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By: April Joy R.

Alis, BSN, RN
l AnaLomy and hyslology of Lhe Lye
O A LocaLlon
O 1hey are above Lhe nose and rlghL underneaLh Lhe
fore head
O 8 SLrucLure
O 1he eyeball a round ballshaped organ
O 1 lnch ln dlameLer (23 cm ln dlameLer 23cm
long)
O lL ls locaLed ln Lhe anLerlor porLlon of Lhe orblL lL
ls Lhe bony sLrucLure LhaL surrounds Lhe eye and
offers proLecLlon Lo Lhe eye
1he eyeball conslsLs of Lhree maln
componenLs
O Tle tunics, wlicl aie iliee layeis ilai male up ile
wall of ile eyeball
O Tle [\tica! c[\[ncnts, also lnown as ile iefiaciile
media componenis, wlicl admii and focus ligli
O Tle ncuva! c[\[ncnts, wlicl consisi of ile ieiina
and ile opiic neive. Tle ieiina is also paii of ile innei
iunic.
L?L C88l1
O C Layers of the Lye
O Lxterna| Layer (1un|c I|brosa)
O Sc|era opaque "wh|tes" of the eye
O r|ch supp|y of b|ood vesse|s and nerves
O prov|des attachment for externa| musc|es
of the eye
O Cornea dense transparent |ayer on front of
the eye
O a||ows ||ght to enter the eye and can be
thought of as be|ng part of the mod|f|ed
sc|era
LA?L8S Cl 1PL L?L
O ,|dd|e Layer (1un|ca Vascu|osa]Uvea)
O Chor|od
O dark brown membrane |ocated between the
sc|era and the ret|na
O conta|ns many b|ood vesse|s and supp||es
nutr|ents to the ret|na
O lllary body connecLs Lhe chorold wlLh Lhe lrls
and secreLes aqueous humor LhaL helps glve Lhe
eye lLs shape
O forms a muscular rlng around Lhe lens
O Lhe clllary muscle whlch ls a smooLh muscle
responslble for lens accommodaLlon ls
conLalned wlLhln Lhe clllary body
O conLracLlon of Lhe clllary muscle enables Lhe
lens Lo focus llghL onLo Lhe reLlna by changlng
lLs shape
O iis -ile coloied poiiion of ile eye, is locaied in
fioni of ile lens, and las a ceniial ciiculai
opening called ile pupil.
O Two layeis - one ilai blocls siiay ligli fiom
ieacling ile ieiina, and anoilei coniaining
cells called cliomaioploies wlicl coniain a
subsiance called melanin. Tle
conceniiaiions of melanin wiilin ilese
cliomaioploies give iise io eye coloui.
O Pupil - coniiol ile amouni of ligli ilai
enieis ile eye and ieacles ile ieiina
O lnLernal Layer (1unlca lnLerna) neural omponenLs
O 8eLlna
O ls a Lhln dellcaLe sLrucLure ln whlch Lhe flbers of
Lhe opLlc nerve are dlsLrlbuLed and ls made up of
sensory recepLors LhaL LransmlL lmpulses Lo Lhe
opLlc nerve
O ls aLLached aL Lwo polnLs Lhe opLlc dlsc where
Lhe opLlc nerve leaves Lhe rear of Lhe eye and
Lhe ora serraLa whlch ls Lhe [uncLlon beLween
Lhe reLlna and Lhe clllary body
O 8eLlna normally aLLaches Lo and depends on Lhe
chorold for oxygen nuLrlLlon and wasLe removal
O 2 lmporLanL layers of Lhe reLlna
18eLlnal plgmenL eplLhellum absorpLlon of llghL
2Sensory reLlna
O 8ods work aL low llghL levels and provlde
perlpheral vlslon
O ones are acLlve aL brlghL llghL levels and
provlde color and cenLral vlslon
O CpLlc lundus CpLlc ulsk
O CpLlc fundus area aL Lhe lnslde back of Lhe
eye LhaL can be seen wlLh an ophLhalmoscope
1hls area conLalns Lhe opLlc dlsk
O CpLlc ulsk ls a creamy plnk Lo whlLe
depressed area ln Lhe reLlna 1he opLlc nerve
enLers and exlLs Lhe eyeball aL Lhls area ls
called Lhe bllnd spoL because lL conLalns only
nerve flbers lacks phoLorecepLor cells and ls
lnsenslLlve Lo llghL
O acula Luiea - a small, oval yellowisl, pinl aiea
locaied laieial and iempoial io ile opiic disl. Tle
ceniial depiessed paii of ile macula is ile fovea
ceniialis, wleie mosi acuie vision occuis]wlicl
pioduces finely deiailed images
LA?L8S Cl 1PL L?L
Chambers of the eye
O 1he Lhree layers of Lhe eye along wlLh Lhe lens acL as
boundarles for Lhe Lhree chambers wlLhln Lhe eye
O nter|or chamber 1hls ls Lhe space beLween Lhe
cornea and Lhe lrls
O 9oster|or chamber 1hls ls Lhe space beLween Lhe
lrls and Lhe lens
O V|treous chamber 1hls ls Lhe space beLween Lhe
lens and Lhe reLlna
O Tle eye can also be divided inio iis anieiioi (fioni) and
posieiioi (bacl) segmenis. Tle foimei consisis of ile
coinea, as well as ile anieiioi and posieiioi clambeis
and ileii conienis.
O Tle posieiioi segmeni coniains ile viiieous clambei,
ile visual ieiina, ieiinal pigmeni epiilelium (RPE),
posieiioi scleia, and ile uvea.
O 8efracLlve SLrucLures and Medla/CpLlcal componenLs
O omponenLs
O ornea acLs as Lhe maln wlndow of Lhe eye
1hls ls Lhe ma[or refracLlve elemenL of Lhe eye
O vlLreous 8ody conLalns Lhe vlLreous humour a
gelaLlnous subsLance LhaL occuples Lhe vlLreous
chamber LhaL malnLalns Lhe shape of Lhe eye
O lL acLs as a shock absorber LhaL proLecLs Lhe
reLlna durlng rapld eye movemenLs
O lL also helps malnLaln Lhe poslLlon of Lhe lens
and Lo keep Lhe neural reLlna ln conLacL wlLh
Lhe reLlnal plgmenL eplLhellum
O ]ueous lumoi - is a cleai waieiy fluid ilai
fills ile anieiioi and posieiioi clambeis of ile
eye. i is pioduced by ile ciliaiy piocesses, and
passes fiom ile posieiioi clambei, iliougl
ile pupil, and inio ile anieiioi clambei. Tle
fluid diains inio ile canal of Scllemm.
