Care For Clients With Eye, Ear

Care for Clients with
(EYES, EARS, Nose, and

Throat Problem)
Prepared by: Lovely Roan R. Riola
Problems of the Eyes
Eyelid Weakness or Drooping of the eyelids (Ptosis)
• It can result from weakness of the levator
muscle that elevates the upper lid in
conjunction with the unopposed action of
the orbicularis oculi that forcefully closes the
eyelids.
• Ptosis can affect one or both eyes. It may

be present at birth (congenital ptosis), or it
CAUSES:
may develop gradually over decades.
• Congenital ptosis
• Aponeurotic ptosis (senile or age-related
ptosis)
• Myasthenia gravis
• Muscle diseases
• Nerve problems
• Local eye problems
DIAGNOSIS:
• Physical Assessment
• CT scan
• MRI
• Blood Test
• Tensilon Test
• Muscle Biopsy
Management/Treatment:
1. Ptosis crutch is a nonsurgical option that involves adding an

attachment to the frames of your glasses. This attachment, or crutch,
prevents drooping by holding the eyelid in place.
Management/Treatment:
1. Surgery
Your doctor may recommend ptosis surgery. During this procedure,
the levator muscle is tightened. This will lift the eyelid up into the
desired position. For children who have ptosis, doctors sometimes
recommend surgery to prevent the onset of lazy eye (amblyopia). In
some cases, corrective surgery causes the eyes to remain open
slightly during sleep, so a nighttime lubricant is applied to the eyes to
prevent drying.
Eyelid Inflammation/Blepharitis
• Is a common bilateral inflammation of the
anterior or posterior structures of eyelid
margins
• Anterior blepharitis, involves the eyelid
skin, eyelashes, and associated glands. Two
types: seborrheic and staphylococcal.
• Posterior blepharitis, is the inflammation of
the eyelids that involves the meibomian
glands. It may result from a bacterial
infection or dysfunction of the meibomian
glands.
Eyelid Inflammation/Blepharitis
Signs/Symptoms:
• For Anterior Blepharitis- irritation, redness, burning, and itching of the eyelid margins.
• For Posterior Blepharitis- frothy and greasy tears, dilation of the glands, plugging of the
orifices, and abnormal secretion.
Nursing management/ Treatment:

For Anterior Blepharitis:
• careful cleaning with a damp applicator to remove the scales
• antibiotic ointment or drops as prescribed.
For Posterior Blepharitis:
• Initial therapies can include warm compression of the eyelids, and use of flaxseed or fish oil
tablets to provide Omega-3 fatty acid benefits to meibomian oil secretions.
• long-term, low-dose systemic antibiotics therapy guided by the result of bacterial culture,
along with short-term topical steroids.
Allergic Conjunctivitis
• Allergic conjunctivitis encompasses a spectrum
of conjunctival conditions usually characterized
by itching. The most common of these is
seasonal allergic rhinoconjunctivitis, or hay
fever.
Signs/Symptoms: Cause:
• Intense Burning feeling in the • You experience allergic conjunctivitis when

eyes your body tries to defend itself against a
• Itching
perceived threat. It does this in reaction to
• Conjunctive becomes red and
swells things that trigger the release of histamine.
Your body produces this potent chemical to
fight off foreign invaders.
Allergic Conjunctivitis
Nursing Management/Treatment:
1. Advice the patient to avoid what causes the allergy.
2. The use of cold compresses and eye washes with tear substitute.
3. Allergic conjunctivitis also has been successfully treated with topical mast
cell stabilizers, histamine type 1 (H1) receptor antagonists, and topical
nonsteroidal anti-inflammatory drugs as prescribed.
4. Systemic antihistamines may be useful in prolonged allergic conjunctivitis.
5. In severe cases, a short course of topical corticosteroids may be required to
afford symptomatic relief.
Infectious Conjunctivitis
a. Bacterial Conjunctivitis
• Bacterial conjunctivitis may present as a hyperacute, acute, or chronic infection. Hyperacute
conjunctivitis is a severe, sight-threatening ocular infection.
Acute Bacterial Conjunctivitis- Acute bacterial conjunctivitis typically presents with burning,
tearing, and mucopurulent or purulent discharge. Common agents of bacterial conjunctivitis are
Streptococcus pneumoniae, S. aureus, and Haemophilus influenzae.
Chronic Bacterial Conjunctivitis- conjunctivitis most commonly is caused by Staphylococcus

species, although other bacteria may be involved. It is often associated with blepharitis and
bacterial colonization of eyelid margins. The symptoms of chronic bacterial conjunctivitis vary
and can include itching, burning, foreign body sensation, and morning eyelash crusting. Other
symptoms include flaky debris and erythema along the lid margins, eyelash loss, and eye
redness.
Diagnostics:
• Diagnostic methods include immediate Gram staining of ocular specimens.
Nursing management/ Treatment:

