Week 5 Sensory Flashcards
White part of the eye that protects the eyeball
Sclera
Black dot in which light can enter is the
Pupil
Color part of the eyes that surrounds the pupil
Iris
Cranial nerve II is the
Optic Nerve
what cranial nerves control EOMs of the eye
3, 4, and 6
Transparent anterior part of the eye ball
Cornea
Fluid filled space betweent cornea and iris
Anterior Chamber
Aqueous Humor
Watery liquid, fills anterior and posterior chambers of the eye, provides nourishment to the eye
Conjunctiva
Mucous Membrane that lines the eye lid and outer surfaces of the eye
Tubes that carry tears to the lacrimal sac
Lacrimal Ducts
Glands of Zeis
Oil glands around the eyelashes - sebaceous glands
Moil gland
Sweat gland - apocrine gland
Meibomian Gland
Secretes oily portion of tears to help keep the eye lubricated from tears evaporating
Fundus
Interior surface of the eye, which includes the retina, optic disk, macula lutea, and posterior pole
Central region of the retina responsible for central vision yellow pigment provides its color
Macula or Macula Lutea
Fovea or Focal Point
Pinpoint depression in the center of the back of the eye- sharpest area vision- near center of macula- where most cones are located
Optic Disc
Exit site of retinal nerve fibers as well as entrance point for retinal arteries and exit point for retinal veins
Perceives and transmits light to the optic nerve
Retina
Contracts and dilates to regulate light from passing through the pupil
Iris
- colored part of the eye
Lens
Transparent structure behind the pupil that bends and focuses light ray to the retina
Area between the iris and lens
Lens is behind the iris and normally clear
Light passes through the pupil to the lens
Lens held in place by small tissue strands or fibers extending from inner wall of the eye
Posterior Chamber
Nerve carrying sense of sight from retina to the brain
Cranial Nerve II
Black circular opening in the center of the iris through which light passes as it enters the eye
Pupil
Vitreous
Jelly like mass filling the inner chamber between the lens and retina that gives bulk to the eye
Eyes are the organ of sight that provide what view?
3D view
Light enters the eye through the pupil and the lens focuses light rays on the retina on what nerve tissue?
Nerve Tissue in the inner posterior of the eye
Distorted Vision
Astigmatism
Hyperopia
Beyond sight - can only see far away
Myopia
Can only see things that are closer to the eye.
Light that is being bent in front of the retina and not exactly at the retina
Hyperopia
Light rays are bent behind the retina
Black and white color
Rods
Different colored tones
Cones
Nerve fibers from the __________and _____________ join into the __________
rods and cones optic disk where the optic nerve carries transmissions to the brain
Where the optic nerves converge and exit the eye
Optic disc
- no light cells to detect light
- Results in a break in the visual field, known as the blind spot
Retinal Detachment
Separation of the retina from the underlying epithelium
Will lead to blindness if not surgically repaired
Anisocoria
Unequal pupils
Need to assess as soon as possible to determine if acute damage or congenital
acute can mean brain bleed
Coloboma
Congenital malformation of the eye causing defects in the lens, iris, or retina
The hole is present from birth and can be caused when a gap called the
Chronic Fissure
Present during early stages prenatal development
Fails to close up completely before a child is born
Eye Strain
Asthenopia
Bleparospasm
Involuntarily contraction of the muscle surrounding the eye causing uncontrolled blinking and lid squeezing
Double Vision
Diplopia
Involuntary, rapid bouncing of the eye
Nystagmus
Extreme sensitivity and discomfort from light
Photophobia
Blind spot in vision
Scotoma
Cataracts can be both what?
Congenital at birth or develop over time or be caused by eye trauma
Blepharitis
Inflammation of the eye lid
Blepharoptosis
Drooping of the eye lid
Cataract
Opaque clouding of the lens
Amblyopia
Decreased vision early life because of a functional defect that can occur as a result of strabismus, ( condition of eye misalignment caused by intraocular muscle imbalance) refractory errors ( one eye being in focused and the other is either near or far sighted) or trauma; it is also lazy eye
3 types of Amblyopia
Hypertropia - Upward
Entropion/ Esotropia - Middle inward
Ectropion/ Exotropia- Top outward
How can lazy eye be corrected?
