(2) Gradual development; loss of visual acuity
(3) Can be due to aging process, congenital defect, trauma, or disease
(4) Surgical procedure

Question 16

Chronic open angle glaucoma
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 16

(1) Damage to the optic nerve in the presence of elevated intraocular pressure.
(2) Silent disease — by the time symptoms appear, significant damage has already been done. Gradual loss of vision is usually the only symptom. IOP will be high
(3) Aqueous humor reabsorption is impaired. Can be secondary to trauma or overuse of topical steroids.
(4) Early treatment is essential as vision loss cannot usually be reversed. Medication to reduce production of aqueous humor, laser treatment to open drainage system. Usually, condition can be controlled with eye drops

Question 17

Acute angle-closure glaucoma
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 17

(1) Damage to the optic nerve in the presence of elevated intraocular pressure.
(2) Blurred vision, severe eye pain, headaches, redness, photophobia, nausea, vomiting, hazy-looking cornea, very high IOP
(3) Opening of aqueous humor drainage system is narrow and can close completely, causing severe increase in IOP over short time
(4) Laser iridotomy - creates small hole in iris to allow drainage system to open

Question 18

Macular degeneration
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 18

(1) Progressive deterioration or breakdown of the macula (area of retina in charge of fine details of central vision)
(2) Mild distortion of central vision, things look wavy, there may be semi-opaque spots in field of vision, central vision may soon disappear altogether
(3) Age, genetics, prolonged exposure to bright light. Abnormal, hemorrhage-prone blood vessels may form behind retina; if they hemorrhage, it causes complete loss of central vision
(4) No definitive treatments, however, vitamin C, E, zinc, and beta-carotene supplements have been shown to slow degeneration in some cases. Blood vessels may be treated with laser photocoagulation, photodynamic laser therapy, or antiangiogenic factor injections

Question 19

Diabetic retinopathy
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 19

(1) Pathologic proliferation of retinal blood vessels
(2) Aneurysms, hemorrhages, dilation of retinal vessels, macular edema, and neovascularization may occur, affecting sharpness and clarity of vision
(3) Often occurs 8-10 years after onset of diabetes mellitus. Diabetes causes poor circulation in retinal blood vessels which causes the aforementioned problems
(4) Laser photocoagulation, careful regulation of blood sugar

Question 20

Retinal detachment
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 20

(1) Separation of retina from choroid
(2) Can be partial or complete, floaters and light flashes in vision, dark shadow that extends from periphery, often happens suddenly and painlessly
(3) Nearsightedness, ocular trauma, retinal atrophy, and diabetic retinopathy may predispose one to this condition. After a tear in the retina forms, fluid leaks between retina and choroid and separates them, causing loss of vision that expands as the detachment gets bigger
(4) Photocoagulation or surgery. Best if treated early to prevent permanent, expansive loss of vision

Question 21

Uveitis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 21

(1) Inflammation of uveal tract including: iris, ciliary body, choroid
(2) Can be unilateral or bilateral. Pain, photophobia, blurred vision, and redness
(3) Associated with autoimmune disorders (juvenile rheumatoid arthritis, ankylosing spondylitis). Some infections and also inflammatory bowel disease may cause this condition. Exact cause is not often determined.
(4) Consists largely of topical or systemic steroid use. Underlying cause must be treated

Question 22

Exophthalmos
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 22

(1) Abnormal protrusion of eyeballs
(2) Dryness and grittiness sensation, diplopia, eye movement restriction, blurred vision if severe
(3) Can be caused by many factors such as: enlarged extraocular muscles, retrobulbar (behind eyeball) mass, edema of soft tissue of bony orbit of eye (the pocket of the skull where the eye is). Can also be associated with hyperthyroidism
(4) Treat underlying cause if hyperthyroidism. Surgical decompression of orbit, steroids for edema

Question 23

Cancer of the eye
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 23

(1) Cancer may involve the globe, orbit, optic nerve, or eyelids. May be benign or malignant and primary or secondary
(2) Tumors on eyelids will present as visual lesions. Ocular tumors may present as a pigmented spot on the iris
(3) Ocular tumors - retinoblastoma in children, ocular / uveal tract melanoma, intraocular lymphoma. Orbital tumors - rhabdomyosarcoma, capillary hemangioma, cavernous hemangioma. Eyelid tumors - skin cancers, papillomas. Some tumors are caused by metastasized cancer from lung, breast, or other
(4) Treatment may involve: excision of tumor, eyeball removal, radiation therapy, chemo, or laser therapy

Question 24

Impacted cerumen
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 24

(1) The wax blob is blocking the ear, causing decreased hearing
(2) Earwax (cerumen) accumulates abnormally and excessively causing loss of hearing (which is often the only complaint), a feeling of something plugging the ear, tinnitus, earache (otalgia)
(3) Can be caused by dryness and scaling of skin or excessive ear-hair. Some people have narrow ear canals which makes them more at risk
(4) Removal of the wax blob. in some cases, It must be softened with oil or hydrogen peroxide and then irrigated with water

Question 25

External otitis media
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 25

(1) Inflammation of the external ear canal
(2) Severe pain, red and swollen ear canal, hearing loss, fever, pruritus, watery or purulent drainage
(3) Bacteria or fungi thriving in cerumen in ear canal. Can be caused by dermatologic conditions seborrhea and psoriasis, trauma to ear canal
(4) Keep ear canal clean and dry, antibiotic or steroid ear drops and/or systemic antibiotics.