1. Administer antibiotics eyedrops or ointment as prescribed.
2. Use a lint-free cotton cloth soaked in boiled water to wipe the lashes and
clean off the crusts.
3. Artificial tear drops may be used to reduce dryness and irritation.
4. Advice the patient to stop wearing contact lenses till eyes are better.
5. Encourage good eye hygiene and handwashing.
b. Viral conjunctivitis is a highly contagious acute conjunctival infection
with worldwide distribution. Most common causes of viral conjunctivitis
is adenovirus type. Other viruses that can cause this infection includes
herpes simplex virus (HSV), varicella zoster virus (HZV), poxvirus
(molluscum contagiosum, vaccinia), picornavirus (enterovirus 70,
Coxsackie A24), and human immunodefiency virus (HIV).
Signs/Symptoms:
• Red or Pink eye

• Watery discharge that is not yellow or green in color
• Nasal congestion
• Runny nose
• Swollen eyelids
• Sensation of having foreign objects in the eye
• Pain when looking in the bright lights
Diagnostic Procedure:
• Clinical; sometimes viral cultures or immunodiagnostic testing is indicated
Nursing Management/Treatment:
1.Topical antibiotics are ineffective in controlling the inciting viral agent but may be used to
prevent secondary bacterial infection as prescribed.
2. The most important aspect of treatment is education regarding the highly transmissible
nature of the infection.
3. Instruct the client and the family by including the need for scrupulous handwashing and
avoiding the shared use of eyedroppers, eye makeup, goggles, and towels.
4. Persons who use contact lenses should avoid them and wear their prescription glasses
instead.
5. Warm compress to the effected eye to relieve symptoms.

Conjunctivitis
c. Chlamydial Conjunctivitis
• When chlamydia affects the eye, conjunctivitis (pink
eye) can occur. This condition is often referred to as
chlamydial conjunctivitis (or inclusion conjunctivitis).
•is usually a benign suppurative conjunctivitis

transmitted by the type of Chlamydia trachomatis
(serotypes D through K) that causes venereal
infections
• It is spread by contaminated genital secretions and

occurs in newborns of mothers with C. trachomatis
infections of the birth canal. It also can be contracted
through swimming in unchlorinated pools. The
incubation period varies from 5 to 12 days, and the
disease may last for several months if untreated.
Signs/Symptoms:
Symptoms of chlamydial conjunctivitis usually develop slowly. One or

both eyes may be affected, though it typically only occurs in one.
•Some of the main symptoms of a chlamydial eye infection include:

•Redness
•Swelling
•Itchiness
•Pus
•Tears and watery eye discharge
•Eyelids crusting or sticking together
•Light sensitivity
Diagnosis:
• Chlamydial conjunctivitis is diagnosed through an eye exam. Eye doctor will
also likely take a swab of your conjunctiva and send it off to be tested in a
laboratory for specific bacteria.
•Additionally, your doctor may recommend that you are tested for additional
sexually transmitted infections or diseases, including syphilis or gonorrhea, both
of which can cause infections that can spread to the eyes.
Treatment:
•Chlamydial conjunctivitis can be treated with oral and/or topical antibiotics,
such as eye drops or ointment. Most cases clear up within a few weeks, but in
order for the infection to heal completely, it is critical to take the full dose of
antibiotics as directed.
•If you have chlamydia or chlamydial conjunctivitis, your sexual partner(s)

should also be treated to prevent further spread of the infection.
Disorders of the Cornea

a. Corneal Trauma
• The cornea is prone to a variety of injuries by virtue of its

location as the window of the eye. Apart from chemical injuries,
physical trauma to the cornea can range from epithelial abrasions
to loss of integrity of the stroma.
Signs/Symptoms:
• Very painful, tearing, foreign body sensation

Causes:
• Among the causes of corneal edema is the prolonged wearing of contact lenses,
which can deprive the epithelium of oxygen, disrupting its integrity. Corneal edema
also occurs after a sudden rise in intraocular pressure. With corneal edema, the
cornea appears dull, uneven, and hazy; visual acuity decreases, and iridescent vision
(i.e., rainbows around lights) occurs.
• The injuries can be caused by large blunt objects often resulting in ruptures of other
parts of the ocular coats as well.
Diagnosis:
• Can be seen or visualized using fluorescein dye under cobalt blue dye
Nursing management/Treatment:
1. Applying a cycloplegic medication, antibiotic ointment, and a patch (unless a

corneal ulcer is suspected).
b. Keratitis
• Keratitis refers to inflammationof the cornea. It can be caused by

infections, misuse of contact lenses, hypersensitivity reactions,
ischemia, trauma, defects in tearing, and interruption in sensory
innervation, as occurs with local anesthesia.
• Staphylococcus aureus is the most common bacterial infection.