O Piovides nuiiienis io ile lens and coinea
O anal of Schlemm
O 1he canal of Schlemm ls a passageway permlLs
fluld Lo draln ouL of Lhe eye lnLo Lhe clrculaLlon
so a consLanL lnLraocular pressure ls malnLalned
O Lens
O lL ls a LransparenL clrcular elasLlc convex
sLrucLure behlnd Lhe lrls and ln fronL of Lhe
vlLreous body lL bends rays of llghL so LhaL Lhe
llghL falls/focus properly on Lhe reLlna
O 1hese changes allow for accommodaLlon Lo allow
proper focuslng on near ob[ecLs
8efracLlve SLrucLures and Medla
O LxLernal SLrucLure
O Lyellds are Lhln movable folds of skln LhaL proLecL
Lhe eyes shuL ouL llghL durlng sleep and keep Lhe
cornea molsL onLalns glands
O anLhus ls Lhe place where Lhe Lwo eyellds
meeL aL Lhe corner of Lhe eye
O on[uncLlvae Lhln LransparenL mucous
membranes 8efers Lo Lhe llnlng of Lhe eye
O lL helps lubrlcaLe Lhe eye by secreLlng mucous
and Lears and serves as a proLecLlve barrler
agalnsL mlcrobes lL conLalns many gobleL cells
whlch secreLe a componenL of Lhe Lears LhaL
baLhe Lhe eye
O palpebral con[uncLlva ls a Lhlck membrane
wlLh many blood vessels LhaL llnes Lhe under
surface of each eyelld
O bulbar con[uncLlva LransparenL Lhln
locaLed over Lhe sclera
O Lacrlmal gland produces Lears and ls locaLed ln
Lhe upper parL of each orblL 1ears funcLlon Lo keep
Lhe con[uncLlva and corneal eplLhellum molsL and
wash away forelgn maLerlal from Lhe eye
O 1ears flow across Lhe fronL of Lhe eye Loward Lhe
nose and lnLo Lhe lnner canLhus
O 1hey draln Lhrough Lhe puncLum lnLo Lhe
lacrlmal ducL and sac and Lhen lnLo Lhe nose
Lhrough Lhe nasolacrlmal ducL
O Teor jlm, foims a pioieciive coai, lubiicaiing youi
eyes and wasling away any foieign bodies ilai migli
cause laim oi obscuie youi vision.
O Tliee main componenis:
Aqueous waiei-based elemeni, laigesi
poiiion, pioduced by ile laciimal gland locaied
on ile uppei, ouiei poiiion of eacl eye, a]ueous
supplies all of ile moisiuie youi eyes need io feel
lealily and comfoiiable.
IpJs on iop of ile a]ueous foiming ile
ouieimosi layei of ile ieai film, foimed by oil-
secieiing glands embedded along ile edges of
ile uppei and lowei eyelids, ile lipids seal in ile
a]ueous and pieveni ii fiom evapoiaiing ioo
]uiclly.
. Mucns below ile a]ueous. Layei of pioiein,
cieaied by cells on ile eyelids and on ile suiface
of ile eye, coai ile eye and allow ile a]ueous io
siicl io ile oileiwise waiei-iepelleni coinea.
LxLernal SLrucLures
O Lye Muscles
O Slx volunLary muscles roLaLe Lhe eye and coordlnaLe
eye movemenLs
O 8ecLus muscles exerL Lhelr pull when Lhe eye Lurns
Lemporally
O Cbllque muscles exerL Lhelr pull when Lhe eye Lurns
nasally
O Superlor 8ecLus Muscle
O LaLeral 8ecLus Muscle
O Medlal 8ecLus Muscle
O lnferlor 8ecLus Muscle
O Superlor Cbllque Muscle
O lnferlor Cbllque Muscle
L?L MuSLLS
O eives
O 1he muscles around Lhe eye are lnnervaLed by
O ranlal nerve ll opLlc nerve (nerve of slghL)
connecLlng Lhe opLlc dlsc Lo Lhe braln
O ranlal nerve lll oculomoLor
O ranlal nerve lv Lrochlear
O ranlal nerve vl abducens
O ranlal nerve v Lrlgemlnal (sLlmulaLes Lhe bllnk
reflex when Lhe cornea ls Louched)
O ranlal nerve vll faclal (lnnervaLes Lhe lacrlmal
glands and muscles conLrolllng lld closure)
O 8lood vessels
O CphLhalmlc arLery ls Lhe ma[or arLery supplylng Lhe
sLrucLures ln Lhe eye 1hls arLery branches Lo
supply blood Lo Lhe reLlna 1he clllary arLerles
supply Lhe sclera chorold clllary body and lrls
O 1wo CphLhalmlc velns draln Lhe blood from Lhe eye
O Iunct|ons of the Lye
O 8efracLlon
O 1he dlfferenL curved surfaces and refracLlve
medla of Lhe eye allow llghL Lo pass Lhrough Lo
Lhe reLlna Lach surface and medla bends
(refracLs) llghL dlfferenLly Lo focus an lmage on
Lhe reLlna
O LmmeLropla ls Lhe perfecL refracLlon of Lhe eye
O Pyperopla (hypermeLropla or farslghLedness)
occurs when Lhe eye does noL refracL llghL enough
lL ls correcLed wlLh a convex lens ln eyeglasses or
conLacL lenses
O Myopla (nearslghLedness) occurs when Lhe eye
overrefracLs or overbends Lhe llghL lL ls correcLed
wlLh a blconcave lens ln eyeglasses or conLacL
lenses
O AsLlgmaLlsm ls caused by unevenly curved surfaces
on or ln Lhe eye especlally of Lhe cornea
8efracLlon
FARSIGHTED
focuses
behind the
eye
FARSIGHTED
Corrective
Lense
EARSIGHTED
focuses in front
of the eye
EARSIGHTED
Corrective
Lense
O uplllary onsLrlcLlon
O 1he pupll conLrols Lhe amounL of llghL LhaL
enLers Lhe eye
O uplllary consLrlcLlon ls called mlosls and
paplllary dllaLaLlon ls called mydrlasls
O AccommodaLlon
O 1he process of malnLalnlng a clear vlsual lmage
when Lhe gaze ls shlfLed from a dlsLanL Lo a
near ob[ecL ls known as accommodaLlon
O onveigence
O is ile simulianeous inwaid movemeni of
boil eyes iowaid eacl oilei, usually in an
effoii io mainiain single binoculai
vision wlen viewing an objeci. Tlis aciion is
mediaied by ile medial iecius muscle,
wlicl is inneivaied by ianial neive .
uplllary onsLrlcLlon
AccommodaLlon
AssessmenL of vlslon
O AculLy
O vlsual AculLy 1esL
O Snellen's charL (Lye harL)
O near vlslon LesLlng
O onfronLaLlon 1esL
O LxLraocular muscle funcLlon
O olor vlslon
O CphLhalmoscopy
O Snellen's claii (eye
claii) simple iool ilai
measuies disiance
vision. Tle clienis siands
:o feei fiom ile claii
and coveis one eye and
uses ile oilei eye io iead
ile line ilai appeais
mosi cleaily.
O eai Vision Tesiing is iesi foi clienis wlo lave
difficuliy ieading and in clienis ovei o yeais of age.
Use a small, landled Snellen claii called a
Rosenbaum Poclei Vision Scieenei oi a }aegei caid.
O onfioniaiional iesi io
examine visual fields oi
peiipleial vision
O Hemianopia blindness
in one lalf ile field of
vision
O Quadianopia
blindness in one fouiil
of ile field oi vision
O Scoiomas blind spois
in ile visual field
LxLraocular muscle funcLlon
O oineal ligli ieflex deieimines alignmeni of ile
eyes. sl ile clieni io siaie siiaigli alead, sline a
penligli ai boil coineas fiom a disiance of i: io i
incles. Tle biigli doi of ligli ieflecied fiom ile sliny
suiface of ile coinea slould be in a symmeiiic
posiiion. n asymmeiiic ieflex indicaies a deviaiing
eye and possible muscle imbalance.
O Six caidinal posiiions of
gaze - clieni lolds lead
siill and is asled io move
eyes and io follow a small
objeci
O ovei-uncovei iesi asl ile clieni io use boil eyes
io lool ai a specific fixed poini, sucl as youi nose.
Tlen place a caid ovei one of ile clieni's eyes, and
obseive ile uncoveied eye io see if ii moves io fix
on ile objeci. f muscle funciion is noimal, ile eye
does noi move.
olor 1esL
O Tesis foi coloi vision
involve picling numbeis
oi leiieis oui of a
complex and colouiful
piciuie
O slilaia claii consisis of
numbeis ilai aie
composed of coloied
dois locaied wiilin a
ciicle of coloied dois.
