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Pathophysiology - Diseases > Diseases and disorders of rhe eye and ear > Flashcards

Diseases and disorders of rhe eye and ear Flashcards

1
Q

purpose of eye?

A

focus light on light-sensitive receptors and transmit nerve impulses to brain wherer info is interpreted to form images

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2
Q

layers of the eye:

A

3 layers:
- sclera (fibrous connective tissue that lends shape and support - whites of eye)
- uvea (vascular layerm provides oxygen and nutrients to innermost layer of eyeball)
- retina (inner, posterior layer which contains light-sensitive nerve endings known as photoreceptors, center is macula, are with high densiive of photoreceptors (responsible for acute vision)

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3
Q

parts of the eyes

A

sclera, uvea, retina
- vitreous humor (thick fluid, fills eyeball posterior to lens, maintain eyeball shape)
- aqueous humor (fluid that fills space in front of lens)
- cornea (anterior surface, curved, transparent structure in front of the lens)
- lens (transparent bioconcave structure, focus light onto retina)
- iris (capable of changing diameter of the pupil opening to adjust amt of light enetering eye)
- pupil
- eyelids (skin-covered flaps close and protect eyes)
- tear glands (secrete lubricating fluid onto outer surface of eye)

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4
Q

What are the diagnostic tests and procedures of eye?

A
  • observe interior of eye with opthalmoscope 9reveals condition of retina, macula, lens and cornea)
  • external physical exam reveals inflammation and infection
  • tonometry measure eyeball pressure to detect glaucoma
  • Snellen eye chart can be used to asses visual acuity
  • visual field tests
  • eye culture
  • dilation
  • electronystagomography (ENG) to measure idrection and degree of nystagmus
  • electroretiunography (measure electric activity of retina in response to flashing light)
  • fluorescein angiography to assess vascularure of eye
  • optical coherence tomography (CT) scans to capture 3d images and measure dimnsions of structire in posterial chambers
  • ocular and orbit ultrasonograpjhy
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5
Q

What are refractive errors?

A

prdouce improperly focused light on the retina = blurred images
- most common vision problems in US (34+ M adults have myopia, 14+ M have hyperopia)
- includes myopia, hyperopia, presbyopia and astigmatism
- s/s r blurred vision and eye fatigue, which can lead to squinting, frequent rubbing of eye and headaches

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6
Q

What is myopia?

A

near sightedness, eye can focus on close but not far

eyeball grows too long and distant images focus short of the retina

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7
Q

What is hyperopia?

A

far sightedness, eye can’t see close object by can see far

eyeball is too short and distant images focus behind retina while close images fall unfocused on retina

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8
Q

cause and risk factor of myopia and hyperopia?

A

risk factor is family history

cause is related to eyeball shape

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9
Q

How to diagnose and treat myopia and hyperopia?

A

diagnose - Snellen eye chart, test for visual acuity, physical exam of eye, dilate pupils w/ eye drops and evaluate eyes w/ retinoscope

treat - for myopia, concave lens, for hyperiopai is treated with convex lense laser surgery on cornea can be used to shape cornea

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10
Q

What is presbyopia?

A

age related refractive disorder in which eye can’t focus on close object
can occur alone or with myopia, hyperopia or astigmatism
9% of Americans have presbyopia
risk factors r age and family history
after 35 some ppl develop small amt of presbyopia and it begins to be noticeable in late 40w
caused by age-related reductions in lens flexibility
s/ss include inability to read small print and focus on near object

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11
Q

how to diagnose and treat presbyopia?

A

diagnose - dilated eye exam and Snellen eye chart

treat - inexpensive nonprescription reading glasses that simply magnify close objects, eyglasses can also be fitted with lenses that magnify in the bottom poritons of lens

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12
Q

What is astigmatism?

A

cornea with surface irregularities like asymmetry or uneven thickness

  • light passes through region of an irregularity falls unfocused on retina = blurry region
  • risk factors include a family history of astigmatism
  • s/s r images that r blurr but recognizable at different distance
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13
Q

how to diagnose and treat astigmatisM

A

diagnose - eye exam and Snellen eye chart

treat - corrective eyeglasses or contacts

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14
Q

What is diabetic retinopathy (DR)?

A

pathological alteratioons of retinal blood vessels and patholgical proliferation of retinal vessels

leading cause of blindness among adults in US

chief risk factor is diabetes mellitus which damages bv including vessels that nourish retina of the eyes

40% of type 1 diabetics will be diagnosed with DR within 3 yrs of diagnosis

20% of ppl with type 2 have some degree of retinopathy

pregant women r also at risk of getting DR if they have gestational diabetes

caused bc diabrtes = poor circulation in retinal blood vessels and may cause leakage of exudate into retina, sometimes neovascularization can grow and leakage of blood into vitreous

4 stages: mild nonproliferative, moderate nonproliferative, severe nonproliferative, proliferative (= retinal detachment and permanent blindness)

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15
Q

s/s of diabetic retinopathy?

A

vascular changes in retina
visual acuity
diminished night vision
microaneurysm
hemorrhages
dialtion of retinal veins
macular edema
formation of abn new vessels (neovascularization)

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16
Q

how to diagnose and treat DR?

A

diagnose - eye exam, opthalmoscope to examin retina

treatment - limited but vessel hemorrhages can be stemmed using laser surgery (laser photocoagulation, panretinal photocoagulation)

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17
Q

What is mascular degeneration?

A

reduction or loss of acute vision

fairly common, leading cause of vision loss in adults

affects central part of retina with highest density of photoreceptros (part that forms sharp images)
affects central vision and leaves peripheral vision inteact

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18
Q

forms of macular degeneration?

A

2 forms:
- atrophic (dry) (90% of cases)
- exudative (wet, hemorrhagic) (more destructive)

  • in dry form macular area degenerates
  • in wet form, capillaries grow under macula leak and disrupt macula
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19
Q

causes and risk factors for macular degeneration?

A

causes - obstructed blood flow, revascularization (damages area of retina responsible for acute vision), injury, inflammation, infection and heredity

risk factors - age, family history and smoking

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20
Q

s/s of maculr degeneration?