Signs/Symptoms:
• Common symptoms include photophobia, pain, and lacrimation.

Severe ulcerations with residual scarring require corneal
transplantation.
Treatment:
Medication
Antibacterial eye drops: To treat bacterial keratitis.
Antifungal eye drops: To treat fungal keratitis.
Antivirals: To prevent the causative virus from reproducing.

Self-care
Use artificial tears or lubricant eye drops to treat dryness.
Nutrition
There is no particular diet known to specially help patients of keratitis. Eat
foods that help in maintaining eye health, and help prevent dry eyes.
Foods to eat:
•Fish containing essential fatty acids such as salmon, halibut, sardines and
tuna
•Fruits and vegetables rich in antioxidants
•Foods rich in potassium like pecans, bananas, dates, figs and avocados
•Foods rich in zinc like kelp, legumes, liver, and mushrooms
Foods to avoid:
•NA
Common tests & procedures:
Eye examination: To check for visual acuity (clarity of vision).

Penlight examination: Used to check the pupil’s size and reaction.
Slit lamp examination: A slit-lamp is used to view the eye under
magnification.
Laboratory examination: Cells from the cornea or tear sample may be
tested to check for infection.
VISUAL DYSFUNCTION
Alterations in Ocular Movements.
a. Strabismus
• is the deviation of one eye from the other when

a person is looking at an object; it results in failure
of the two eyes to simultaneously focus on the
same image and therefore loss of binocular vision.
• The deviation may be upward, downward,

inward, or outward, resulting from a weak or
hypertonic muscle in one of the eyes.
Causes:
• Strabismus may be caused by a neuromuscular disorder of the eye muscle,
diseases involving the cerebral hemispheres, or thyroid disease.
Signs/Symptoms:
•Diplopia (double vision) is the primary symptoms

•Eyes that don't look in the same direction at the same time. (If your child's
eyes are only slightly misaligned, you may not notice.)
•Eyes that don't move together.
•Squinting or closing one eye in bright sunlight.
•Tilting or turning the head to look at an object.
•Bumping into things. (Strabismus limits depth perception.)
Diagnosis:
•Visual acuity test: to assess the changes in vision and clarity of sight at short
and long-distance. (e.g. reading letters on a chart at short and long distances)
•Corneal light reflex test: used to determine the extent of refractive error,
which is useful in the decision of the lens power needed to compensate for
changes.
•Alignment and focus test: to assess movement, focus and unity of the eyes.
•Retinal exam: observation of the physical structure of the eye to check for
the presence of other diseases of the eye that may be causing the presenting
symptoms.
•Cover/uncover test: to measure the deviation and movement of the eyes.

Treatment:
•Glasses. Wearing glasses can sometimes correct mild strabismus.
•A temporary eye patch over the stronger eye if your child has amblyopia. This
can make the weak eye stronger, which may help align the eyes. Your child may
have to wear the patch some or all of the time for a few weeks or months.
•Surgery on the eye muscles. This is often the only way to improve vision and
better align the eyes. It may take more than one surgery, and your child may still
need to wear glasses.
Other treatments may include medicines and eye exercises.

Treatment for strabismus should begin as soon as possible. In general, the
younger the child is when treatment begins, the better the chances are of
correcting the problem.
It's also important for your child to get follow-up exams.
b. Nystagmus
• Is an involuntary unilateral or bilateral rhythmic
movement of the eyes and can occur in infants (congenital)
or adults (acquired). It may be present at rest, or it may
occur with eye movement.
Two Major forms:
1. Pendular nystagmus- is characterized by a regular

alternating forward and backward movement of the
eyes in which both phases of the movement are equal in
length.
2. Jerk nystagmus- one phase of the eye movement is

faster than the other.
Causes:
Nystagmus is not always related to an underlying condition. It may be
caused by:
•Congenital that is passed from parents