Tle iesi is sensiiive foi
ile diagnosis of ied
CphLhalmoscopy
O 1hls ls Lo examlne Lhe exLernal sLrucLures and Lhe
lnLerlor of Lhe eye
O rocedure
O erformlng ophLhalmoscopy hold Lhe lnsLrumenL
wlLh your rlghL hand when examlnlng Lhe rlghL eye
and wlLh your lefL hand when Lhe examlnlng Lhe
lefL SLand on Lhe same slde as Lhe eye belng
examlned 1ell Lhe cllenL Lo look sLralghL ahead aL
an ob[ecL on Lhe wall behlnd you
O len using ile oplilalmoscope, move iowaids
ile clieni's eye fiom aboui i: io i incles away and
io ile side of lis oi lei line of vision. s you diieci
ile oplilalmoscope ai ile pupil, a ied glaie (ied
ieflex) slould be seen in ile pupil. Tle ied ieflex
is a ieflexion of ile ligli of ile ieiina. n abseni
ied ieflex may indicaie a lens opaciiy oi cloudiness
of ile viiieous.
ulagnosLlc 1esL for Lhe Lye
O luoiescein ngiogiaply
O ompuied Tomogiaply
O Slii lamp
O oineal Siaining
O Tonomeiiy
lluoresceln Anglography
O i is ile deiailed imaging and iecoiding of oculai
ciiculaiion by a seiies of ploiogiapls afiei ile
adminisiiaiion of a dye iniiavenously.
O Tlis iesi is useful foi assessing pioblems of ieiinal
ciiculaiion (diabeiic ieiinopaily, ieiinal
lemoiilage, and maculai degeneiaiion) oi foi ile
diagnosis of iniiaoculai iumois.
O Piepioceduie nieiveniions
O Explain ile pioceduie io ile clieni
O ssess ile clieni foi alleigies and pievious ieaciions
io dyes
O Obiained infoimed conseni
O mydiiaiiic medicaiion is insiilled in ile eye i loui
befoie ile iesi. ain ile clieni ilai ile dye may
cause ile slin io appeai yellow foi seveial louis
afiei ile iesi. Tle siain is eliminaied iliougl ile
uiine, wlicl also clanges coloi.
O Tle clieni may expeiience nausea, vomiiing,
sneezing, paiasilesia of ile iongue, oi pain ai ile
injeciion siie
O Pioceduie
O niiavenous access musi be obiained.
O fiei ile needle is in ile vein, ml of a io%
soluiion of fluoiescein is injecied.
O digiial cameia is sei up wiil e]uipmeni io
ploiogiapl ieiinal and cloiiodal blood vessels
as ile dye passes iliougl ilem. Tle iesulis can
be viewed immediaiely on a compuiei scieen.
O Tle pioceduie iales only minuies because ile
vessels fill ]uiclly.
O Posipioceduie nieiveniions
O Encouiage fluid iniale io assisi in eliminaiing
ile dye fiom ile clienis sysiem
O Remind ile clieni ilai ile yellow slin
appeaiance will disappeai
O nsiiuci ile clieni ilai uiine will appeai biigli
gieen uniil ile dye is excieied.
O nsiiuci io avoid diieci sunligli foi a few louis
afiei ile iesi
O Ploioplobia will coniinue uniil pupil size
ieiuins io noimal
ompuLed Lomography
O i is a beam of x-iays scans ile slull and oibiis of
ile eye. lso used foi deieciing iumois in ile
oibiial space. Usually iwo seis of T scans aie
peifoimed, one sei ialen in ile supine posiiion
(axial images) and one sei ialen wiil ile lead
iipped bacl as fai possible (coional images)
O nieiveniion
O nsiiuci ile clieni ilai le oi sle will be
posiiioned in a confined space and will need io
leep ileii leads siill duiing ile pioceduie
MagneLlc 8esonance lmaglng
O i las ieplaced T in many seiiings foi looling
ai ile oibiis and ile opiic neives.
O R is also useful foi evaluaiing oculai iumois
O eial in ile eye is an absoluie coniiaindicaiion
foi R
8adlolsoLoplc Scannlng
O ie used io locaie iumois and lesions in vaiious
body oigans. soiope siudies diffeieniiaie an
iniiaoculai iumoi fiom a lemoiilage, especially
in ile cloioid layei.
O lieni piepaiaiion
O nfoimed conseni. Tle clieni ieceives a iiacei
dose of ile iadioaciive isoiope, eiilei oially oi
by injeciion
O Pioceduie:
O Tle clieni is asled io lie siill and bieaile
noimally. Tle scannei measuies ile
iadioaciiviiy emiiied by ile iadioaciive aioms
conceniiaied in ile aiea being siudied. lienis
wlo aie anxious oi agiiaied may ie]uiie
sedaiion
O Posipioceduie
O ssuie ile clieni ilai ile amouni of
iadioisoiope used is small and ilai le oi sle is
noi iadioaciive. o oilei special follow-up caie
is ie]uiied.
SllL lamp
O i allows examinaiion of ile anieiioi oculai
siiuciuies undei micioscopic magnificaiion. Tle
clieni leans on a clin iesi io siabilize ile lead
wlile a naiiowed beam of ligli is aimed so ilai ii
illuminaies only a naiiow segmeni of ile eye is
biiglily liglied.
O nieiveniion
O dvise ile clieni aboui ile biigliness of ile
ligli and ile need io lool foiwaid ai poini ovei
ile examinei's eai
orneal sLalnlng
O iopical dye is insiilled inio ile conjuciival sac io
ouiline iiiegulaiiiies of ile coineal suiface ilai aie
noi easily visible. Tle eye is viewed iliougl a blue
filiei, and a biigli gieen coloi indicaies aieas of a
non-iniaci coineal epiilelium. s used foi coineal
iiauma, pioblems caused by coniaci lens, oi ile
piesence of foieign bodies, abiasion, ulceis oi
oilei coineal disoideis.
O Pioceduie
O oninvasive and peifoimed undei asepiic
condiiions.
O Tle dye is applied iopically io ile eye, and ilen
viewed iliougl a blue filiei. oniniaci aieas of
coinea siain a biigli gieen coloi.
O nieiveniions
O f ile clieni weais coniaci lenses, ile lenses
musi be iemoved
O Tle clieni is insiiucied io blinl afiei ile dye las
been applied io disiiibuie ile dye evenly acioss
ile coinea
1onomeLry
O Tle iesi is used piimaiily io assess foi an inciease
of iniiaoculai piessuie and poieniial glaucoma.
oimal oculai piessuie is io io :i mmHg.
O ndicaied foi all clienis oldei ilan o yeais of age.
oi adulis wiil a family lisioiy of glaucoma
slould lave ileii OP measuied once oi iwice a
yeai.
O OP vaiies iliougloui ile day. i is ofien liglei in
ile moining bui may peal ai any iime of ile day.
O nieiveniions
O Eacl eye is anesileiized
O Tle clieni is asled io siaie foiwaid ai a poini
above ile examinei's eai
O flaiiened cone is biougli in coniaci wiil ile
coinea
O Tle amouni of piessuie needed io flaiien ile
coinea is measuied
O Tle clieni musi be insiiucied io avoid iubbing
ile eye following ile examinaiion if ile eye las
been anesileiized because ile poieniial foi
sciaicling ile coinea exisis.
ulLrasonography
O Used io examine ile oibii and eye wiil ligl-
fie]uency sound waves. Tlis noninvasive iesi aids
in ile diagnosis of iiauma, iniiaoibiial iumois,
piopiosis, and cloiiodal oi ieiinal deiaclmenis]
O lieni Piepaiaiion:
O Explain ile iesi io ile clieni and insiill ile
anesileiic diops inio ile lowei lid
O auiion ile clieni io avoid iubbing ile eye.