A
  • inability to see faces clearly
  • difficulty reading
  • problems performing close work such as sewing or repairing machinery
  • mild distortion of central vision (wavy lines when looking at straight lines, semiopaque spots in visual field)
  • most r both eyes
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21
Q

how to diagnose and treat macular degeneration?

A

diagnose - dilated eye exam with opthalmoscope, amsler grid (gird of fine lines) can detect distorted, incomplete or wavy images in central vision filed, fluorescein angiography (uses dye injected via VI and special camer to reveal leaking vessels below retina)

treat - no cure, can reduce wet degeneration with laser surgery, vitamin supplementation (vitamin C and E, beta-carotene, zine) may shlow dry macular degeneration, for some pt surgical implant of telescopic lens can improve central vision, tradtional laser photocoagulaton, photodynamic laser therapy, injection of antiangiogenic factors, intraocular injection w/ anti-vascular endotherlial growth factor (anti-VEGF)

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22
Q

What is retinal detachment?

A

emergency condition in which retina pulls away from back of eyeball

results in blindness in affected eye bc underlying layer of eyeball provides O2 and nutrients to retina

risk factors include aging, extreme nearsightedness, advanc ed diabetes and eye trauma

caused by diabetic retinopathy, extremely nearsightedness, ocular trauma or retinal atrophy, tear in retina (fluid then leaks under retina and separaties it from choroid)

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23
Q

s/s of retinal detachment?

A

sudden appearance of floaters (floating debris) in the affected
eye.

Sudden flashes of light or dark shadows like a curtain

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24
Q

how to diagnose and treat retinal detachment?

A

diagnose - history and ophthalmoscopic exam of eye and ultrasound of eye

treatment - photocoagulation, crotherapy, laser surgery, injection of gas or fluid into eye to press retina back into place

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25
Q

What is glaucoma?

A

increased pressure in eye
painless, damages optic nerve and leading cause of blindness in US
more than 2 M americans have glaucoma
major causes of blindness
related to issues in fluid drainage

s/s not noticed until vision loss occurs

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26
Q

risk factors of glaucoma?

A

risk is highest for ppl over 60 (esp Mexican americans) and over 40 (esp African Americans) as well as family hsitory
nearsightedness, bloood relatives with glaucoma and AA descent

Risks for glaucoma can be
reduced by controlling blood sugar and hypertension and by getting regular eye exams.

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27
Q

how to treat glaucoma?

A

aimed at decreasing intracoular pressure and include meds (medicated eye drops to reduce production of fluid and promote fluid drainage) and laser surgery (piercing anterior chamber with a lasber bean to promtoe drainage and reduce pressure_

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28
Q

how to diagnose glaucoma/

A

diagnose - tonometry (measures intraocular pressure), visual field testing (measures filed peripheral vision), Pachymetry (measure thickness of cornea, important bc corneal thickness causes high-pressure readings in ppl w/o glaucoma)

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29
Q

What are cataracts?

A

clouding (opacification) of lens

most related to age - by 54 almost 1/2 of Americans ahve some cataract formation and after 75 this figure is close to 70%

In early stages, a cataract can be seen through a dilated
pupil with an ophthalmoscope or slit lamp.

As the cataract continues to develop, the retina becomes more difficult to visualize and the pupil develops white discoloration.

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30
Q

risk factors for cataracts?

A

trauma
smoking
alcohol use
exposure to radiation or ultraviolet rays
systemic diseases such as diabetes or hypertension
poor nutrition
intrauterine infections

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31
Q

s/s of cataracts?

A

depends extebt if lens opacity and whether one or both eyes r affected
- age-associated cataracts occurs in both eyes, congenital cataracts may occur in 1 eye
- visual impairment
- visual distortion
- vlurred vision
- poor night vision
- yellowing or fading of colors
- loss of brightness of color
- need for bright light for reading
- glare (esp in bright light or when drivign at night)

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32
Q

how to diagnose and treat cataracts?

A

Diagnosis - routine eye exam using ophthalmoscopy. Early detection allows planning for treatment or preventative measures to reduce the progression of cataracts.

treatment - Outpatient lens replacement surgery (phacomulsification (ultrasonic proble vibrates to break up catact which aspirated through small incision) & extracapsular surgery, remove nucleas/ center of catact in 1 piece) (leave posterior membrane in but when it becomes cloudy then YAG capsulotomy) has become a routine procedure, and vision is restored to normal in 95% of patients.

Prevention is almost
impossible because this is a condition related to
aging

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33
Q

What is conjunctivitis?

A

inflammation of the superficiali cover of the sclera and inner lining of the eyelid
- ant 30% of all eye complaints r for conjunctivitiis (commonly called pink eye)
risk factors include age bc most common in children
caused by bacteria, viruses or irritating chemicals (contagious)

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34
Q

s/s of conjunctivitis?

A
  • red swollen eyes with yellow discharge
  • itching of conjunctiva
  • excessive tears
  • extra sensitive to light
  • light-sensitive
  • viral infections = watery discharge
  • foreign body sensation
  • reinfectoin occurs by rubbing or touchign eye with contaminated hands
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35
Q

Type of conjunctivitive in newborns?

A

inclusion conjunctivitis which is caused by chlamydia trachomatis and transmitted during childbirth when a mother has a vaginal chlamydia infection.

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36
Q

how to diagnose and treat conjunctivitis?

A

diagnose - examination and history, test of discharge for culture and sensitivty testing

treatment - antiiotic drops for bacterial, no treatment for viral, keep eyes free from discharge w/ cool compresses

prevent by reducing hand to eye contat, dispoing of contaminated materials such as contact lenses and beauty products and avoidign known chemical triggers

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37
Q

What is keratitis?

A

inflammation of cornea caused by infection with bacteria, viruses, fungi or other parasites
- not common
- risk factors incude injury such as abrasions, immune deficiency or genital herpes infection
- s/s r pain and inflammation, decreased visual acuity, irritation, tearing, photophobia, mild redness
- often caused by infection resulting from herpes simplex virus (after upper respiratory infection (URI)) w/ facial cold sores, certain bacteria (Pseudomonas aeruginsoa or Neisseria gonorrhoea) and fungi, contact lens

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38
Q

how to diagnose and treat keratitis?