•Disorientation (such as on amusement rides)
•Induced by alcohol or drug use
•Medication such as drugs for seizures
•Head injures/spinal injury
•Imbalance in the normally coordinated reflex activity of the inner ear,
vestibular nuclei (connecting the vestibular nerve with vestibulospinal
tracts), cerebellum, medial longitudinal fascicle (connecting the
mesencephalon with the upper portion of the spinal cord), or nuclei of
the oculomotor, trochlear, and abducens cranial nerves
Management:
See a doctor if you notice:
Headache especially after seeing the light
See a doctor immediately if you notice:
Symptoms such as head tilting, shaky vision, dizziness or difficulties
seeing in darkness
Alteration in Visual Acuity:
a. Amblyopia (lazy eye)
• Is a reduction or dimness of vision related to altered development of

the visual cortex and is the most common cause of childhood monocular
blindness.
Causes:
Amblyopia occurs when one eye has much better focus than the other, which may be
due to:
•Imbalance in the muscles that position the eye causing misalignment of the eyes (cross-
eyes or wall eyes).
•High refractive error in one or both eyes that are either not corrected or
undercorrected, causing a difference in sharpness of vision between the eyes.
•Any problem in media of one eye can deprive the child of a clear vision in that eye.
Signs/Symptoms:
•An eye that wanders inwards or outwards
•Eyes that appear not to work together
•Poor depth perception
•Blurred vision
•Double vision
•Squinting or shutting An eye
•Head tilting
•Abnormal results of vision or screening tests
Diagnosis:
Eye examination: Thorough eye exam is done to check for eye health, any
media opacity or check for a wandering eye.
Visual acuity examination: Testing using pictures or letters in children 3
years or older can help assess the child’s eye. Special visual charts are
available for amblyopia screening.
Stereopsis test: To check how good the 3D vision is.
Measurement of squint (misalignment of eyes): To check amount of
misalignment of eyes.
Treatment:
• The condition is treatable using corrective glasses, eye patches, eye

drops and surgery.
Anticholinergics: Given in the form of mild drops to blur vision in the

healthy eye and encourage the patient to use the weak eye; used to treat
mild cases. Usually recommended in rare cases.
Procedures:
Cataract surgery: To correct vision due to unclear media in the eye.
Optical penetrating keratoplasty: Replace part of the cornea with corneal

tissue from a donor. Usually done in very rare cases.
b. Scotoma/Blind Spot
• Is a circumscribed defect of the central field of vision.
• is an area of partial alteration in the field of vision consisting of a
partially diminished or entirely degenerated visual acuity that is
surrounded by a field of normal – or relatively well-preserved –
vision . Every normal mammal eye has a scotoma in its field of
vision, usually termed its blind spot.
Causes:
Blind spot is not always related to an underlying condition. It may

be caused by:
•Directly viewing the sun

•Injury to the eye
•Lesions of the central retina or a sequela to demyelinating optic
neuritis, an inflammatory lesion of the optic nerve frequently
associated with optico-spinal multiple sclerosis
•Exposure to chemicals (methyl alcohol
•poisoning and use of tobacco)
•Squinting
Signs/Symptoms:
• It may appear as a blind spot, a dark spot, a light spot, a flickering

light or a blurred area in the visual field.
Diagnosis:
• The diagnosis of this disease usually begins with a physical

examination in the initial stages. Doctors examine the eyes of
sufferers and also ask them questions about their symptoms. They
are also asked about any other conditions or any eye surgery that
they may have recently suffered or gone through.
Treatment:

•Blind spots occur too frequently or are permanent
•It leads to disruption in everyday activities like reading,
driving etc.

•It affects central vision
•Vision loss in one eye or blurred vision
•Severe headache or dizziness
•Eye pain
Cataract
• Is a cloudy or opaque area in the ocular lens and leads

to visual loss when located on the visual axis.
Causes:
The majority of cataracts are related to ageing, cataracts are sometimes seen in babies. This
type of cataract is called congenital cataract. Cataracts may also develop as a result of other
diseases such as diabetes or trauma to the eye.
Risk factors associated with cataract development (after infancy)are:
•Ageing -people above 55 years of age are at higher risk

•Family history - more likely to develop if any member in the family had cataract.
•Diabetes
•Injury to the eye
•Long-term use of steroid medications, especially eye drops
•Past surgery to the eye
•Smoking
•Obesity
•High blood pressure
•Other diseases like myotonic dystrophy and use of medications
Signs/Symptoms:
Cataracts usually progresses gradually. Most age-related cataracts may

progress over a period of two years. Other types of cataracts, especially in
younger people and diabetics, may progress fast. The symptoms include:
•Clouded or blurred vision

•Difficulty in seeing during the night
•Sensitivity to light and glare
•Need for brighter than normal light to read or see objects
•Seeing halo around lights
•Seeing objects in faded or yellow color
•Headache due to changes in vision
•Eye pain
Visual acuity test: To assess your ability to view details of an image clearly.
Refractive error assessment: To assess amount of refractive error induced by
cataract in the eye and whether it can be resolved by glasses alone and
without surgery.
Slit lamp examination: After putting pupil dilating eye drops detailed
examination of the eye is done to view the severity of cataract.
Indirect ophthalmoscopy: Examining the retina for abnormalities.
Tonometry: Measuring the pressure of the eye.
Treatment:
Cataract surgery: Replacing the natural lens of the eye with an artificial lens
or intraocular lens (IOL).
• Cataracts can be removed completely through surgery.