O Seai ile clieni upiigli wiil lis oi lei clin in ile
clin iesi
O Pioceduie
O Tle piobe is ioucled againsi ile clieni's
anesilesized coinea and sound waves aie
bounced iliougl ile eye.
O Tle sound waves ieiuin io ile iiansducei wlen
iley siiile a non-fluid filled siiuciuie.
Siiuciuies ilai iefleci sound waves aie ile
coinea, anieiioi, and posieiioi lens capsule, and
ieiina.
O len ilese ieflecied sound waves ieiuin io ile
iiansducei, a "spile" paiiein appeais on ile
scieen
O Posipioceduie
O Remind ile clieni noi io iub oi bump ile eye
uniil ile effecis of ile anesileiic diops lave
woin off
LlecLroreLlnography
O s ile piocess of giapling ile ieiina's iesponse io
ligli siimulaiion. Tlis iesi is lelpful in deieciing
and evaluaiing blood vessel clanges fiom a disease
oi diugs. Tle giapl is obiained by placing a
coniaci lens eleciiode on an anesilesized coinea.
Liglis ai vaiying speeds and iniensiiies aie
flasled, and ile neuial iesponse is giapled.
O Piepaiaiion
O ncludes insiilling an anesileiic inio ile eye
O Remind ile clieni io avoid iubbing ile eye uniil
ile effecis of ile anesileiic lave disappeaied.
M?u8lA1l/?LCLLCl Anu
An1lPCLlnL8Cl MLulA1lCnS
O esciipiion
O ydiiaiics and cycloplegic dilaie ile pupils
(mydiiasis) and ielax ile ciliaiy muscles
(cycloplegia)
O niiclolineigics blocl iesponses of ile
splinciei muscle in ile ciliaiy body, pioducing
mydiiasis and cyclopegia
O Tlese medicaiions aie used pieopeiaiively oi foi
eye examinaiions io pioduce mydiiasis
O oniiaindicaiions
O Tlese medicaiions aie coniiaindicaied in clienis
wiil glaucoma because of ile iisl of incieased
iniiaoculai piessuie
O ydiiaiics aie coniiaindicaied in caidiac
dysilyilmias and ceiebial aileioscleiosis and
slould be used wiil cauiion in ile oldei clieni
and in clienis wiil piosiaiic lypeiiioply,
diabeies melliius, oi pailinsonism
O Side Effecis
O Taclycaidia
O Ploioplobia
O onjunciiviiis
O eimaiiiis
O Sysiemic ieaciions of
aniiclolineigics
O iy mouil
O evei
O Tliisi
O onfusion
O Hypeiaciiviiy
O iiopline Toxiciiy
O iy mouil
O Bluiied vision
O Ploioplobia
O Taclycaidia
O evei
O Uiinaiy ieieniion
O onsiipaiion
O Headacle, biow pain
O onfusions
O Hallucinaiions, deliiium
O oma
O oisening of naiiow-
angle glaucoma
O nieiveniions
O oniioi foi alleigic iesponse
O ssess foi iisl of injuiy
O ssess foi consiipaiion and uiinaiy ieieniion
O nsiiuci ile clieni ilai a buining sensaiion may
occui on insiillaiion
O nsiiuci ile clieni noi io diive oi peifoim
lazaidous aciiviiies foi : louis afiei
insiillaiion of ile medicaiion unless oileiwise
diiecied by ile plysician
O nsiiuci ile clieni io weai sunglasses uniil ile
effecis of ile medicaiion weai off
O nsiiuci ile clieni io noiify ile plysician if
bluiiing of vision, loss of sigli, difficuliy
bieailing, sweaiing, oi flusling occuis
O nsiiuci ile clieni io iepoii eye pain io ile
plysician
O lpla-dieneigic bloclei
O edicaiion: dapipiazole lydioclloiide (Rev-
Eyes)
O Use: io counieiaci mydiiasis
,ydr|at|c]Cyc|op|eg|c Lye ,ed|cat|ons
O iiopine sulplaie (sopio iiopine, Ocu-Tiopine,
iiopaii, iiopisol)
O yclopeniolaie and plenylepliine (yclomydiil)
O yclopeniolaie lydioclloiide (yclogyl, -Peniolaie,
Peniolaii)
O Homaiiopine lydiobiomide (sopio Homaiiine, -
Homaiiopine, Speciio-Homaiiine)
O Scopolamine plenylepliine (uiocoll :)
O Scopolamine lydiobiomide (sopio-Hyoscine)
O Tiopicamide (ydiiacyl, -Piiamide, Tiopicacyl)
O Tiopicamide and lydioxyampleiamine (Paiemyd)
iiopine Sulfaie
Plenylepliine
yclopentolate
An1llnlL1lvL L?L MLulA1lCnS
O esciipiion: niiinfeciive medicaiions lill oi
inlibii ile giowil of bacieiia, fungi, and viiuses
O Side effecis
O Supeiinfeciion
O Global iiiiiaiion
O nieiveniions
O ssess foi iisl of injuiy
O nsiiuci ile clieni low io apply ile eye
medicaiion
O nsiiuci ile clieni io coniinue iieaimeni as
piesciibed
O nsiiuci ile clieni io wasl lands iloiouglly
and fie]uenily
O dvise ile clieni ilai if impiovemeni does noi
occui io noiify ile plysician
O ntiinIcctivc Eyc Mcdicati[ns
O MINOGLYCOSIDES
O Gcntaycin su!\atc (Gavaycin, Gcn[\tic)
O T[Tvaycin (NcTcin, T[Tvcx)
O NTIBCTERIL
O C![va\cnic[! (C![v[ycctin,
C![v[\tic)
O Evytv[ycin (I![tycin)
O NTIFUNGL
O Nataycin (Natacyn)
O NTIVIRL
O Id[xuvidinc (St[xi!, Hcv\!cx)
O TviI!uvidinc (Viv[\tic)
O VidavaTinc (Viva-)
O SULFONMIDES
O Su!Iacctaidc (B!c\-Io, Su!ayd)
O Su!Iis[xad[!c (Gantvisin)
An1llnlLAMMA1C8? L?L MLulA1lCnS
O esciipiion
O niiinflammaioiy medicaiions coniiol
inflammaiion, ileieby ieducing vision loss and
scaiiing
O niiinflammaioiy medicaiions aie used foi
uveiiis, alleigic condiiions, and inflammaiion of
ile conjunciiva, coinea, and lids
O Side Effecis
O aiaiacis
O ncieased OP
O mpaiied lealing
O aling signs and sympioms of infeciion
O nieiveniions
O nieiveniions aie ile same as foi aniiinfeciive
medicaiion
O oie ilai dexameilasone (axidex) slould noi
be used foi eye abiasions and wounds
nt||nf|ammatory Lye ,ed|cat|ons
O NTILLERGIC GENTS
O Cv[[!yn s[diu (O\ticv[)
O Kct[tiIcn Iuavatc (Zadit[v)
O Lcv[caTastinc (Liv[stin)
O L[d[xaidc (![idc)
O NONSTEROIDL NTIINFLMMTORY
GENTS
O Dic![Icnac (V[!tavcn)
O F!uvTi\v[Icn s[diu (OcuIcn)
O Kct[v[!ac tv[ctainc (cu!av)
O CORTICOSTERIODS
O Bctactas[nc (Bctncs[!)
O Dcxactas[nc (Maxidcx)
O F!u[v[ct[!cnc (FML-S O\ta!ic
Sus\cnsi[n, FML)
O Mcdvys[nc (HMS LiquiIi!)
