Cataracts
An increase in the opacity of the lens of the eyes. A progressive, painless loss of vision is the main characteristic of cataracts.
Risk Factors
(mn. CARDDS)
- Corticosteroids
- Aging
- Retinal Detachment
- Diabetes Mellitus, Down Syndrome
- Smoking
Symptoms
- Painless blurring of vision
- White-colored or cloudy lens/pupil
Treatment
- Cataracts are done primarily through lens removal. This may be done with ultrasound vibrations that breaks the lens into fragments.
- Patients without lens are aphakic (has aphakia). Surgical management is through lens replacement, which uses lens implants or corrective lenses.
Nursing Intervention
- Post-op: monitor vital signs, level of consciousness, and dressings.
- Elevate the head of the bed.
- Lie on the unaffected side.
- Eyeglasses will be given for the patient when discharged. At night, an eye shield is used to prevent scratching.
- Avoid activities that elevate the IOP: sneezing, coughing, straining or using the valsalva maneuver (utilize a papaya + high residue/fiber diet) To prevent constipation, laxatives may be given. Antiemetics may be given for vomiting patients. Increased IOP may cause hemorrhaging.
- Priority after surgery: safety. Set siderails.
Glaucoma
Increased IOP (normal: 10 to 21 mmHg) due to an imbalance in the production and drainage of aqueous humor.
Symptoms
- Open Angle Glaucoma: loss of peripheral vision (tunnel vision), where halos are seen when around lights.
- Closed Angle Glaucoma: headache and eye pain present due to higher IOP compared to open angle.
Risk Factors
- Smoking, Steroids
- Aging
- Diabetes Mellitus
Diagnostic Examination
- History
- Tonometry through a tonometer, which measures IOP
Nursing Intervention
- Priority Nursing Diagnosis: risk for injury due to sensory impairment; ensure safety.
- Keep lights open to promote pupil constriction. Dark environments allow for dilation, and increase IOP.
Treatment
- Miotics: drugs that constrict the pupil. Pilocarpine
- Topical Beta-Blockers instilled at the lower conjunctiva; betaxolol, timolol. Always monitor heart rate to check for bradycardia. Trivia: only 7% of eye drops enter systemic circulation.
- Prostaglandin Analogs: travoprost, latanoprost
- Surgical Management: iridectomy, iridotomy used to facilitate aqueous drainage.
Retinal Detachment
The separation of the choroid from the retina, forming a retinal pigment epithelium (RPE) detached from the sensory layer.
Causes
- Diabetic retinopathy
- Aphakia
- Tumor of the eye
- Inflammation of the eye: uvitis (middle layer inflammation)
- High myopia
Symptoms
- Flashes of light and sight of floaters (light spots on the foreground of one’s sight)
- Sense of a curtain being drawn over the eye.
- Painless blurring of vision.
Treatment
- Scleral buckle, which promote reattachment of the choroid to the senosry retina.
- Pneumatic retinopexy, where the retinal pigment epithelium (RPE) is pushed into the retina via the administration of gas bubbles or silicone oil into the vitreous cavity.
- Importantly, position the patient PRONE after surgery to position the gas bubble properly in pushing the RPE to the retina.
- Avoid activities that increases IOP: sneezing, coughing, straining/valsalva, vomiting (use antiemetics), constipation (use high fiber/high residue + papaya diet, or laxatives as ordered)
Ear Disorders
- External Ear: ear canal
- Erythematous ear canal; otitis externa, inflammation of the ear canal.
- The ear canal is normally skin colored. If inflamed, it is erythematous.
- Aural tenderness occurs, where manipulation of the pinna, oracle, or canal causes pain.
- Treatment: analgesics (otic drops)
- Middle Ear: tympanic membrane, eustachian tube (connects the ear to the nasopharynx), malleus, indus, stapes.
- Problems with the external or middle ear that results in hearing loss is conductive hearing loss
- In otitis media, the tympanic membrane bulges and becomes erythematous (normally pearly grey).
- A consequence of URTIs travelling through the eustachian tube.
- Inner Ear: a.k.a. labyrinth; cochlea
- Labyrinthitis.
- Problems with the inner ear or labyrinth that results in hearing loss is sensorineural hearing loss. Often caused by (mn. LMP) labyrinthitis, Meniere’s syndrome, and presbycusis.
Otitis Externa
Containing the ear canal and other external ear structures, otitis externa is the inflammation of the ear canal.
Symptoms
- Erythematous ear canal
- Aural Tenderness
Treatment
- Antibiotics for infection
- Analgesia with otic drugs (ear drops) for pain
Otitis Media
Associated with URTIs (cough or cold). This features a tympanic membrane that bulges and becomes erythematous. Hearing loss associated with this condition is conductive hearing loss. If untreated, this may also cause mastoiditis.
Symptoms
- Fever
- Ear Pain (Otalgia), a classic symptom of otitis media.
- Ear Pressure
- Bulging Eardrum
- Ear Discharge
Treatment
- Tympanotomy or Myringotomy: a surgical perforation of the tympanic membrane used to relieve otalgia and facilitate drainage.
Mastoiditis
A complication of otitis media.
Symptoms
The tympanic membrane is described as (mn. DIRT) dull, immobile, red, and thick.
Treatment
Surgery to remove infected mastoid ear cells: mastoidectomy.
- If unsuccessful in removing infected cells, meningitis, dizziness, and damage to CN 6 (abducens) and 7 (facial).
Otosclerosis
Abnormal bone growth at the level of the stapes.
Symptoms
- Conductive hearing loss
- Normal tympanic membrane (pearly grey)
- Often occurs in pregnant patients.
Treatment
- Stapedectomy: removal of the stapes and abnormal bone growths.
- Application of hearing aids
- Sodium fluoride may prevent otosclerosis.
Presbycusis
A form of sensorineural hearing loss related to aging. Hearing is lost due to age because of degenerative changes (atrophy) of the cochlea. Irreversible.
Meniere’s Disease
An inner ear (labyrinth) disorder, where there is an increased fluid (endolymphatic fluid) in the membranous labyrinth.
Symptoms
- Tinnitus, ringing within the ears.
- Sensorineural Hearing Loss
- Vertigo (most common due to affectation of the cochlea)
Management
- Risk for falls or injury due to impaired vestibular function; ensure safety.
- Low sodium diet as episodes may be related to high sodium consumption.
- Diuretics to reduce fluid volume
- Vestibular nerve resection to remove vertigo.
- Labyrinthectomy, removal of the inner ear. Permanent deafness.