Glaucoma
• A condition where the eye’s optic nerve, which provides

information to the brain, is damaged with or without raised
intraocular pressure. If untreated, this will cause gradual vision
loss.
• are the second leading cause of blindness and are characterized by intraocular pressures
greater than 12 to 20 mmHg, with death of retinal ganglion cells and optic nerve axons.
Causes:
The fluid inside the eye, called aqueous humor, nourishes the lens and the cells of the cornea
and maintains a pressure, which allows the cornea to maintain its convex shape that is
necessary for good vision. The pressure inside the eye or the intraocular pressure is
maintained at a constant due to drainage of excess fluid out of the aqueous humor.
Increased pressure inside the eye due to the obstructed flow of aqueous humor may lead to
glaucoma.
The other causes may include:

•Family history
•Association with other diseases like systemic hypotension, diabetes mellitus
•Burn or chemical injury to the eye or trauma to the eye
•Severe eye infection or inflammation (uveitis)
•Diseases of retina leading to abnormal vessels on the iris that may cause glaucoma
Symptoms:
Initially the condition remains asymptomatic but the gradual progression

may lead to symptoms such as:
•Loss of peripheral or side vision
•Seeing halos around lights and glare in bright light
•Redness in the eye
•Eye pain
•Eye that looks hazy (particularly in infants)
•Narrow or tunnel vision
•Vision Loss
• To diagnose glaucoma complete eye examination is recommended which
involves measuring eye pressure, inspecting the eye’s drainage angle,
examining the optic nerve, testing vision, getting measurements of optic
nerve and measuring the thickness of cornea.
Tonometry: To measure the inner pressure of the eye.

Ophthalmoscopy: To check the shape and color of the optic nerve.
Perimetry: The patient’s ability to see the object clearly at several points is
checked during this procedure.
Gonioscopy: To distinguish between open-angle and closed-angle
glaucoma.
Pachymetry: To find out the thickness of the cornea.
• Treatment aims at reducing the intraocular pressure and preventing further damage to the
optic nerves. Intraocular pressure can be reduced by increasing the drainage of aqueous humor
or reducing its production through medications.
Medication:
Beta-adrenergic antagonists: This helps reducing the production of aqueous
humor.
Prostaglandin analogues: Drugs help in the outflow of fluid from the eyes.
Adrenergic agonists: Drug that stimulates the reduced production of aqueous
humor and increases the outflow.
Carbonic anhydrase inhibitors: Topical or oral medications that help in reducing
the eye pressure by decreasing production of aqueous humor in the eye.
Parasympathomimetic agents: Improve the outflow of aqueous humor from the
eye. Usually recommended for open angle glaucoma.
Osmotic agents: These are used to treat sudden and severe rise in intraocular
pressure. Recommended in severe cases.
Procedures:
Trabeculectomy: Conventional surgery for glaucoma done to remove the

accumulated fluid.
Laser assisted non penetrating deep sclerectomy: This is the currently used
surgical technique for glaucoma. The procedure is similar to trabeculectomy
but here penetration of sclera bed isn’t involved.
Glaucoma drainage implant surgery: Done by inserting a flow tube in anterior
chamber of the eye and implanting a plate under the conjunctiva to allow the
flow of aqueous humor. Usually recommended for severe cases of open angle
glaucoma.
Laser trabeculoplasty: To create holes in the trabecular meshwork for drainage
of aqueous humour. Also known as Argon laser. Usually recommended for
some cases of open angle glaucoma.
Canaloplasty: It is a nonpenetrating procedure done using microcatheter
technology.
Retinal detachment
• is a common cause of visual impairment and blindness. Risk factors

include retinal holes and vitreoretinal traction. Fluid (exudate,
hemorrhage, or liquid vitreous) separates the photoreceptors from the
retinal pigment epithelium. The separation deprives the outer retina of
oxygen and nutrients because the diffusion distance is increased.
Communication is also disrupted between the pigment epithelium and
photoreceptors.
Rhegmatogenous retinal detachment (full thickness retinal breaks

caused by vitreoretinal traction) is the most common form of retinal
detachment. Causes include intracapsular cataract extraction, severe
myopia, age-related lattice degeneration, vitreoretinal traction, and
trauma.
Causes:
•Risk factors include:

