Ear & EYE

By
Syed Yousaf Shah
 Learning Objectives

• Describe the structure and function of the ear

& eye.

• Discuss the terms related to ear & eye.

• Describe the diagnostic tests & disorders of

the ear & eye..
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 Basic Mechanics of Hearing

• Ears are important for hearing and for

controlling a sense of position and balance.
• Each ear is divided into three sections:
• The outer ear.
• The middle ear.
• The inner ear.

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 The Outer Ear

• The external part of the ear consists of the

pinna and ear lobe.

• The outer ear functions to collect sound

(acoustic energy), and funnel it to the
eardrum (tympanic membrane).

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 The Middle Ear

• The middle ear is an air-filled space that

contains three tiny bones known as ossicles
which transmit sound.
• The bones are known individually (according
to their shapes) as the:
• Malleus (hammer).
• Incus (anvil).
• Stapes (stirrup).
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 The Eustachian Tube

• The Eustachian tube is a narrow tube that

connects the middle ear to the back of the
nose and throat.
• During swallowing, the Eustachian tube opens
up to allow air into the middle ear, so that air
pressure on either side of the tympanic
membrane is the same.

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 The Inner Ear

• The inner ear contains two main structures:

• The cochlea, in the shape of a snail, which is
involved in hearing.

• The round window (fenestra cochlea) is a

membrane that connects the cochlea to the
middle ear.

• It helps dampen the vibrations in the cochlea.

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 The Inner Ear
• The vestibular system (consisting of the
semicircular canals, saccule and utricle), which
is responsible for maintaining balance and a
sense of position.

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 Transmission of Sound through
the Ear.
• A sound wave enters the outer ear, then goes
through the auditory canal, where it causes
vibration in the eardrum.
• The vibration makes three bones in the middle
ear move.
• The movement causes vibrations that move
through the fluid of the cochlea, which is
located in the inner ear.

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Physiology of Hearing and Balance
• The cochlea, in the shape of a snail, which is
involved in hearing.

• The vestibular system (consisting of the

semicircular canals, saccule and utricle), which
is responsible for maintaining balance and a
sense of position.

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 EYE

The eye is the organ of the sense of sight

situated in the orbital cavity and it is supplied
by the optic nerve (2nd cranial nerve).
 Structure
There are three layers of tissue in the walls of the eye.
They are:
1.The outer fibrous layer: sclera and cornea
2. The middle vascular layer or uveal tract:
choroid,ciliary body and iris
3. The inner nervous tissue layer: retina.
Structures inside the eyeball are the lens, aqueous fluid
(humour) and vitreous body (humour).
 Sclera and Cornea
The sclera, or white of the eye, forms the
outermost layer of tissue of the posterior and
lateral aspects of the eyeball and is continuous
anteriorly with the transparent cornea.

It consists of a firm fibrous membrane that

maintains the shape of the eye and gives
attachment to the extraocular or extrinsic
muscles of the eye.
 Cornea
• Anteriorly the sclera continues as a clear
transparent epithelial membrane, the cornea.
Light rays pass through the cornea to reach
the retina.

• The cornea is convex ante-riorly and is

involved in refracting or bending light rays to
focus them on the retina.
 Choroid
The choroid lines the posterior five-sixths of
the inner surface of the sclera.

 It is very rich in blood vessels and is deep

chocolate brown in colour.

 Light enters the eye through the pupil,

stimulates the nerve endings in the retina and
is then absorbed by the choroid.
 Ciliary Body
The ciliary body is the anterior continuation of
the choroid consisting of ciliary muscle
(smooth muscle fibres) and secretory
epithelial cells.

 It gives attachment to the suspensory

ligament which, at its other end, is attached to
the capsule enclosing the lens.
 Iris
The iris is the visible coloured part of the eye
and extends anteriorly from the ciliary body,
lying behind the cornea in front of the lens.

It divides the anterior segment of the eye into

anterior and posterior chambers which
contain aqueous fluid secreted by the ciliary
body.
 Lens
• The lens is a highly elastic circular biconvex
body, lying immediately behind the pupil.