A

diagnose - exam cornea and culture of pathogens, med history for recent URI

treatment - antibioutcs, antifungal, antivrial (quick treamtnet prevents corneal scarrign and vision loss), opthalmic moisturizing ointments and eyeballs

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39
Q

how to prevent keratitis?

A
  • wearing protective eyewar when needed (like power tools)
  • contact lens should be maintinated in clean condiiotn and discarded when scratched
  • lens cases should be disinfected regularly and replaced periodically
  • treat underlying herpres infections
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40
Q

What is uveitis?

A

inflammation of uvea (vascular layer of eyeball) (includes iris, ciliary body and choroid)
- affects abt 38,000 ppl annually in US
- risk factors include immune deficicieny
- in HIV/ AIDS, uveitis is caused by cytomegalovirus, herpres simplex, Toxoplasma and Candida
- associated w/ autoimmune disorders, juvenile RA, ankylosing spondyltiis, infections (syphilis, tuberculosis, toxopalsmosis, and histoplasmosis or IBD)

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41
Q

s/s of uveitis?

A
  • pain
  • redness
  • photophobia
  • blurred vision
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42
Q

how to diagnose and treat uveitis?

A

diagnose - slit lamp exam, skin tests for tuberculosis, toxoplasmosis, histoplasmosis

treatment - topical or systemic steroid use: corticosteriods and system or topical meds depending on location and type of pathogen, posterior uveitis requires treatment eith systemic meds or corticosteriods injected within eye, cycloplegic agents that cause paralusos pf ciliary muscle

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43
Q

What are eyelid infections?

A
  • one of most common lesions found on eyelid is common stye or hordeolum
  • etiology of hordeoulum is infected with staphylococcus bacteria, triggering abscess formation of upper and lower eyelid and is secondary to blepharitis
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44
Q

s/s of eyelid infections?

A
  • redness
  • pain
  • swelling with foreign body sensation on eye
  • formation of pus
  • small styes tend to develop on external eyelid surfaces and margin
  • internal styes project toward the surface of teh eye
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45
Q

treatment of stye/ hordeolum

A

if small it may rupture spontaneously, resolving itself
- large lesions may reduce filed of vision and require mechanical excision
- cleaned genetly with soft washcloth
- antibiotic eye drpos

  • warm compress
  • topical antibiotidcs
  • oral antibiotics if surrounding soft tissue becomes infected (cellulitis)

prevention requires good hand hygeine and avoiding hand-eye contact

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46
Q

What are cones?

A

photoreceptors in retina
make color vision possible bc they r sensitivie to certain wavelengths of light that r assoicated with diffferent colors

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47
Q

What color can most ppl w/ impaired color vision can’t see?

A

red and green, 1 in 12 males of Northen European ancestry cant distinguish them

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48
Q

yellow and blue impaired color vision

A

affects at 1 in 10,000 ppl worldwide

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49
Q

What is colorblindness?

A

complete absence of color vision
rare, affects 1 in 30,000 ppl worldwide
only see shadesof gray

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50
Q

Cause of color vision impiaremnets and color blindness?

A

carried in X chromosome so most common in men

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51
Q

diagnsoe and treat colorblindness?

A

diagnose - multicolored spotted eye chart in which colored number r embedded and visioble to those with normal color eyes (no cure)

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52
Q

What is retinoblastoma?

A

rare, recessively inherited childhood tumor of retina
- approx 40% of retinoblasomas r inherited with carriers of mutant gene being 10,000x more likely to get it
- affects children under 6, most commonly diagnosed durign first 2 years

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53
Q

s/s retinoblastoma?

A
  • crossed eyes
    – eye pain
  • redness
    – appearance of white reflex in eye called leukocoria or cat’s eye reflex
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54
Q

how to diagnose and treat retinoblastoma?

A

diagnose - ultrasound, MRI, CT and eye exam

treat - aimed to preserving vision, destroyig tumor and monitoring for metastasis, chemo and surgery, large tumors r treated with removal of eye

in 90% of cases of intraocular tumors can be cured
- metastatic retinoblastoma tends to spread to the brain and bone marrow and is associated with a poor prognosis

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55
Q

prevention of retinoblastoma?

A

for children at risk, prevention requires exam every 2-4 motnsh for 2 yr to screen for development of additional tumor

  • genetic counseling
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56
Q

Parts of ear?

A
  • organ of hearing and balance
    3 regions:
  • outer ear:
  • middle ear:
  • inner ear:
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57
Q

What is the outer ear?

A

external to skull, called pinna, covered by skin and supported by cartialge, directs sound into audistory canal (auditory canal is lined with glands that secrete cerumen, waxy substance that keeps tympanic membrane soft and flexible)

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58
Q

What is middle ear?

A

begins at tympanic membrane (ear drum), fibrous tissue spanning auditory canal, transmitts vibration to the auditory ossicles (malleus, incus and stapes)
- stapes vibrates against an opening in cochlea, snail-shaped organ within the inner ear
- vibration through fluid of cochlea stimulated hair cells to transmit infor abt vibration along auditory nerve to brain

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59
Q

what is inner ear?

A

vestibular apparatus and semicircular canals
sensitivie to head position and motion and this giving berain info and maintiaing balanace

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60
Q

diagnostic tests and procedures of ear?

A
  • external exam
  • otoscope permits visualization of auditory canal and condition of tympanic membrane
  • hearing tests utilize head phones or tuning forks to assess hearing and causes of hearing loss
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61
Q

What is cerumen impact?

A

cerumen keeps tympanic membrane soft and flexible

cerumen impact is excess wax buildup (in most ppl cerumen that is secreted slowly moves to the outer ear and flakes but in some ppl it builds up) that has a tendecy to prevent sound waves from reaching tympanic membrane (eardrum), = decreased hearing

can be caused by dryness and scaling of skin or by excessive hair in ear canal, abn narrow ear canals

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62
Q

s/s of cerumen impaction?