Can be done through brain training by wearing a patch over the good eye to strengthen the lazy eye muscles to force the brain to recognize the weaker eye
May need to wear glasses
If not corrected; then surgery can be done to tighten the loose eye
Drooping of the eyelid usually caused by paralysis
Blepharoptosis
Chronic nodular inflammation of the meibomian gland, usually the result of the blocked duct
Chalazion; also known as a Stye
Pink eye inflammation of the conjunctiva
Conjunctivitis
Inflammation of the lacrimal duct
Dacryoadenitis
Inflammation of the iris
Iritis
Inflammation of the cornea
Keratitis
Snellen Eye Chart
Used for distance acuity
Measure to see details and shape from 20ft, normal is 20/20U
Use of ophthalmoscope to view the interior of the eye
Ophthalmoscopy
Slit Lamp
Tabletop microscope used to examine the eye, especially the cornea, lens, fluids, and membranes
Used to measure intraocular pressures, the eye pressure is elevated in glaucoma
Tonometry
Fluorescein Angiography
Visualization and photography of retinal and choroidal vessels made as fluorescein dye circulates through the eye, the dye is injected into patients vein
Wet Type
Macular Degeneration
AMD
Age related Macular Degeneration
Most common cause of vision loss in persons older than age 60 years
Wet Type
Neovascular or Exudative
May have abrupt onset
Dry or Nonexudative Type
Most common 85-95
Slow breakdown of the layers of the retinal with the appearance of drusen(yellow discolorations under the retina)
Proliferation of abnormal blood vessels growing under the retina
Choroidal Revascularization
AMD Pathways to Vision Loss
Risk Factors
Age
Smoking History
HTN
Obesity
Hyperopia
Wet AMD
Use of thyroid
Arthritis
Drusen
Yellow spots associated with aging and appear in retina
No visual symptoms if not located in macula. Mary vary in size.
Macula is the area of the retina where _____________ focuses
Light
Fovea centralis is the center point of the macula
Drusen
Deposits of fatty proteins of lipids
Presence of drusen does NOT indicate AMD, but increases chance of AMD
As drusen hardens over time, bleeding and scarring may occur on the macula
What is used to determine macular degeneration?
Amsler Grid
Amsler Grid
Test eyes under normal lighting for reading
14-16 in away Test each separately cover one eye
Keep eye focused on the dot in center and answer questions
- Lines wavy or blurred?
- Do all boxes look the same?
- Are there any holes?
- Can you see all corners and sides?
Photodynamic Therapy for Slowing Progression of AMD
Light sensitive verteporfin dye injected to vessels
A laser then activates the dye, shutting down the vessels without damaging the vessels
Result is slow or stabilize vision loss
Patient must avoid exposure to sunlight or bright light for 5 days to avoid activation of dye in vessels near the surface of the skin
Blurred vision is key symptom
AMD
A special combination of vitamins and minerals may reduce disease progression. Surgery may also be an option
AREDS Formula for AMD
VEGF occurs in eyes with
Wet AMD
These elevated levels of VEGF promote the growth of abnormal new blood vessels
Several anti- VGEF drugs are available to do what?
Help slow down vision loss from AMD, and in some cases, improve sight
AREDS 2 is composed of?
Zeaxanthin
Vitamin C
Vitamin E
Copper
Bevacizumab
Blood vessel growth inhibitor (chemotherapy)
Treat wet AMD
Just as effective and safe as Lucentis
Ranibizumab
Lucentis
Blood Vessel Growth Inhibitor (chemotherapy)
Treats wet AMD
Slows the rate of vision loss from wet AMD
1/3rd significant improvement of vision
Alibercept
Eylea
Blood vessel growth inhibitor (chemotherapy)
Tx for wet AMD
Can be given less frequent than Lucestin and Avastin
Pegaptanib Sodium
Macugen
Anti angiogenic
Tx of wet AMD
Used for patients with allergies with other drugs and/ or long term Tx
Nursing Management of AMD
Pt education
Supportive care
Promote safety
Recommendations to improve lighting, magnification devices, and referral to vision center to improve or promote function
Ensure Pt must manage symptoms for entire life
Opacity or cloudiness of the lens
Cataracts
Due to protein aggregation or destabilization
Increased incidence with aging
Leading cause of disability
Cataract lens does what to light?