The lens bends (refracts) light rays reflected by

objects in front of the eye.

The nearer is the object being viewed the

thicker the lens becomes to allow focusing.
 Retina
The retina is the innermost layer of the wall of
the eye It is an extremely delicate structure
and is especially adapted for stimulation by
light rays.

 It is composed of several layers of nerve cell

bodies and their axons, lying on a pigmented
layer of epithelial cells which attach it to the
choroid.
 Retina
• Towards the anterior part of the retina there
are fewer cone- than rod-shaped cells .
• The rods and cones contain photosensitive
pigments that convert light rays into nerve
impulses.
• The small area of retina where the optic nerve
leaves the eye is the optic disc or blind spot.
It has no light-sensitive cells.
 Blood Supply
• The eye is supplied with arterial blood by the
ciliary arteries and the central retinal artery.

• Venous drainage is by a number of veins,

including the central retinal vein, which
eventually empty into a deep venous sinus.

The central retinal artery and vein are encased in

the optic nerve, entering the eye at the optic
disc.
 Physiology of sight
• Light waves travel at a speed of 186 000 miles
(300 000 kilometres) per second.
• Light is reflected into the eyes by objects
within the field of vision.
• White light is a combination of all the colours
of the visual spectrum (rainbow),i.e. red,
orange, yellow, green, blue, indigo and violet.
 Physiology of Sight
• This range of colour is the spectrum of visible
light.In a rainbow, white light from the sun is
broken up by raindrops which act as prisms
and reflectors.
 Extraocular Muscles of the Eye

• Medial rectus
• Lateral rectus
• Superior rectus
• Inferior rectus
• Superior oblique
• Inferior oblique.
 Accessory Organs of the Eye

Eyebrows
 Eyelids and eyelashes
 Lacrimal apparatus.
 Terminology
• OD: oculus dexter (right eye)
• OS: oculus sinister (left eye)
• OU: oculus uterque (both eyes)
• Hyperopia: Farsightedness
• Miotic: Medication that causes contraction of
the pupil.
• Mydriatic: Medication that dilates the pupil.

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 Terminology
• Myopia: Nearsightedness.
• Enucleation: is the removal of the entire
eyeball.
• Exenteration: is the removal of the eyeball &
surrounding tissues & bone.

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 DIAGNOSTIC TESTS FOR THE EYE
• Fluorescein angiography:A detailed imaging
and recording of ocular circulation by a series
of photographs after the administration of a
dye.

• Slit lamp: A slit lamp allows examination of

the anterior ocular structures under
microscopic magnification.

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 DIAGNOSTIC TESTS FOR THE EYE
• Corneal staining:A topical dye is instilled into
the conjunctival sac to outline irregularities of
the corneal surface that are not easily visible.

• Tonometry: the test is used primarily to

assess
for an increase of intraocular pressure and
potential glaucoma.

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 DISORDERS OF THE EYE
• Cataracts
• A cataract is an opacity of the lens that
distorts the image projected onto the retina
and that can progress to blindness.

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 DISORDERS OF THE EYE

• Causes :include the aging process (senile

cataracts ), inherited (congenital cataracts),
and injury (traumatic cataracts); cataracts
also can result from another eye disease
(secondary cataracts).

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 DISORDERS OF THE EYE
• Assessment:

• Blurred vision and decreased color percep-

tion are early signs.
• Loss of vision is gradual.

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 DISORDERS OF THE EYE
• Interventions
• Surgical removal of the lens, one eye at a
time, is performed.

• A lens implantation may be performed at the

time of the surgical procedure.