A
  • ringing in ear (tinnnitus)
  • earache (otalgia)
  • gradual diminished hearing
63
Q

diagnose and treatment and prevention for cerumen impact

A

diagnose - physician or specialist does an otolgoic exam, pt history of symptoms

treatment - should be done by doctor bc tympahnic membrane is delecate and can be easily injured, occassionally applying baby oil or hydrogen peroxide to soften cerumne following warm water to flush it out

prevention - ear shouldn’t be clenaed with cotton swabs (pushes cerumen in)

64
Q

What is otitis externa?

A

aka swimmer’s ear
- infection of auditroy canal caused by bacteria and fungi
- chief risk is swimming, usually caused by water remaining in external ear after swimming
- also caused by abrasion of external auditory caanal

65
Q

s/s of otitis externa?

A
  • pain
  • itching
  • redness
  • discharge
  • may cause fever and temporary hearing loss if advance
  • red, swollen ear canal
  • hearing loss
66
Q

diagnose and treat otitis externa?

A

diagnose - physical exam of ear, culture of pathogen, history of syptoms

treatment - antibiotic or antifungal and analgesics (prevented d by drying the
external ear opening after bathing or swimming. Foreign objects should not be inserted into the auditory canal. Earphones and earplugs should be cleaned regularly)

67
Q

What is otitis media

A

middle ear infection (normally filled with air) with accumulation of fluid behind tympanic membrane (eardrum) and is either unilateral or bilateral

More than 5 million cases of acute otitis media occur among children in the United States
each year.

Age is the main risk factor for otitis media, which affects mainly infants and children. (Children are more susceptible bc their nearly horizontal auditory tubes prevent adequate drainage)

cause: Bacteria (often - suppurative otitis media, which also can enter the middle ear through eustachian tube from nose or throat or from ruptured tympanic membrane, after influenza or mumps) and viruses (for acute serous otitis, virus from URI) (chronic can develop from acute attack, hypertrophy of adenoids, chronic sinus infections)

68
Q

s/s of otitis media?

A

pain
swelling
edema
pus
Severe swelling may perforate the tympanic membrane
feeling of fullness or pressure
dizzines
muffled hearing to significant loss of hearing
classified as either serous (clear and sterle fluid) and suppurative (purulent)

if suppurative then ifneciton, fever, chills, nausea, vomiting

69
Q

how to diagnose and treat otitis media?

A

diagnose - bluging, inflammed tympanic membrane w/ fluid bubles, effusion, culture shows bacteria and WBC - suppurative, audiometry may erveal mild to sever hearing loss, tympanogram = test for pressure in middle ear

treat - mostly resolves self, antibiotics, analgesics (acetaminophen or ibuprofen), recurrent/ chronic infection may require small ear tubes (tympanostomy tubes) in the tympanic membrane that assist drainage and prevent recurrence, myringtomy for surgical evacuation of fluid, insurt myringotomy tubes to prevent fluid from accumulating

reduce risk by avoiding exposure to smoking and air pollitioon, breastfeeding infants til 6 months

70
Q

What is presbycusis?

A

age related hearing loss, most common cause of hearing loss in adults

Presbycusis occurs in a third of
adults age 65–75 and half of those over age 75.

risk factors r increasing age, family history of presbycusis, repeated exposure to loud
noises, smoking, and certain medical conditions.

71
Q

s/s of presbycusis?

A

difficulty understanding conversations (especially in a noisy room)
withdraw from social situations to avoid hearing problems.
Tinnitus
inability to hear high pitches

72
Q

how to diagnose and treat presbycusis?

A

diagnose - routien hearing tests, tuning forks

treatment - hearing aids if auditory nerve and cochlea remain functional

prevented by reducing exposure to loud noises or by
using ear plugs and ear protection when exposed
to loud noises

73
Q

other causes of hearing loss

A

trauma, high fever, toxins, certain antibiotics, and
infections. Genetic causes of hearing impairment
or deafness may be noted in newborns

74
Q

What is meniere’s disease?

A

chronic disease of inner ear that affects the labryinth

condition of intermittent hearing impairment, tinnitus, and vertigo (dizziness).

affects more than 600,000 people in the United States annually, mainly people age
40–60, can occur at any age.

The cause is unknown, although it could be an autoimmune or inflammatory disease, disease process seems to involve destruction of tiny hair cells inside cochlea (increase in endolymph may cause the membranous labyrinth to dilate)

Fluid accumulation in the inner ear is responsible for its s/s

75
Q

s/s of Meniere’s disease

A

sudden episodes of vertigo that may last
20 minutes, intermittent hearing loss, tinnitus, and pressure in the ear

76
Q

how to diagnose and treat Meniere’s disease

A

diagnose - 4 core symptoms, physical exam, hearing test, and specialized tests for vertigo, audiometry, balance studies, radiographic studies (MRI and ENG), EcoG

treat - no cure, treatment is symptomatic and includes meds for vertigo, N&V, dizziness, diuretics and anti-inflammatory drugs, surgical destruction of affected labrynth, using ultrasound which relieves sympomt but also causes permanent hearing loss

77
Q

aging and disease of eye

A

loss of visual acuity
decreased sensitivity to light.
curvature of the cornea decreases, impairing refraction and its ability to focus light.
lens increases in thickness and
decreases in elasticity, making it more difficult to accommodate and focus on objects at a close
distance.
A thickened lens becomes less transparent and admits less light into the eye.

78
Q

aging and disease of ear

A

Age-related hearing loss is especially pronounced at high frequencies. Alterations in sound receptors, neurons, and blood supply to the inner
ear are among the changes associated with age.

79
Q

how to manage changes in vision and hearing

A

surgical procedures, eyeglasses, and
hearing aids

80
Q

what contribute to falls among aging adults

A

vision and hearing impairment, balance problems, and reduced muscle strength
and coordination

81
Q

extrinsic muscles of the eye

A

inferoir rectus - rotate eyeball down and medially
lateral rectus - rotates eye laterally
medial rectus - rotates eye medially
superior rectus - causes eye to lopop up
inferoir oblique - rotates eye up and outward
superior oblique - rotates eye down and outward

82
Q

diagnose and treat nystagmus?