It scatters light causing hazy and out of focus vision with colors hazy too
Clinical Manifestations of Cataracts
Painless, Blurry Vision
Sensitivity to glare
Reduced visual acuity
Other effects of cataracts include
Myopic shift
Astigmatism, diplopia, and color shifts, including brunecens
Dx Findings of Cataracts
Decreased Visual Acuity and opacity of the lens by ophthalmoscope, slit lamp, or inspection
Surgical Management of Cataracts
If reduced vision does NOT interfere with normal activities than surgery is not needed
Surgery performed on outpatient basis with local anesthesia
Surgery usually takes less than a hour and patients are soon discharged after
Complications are rare but may be significant
ICCE
Type of Cataract Surgery
Intracapsular Cataract Extraction
Removes entire lens; rarely done today
ECCE
Cataract Surgery
Extracapsular Cataract Extraction
Maintains the posterior capsule of the lens, reducing potential post op complications
Phacoemulsification
Cataract Surgery
An ECCE that uses an ultrasonic device to suction the lens out through a tube, incision is smaller than with standard ECCE
Lens Replacement
After removal of the lens by ICCE or ECCE, the surgeon inserts an intraocular lens implant
This eliminates the need for aphakic lenses
Pt may still require glasses
Intraocular Lens Implant
Implantation of an artificial lens to replace defective natural lens
Phacoemulsification
Use of ultrasound to shatter and break up cataract, with aspiration and removal
Surgical Tx of Cataracts
Telescopic lens
- In one ye
Plastic tube magnifies field of vision
IOL= Intraocular Lens
Nursing Management for Cataracts
Preoperative Care
Usual preoperative care for ambulatory surgery
Dilating eye drops or other medications as ordered
Post op care
Pt education normal for eye to shine or flicker after cataract removal
Provide written and verbal instructions
Nursing management for Cataracts
Instruct pt. to call physician immediately if vision changes
Continuous flashing lights, redness, swelling, or pain increase
Type and amount of drainage increases
Or significant pain is not relieved by acetaminophen
AMD is leading cause of
Disability
Glaucoma is leading cause of
Blindness
Group of ocular conditions in which damage to the optic nerve is related to increased IOP caused by congestion of aqueous humor
Glaucoma
Risk Factors of Glaucoma
Increases incidence with age
Aqueous production and drainage are not in balance
Glaucoma
When aqueous outflow is blocked, pressure builds in the eye
IOP causes what type of damage ?
Irreversible mechanical or ischemic damage
Ophthalmic Medications
Ability of eye to absorb medication is limited
What are barriers of absorption for ophthalmic medications?
Size of conjunct. sac, corneal membrane barriers, blood-ocular barriers, tearing, and blinking, and drainage
Intraocular or systemic medication may be needed to treat some eye structures or to provide high concentrations of medication
TRUE
Topical medications are used the most for the eye. Why?
Least invasive, fewer side effects, and permit self administration
Tx goal is to manage or decrease IOP
How do prostaglandins work?
Relaxing muscles in the eye interior structure to allow better outflow of fluids, thus reducing buildup of eye pressure
Eye Medications
Xalatan
Lumigan
Travatan Z
Rescula
Side Effects of Eye Medications
Eye color change
Darkening of eyelid
Eyelash growth
Droopy eyelids
sunken eyes
stinging
eye redness
itching
What drugs were once the first choice in treating glaucoma?
Beta Blockers
Work by decreasing fluids production in the eye and are now often prescribed as adjunct or in combination with prostaglandins
Betablocker eye Medications
Timolol
Timoptic
Isatol
Betoptic
Side Effects include: Low BP, reduced pulse rate, fatigue, SOB, reduced libido, depression
Alpha Agonists
Decrease production of fluid and increase drainage
Brimonidine- preservative breaks down into natural tear components and has better client tolerance
Side Effects: burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, higher likelihood of allergic reaction
Carbonic Anhydrase Inhibitors
CAIs
- Decrease rate of aqueous humor production
Eye drops include: Trusopt, Azopt
Pill form of carbonic anhydrase inhibitors
Diamox
Neptazane
Daranide
Side Effects include: stinging, burbing, eye discomfort
Pill form SE: tingling hands and feet, fatigue, stomach upset, memory problems, frequent urination
Rho Kinase Inhibitors
Increase drainage of intraocular fluid
Netarsudil
SE: eye redness, corneal deposits, stinging, and small bleeds on the white of the eye
Medications used for glaucoma
Increase aqueous outflow or decrease production
May constrict the pupil and may affect ability to focus the lens of the eye; main side effect of blurred vision
-May also produce systemic effects
Anti-inflammatory Drugs, corticoid suspensions
Side Effects
Long term use include: glaucoma, cataracts, and increased risk of infection