Question 26

Swimmer’s Ear
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 26

(1) Inflammation and resulting infection of the outer ear canal after water has been entrapped during swimming
(2) Severe pain, red and swollen ear canal, hearing loss, fever, pruritus, watery or purulent drainage
(3) Accumulation of water, caused by swimming, and cerumen allows bacteria and fungi to thrive
(4) Keep ear canal clean and dry after swimming. Antibiotic or steroid ear drops and/or systemic antibiotics.

Question 27

Otitis media
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 27

(1) Inflammation and accumulation of fluid in normally air-filled middle ear behind tympanic membrane
(2) Two types. Serous: clear, sterile fluid; fullness/pressure; impaired/muffled hearing, dizziness. Suppurative: purulent fluid, pain, fever, chills, nausea and vomiting, dizziness, impaired/muffled hearing
(3) Serous: virus, allergy, hypertrophy of adenoids, chronic sinus infections. Suppurative: bacterial infection
(4) Pain medications, antibiotics if needed, surgical evacuation of fluid (myringotomy)

Question 28

Otosclerosis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 28

(1) Abnormal bone growth in the middle ear impairs movement of the hearing bones that conduct sound (stapes and ossicles)
(2) This results in hearing loss and tinnitus
(3) Unknown though genetic factors are suspected
(4) A stapedectomy (removal of the diseased ear bone(s) and replacement with a prosthetic)

Question 29

Meniere disease
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 29

(1) Chronic disease of the inner ear that affects the labyrinth
(2) Recurring attacks (can last hours or days) that include: vertigo, tinnitus, pressure, sweating. Progressive hearing loss also occurs
(3) Unknown cause; though the pathogenesis is suspected to involve destruction of hairs in the cochlea
(4) Medications for nausea and vomiting, salt-free diet, reduced fluids, diuretics; if severe, surgical destruction of affected labyrinth may be necessary, though this results in hearing loss

Question 30

Cholesteatoma
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 30

(1) A pocket of skin cells in the middle-ear forms a cyst-like mass
(2) The mass may become infected and damage the ear, causing: hearing loss, purulent drainage, headache, vertigo, earache, weakness of facial muscles
(3) May develop in infancy because the eustachian tube failed to open or result from chronic ear infection which blocks the eustachian tube. This creates a weak vacuum that retracts the tympanic membrane, creating a pocket for the cholesteatoma to develop
(4) Surgical removal; though risk of complications increases as the disease progresses

Question 31

Mastoiditis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 31

(1) Inflammation of the mastoid bone or mastoid process (posterior to the ear)
(2) Pain, edema, fever, chills, headache, hearing loss
(3) Can result from untreated otitis media. Is also associated with cholesteatoma
(4) Antibiotics, mastoidectomy if severe

Question 32

Benign paroxysmal positional vertigo
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 32

(1) Vestibular system disorder; feels as if head is spinning or surroundings are moving
(2) Spinning sensation with movement of the head, room feels like it is spinning while body is still, difficulty standing and walking, lightheadedness, unsteadiness, mostly lasts 3-10 seconds but can feel longer or be longer
(3) Head trauma and otitis media may be causative factors. Free-floating carbonate crystals may find their way into the semi-circular canals and cause vertigo. May also be from viral infection or of vascular origin
(4) Medications can be used to subdue the vertigo; certain exercises such as turning head side-side may help

Question 33

Labyrinthitis
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 33

(1) Inflammation or infection of the labyrinth of the inner ear
(2) Fever, extreme vertigo, loss of hearing in one ear, possible nausea and vomiting, tinnitus, difficulty focusing eyes
(3) Usually results from a viral infection but may be caused by a bacterial infection that has spread from elsewhere. Meningitis is also a possible cause
(4) Tranquilizer, antiemetic agents, and antibiotics (if bacterial).

Question 34

Ruptured tympanic membrane
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 34

(1) Tear or injury of eardrum that causes a breach in the integrity of the membrane.
(2) Slight pain and partial loss of hearing, may entail discharge and/or bleeding, buzzing, facial weakness, dizziness. Symptoms last a few hours; real risk is the development of an infection
(3) Insertion of sharp object into ear, nearby explosion or lightning strike, severe middle ear infection, blow to the ear, fractured skull. May also occurs spontaneously
(4) Antibiotic to prevent infection, patch to aid healing

Question 35

Sensorineural hearing loss
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 35

(1) Sound waves reach the inner ear but are not perceived because the nerve impulses are not transmitted to the brain
(2) Partial to severe hearing loss and maybe tinnitus
(3) Nerve failure or damage to the cochlea or auditory nerve. Can result from aging process, exposure to loud noise, fracture of temporal bone, certain infections, or certain medications
(4) Steps to reduce damage such as avoiding loud noise must be taken

Question 36

Cancer of the ear
(1) Description
(2) S&S
(3) Etiology
(4) Treatment

Answer 36

(1) Include skin cancers of the external ear, ceruminal gland neoplasms, acoustic and facial neuromas, glomus tumors, secondary ear cancer
(2) Symptoms commonly include: progressive hearing loss, chronic otic discharge, visible mass or lesion on ear, loss of equilibrium, tinnitus.
(3) Mutations of oncogenes, skin cancer, chronic inflammation may raise risk for squamous cell carcinoma
(4) Surgical excision or radiation if tumor is known to be aggressive