A

diagnose - external exam of eyes and obseravation of any invioluntary movement

treat - treat underlying cause for acquired, for congenetical lessened with Kestenbaum proceudre in which eyes r surgical rotated toward null point of eye

83
Q

intrisnsic smooth muscles of the eye

A

ciliary muscle - regulation of lens shape for close vision
iris (radial muscles) - sympathetic stimulation, dilation of pupil
iris (circular muscles) - parasympathetic stimulation, contraction

84
Q

functions of majr parts of eyes:

A

sclera - external protection
cornea - light refraction
choroid - blood supply
iris - light absorption and regulation of pupilary width
ciliary body - secretion of vitreous fluid & its smooth muscles change shapes of lens
lens -light refraction (retinal layer = light receptor that transpfroms optic signals intro nerve impulses) (rods = light fron dark, shape and movement) (cones = color)
central fovea - area of sharpest vision
macula lutea - blind spot
external ocular muscles - movement of the globe
optic nerve (cranial nerve II) - transmission of visual info to brain
lacrimal - secretion of tears
eyelid - eye protection

85
Q

common s/s of eye disease and condiitons?

A
  • redness of eye
  • pain, itching or burning in or around the eye
  • swoollen red eyelids
  • drainage from eyes
  • lesions/ sores in or around the eyes
  • visual distrubrances
  • unequal pupils, sudden loss of vision, persistent pain, other symptoms associated w/ eye injury
  • repetitive involuntary movmenet of the eye
86
Q

laser surgery for refractive errors:

A
  • laser-assisted in-situ keratomileusis (LASIK)
  • astigmatic keratotomy (AK)
  • photorefractive keratotomy (PRK)
  • laser thermal keratoplasty (LTK)
  • conductive keratoplasty (CK)
  • introcular contact lenses (lens permanently placed in eye)
87
Q

What is nystagmus?

A
  • involuntarny, repetitive, rhytmic momvement of 1 or both eyes
  • s/s r repetitive or involuntary eye movement that r horizontal, vertical, circular or combo, blurred or decreased vision
  • spontaneous nystagmus can be congenitial or acquired (congenital manifests before 6 motnsh to 1 yr and most common) (Acquired mystagmus results when disease process produces lesions in brain or inner ear, alc use and abuse of certain drugs, brain tumors, cerebrovascular lesions, abn development of nervous system)
88
Q

What is strabismus?

A
  • visual defect of misalignment
  • fialure of eyes to look in same direction at smae time
  • primarily occrs bc weakness in nerves stimulating muscles that control positions of eyes
89
Q

s/s of strabismus?

A
  • in esotropia both eyes turn in ward
  • in exotropia both eyes turn inward
  • diplopia is main symptom
  • diplopia is usually not present when strabismus is congenital
90
Q

etiology of strabismus

A
  • esotropia develops in infancy or early childhood and may be associated w/ amblyopia (is reversible until visual pathways fully develop at abt 7 to 8 yrs)
  • in almost all cases, esotropia that develops in adults is caused by a condition or disease elsewhere in body
  • brain, cranial nerves or muscles themselves r affected (diabetes, temorial arteritis, muscular dystrophy, high bp, trauma, aneurysm, or intracranial lesion)
91
Q

how to diagnose and treat strabismus?

A

diagnose - complete opthamic exam and various appropriate radiographic studies and blood tests

treat - corrective glasses, treatment to minimizes or prevent amblyopia, surger to rstore eye muscle balance, covering fixing eye to force child to use deviating eye

92
Q

What is chalazion?

A
  • small, firm, nonmobile, painless, subcutaneous module on the margin or body of the eyelid
  • it occurs with occlusion of the meibomian glands
  • vary in size, from barely visible to size of a pea, can become infected, producing redness, swelling and pain
93
Q

how to diagnose and treat chalazia?

A

diagnose - visual exam and pt history
treat - small dissapear spontaneously over a month or 2 with ppliation of warm compresses
- topical antibiotic treatment (gentamicin r tobramycin to azithromycin or quinolone drops)
- isolated recurrent may respond to corticosteroid injection
- larger chalazia may be need to be removed surgically

94
Q

What is blepharitis?

A
  • inflammation of margins of eyelids involving hair follicles and glands
95
Q

s/s of blepharitis?

A
  • persistent redness and crusting on and around eyelids
  • itching
  • burning
  • foreign body sensation
  • usuallly bilateral and symmetric
  • sever cases = eyelashes can fall out, pt may experience persistent irritation of eyes
96
Q

how to diagnose and treat blepharitis?

A

diagnose - visual exam of eyelids and presence of collarettes (tiny scales)

treat - warm wet compresses, cleansing of lids w/ mild solution of baby shampoo and water, antiobtic ophtlamic ointments (bacitracin or erythromycin)

97
Q

What is entropion?

A
  • eyelid margins (more often just lower lid marjoin) turn inward, causing lashes to rub conjunctiva
  • s/s r sensation of foreign body, tearing, itching, itching, conjunctivitis, damage to cornea = epithelial defects and vision problems
  • mostly in older people bc w/ aging soft tissue on lower eyelids lose elasticity causing eyelids to turn inward
  • diagnose with visual exam
  • for persistent irritation see physician, may need minor surgical procedure
98
Q

What is ectropin?

A
  • condition in which lower eyelid everts from eyeball and exposed surface of eyeball and conjunctival membrane lining of eyelid become dry and irritated
  • s/s r tears diverted from tear duct and run down cheeks + dryness
  • older adults as result of decreased elasticity of lower eyelid (scar on eyelid or cheek that contracts and pulls eyelid down)
  • diagnose w/ visual exam
  • need to consult physician, minor surgical procedure
99
Q

What is blepharoptosis?

A
  • aka ptosis
  • permanent drooping of upper eyelid, such taht it partially or compeltely covers eye
  • s/s: usually 1 eye, any age, often familial, and can obstruct vision
  • caused by weakness of CN III or weakness of muscle that raises eyelid, muscle of eyelid or nerve that controls that muscle is damaed, muscular dystrophy and myasthenia gravis
  • diagnose w/ opthalmic exam w/ blood testing and imaging to rule out underlying
  • treat w/ operation to elevate eyelid position or systemic meds
100
Q

What is keratoconjunctivitis sicca?