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 DISORDERS OF THE EYE
• Glaucoma
• A group of ocular diseases resulting in
increased intraocular pressure.
• Types
• Primary open-angle glaucoma (POAG)
• Primary angle-closure glaucoma (PACG)

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 DISORDERS OF THE EYE
• Assessment
• Early signs include diminished
accommodation and increased intraocular
pressure.
• Primary open-angle glaucoma (POAG):
Painless, and vision changes are slow;
results in “tunnel” vision.
• Primary angle-closure glaucoma (PACG):
Blurred vision, halos around lights, and
ocular erythema
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 DISORDERS OF THE EYE
• Interventions for acute angle-closure
glaucoma:
a. Treat acute angle-closure glaucoma as a
medical emergency.
b. Administer medications as prescribed to
lower intraocular pressure.
c. Prepare the client for peripheral iridectomy,
which allows aqueous humor to flow from
the posterior to the anterior chamber.

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 DISORDERS OF THE EYE
• Interventions for the client with glaucoma

• Instruct the client on the importance of

medications to constrict the pupils
(miotics),to decrease the production of
aqueous humor (carbonic anhydrase
inhibitors), and to decrease the
production of aqueous humor and
intraocular pressure (b-blockers).
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 DISORDERS OF THE EYE
• Interventions for the client with
glaucoma
• Instruct the client of the need for lifelong
medication use.
• Instruct the client to wear a Medic-Alert
bracelet.
• Instruct the client to avoid anticholinergic
medications.

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 DISORDERS OF THE EYE
• Retinal detachment
• Detachment or separation of the retina from
the epithelium.
• Retinal detachment occurs when the layers of
the retina separate because of the
accumulation of fluid between them, or when
both retinal layers elevate away from the
choroid as a result of a tumor.

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 DISORDERS OF THE EYE
• Assessment
• Flashes of light
• Floaters or black spots (signs of bleeding)
• Increase in blurred vision
• Sense of a curtain being drawn over the
eye
• Loss of a portion of the visual field;
painless loss of central or peripheral
vision
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 DISORDERS OF THE EYE
• Immediate interventions
• Provide bed rest.
• Cover both eyes with patches as prescribed to prevent further
detachment.
• Speak to the client before approaching.
• Position the client’s head as prescribed.
• Protect the client from injury.
• Avoid jerky head movements.
• Minimize eye stress.
• Prepare the client for a surgical procedure as prescribed.

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 DISORDERS OF THE EYE
• Surgical procedures
• Draining fluid from the subretinal
space so that the retina can return to
the normal position.
• Sealing retinal breaks by
cryosurgery, a cold probe applied to
the sclera, to stimulate an
inflammatory response leading to
adhesions
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 DISORDERS OF THE EYE
• Surgical procedures
• Diathermy, the use of an electrode needle
and heat through the sclera, to stimulate
an inflammatory response.

• Laser therapy, to stimulate an

inflammatory response and seal small
retinal tears before the detachment
occurs

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 DISORDERS OF THE EYE
• Postoperative interventions
• Maintain eye patches as prescribed.
• Monitor for hemorrhage.
• Prevent nausea and vomiting and
monitor for restlessness, which can
cause hemorrhage.
• Monitor for sudden, sharp eye pain
(notify the physician).
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 DISORDERS OF THE EYE
• Macular degeneration
• A deterioration of the macula, the
area of central vision.

• Can be atrophic (age-related or dry)

or exudative (wet).

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 DISORDERS OF THE EYE
• Assessment

• A decline in central vision

• Blurred vision and distortion

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 DISORDERS OF THE EYE
• Interventions
• a. Initiate strategies to assist in
maximizing remaining vision and
maintaining independence.

• Laser therapy, photodynamic therapy,

or other therapies may be prescribed
to seal the leaking blood vessels in or
near the macula.
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 DISORDERS OF THE EYE
• Ocular melanoma
• Most common malignant eye tumor
in adults.

• Tumor usually found in the uveal

tract and can spread easily because
of the rich blood supply.

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 DISORDERS OF THE EYE
• Assessment

• blurring of vision occurs.

• Increased intraocular pressure (IOP).
• Change of iris color.

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 DISORDERS OF THE EYE
• Interventions
• Enucleation: The entire eyeball is
removed surgically and a ball implant
is inserted to provide a base for a
socket prosthesis.