O Pvcdnis[![nc (Pvcd-F[vtc, Pvcdaiv-)
1ClAL AnLS1PL1lS lC8 1PL L?L
O esciipiion
O Topical anesileiics pioduce coineal anesilesia
O Topical anesileiics aie used foi anesilesia foi
eye examinaiions and suigeiy oi io iemove
foieign bodies fiom ile eye
O Side Effecis
O Tempoiaiy siinging oi buining of ile eye
O Tempoiaiy loss of coineal ieflex
O nieiveniions
O ssess foi iisl of injuiy
O oie ilai ile medicaiions slould noi be given
io ile clieni foi lome use and aie noi io be self-
adminisieied by ile clieni
O oie ilai ile blinl ieflex is losi iempoiaiily and
ilai coineal epiilelium needs io be pioiecied
O Piovide an eye paicl io pioieci ile eye fiom
injuiy uniil ile coineal ieflex ieiuins
1op|ca| nesthet|cs for the Lye
O Pv[\avacainc ydv[c![vidc (O\tainc,
O\tctic)
O Tctvacainc ydv[c![vidc (P[nt[cainc)
L?L Lu88lAn1S
O esciipiion
O Eye lubiicanis ieplace ieais oi add moisiuie io
ile eyes
O Eye lubiicanis moisien coniaci lenses oi an
aiiificial eye
O Eye lubiicanis pioieci ile eyes duiing suigeiy oi
diagnosiic pioceduies
O Eye lubiicanis aie used foi leiaiiiis, duiing
anesilesia, oi in a disoidei ilai iesulis in
unconsciousness oi decieased blinling
O Side Effecis
O Buining on insiillaiion
O iscomfoii oi pain on insiillaiion
O nieiveniions
O nfoim ile clieni ilai buining may occui on
insiillaiion
O Be aleii io alleigic iesponses io ile pieseivaiives
in ile lubiicanis
Lye Lubr|cants
O Hydv[xy\v[\y! cty!cc!!u![sc (Lacvi!, Is[\t[
P!ain)
O Pctv[!cu-Tascd [intcnt (avtiIicia! tcavs,
LiquiIi! Tcavs
MlC1lS
O esciipiion
O ioiics ieduce iniiaoculai piessuie by consiiiciing
ile pupil and coniiaciing ile ciliaiy muscle,
ileieby incieasing ile blood flow io ile ieiina and
decieasing ieiinal damage and loss of vision
O ioiics open ile anieiioi clambei angle and
inciease ile ouiflow of a]ueous lumoi
O ioiic clolineigic medicaiions ieduce iniiaoculai
piessuie by mimicling ile aciion of aceiylcloline
O ioiic aceiylcloline inlibiiois ieduce iniiaoculai
piessuie by inlibiiing ile aciion of clolinesieiase
O ioiic aie used foi clionic open-angle glaucoma
oi acuie and clionic closed-angle glaucoma
O ioiics aie used io aclieve miosis duiing eye
suigeiy
O ioiics aie coniiaindicaied in clienis wiil ieiinal
deiaclmeni, adlesions beiween ile iiis and lens,
oi inflammaioiy diseases
O Use mioiics wiil cauiion in clienis wiil asilma,
lypeiiension, coineal abiasion, lypeiilyioidism,
coionaiy vasculai disease, uiinaiy iiaci
obsiiuciion, gasiioiniesiinal obsiiuciion, ulcei
diseases, pailinsonism and biadycaidia
O Side Effecis
O yopia
O Headacle
O Eye pain
O ecieased vision in
pooi ligli
O Local iiiiiaiion
O Toxiciiy
O Veiiigo and syncope
O Biadycaidia
O Hypoiension
O aidiac dysilyilmias
O Tiemois
O Seizuies
O Sysiemic effecis
O lusling
O iaploiesis
O Gasiioiniesiinal upsei
and diaiilea
O ie]ueni uiinaiion
O ncieased salivaiion
O uscle wealness
O Respiiaioiy difficuliy
O nieiveniions
O ssess viial signs
O ssess foi iisl of injuiy
O ssess ile clieni foi ile degiee of diminisled
vision
O oniioi foi side effecis and ioxic effecis
O oniioi foi posiuial lypoiension and insiiuci ile
clieni io clange posiiions slowly
O ssess bieail sounds foi wleezes and iloncli
because clolineigic medicaiions can cause
bionclospasms and incieased bionclial
secieiions
O ainiain oial lygiene because of ile inciease in
salivaiion
O Have aiiopline sulplaie available as an aniidoie
foi pilocaipine
O nsiiuci ile clieni oi family iegaiding ile
coiieci adminisiiaiion of eye medicaiions
O nsiiuci ile clieni noi io siop ile medicaiion
suddenly
O nsiiuci ile clieni io avoid aciiviiies sucl as
diiving wlile vision is impaiied
O nsiiuci clienis wiil glaucoma io iead labels on
ovei-ile-couniei medicaiions and io avoid
aiiopine-lile medicaiions because aiiopine will
inciease OP.
,|ot|cs
O CavTac[! (CavT[\tic)
O Dcccaviu Tv[idc (Hu[vs[!)
O Ec[ti[\atc (P[s\[!inc I[didc)
O Is[I!uv[\atc (F![v[\vy!)
O Pi![cav\inc ydv[c![vidc (Is[\t[ Cav\inc)
CuLA8 S?S1LM
O esciipiion
O Ocuseii is a ilin eye wafei (disl) impiegnaied
wiil a iime-ielease dose of pilocaipine
O Ocuseii is devised io oveicome ile fie]ueni
applicaiion of pilocaipine
O Ocuseii is placed in ile uppei oi lowei cul-de-sac
of ile eye
O Tle pilocaipine is ieleased ovei i weel
O Tle disl s ieplaced eveiy days
O iawbacls of iis use include sudden lealage of
pilocaipine, migiaiion of ile sysiem ovei ile
coinea, and unnoiiced loss of ile sysiem
O nieiveniions
O ssess ile clieni's abiliiy io inseii ile medicaiion
disl
O Sioie ile medicaiion in ile iefiigeiaioi
O nsiiuci ile clieni io discaid damaged oi
coniaminaied disls
O nfoim ile clieni ilai iempoiaiy siinging is
expecied bui io noiify ile plysician of bluiied
vision oi biow pain occuis
O nsiiuci ile clieni io clecl foi ile piesence of ile
disl in ile conjunciival sac daily ai bediime and on
aiising
O Because vision may clange in ile fiisi few louis
afiei ile eye sysiem is inseiied, insiiuci ile clieni io
ieplace ile disl ai bediime
Au8LnL8Cl 8LClnC L?L MLulA1lCnS
O esciipiion
O Tlese medicaiions ieduce OP by decieasing
sympaileiic impulses and decieasing a]ueous
lumoi pioduciion wiiloui affeciing
accommodaiion oi pupil size
O Tlese medicaiions aie used io iieai clionic
open-angle glaucoma
O Tlese medicaiions aie coniiaindicaied in ile
clieni wiil asilma because sysiemic absoipiion
can cause incieased aiiway iesisiance
O Use ilese medicaiions wiil cauiion in ile clieni
ieceiving oial p-blocleis
O Side Effecis
O Oculai iiiiiaiion
O Visual disiuibances
O Biadycaidia
O Hypoiension
O Bionclospasm
O nieiveniions
O oniioi viial signs, especially blood piessuie
and pulse, befoie adminisieiing medicaiion
O f ile pulse is o oi less oi if ile sysiolic blood
piessuie is less ilan ommHg, wiillold ile
medicaiion and coniaci ile plysician
O oniioi foi sloiiness of bieail
O ssess foi iisl of injuiy
O oniioi iniale and ouipui
O nsiiuci ile clieni io noiify ile plysician if