•Extreme near sightedness
•Eye injury/trauma
•Cataract surgery
•Family history
•Advanced diabetes
•Aging
•Eye disease or disorders like retinoschisis, uveitis, degenerative
myopia, or lattice degeneration
Symptoms:
Patient does not suffer from pain, and there are no warning signs for
the disease. However, one may experience:
•Sudden appearance of many floaters

•Flashes of light
•Gradually reduced peripheral vision
•Tunnel vision
•Blurred or disturbed vision
•Curtain like shadow over visual field
•A through eye exam is performed to check vision, eye pressure,

physical appearance of the eye and ability to see colors.
Retinal examination: The doctor dilates your eye with eye drops and
then has a detailed examination of the retina and back of your eye with
bright eye and ophthalmoscope.
Ultrasound: It is required if bleeding has occurred.
Procedures:
Laser surgery: Laser beam is used to burn the retinal tear that
further welds into underlying tissue.
Freezing (Cryopexy): Freezing probe is directly applied over
the tear causing a scar that helps retina secure to the eye
wall.
Pneumatic retinopexy: In the case of small tear, a tiny gas
bubble is inserted into the vitreous that will seal the tear.
Scleral buckle: A silicon band is sewed around the white of
eye. This pushes it towards the tear until it heals.
Vitrectomy: It is required in case of large tears where vitreous
is removed and replaced with saline solution.
Age-related macular degeneration (AMD)
• Is a severe and irreversible loss of vision and a major cause of central

blindness in older individuals.
• Risk factors include older age, hypertension,

cigarette smoking, diabetes mellitus, previous cataract surgery, and
family history of AMD. The degeneration usually occurs after the age
of 60 years.
There are two forms:
a. Atrophic form (dry, nonexudative–geographic atrophic), is more

common and is slowly progressive with inflammation and accumulation
of lipofuscin (a lysosomal pigmented residue) and drusen (waste
products from photoreceptors) in the retina. Symptoms include limited
night vision and difficulty reading.
b. Neovascular form (wet, exudative), includes accumulation of drusen

and lipofuscin, abnormal choroidal blood vessel growth, leakage of blood
or serum, retinal detachment, fibrovascular scarring, loss of
photoreceptors, and more severe and rapid loss of central vision.
Treatment for wet AMD includes antivascular endothelial growth factor
(anti-VEGF) injections;new treatments are under investigation.
Signs/Symptoms:
Early stages of macular degeneration are often symptomless. Disease

progression leads to:
Wavy or blurred vision

Visual distortion
Loss of central vision, with dark or blurry spots in the middle of vision
Change in the perception of color
Need for brighter light to see
Trouble recognizing faces
Eye examination: Checking the back of the eye after using medications to
dilate the eye.
Amsler grid test: A grid with straight lines is used to assess defects in central
vision.
Indocyanine green angiography: Similar to fluorescein angiography, this test

is used to check for the type of degeneration.
Optic coherence tomography: Images of the retina are taken to examine for
its swelling, thickening, or thinning.
Fluorescein angiogram: Taking images of the eye after injecting a colored

dye to examine the blood vessels.
There is no permanent cure for macular degeneration. Treatments aim at slowing down the progression of disease and preventing vision loss.
Treatment:
Anti angiogenesis drugs: Prevent the formation of new blood vessels and leakage
from the abnormal vessels.
Vitamin supplements: To reduce the risk of vision loss.
Therapy:
Laser therapy: High-energy laser rays are used to destroy the abnormal blood
vessels.
Photodynamic therapy: A light sensitive drug is used to damage the abnormal

blood vessels, followed using laser rays to destroy them.
Low vision rehabilitation: Working with professionals to cope with changing

vision.
Alterations in Accommodation
Presbyopia
• a condition in which the ocular lens becomes larger, firmer, and less
elastic in response to ciliary muscle contraction.
Causes:
•Hardening of the lens with age, especially after the age of 45

•Reduced flexibility of eye muscles
•Reduced elasticity of eye lens
Symptoms:
•Blurred vision
•vision and focusing problems with nearby objects
•Eyestrain or headache after reading or doing close work like embroidery or sewing
•Difficulty in reading small print and fonts
•Requirement of brighter lightning while reading or doing close work
•Need to hold the magazine, newspaper or reading material at An arm’s distance
to attain proper focus
•Squinting
Ophthalmoscopy: Examination of the retina to evaluate the back of the eye.
Muscle integrity test: To check the functioning of eye muscles.
Refraction test: To check the focusing power for prescription glasses or contact
lenses.
Slit lamp test: To check the anterior part of the eye.
Visual acuity test: To assess the clarity of vision.