A
  • aka dry eye syndrome
  • tears do not furnish eyes w/ ample lubrication (uncomfy and irritating)
  • caused by inadequate tear production mostly, med conditions, med, damage to tear glands from radiation or inflammation, temporary damage related laser eye surgery
101
Q

s/s of keratoconjunctivitis sicca

A
  • FEELING OF having foreign object in eyes
  • scratchy
  • burning
  • stinging sensation in eye
  • sensitivity to light
  • blurred vision
  • redness of eye
  • difficult with nighttime driving or w/ wearing of contact lenses
102
Q

diagnose and treat keratoconjunctivitis sicca

A

diagnose - pt history and s/s

treat - OTC eye drops, meds such as cyclosporin ophthalmic emulsion (restasis) and lifitegrast ophthalmic solution (Xiidra)

103
Q

What is corneal abrasion/ ulcer?

A
  • abresion is painful loss of surface epithelium or outer layer of cornea, ulceration is infection of cornea
  • s/s r pain, rednessm tearing, foreign sensation, visionn impariemnt
  • may be caused by foreign bodies, direct truam to cornea, contact lenses
104
Q

diagnose and treat corneal abrasion/ ulcer?

A

diagnose - s/s, they stain with flurescein which makes them readily detectable + ulcers = opaque area on cornea

treatment - remove foreign body, ophthalmnic antibiotic ointment or drops, eye dressing, if ulcer then intensive broad-spectrum antibiotic therapy

105
Q

What is spontaneous subconjunctival hemorrhage?

A
  • result of small blood vessel rupturing underneath surface of conjunctiva
  • all or portion of sclera appears bright red
  • painless and observed when looking in mirror
  • from violent sneezing or sever e coughing, vomiting, straining, trama to eye
  • resolve spontaneously within 10days to 2 weeks
106
Q

What i episcleritis/scleritis + etiology?

A
  • inflammation of episclera (external surfaceof sclera) = episcleritis, inflammation of deeper sclera = scleritis (episcleritis is more common)
  • etiolgoy of episcleritis is unknown
  • scleritis etiolgoy is often associated w/ rheumatoid arthritis and certain digestive disorders such as Crohn disease or ulcerative colitis
107
Q

s/s of episcleritis&scleritis

A

episcleritis - 1 eye, redness and irritation in isolated portion of eye

scleritis = 1 or both eyes, iontense redness in 1 or more areas of sclera, more commonly associated w/ pain and blurred vision, inflammation in posterior = loss of vision

108
Q

diagnose and treat episcleritis/scleritis

A

diagnose - ophthalmologist, thorough opthalmic exam, blood tests, ultrasonography, MRI to identify infectious or autoimmune connective tissue

treat - instillation of topical steroid eye drops, artifical tears, lubricating ophthalmic ointments, immunosuppressive drys, perforation of sclera = scleroplasty

109
Q

Cataracts r present in about __% of persons over 75, risk for catacterts increase with each edaced starting around ___. By __, __ of white Americans have cataract/ By age___, ___% of whites have cataracts compared with __% of blacks and __% Hispanic Amiercan

A

50
40
75
half
80
70
53
61

110
Q

types of glaucoma?

A
  • chronic open-angle
  • acute angle-closure
  • secondary: specific disease in eye and can occur after trauma or neovascularization in anteroir chamber and may occur after diabetes
  • congenital: causes eye to distend and resemble eye of an ox
111
Q

What is chronic open-angle glaucoma?

A
  • siulent diseas,e most common form of glaucoma, most treatble cause of blindness
  • best way to detect is periodic routine ophthalmic exams, including IOP readings and optic nerve eval
  • caused by block at level of trabecular meshwork that imairs aqueous humor reabsoprtion, trauma, overuse of topical steroids
112
Q

how to diagnose and treat chronic open-angle glaucoma?

A

diagnose - [pt history, ophthalmic exam with tonometry, exam of optic nerves, visual field analysis

treat - med to decrease production of aqueous humor (carbonic anhydrase inhibitors, beta-blockers, and alpha-adrenergic agents) or increased uveoscleral outflow (prostaglandin analogues) (laser treatment, including argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT), trabeculectomy or draininage implantation, most of the time eye drops tho

113
Q

what is acute angle-closure glaucoma

A
  • associated with blurred vision, sever eeye pain, headahces, redness, photphobic and see halos around ligjht, associated with nausea and vomiting, corena becomes hazy,
  • cause is mouth or opening of draiinage is narrow and can close completely
114
Q

how to diagnose and treat acute angle-closure glaucoma

A

diagnose - pt history and nootable inrease in IOP, with special lens called goniolens opthalmologist can directly view opening of drainiange system to determine if its open or clsoed

treat - laser iridotomy (small opening in iris, allowing filtering angel to open), lower IOP with meds

115
Q

What is exophthalmos?

A
  • abnormal protrusion of eyeballs
  • exposes abn large amount of anterior eye, dryness, gritty feeling in affected ee(s), double vision, eye movement resitrciton
  • caused by enlarged extraocular muscle, retrobulbar mass, edema of soft tissue that liens bony orbit, hyperthyroid, hypothyroid, euthyroid (normal), sudden unilateral = retrobulbar hemorrhage or inflammation
116
Q

how to diagnose and treat exophthalmos?

A

diagnose - complete ophthalmic exam, blood tests, radiogrpahic studies, CT, echography

treat - based on diagnosis (underlying disorder0, severre = surgical decompression of orbit and system steroid

117
Q

What are cancer of the eye?

A
  • globe (ocular tumors), orbit (bone surrounding orbital cavity and soft tissue and muscles that lie btwn globe and bone), optic nere or eyelid
  • seborrheic keratosis = skin tag on eyelid
  • ocular melanoma = growing pigmented psot on iris
  • secondary = pain
118
Q

etiology of cancer of the eye?