• Radiation is given via a radioactive

plaque that is sutured to the sclera.

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 DISORDERS OF THE EYE
• Contusions
• Bleeding into the soft tissue as a result
of an injury.
• A contusion causes a black eye; the
discoloration disappears in about 10
days.
• Pain, photophobia, edema, and
diplopia
• may occur.
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 DISORDERS OF THE EYE
• Interventions

• Place ice on the eye immediately.

• Instruct the client to receive a
thorough eye examination.

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 DIAGNOSTIC TESTS FOR THE
EAR
• Tomography
• Tomography assesses the mastoid, middle
ear,
and inner ear structures.
• Multiple radiographs of the head are
obtained.
• Tomography is especially helpful in the
diagnosis of acoustic tumors.
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 DIAGNOSTIC TESTS FOR THE
EAR
• Audiometry

• Audiometry measures hearing acuity.

• Audiometry uses two types, pure
tone audiometry and speech
audiometry.

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 DISORDERS OF THE EAR
• Conductive hearing loss
• Conductive hearing loss occurs when
sound
waves are blocked to the inner ear
fibers
because of external or middle ear
disorders.

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 DISORDERS OF THE EAR
• Sensorineural hearing loss

• Sensorineural hearing loss is a

pathological
process of the inner ear or of the
sensory
fibers that lead to the cerebral cortex.

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 DISORDERS OF THE EAR
• External otitis

• External otitis is an infective

inflammatory or allergic response
involving the structure of the
external auditory canal or auricles.

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 DISORDERS OF THE EAR
• Assessment
• Pain
• Itching
• Plugged feeling in the ear
• Redness and edema
• Exudate
• Hearing loss

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 DISORDERS OF THE EAR
• Interventions
• Apply heat locally for 20 minutes
three times a day.
• Encourage rest to assist in reducing pain.
• Administer antibiotics or corticosteroids as
prescribed.
• Administer analgesics such as aspirin or
acetaminophen.
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 Practice Questions
• During the early postoperative period, the client who
has had a cataract extraction complains of nausea
and severe eye pain over the operative site. The
initial nursing action is to:
• 1. Call the physician.
• 2. Reassure the client that this is normal.
• 3. Turn the client on his or her operative side.
• 4. Administer the prescribed pain medication and
antiemetic.

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 Practice Questions

• Rationale: Severe pain or pain accompanied

by nausea following a cataract extraction is an
indicator of increased intraocular pressure
and should be reported to the physician
immediately.
• Options 2, 3, and 4 are inappropriate actions.

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 Practice Questions
• The nurse is developing a teaching plan for the client
with glaucoma. Which of the following instructions
would the nurse include in the plan of care?
• 1. Avoid overuse of the eyes.
• 2. Decrease the amount of salt in the diet.
• 3. Eye medications will need to be administered for
the client’s entire life.
• 4. Decrease fluid intake to control the intraocular
pressure

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 Practice Questions

• Rationale: The administration of eye drops is

a critical component of the treatment plan for
the client with glaucoma.
• The client needs to be instructed that
medications will need to be taken for the rest
of his or her life. Options 1, 2, and 4 are not
accurate instructions.

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 Practice Questions
• The nurse is caring for a hearing-impaired
client. Which of the following approaches will
facilitate communication?
• 1. Speak loudly.
• 2. Speak frequently.
• 3. Speak at a normal volume.
• 4. Speak directly into the impaired ear.

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 Practice Questions

• Rationale: Speaking in a normal tone to the client with

impaired hearing and not shouting are important. The nurse
should talk directly to the client while facing the client and
speak clearly. If the client does not seem to understand what
is said, the nurse should express it differently. Moving closer
to the client and toward the better ear may facilitate
communication, but the nurse should avoid talking directly
into the impaired ear.

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 References
• Porth. C.M (2006). Pathophysiology
• McPhee. S.J, & Papadakis. M.A (2011)
Currentmedical diagnosis and treatment.
McGrahill: Lange. Chp12, Page. 394

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