Treatment:
• It can be corrected with the use of glasses. The aim of treatment to correct
the vision to focus nearby objects. Corrective measures include wearing
corrective eyeglasses or contact lenses, undergoing refractive surgery, or
getting lens implants for presbyopia.
Procedures if needed:
Refractive surgery: Conductive Keratoplasty, Laser-assisted in situ

keratomileusis (LASIK), Laser-assisted subepithelial keratectomy (LASEK),
Photorefractive keratectomy are used to correct the vision.
Artificial lens implantation: Natural eye lens is replaced with synthetic lens
(intraocular lens).
Corneal inlay implantation: A plastic ring with a central opening is inserted

into the cornea acting like a pinhole camera and helps focusing nearing
objects.
Alterations in Refraction:
a. Myopia (nearsightedness), the axis of the eyeball is lengthened, and light

rays are focused in front of the retina when a person is looking at a distant
object, resulting in blurred vision. The cause is unknown. A concave lens is
needed for correction. Myopia requires frequent changes of eyeglasses while
the eyeball is lengthening in childhood. Myopia is a risk factor for retinal
detachment, cataract formation, and glaucoma.
b. Hyperopia (farsightedness), the axis of the eyeball is too short and light rays are
focused behind the retina when a person is looking at a near object. Treatment
options include eyeglasses, contact lenses, or surgery.
Symptoms:
Headache - persistant headache

Blurred vision - near objects looks blurred
Difficulty in activities such as reading, stitching
Eyestrain - feeling heavyness in the eye
Squinting

Visual acuity examination: Snellen's visual acuity chart, Jaeger's near vision charts
Retinoscopy: To measure the amount of hyperopia and if any astigmatism is also
present with the hyperopia.
c. Astigmatism is caused by an unequal curvature of the cornea. In

astigmatism, light rays are bent unevenly and do not come to a single focus on
the retina. Astigmatism may coexist with myopia, hyperopia, or presbyopia.
Hyperopia is corrected with a convex lens or laser refractive surgery..
Symptoms:
•Blurred or distorted vision
•Eyestrain or discomfort or tiredness of eyes
•Headaches
•Squinting
•Seeing multiple images
•Burning and itching sensation in eyes
•Holding reading material close to eyes
•Tilting of head

Visual acuity test: Test to check the clarity of vision.
Keratometry: To measure the curvature of cornea. It involves focusing

light on the cornea and its reflection.
Refraction test: To measures how a series of lenses in front of the eyes

focus light usually done using a retinoscope
Corneal topography and tomography: Gives graphical depiction of

curvature of cornea in different meridia and areas of thinning if present.
Treatment of astigmatism aims at improving vision clarity and eye comfort. This can be
achieved through corrective lenses or refractive surgery.
Procedures:
Orthokeratology: Eyesight is corrected by fitting rigid contact lenses to reshape the cornea.
If opted for.
Laser-assisted in-situ keratomileusis (LASIK): Cornea is reshaped using laser or a

microkeratome to improve visual acuity. If opted for
Laser-assisted subepithelial keratectomy (LASEK): Epithelium of the cornea is loosened

using alcohol solution and excimer laser changes the curvature of cornea.
Photorefractive keratectomy (PRK): This procedure is similar to LASEK. However, the

epithelium can be removed by alcohol or rotary brush or laser, and it grows back naturally.
Epi-LASIK: A variation of LASEK where a mechanized blunt blade called epikeratome is used
to separate thin sheet of epithelium.
Problems of the Ear
Aging and Hearing
a. Presbycusis
• is loss of hearing in older age
• Auditory changes caused by aging are common, incremental, and with
considerable individual variation.
Signs/Symptoms:
• Difficulty in understanding words with the presence of background noise
or in the presence of a crowd.
• Trouble to hear the consonants (all alphabets in the English alphabets
except a, e, i, o, and u)
• Muffling of the sound or the speech
• The constant need to turn the volume of radio or television high
Changes in Hearing by Aging
CHANGES IN CHANGES IN FUNCTION
STRUCTURE
Cochlear hair cell Inability to hear high-frequency sounds (presbycusis, sensorineural
degeneration loss);
interferes with understanding speech; hearing may be lost in both ears
at different times
Loss of auditory neurons in Inability to hear high-frequency sounds (presbycusis, sensorineural