sloiiness of bieail occuis
O nsiiuci ile clieni noi io disconiinue ile
medicaiion abiupily
O nsiiuci ile clieni io clange posiiions slowly
because of ile poieniial foi oiilosiaiic
lypoiension
O nsiiuci ile clieni io avoid lazaidous aciiviiies
O nsiiuci ile clieni io avoid ovei-ile-couniei
medicaiions wiiloui ile plysician's appioval
O dieneigic medicaiions
O dieneigic medicaiions deciease ile
pioduciion of a]ueous lumoi and lead io a
deciease in OP
O dieneigic medicaiions may be used io iieai
glaucoma
O p dieneigic Blocling
Eye edicaiions
O Beiaxolol lydioclloiide
(Beiopiic)
O aiieolol lydioclloiide
(Ocupiess)
O Levobunolol
lydioclloiide (Beiagan)
O eiipianolol
(Opiipianolol)
O Timolol maleaie
(Timopiic)
O dieneigic edicaiions
O Epinepliine (Epifiin,
Glaucon)
O Hydioxyampleiamine
(Paiadiine)
O aplazoline (lleiesi,
Vasocleai)
O Oxymeilazoline
(Oculeai)
O Plenylepliine (-
epliin, Piefin)
O Teiialydiozoline
(uiine Plus, Visine)
A88Cnl An?P?u8ASL lnPl8l1C8S
O esciipiion
O aibonic nlydiase inlibiiois inieifeie wiil
ile pioduciion of caibonic acid, wlicl leads io
decieased a]ueous lumoi foimaiion and
decieased OP
O Tlese medicaiions aie used foi long-ieim
iieaimeni of open-angle glaucoma
O Tlese medicaiions aie coniiaindicaied in ile
clieni alleigic io sulfonamides
O Side Effecis
O ppeiiie loss
O G upsei
O Paiesilesias in ile fingeis, ioes, and face
O Polyuiia
O Hypolalemia
O Renal calculuses
O Ploiosensiiiviiy
O Leilaigy and diowsiness
O epiession
O nieiveniions
O oniioi viial signs
O ssess visual acuiiy
O ssess foi iisl of injuiy
O oniioi iniale and ouipui
O oniioi weigli
O ainiain oial lygiene
O oniioi foi side effecis sucl as leilaigy,
anoiexia, diowsiness, polyuiia, nausea and
vomiiing
O oniioi eleciiolyies foi lypolalemia
O nciease fluid iniale unless coniiaindicaied
O dvise ile clieni io avoid piolonged exposuie io
sunligli
O Encouiage ile use of aiiificial ieais foi diy eyes
O nsiiuci ile clieni noi io disconiinue ile
medicaiion abiupily
O nsiiuci ile clieni io avoid lazaidous aciiviiies
wlile vision is impaiied
Carbon|c nhydrase Inh|b|tors Lye
,ed|cat|ons
O cctaz[!aidc (Dia[x)
O Dic![v\cnaidc (Davanidc)
O D[vz[!aidc ydv[c![vidc (Tvus[\t)
O Mctaz[!aidc (Nc\tazanc)
CSMC1l MLulA1lCnS
O esciipiion
O Osmoiic medicaiions loweis OP
O ie used in emeigency iieaimeni of acuie
closed-angle glaucoma
O ie used pieopeiaiively and posiopeiaiively io
deciease viiieous lumoi volume
O Side Effecis
O Headacle
O ausea, vomiiing, diaiilea
O isoiieniaiion
O Eleciiolyie imbalances
O nieiveniions
O ssess viial signs
O ssess visual acuiiy
O ssess foi iisl of injuiy
O oniioi iniale and ouipui
O oniioi weigli
O oniioi eleciiolyie imbalances
O nciease fluid iniale unless coniiaindicaied
O oniioi foi clanges in level of oiieniaiion
smot|c ,ed|cat|ons for the Lye
O G!yccvin (Os[Y!yn)
O Mannit[! (Ositv[!)
L?L Su8CL8?
O Eyc suvYcvy, a!s[ kn[cn as [v[Y[![istician
suvYcvy [v [cu!av suvYcvy, is suvYcvy \cvI[vcd [n
tc cyc [v its adncxa, ty\ica!!y Ty
an[\ta![![Yist.
O Lasei eye suigeiy
O aiaiaci suigeiy
O Glaucoma suigeiy
O analoplasiy
O Refiaciive suigeiy
O oineal suigeiy
O Viiieo-ieiinal suigeiy
O Eye muscle suigeiy
O Oculoplasiic suigeiy
O Eyelid suigeiy
O Oibiial suigeiy
O Oilei oculoplasiic
suigeiy
O Suigeiy involving ile
laciimal appaiaius
O Eye iemoval
orneal Surgery
O eiaioplasiy (coineal iiansplani) suigical iemoval of
diseased coineal iiisue and ieplacemeni wiil iissue
fiom a luman donoi coinea.
O Pieopeiaiive aie
O Use calm appioacl io assess ile clieni's lnowledge
of ile suigeiy and of expecied caie befoie and afiei
suigeiy
O ssess foi clienis eyes foi signs of infeciions and
iepoii any iedness, diainage, oi edema and iepoii
O nsiill aniibioiic diops inio ile eye io ieduce ile
iisl foi infeciion
O V access is placed befoie suigeiy
O Opeiaiive Pioceduie
O Regional anesilesia is used (neives aiound and
belind ile eye aie numbed)
O Tle suigeon iemoves ile ceniei io mm of
ile diseased coinea wiil a iiepline, insiiumeni
ilai woils lile a coolie cuiiei.
O Posiopeiaiive aie
O fiei ile pioceduie is compleied, a subconjunciival
aniibioiic injeciion is given and an aniibioiic
oinimeni is insiilled.
O Eye coveied w] piessuie paicl and pioieciive slield
uniil ile nexi day
O nsiiuci clieni io lie on ile opeiaiive side io ieduce
OP
O nflammaiion siaiis in ile donoi coinea neai ile
giafi end and moves iowaid ile ceniei (sign of
iejeciion) fie]ueni applicaiion of coiiicosieiiods aie
used.
aLaracL Surgery
O i is ile only cuie foi caiaiacis
O Ouipaiieni pioceduie
O Pieopeiaiive pioceduies
O Give accuiaie infoimaiion aboui ile naiuie of
caiaiacis, ileii piogiession and ileii iieaimeni
O Siiess io ile clieni ilai caie afiei suigeiy ie]uiies ile
insiillaiion of diffeieni iypes of eyediops seveial
iimes a weel foi : io weels.
O V infusion may be siaiied in ile OR. sedaiive is
given befoie suigeiy, and oial aceiazolamide may be
given on ile moining io ieduce OP.
O Local anesilesia is injecied inio ile muscle cone
belind ile eye
O Opeiaiive pioceduies
O Exiiaciion of ile lens can be iniiacapsulai
(iemoves ile lens and capsule compleiely) oi
moie commonly, exiiacapsulai (ile fioni poiiio
of ile capsule is opened and iemoved)
O niiacapsulai placing ile gieaiei iisl foi ieiinal
deiaclmeni.
O fiei caiaiaci is iemoved, a small, cleai, plasiic
lens is implanied ai ile iime of caiaiaci iemoval
O Posiopeiaiive aie
O mmediaiely afiei suigeiy, aniibioiic aie given
subconjunciively
O Eye is usually lefi unpaicl and clieni is disclaige
wiilin an loui afiei suigeiy
O nsiiuci io weai dail eyeglasses
O ild iicling is noimal, eyelid may be sliglily
swollen. Pui cool compiesses and can iale mild
analgesics foi discomfoii
O void aciiviiies ilai incieases OP, majoi
complicaiion afiei suigeiy
O Obseive foi signs of infeciion
O Bleeding inio ile anieiioi clambei of ile eye also
may occui, usually seveial days afiei suigeiy.