A
  • ocular tumors include retinoblastoma (most common priamry malignancy of eye in children = 3%), and ocular 9or uveal tract) melanoma and intraocular lymphoma, most common ocular tumor in adults
    orbital r more rare and include rhabdomyosarcoma, capillary hemangioma and cavernous hemangioma\eyelid melnoa = 1% of eyelid tumors by over 65% of deaths
    optic pathyway glioma occurs in children under 20
    most common tumor of eye is metasized (lung for men and breat for women)
119
Q

What is the most common malignant eyelid tumor?

A

0 benign squamous papilloma (caused by HPV infection)
- 85-90% of eyelid lesions

120
Q

how to diagnose and treat ocular melanoma?

A

diagnose - rountien eye exam, ultrasound, biopsy, funduscopic exam and MRI, CT and chest radiograph for staging, molecular genetic testing if retinobalstoma

treatment - excision of tumor, eyeball removal, radiation therapy, chemo, laser therapy

121
Q

common s/s of ear diseases and conditions?

A

hearing loss
ear pain or pressure
tinnitus
vertigo
N&V

122
Q

types of deafness or hearing loss?

A

conductive deafnes - imapirment of eardrum ro bones of middle ear, which conduct sound waves to cochela in inner ear

sensorinerual deafness = impairment of chochela or autidotory nerve

central deafness - when CNS cannot interpret impulses bc of CVA or brain tumor

123
Q

What is ototoxicity?

A
  • when drug or chemical causes damage to CN VII (acoutsitc nerve) or to inner ear, resulting in temprorary or permanent hearing loss or disutrubance in blanace
  • s/s usually have indsidious onset, include tinnitus, feeling of fulnnes or pressure in ears, hearing losss, vertigo, occassionally nausea
  • environmental chemicals include butyl nitrite, carbon disulfude, hexane, styrene, toluene, trichlorethylene, xyelene
  • damage can’t be reverse but can be helped w hearing aids, cochlear implants, PT (for loss of balance)
124
Q

drugs that can cause ototoxicity?

A
  • salicylates 9aspirin and aspirin-containing products)
  • NSAIDs
  • certain antibiotics (aminoglycosides. erythomycin, and vancomycin)
  • loop diuretics (furosemid (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin))
  • chemotherapeutic agents (cisplatin, vincristine, vinblastine), quinines (quinidine and quinin)
  • heavy metals, including mercury and lead
125
Q

What is infectve otitis externa?

A
  • inflammation of external ear canal, usually accompanied by an infectious priocess
  • when cerumen accmulated in ear canal mixes with water it’s a culture medium for bacteria or fungi
  • can also be caused by dermatolgic conditions, such as seborrhea and psoriasis, truama to ear canal (attempts to clean or scratch inside ear w/ foreign objects)
  • red, swollen ear canal
  • hearing loss
  • fever
  • pruritus
  • watery or purelent drainage from ear
126
Q

What is otosclerosis?

A
  • abn bone frowth in middle ear, primarily affects stapes, as indv ages
  • movement of ossicles is impaired = diminished conduction of sound waves and resulting hearing loss
  • young person’s disease, usually begins after pubery and before age 35
  • etiology is idiopatahic, familial tendency, more prevnalaent in women
127
Q

s/s of otosclerosis?

A
  • an growth of spongy bone forms around oval window, causing ankylosis of stapes
  • conducitve deafenss
  • tinnituis
  • gradual hearing loss of low or soft sounds (unilataeral at first but affects both ears at some point)
128
Q

how to diagnose and treat otosclerosis?

A

diagnose - audiogram, pt history, otoscopy

treat - only treatment is stapedectomy (remove diseased stapes and replace w/ prosthetic, mostly ceramic or plastic, if bilateral 1 ear at time, perfromed with laser, if surgery is not optin then hearing aid)

129
Q

what is benign paroxysmal positional vertigo?

A
  • vestibular system disorder
  • pt compain of spinnign sensation which becomes worse with movement of the head
  • may compain of feeling that their surroudnings are movement
130
Q

s/s of BPPV?

A
  • spinning sensation w/ movement of head
  • dizziness is experiecnes is that room is spinning while body is still
  • closed eyes = body is moving, open eyes = spinning surroundings
  • NV
  • involuntary eye movement
  • difficulty standing or walking
  • light-headness
  • unsteadiness
  • feeling faint
  • most episodes r 3-10 seconds
    = onset is uslay with change of position
131
Q

how to diagnose and treat BPPV?

A

diagnose - fasle sensation of room spinning or pt spinning, nystagmus, audiogram, lack of coordination, weakness and unsteadiness in legs, head CT, MRI of head, MRA, caloric stimulation (use syringe with cold water then warm water against eardrum, if nomral then no abn eye movemnt)

treat - antihistamines and benzodiazepines to reduce symptoms of positonal vertigos, exercises (such as indv repeatedly turnnig head from side to side)

132
Q

What is labyrinthitis?

A
  • inflammation of labryinth of inner ear
  • usually result of virus but can be bacterial ifnectoin from middle ear or meningitis
133
Q

s/s of labyrinthitis?

A
  • inflammation or infection of Labyrinth (group of 3 fluid-filled chambers (semicircular canals)
  • fever (100 - 101F)
  • extreme vertigo
  • balance is affected
  • N&V
  • tinnitus
  • loss of hearingin one ear
  • difficulty focusing eye
134
Q

how to diagnose and treat labyrinthitis?

A

diagnose - based on results of several tests (audiometry, blood, neurologic, caloric and possibly imaging studies)

treat - bed rest, prescription for tranquilizer, antiemetic, antibiotic, antihistamines

135
Q

What is a ruptured tympanic membrane (eardrum)

A
  • any type of tear or injury to the eardrum causes a breach in the integrity of membrane
  • can be result of pressure, force or insult from aspect from exterior aspect or increased pressure within middle ear
  • most common causes r sharp objects into ear canal, nearby explosion, severe middle ear infection, blow to ear (can also be result of fractured skull)
136
Q

s/s of ruptured eardrum?

A
  • slight pain
  • partial loss of hearing
  • slight discharge or bleeding from the ear
  • buzzing in ear
  • facial weakness or dizzines
  • purulent dizziness
137
Q

how to diagnose and treat ruptured eardurm>

A

diagnose - visual exam of ear with otoscope, purulent drainainge, audiometry

treat - antibiotic, patch to eardrum (tympanoplasty - graftubg if tissue for eardurm repair) and analgesics

138
Q

What is cholesteatoma?