Avoid these effects use NSAID therapy as alternate use than steroids
Guidelines for ophthalmic therapy
Topical most common
Correct Administration required
Systemic absorption decreased by occluding the lacrimal duct
Multiple drops need 5-10 min intervals
Absorption decreased with eye inflammation
Example of topical anesthetic is
Proparacaine
Drugs to avoid IOP
Topical Anesthetics
Mydriatics and cycloplegics
Contraindicated with narrow angles or shallow anterior chambers and inpatients on monoamine oxidase inhibitors or TCAs
- May increase IOP can cause CNS symptoms and high BP
Topical anticholinergic or sympathomimetic,TCAs, MAOIs, antihistamines, antiparkinsonian, antipsychotic, and antispasmolytic
Nursing Dx for Ophthalmic
Disturbed Sensory Perception
Risk for injury
Risk for falls
Self- Care deficit
Deficient Knowledge
Eustachian Tube
Auditory tube
Provides passageway to the throat allowing air to pass to and from outside the body
important to maintaining equal air pressure
Tympanic Membrane
Eardrum; receives sound collected in the external auditory canal and amplifies in through the middle of the ear
Assessment of the Ears
Inspection of external ear
Otoscopic examination
Gross auditory acuity
Whisper Test
Weber Test
Rinne Test
Inner Ear
Receives sound vibrations passed from oval window to the cochlea
Cochlea
Coiled tubular structure that contains the organ of Corti
Perilymph
Fluid that fills the bony labyrinth of the ear
Endolymp
Fluid within the cochlear duct of inner ear
Organ of Corti
Contains receptors that receive vibrations and generate nerve impulses for hearing
Vestibule
Middle part of the inner ear that contains the utricle and the saccule
Larger of the two sacs in the inner ear
Utricle
Smaller of the two sacs
Saccule
Semicircular Canals
3 canals within the inner ear that contain specialized receptors that generate nerve impulses with body movements
Altered sense of orientation in space
- client has sensation of spinning
Dizziness
The illusion of motion or spinning motion
Illusion
Ringing of the ear
Tinnitus
Involuntarily movement rhythmically associated with vestibicular dysfunction
Nystagmus
Labrythititis
Inflammation of the inner ear
Imbalance of inner ear fluids
Ménière’s disease
Imbalance of inner ear fluids
Ménière’s disease
Benign Positional Vertigo
Dizziness occurs with change of head position
Hearing or balance issues related to meds
Ototoxicity
NSAIDS, alcohol, caffeine
Acoustic Neuroma
Tumor of the cranial nerve 8
Vestibulocochlear
Abnormal inner ear fluid balance caused by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct
Meniere’s Disease
What are the various causes of Meniere’s Disease?
Head Injury
Infections
Seasonal Allergies
Alcohol Use
Stress or anxiety
Certain Medications
Smoking
Fatigue
Migraines
Abnormal Immune Response
One of the first signs of Meniere’s Disease
Tinnitus or muffled hearing
Manifestations of Meniere’s Disease
Tinnitus
Feeling of pressure in one ear
Hearing loss that comes and goes ( early stage)
Recurring episodes of vertigo that start and stop ( late stage )
Unstable balance in dark conditions
Tx of Meniere’s Disease
Low sodium diet
Decrease caffeine, alcohol
Smaller more frequent meals
Smoking cessation
Stress and anxiety management
Tx of Meniere’s Disease
Meclizine
Benzo- ending in -lam, -pam
Barbiturates
Antiemetics’
Diuretics may be used
Surgical Management to eliminate attacks of vertigo
Also includes
- Endolymphatic sac decompression, middle and inner ear perfusion, and vestibular sectioning
Two types of Labyrinthitis include
Viral and Bacterial
Inflammation of the inner part of the ear
Usually affects only one ear
The labyrinth is made up of
Fluid filled channels that control balance and hearing
Hearing is controlled by the
Cochlea
Organs of ear are inflamed , then what happens
Information sent to the brain will be different from the unaffected ear
Varied information can make a person feel dizzy
Hearing is also affected
Viral Labyrinthitis
Most cases
Often follows common illnesses such as cold or flu
Sudden incapacitating onset of vertigo, nausea and vomiting as well as sudden unilateral hearing loss
Viral Labyrinthitis
Tx of Viral Labyrinthitis
Symptomatic
Antivertiginous medications
Antihistamines
Antiemetics
Bed rest
Hydration
Bacterial Labyrinthitis
Occur after chronic middle ear infection
Bacteria enters the inner ear through the oval or round windows, through the bone or as a result of injury to the head or ear
Sudden unilateral hearing loss along with nystagmus, vertigo, and sickness
Bacterial Labyrinthitis
Tx is antibiotics
Care should be taken with driving, ladders or operating machinery for at least a week after symptoms have gone as they may return
Dizziness with quick head movements may last for…
Years
Bacterial Labyrinthitis more likely to cause residual affects of hearing loss, tinnitus, or imbalance