O ciiviiies ilai ncieases OP
O Bending fiom ile waisi
O Sneezing, cougling
O Blowing ile nose
O Siiaining io lave bowel movemeni
O Vomiiing
O Sexual inieicouise
O eeping ile lead in a dependeni posiiion
O eaiing iigli sliii collais
Laser Surgery
O len diugs foi ile clieni wiil open-angle glaucoma
aie noi effeciive ai coniiolling OP, lasei suigeiy is
indicaied
O Pieopeiaiive aie
O nfoim clieni aboui lasei ieclnology, expecied siglis
and sounds ofien leaid duiing ile pioceduie and
expecied ouicomes
O Opeiaiive Pioceduies
O lasei iiabeculoplasiy buins ile iiabeculai
meslwoil, scaiiing ii and causing ile
meslwoil fibeis io iiglien. ibei iigilening
incieases ile size of ile spaces beiween ile
fibeis, impioving ouiflow of a]ueos lumoi and
a ieduciion of OP.
O Topical oi local anesilesia is used
O Posiopeiaiive aie
O nsiiuci ile clieni io aiiange foi iianspoiiaiion
lome because of diiving is piolibiied afiei
suigeiy
O Tle pioceduie can someiimes cause inciease
OP, piessuie slould be clecl i loui afiei
suigeiy and befoie disclaige
O n oculai sieiiod may be piesciibed sucl as
Piednisone aceiaie
vlslonenhanclng Surgerles
O Radial leiaioiomy
O Ploioiefiaciive leiaieciomy
O Lasei in-siiu leiaiomileusis (LS)
O Placemeni of niacs coineal iing
8adlal eraLoLomy
O Ouipaiieni suigical pioceduie foi ile iieaimeni of
mild io modeiaie myopia
O io i incisions aie made iliougl o% of ile
peiipleial coinea. Tlese incisions flaiien ile
coinea, wlicl allows ile image io be focused
closei io ile ieiina
hoLorefracLlve eraLoLomy
O Used foi people wiil mild io modeiaie siable myopia
and low asiigmaiism
O n excimei lasei pulses a biief bui poweiful beam on
ile ouiei suiface of ile ceniial coinea. Tlis beam
iemoves small poiiions of ile iissue suiface, ieslaping
ile coinea io piopeily focus an image on ile ieiina
O One eye is iieaied ai a iime, usually ai leasi monils
apaii.
O Tle eye is paicled afiei suigeiy
O ompleie lealing may iale up io monils
O Expecied Side Effecis
O Pain
O Hazy vision
O Ligli sensiiiviiy
O Teaiing
O Pupil enlaigemeni
O omplicaiions
O Reduced nigli vision
O oineal clouding
O Undeicoiieciion
O ai-sigliedness
O ncieased OP
O lionic diy eyes
O Glaie
Laser lnSlLu eraLomlleusls
O Populai foi coiieciing neai-sigliedness, fai-
sigliedness, and asiigmaiism using ile excimei lasei
O Tle supeificial layeis of ile coinea aie lified
iempoiaiily as a flap and biief bui poweiful lasei
pulses ieslape ile deepei coineal layeis. fiei
ieslaping ile deepei layeis, ile coineal flap is placed
bacl inio iis oiiginal posiiion
O Boil eyes aie iieaied ai ile same iime
O fiei LS coiieciion of iefiaciive eiiois, many
clienis no longei ie]uiie eyeglasses oi coniaci lenses
O omplicaiions:
O oineal clouding
O lionic diy eyes
O Refiaciive eiiois
O Bluiied vision and oilei iefiaciive
lnLacs orneal 8lng
O Enlances vision foi neai-sigliedness
O Tle suigeiy does noi involve ile use of a lasei and las
ile advaniage of being ieveisible.
O iil ilis pioceduie, ile slape of ile coinea is
clanged by placing a flexible iing in ile ouiei edges of
ile coinea
O Undei local anesilesia
O Because ile iing is applied io ile coinea ouiside of ile
opiical zone, ile iisl foi coineal clouding oi scaiiing
is lowei ilan wiil oilei suigical pioceduies.
nonsurglcal ManagemenL for
8efracLlve Lrrors
O Eyeglasses
O - ie ease of use, duiabiliiy, availabiliiy and low
cosi
O clange in appeaiance, weigli of ile fiame on
ile nose, ieduced peiipleial vision
O oniaci Lenses
O Round plasiic disl iesi againsi ile coinea and fii
undei ile eyelid
O Haid and sofi Lenses
Lye aLches and Shlelds
O Have clieni close boil eyes duiing applicaiion of paicl
oi slield
O Posiiion paicl and secuie wiil iwo siiips of iape
exiending fiom midfoielead io laieial cleelbone
(medial iop io laieial boiiom) on same side
O o noi use piessuie unless specifically oideied, and
ilen use iwo io iliee pads and exiia iape
O lange only wiil plysician oidei
O pply slield alone oi ovei an eye paicl io pioieci eye
fiom piessuie oi oilei iype of iiiiiaiion
O Place slield on bony piominences of cleel, nose, and
biow, secuie w] iianspaieni iape in same mannei as
foi eye paicl
Lye prosLhesls
O llow clieni io peifoim own aiiificial eye caie if
piefeiied, some piosileses aie peimanenily implanied
wlile oileis aie iemovable
O Remove piosilesis by ieiiaciing lowei eyelid and
exeiiing piessuie jusi below eye io bieal suciion and lifi
ii fiom soclei, can also use iubbei bulb syiinge oi
medicine dioppei bulb io cieaie suciion effeci
O leanse wiil noimal saline oi iap waiei accoiding io
clieni's iouiine
O iiigaie eye soclei wiil noimal saline using asepiic
ieclni]ue if oideied
O leanse edges of eye soclei and suiiounding aiea w]
moisiened gauze
O Reinseii by ieiiaciing uppei and lowei eyelids and
slipping piosilesis inio eye soclei comfoiiably
undei uppei eyelid
O len piosilesis is sioied, place in labeled
coniainei wiil saline oi iap waiei
1nL LND
The SpeciaI Senses
. Location
2. Structure of the eye
A. Structure and function of the eye
a. Fibrous tunic
i. Sclera
ii. ornea
sclera
pupil
iris
sclera
cornea
canals of
Schlemm
fibrous
tunic
dura mater
optic
nerve
The SpeciaI Senses
2. Structure of the eye
A. Structure and function of the eye
b. Vascular tunic
i. horoid
ii. iliary body
iii. ris with pupil
choroid ciliary
body
iris
pupil
pupil
FULL
DLATON
FULL
ONSTRTON
a) Sphincter pupillae
b) Dilator pupillae
The SpeciaI Senses
2. Structure of the eye
A. Structure and function of the eye
c. Nervous tunic (retina)
i. Photoreceptors
(rods and cones)
ii. Photopigments
iii. Optic nerve
iv. Optic disc
v. Fovea centralis
retina
ora
serrata
optic
disk
optic
nerve
The SpeciaI Senses
2. Structure of the eye
A. Structure and function of the eye
d. Lens
e. Aqueous humor
f. Vitreous humor
anterior
cavity
posterior
chamber
anterior
chamber
posterior
cavity
The SpeciaI Senses
. Accessory structures
A. Structure and function of the eye
a. Eyelids
b. onjunctiva
c. Lacrimal apparatus
d. Extrinsic muscles
lacrimal
gland
lacrimal ducts
lacrimal puncta
lacrimal caruncle
nasolacrimal
duct
superior and
inferior lacrimal
canals
The SpeciaI Senses
. Light refraction and the accommodation reflex
A. Structure and function of the eye
The SpeciaI Senses
. External changes
B. Age-related changes of the eye
a. Wrinkles and sags
b. Eyelids tend to not meet when eyes are closed
c. Upper eyelids tend to droop
d. onjunctival changes
e. Fibrous tunic
i. Sclera yellows and has transparent spots
ii. ornea becomes more translucent and less spherical,
leading to astigmatism
iii. Senile ring may form
The SpeciaI Senses
2. nternal changes
B. Age-related changes of the eye
a. Vascular tunic
i. Retinal surface becomes uneven and fragile
ii. Less aqueous humor produced
iii. iliary muscles lose mass due to atrophy
iv. ris hardens, color fades, dilator pupillae atrophies
(senile miosis)
The SpeciaI Senses
2. nternal changes
B. Age-related changes of the eye
b. Nervous tunic (retina)
i. General decline in photoreceptors (?)