A
  • pocket of skin cell located in middle ear, normally shed by eardrum and that collect into cystlike mass or ball and become infected
  • bone lining the middle ear cavity erodes and ossicles become damages
139
Q

What is cholesteatoma?

A
  • pocket of skin cell located in middle ear, normally shed by eardrum and that collect into cystlike mass or ball and become infected
  • bone lining the middle ear cavity erodes and ossicles become damages
  • usually develops in infancy or may be result of chronic ear infection (eustachian tube from middle ear to pharynx either fails to open proplery or becomes blocked with material from recurring middle ear infection = weak vacuum, causing eardrum to retract, allowing cholesteatoma to develop)
140
Q

s/s of cholesteatoma?

A
  • mild to moderate hearing loss
  • purulent substance may drain from affected ear
  • earache
  • headache
  • vertigo
  • some weakness of facial muscles
141
Q

diagnose and treatment of choleastoma

A

diagnose - pt history, otoscopy, audiometry, radiographic studies including CT, culture of purulent drainiange

treatment - removed with thorough cleaning of middle ear cavity, inflation of eustacian tube, treatment with steroid and antiobiotics, surgical reconstruction of middle ear strucutre,

142
Q

complications of choleastoma?

A
  • deafness in oen ear
  • persistent ear draiiange
  • vertigo
  • badly damaged hearing
  • erosion into facial nerver = facial paralysis and/or labyrinthistis
  • epidural absecess or meningitis
143
Q

what is mastoiditis?

A
  • inflammation of mastoid bone/ process
  • pain, edema over and around mastoid, fever and chills, headache and hearing loss, drainage
  • neglected acute otitis media (Streptococcus penumoniae, haemophilus influenzae, Moraxella catarrhalis, less common r group A streptococci and Staphylococcus aureus)
  • if chronic associated with cholesteatoma
144
Q

how to diagnose and treat mastoiditis?

A

diagnose - pt history, otoscopy, audiometry, radiographic studies, radiographic and CT, blood and culture studies

treatment - based on results of the sensitivity studes, antiobitic or sulfonamid therapy is prescribed, if not responding then simple mastoidectomy

145
Q

What is sensorineural hearing loss?

A
  • aka occupational hearing loss
  • sound waves reach inner ear but r not percieved bc nerve impusles r not transmitted to brain
  • s/s r tinnitus and partial to severe hearing loss
  • cause is nerve failure or damage to cochlea or aditory nerve (from aging, loud noise, medication, mumps, measles, syphilis, meningitis, suppurative labyrinthitis, viral infection, or physical trauma)
146
Q

What is sensorineural hearing loss?

A
  • aka occupational hearing loss
  • sound waves reach inner ear but r not percieved bc nerve impusles r not transmitted to brain
  • s/s r tinnitus and partial to severe hearing loss
  • cause is nerve failure or damage to cochlea or aditory nerve (from aging, loud noise, medication, mumps, measles, syphilis, meningitis, suppurative labyrinthitis, viral infection, or physical trauma)
147
Q
  • cochlear hair cell degeneration
  • loss of auditory neurons in spiral ganglia of organ of Corti
  • degeneration of basilar conductive membrane of cochlea
  • decreased vascularity of cochlea
  • loss of cortical auditory neurons
A
  • inability to hear high-frequency sounds, interfere with understanding speech
  • inability to hear high frequency sounds, interferes with understanding speech
  • inability to hear at all frequency but more pronounced at higher frequencies
  • equal loss of hearing at all frequencies, inability to disseminate localization of sound
  • equal loss of hearing at all frequencies, inability to disseminate localization of sound
148
Q

how to diagnose and treat sensorineural hearing loss/

A

diagnose - pt history, audiomentry, could be s/s of space-occupaying mass such as tumor or aneurysm

treat - try to prevent further damage, reducign nosie levels

149
Q

types of Cancer of the ear

A
  • include skin cancer of external ear
  • ceruminal gland neoplasms
  • acoustic and facial neuromas
  • glomus tumors
  • could be metastasized from otehr locations in the body
150
Q

s/s of cancer of the ear?

A
  • progressive hearing loss
  • chronic otic discharge
  • bisible mass or lesion on ear examination
  • loss of equilibrium
  • tinnitus
  • painful (some caner such as SCC of midle ear)
  • glomus tumors = pulsatile tinnitus from pressing on bones of hearing
151
Q

etiology of cancer of ear

A

benign tumors r acoutsitc neuromas (caused by CN VIII), facial neuromas (tumor of facial nerve), and glomus tumors (most common and arise from glomus bodies)

malignants tumors r skin cancers (BCC and SCC) (most common), ceruminal gland neoplasm (tumor arising from glands producing cerumen) which can be either malignant or benign, malignants tumor of middle ear r very uncommon

152
Q

diagnose and treat cancer of ear?

A

diagnose - examination, bopsy, CT and MRI

treat - surgical exicision, radioation therapy if tumor is known to be aggressive, nerve graft after surgical excision of neuroma

153
Q

What are foreign bodies in the ear?

A
  • typicall range from bugs, pebbles, bits of cotton to anythign small enough to fit in the ear canal
  • may complain of feeling stuffiness and smthng in ear, buzzing sound, pain, decreasing hearing
  • cause r flying insects accidently in course of flight, children placeing small objects in ear canal, vegetative foreign bodies,
  • use history and visual and/or oroscopic inspection of the ear
  • if bug place pt in dark room and shine light in ear to crawl out or flush out w/ warm solution of 50% water and 50% hhydrogen peroxide
154
Q

What are forieng bodies in the eye?

A
  • objects that would not be found in the eye
  • bugs, rust, ust, sand, hair, small pieces of metal, brush or tree branches, chemicals
  • scratching or irritation of eye, pain, blurred or compromised vision, tearing
  • diagnose w/ visual and ophthalmoscopic exam of eye
  • treat w/ removal (gentle irrigation, remove w/ surgical instruments, antibacterial drops)

Pathophysiology - Diseases (22 decks)

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