ii. Decreased total rhodopsin, regeneration rate, adaptation
iii. Less efficient removal of debris and wastes
iv. ncreased atherosclerotic blood vessels
c. Vitreous humor
i. Becomes more liquid, causing light flashes
ii. Floaters
iii. More opaque
The SpeciaI Senses
2. nternal changes
B. Age-related changes of the eye
d. Lens
i. Yellows and becomes less transparent
ii. ncreased cell growth on outside of lens
e. Functional changes
i. Altered refraction
ii. Less light reaching the retina
iii. Reduced light sensitivity
iv. Decreased central visual processing times
The SpeciaI Senses
. Presbyopia (farsightedness)
. Age-related dysfunctions of the eye
a. Practically universal post-
b. Results from loss of elasticity, flattening, and increased
density of the lens
c. Loss accommodation during near vision
2. Blindness
a. ncidence of blindness increases with age
b. of people 75 8 legally blind
c. Variety of causes
The SpeciaI Senses
. Glaucoma
. Age-related dysfunctions of the eye
a. Most serious eye problem of aging
b. 2 of blindness in the US
c. aused by increased intraocular pressure
i. Poor drainage of aqueous humor from
anterior cavity
ii. Elevated pressure presses against retinal
blood vessels
iii. Leads to degeneration of optic nerve fibers
where they exit the eye
iv. "Tunnel vision
The SpeciaI Senses
. Glaucoma
. Age-related dysfunctions of the eye
d. Etiology mostly unknown
e. Onset
f. Symptomology
g. Treatments
The SpeciaI Senses
. Diabetic retinopathy
. Age-related dysfunctions of the eye
a. 7 of blindness in US (, people)
b. Microaneurysms form in retinal capillaries
c. Areas of hemorrhage vs. areas of starvation
d. Symptomology
e. Treatments
The SpeciaI Senses
5. ataracts
. Age-related dysfunctions of the eye
a. 7 of people over 7 have some level
b. loudy (opaque) lens interfering with light passage
c. auses
i. ompression of old lens fibers by newer ones
ii. Oxidative reactions in lens proteins
d. Symptomology
e. Treatments
The SpeciaI Senses
. Age-related macular degeneration
. Age-related dysfunctions of the eye
a. Disease of the macula lutea ( cone cells)
b. Loss of central vision (acuity and color) -- the
opposite of tunnel vision
c. ause
d. Two forms
i. Dry (atrophy) more common and very gradual
ii. Wet (hemorrhage) rare and sudden
e. No medical treatment
The SpeciaI Senses
7. Detached retina
. Age-related dysfunctions of the eye
a. Retina attached to vascular pigment only at
optic disc and ora serrata
b. Pressure exerted by vitreous humor "holds the
rest of the retina in place
c. As vitreous diminishes with age, detachment
risk increases
d. Effects
e. Treatments
The SpeciaI Senses
. Location
2. Divisions
D. Structure and function of the ear
a. External (outer) ear
i. Auricle (pinna)
ii. External auditory meatus
iii. Tympanic membrane (eardrum)
external auditory meatus
temporal
bone
tympanic
membrane
auricle
(pinna)
The SpeciaI Senses
. Location
2. Divisions
D. Structure and function of the ear
b. Middle ear
i. Ossicles
(malleus, incus, stapes)
ii. Auditory (Eustachian) tube
iii. Oval and round windows
middle ear cavity
malleus
incus
stapes
round
window
oval
window
tympanic
membrane
The SpeciaI Senses
. Location
2. Divisions
D. Structure and function of the ear
c. nternal (inner) ear
i. Bony labyrinth
ii. Membranous labyrinth
iii. Perilymph and endolymph
iv. ochlea (spiral organ)
v. Vestibular apparatus
inner ear
a) Semicircular ducts
b) Utricle and saccule
vi. Vestibulocochlear nerve
semicircular ducts
utricle
saccule
cochlea
The SpeciaI Senses
. Functions
D. Structure and function of the ear
a. Hearing
b. Equilibrium
The SpeciaI Senses
. External ear
E. Age-related changes of the ear
a. Auricles increase in size, lose flexibility
b. External auditory meatus becomes wider,
causing skin within to become dry and brittle
c. Ear hairs become stiffer and grow longer
d. Earwax becomes drier, causing it to build-up
The SpeciaI Senses
2. Middle ear
E. Age-related changes of the ear
a. Tympanic membrane becomes thinner and less rigid
b. Ossicular joints ossify
c. Minor loss of hearing
. nternal ear
a. Some degeneration of spiral organ cells, ganglion cells, and
equilibrium receptor cells by age 5
b. Loss of nerve fibers in vestibulocochlear nerve
c. hanges especially noticeable post-7 years
The SpeciaI Senses
. Presbycusis
F. Age-related dysfunctions of the ear
a. Hearing loss as a result of aging
b. Loss of high-pitch (2kHz at childhood drops to 8kHz
by age 5
c. Post-5 there is also loss of low-range frequencies =
difficult understanding speech
d. nterrupted pattern or rate of speech, or interference
from background noises affects understanding of
conversation
e. Environmental factors contribute significantly
f. Hearing loss is usually not severe
The SpeciaI Senses
2. Tinnitus
F. Age-related dysfunctions of the ear
a. onstant background ringing, hissing, whistling
in one or both ears
b. Usually accompanied with some hearing loss
c. Mechanism unknown
i. Obstruction of ear canal
ii. Middle ear infection
iii. Meningitis
iv. Hypertension
d. over age 5 complain of tinnitus
The SpeciaI Senses
. Deafness
F. Age-related dysfunctions of the ear
a. omplete loss of hearing is not common
b. onduction deafness vs. nerve deafness
. Dizziness and vertigo
a. What's the difference between the two?
b. 9 of elderly complain of one or the other
c. Often caused by inflammation of inner ear or
vesitibulocochlear nerve
d. People tend to compensate by standing with
feet wider apart and arms away from the body
. Location of taste buds
2. Taste bud cells
. Taste sensations
a. Substances must be dissolved
b. Sweet, salty, sour, bitter
c. Most of taste is olfaction
The SpeciaI Senses
G. Structure and function of taste
. General decrease in taste with age, thought to be
due to decreased central sensation, not loss of cells
2. Decreased salivary secretion and volume
. Fissure and furrow formation on tongue
. Effects of tobacco
The SpeciaI Senses
H. Age-related changes in taste
. Slow generalized loss of olfactory cells
2. Loss of neurons in olfactory bulbs
. Gradual decline in smell beginning in middle age,
also related to decline in central processing
The SpeciaI Senses
. Structure and function of smell
a. Smell identification increases to
age -
b. Smell identification decreases
post-
c. 7 identification between 2-,
but 5 >age 7
end
The SpeciaI Senses
J. Take home messages
. Generalized loss of receptors
2. Eye changes in lens, pupil size, and corneal
curvature; loss of vitreous humor; adaptation
time increases
. Ear loss of nerve fibers and sensory cells
allows loss of hearing and balance with aging
. General decline in taste and smell
5. Much decline attributed to decreased central
processing