spiral ganglia of organ of loss);
Corti interferes with understanding speech; hearing may be lost in both ears
at different times
Degeneration of basilar Inability to hear at all frequencies, but more pronounced at higher
(cochlear) conductive frequencies (cochlear conductive loss)
membrane of cochlea
Decreased vascularity of Equal loss of hearing at all frequencies (strial loss); inability to
Cochlea disseminate
localization of sound
Loss of cortical auditory Equal loss of hearing at all frequencies (strial loss)
neuron
Changes in hearing caused by Aging
Ototoxic drugs include antibiotics, such as streptomycin, neomycin,

gentamicin, and vancomycin; diuretics, such as ethacrynic acid and
furosemide; chemicals, such as salicylate, quinine, carbon monoxide,
nitrogen mustard, arsenic, mercury, gold, tobacco, and alcohol; and cancer
drugs (i.e., cisplatin). Because of increased concentrations of antibiotics in
the endolymph, these drugs generally cause damage to the cells of the
cochlea or the hair cells of the organ of Corti. Diuretics affect hearing
primarily by altering the sodium-potassium balance, causing extracellular
fluid accumulation and changes in the microstructure of secretory cells.
Quinine, mercury, and lead affect the neural pathways of hearing, including
the spinal ganglia, the eighth cranial nerve, and the cochlear nucleus.
Changes in hearing caused by Aging
• Loss of hearing for sounds in the high-frequency range is most common
and interferes with understanding speech, particularly high frequency
consonant sounds (e.g., s, sh, f).
• Hearing may be lost in both ears but not at the same time.
• The ability to discriminate localization of sound varies with high and low
frequencies and diminishes with age.
• Because older adults tend to lose high-frequency hearing first, they may
have difficulty localizing high-frequency sounds and understanding speech.
Cognitive impairment and poor quality of life are associated with
presbycusis.
Auditory Dysfunction
Conductive Hearing Loss
• Occurs when a change in the outer or middle ear impairs sound from being
conducted from the outer to the inner ear.
• Conductive hearing loss occurs when there is interference in air

conduction.
Causes:
• impacted cerumen
• foreign bodies lodged in the ear canal
• benign tumors of the middle ear
• carcinoma of the external auditory canal or middle ear
• eustachian tube dysfunction
• otitis media
• acute viral otitis media
Auditory Dysfunction
• chronic suppurative otitis media, cholesteatoma

• otosclerosis (impaired mobility of the stapes footplate in the presence of
dense sclerotic bone)
Symptoms:
• diminished hearing and soft speaking voice

• the individual often hears better in a noisy environment than in a quiet one
(a condition called paracusia willisiana)
Treatment:
• Treatment of the underlying cause generally improves hearing, and a
hearing aid can improve quality of life
Sensorineural Hearing Loss
• Sensorineural hearing loss (SNHL) is a type of hearing loss in which

the root cause lies in the inner ear or sensory organ (cochlea and
associated structures) or the vestibulocochlear nerve (cranial nerve
VIII).
Sensorineural Hearing Loss
Causes:
• Impairment of the organ of Corti or its central connections

• Congenital and hereditary factors
• Noise exposure
• Aging
• Ménière disease
• Ototoxicity
• Systemic disease (syphilis, Paget disease, collagen diseases, diabetes
mellitus)
• Congenital and neonatal sensorineural hearing loss may be caused by
maternal rubella, cytomegalovirus, ototoxic drugs, prematurity,
traumatic delivery, erythroblastosis fetalis, and congenital hereditary
malfunction.
Symptoms:
•Difficulty to pick out words amidst background noise

•Hearing loss
•Tinnitus
•Speech delay in a child
•Turning up the TV and radio volume to excessive levels
Physical Examination: Doctor will look for inflammation, ear wax

buildup in the ear or damage to eardrum.
Otoscope exam: It is done by an instrument known as otoscope. It
helps to identify damage or infection in the external auditory ear.
Tympanometry: Used to test the function of the middle ear and
mobility of the eardrum.
Weber test: Used to check unilateral hearing loss.
Rinne test: It is done by a tuning fork. It compares between the sound
transmission of bone conduction and air conduction.
Magnetic resonance imaging (MRI): To identify gross structural causes
of hearing loss.
Treatment:
• Treatment includes hearing aids and cochlear implant.

Gene therapy and allotransplantation of stem cells are under
investigation.
Mixed Hearing Loss
• A mixed hearing loss is caused by a combination of

conductive and sensorineural losses.
Functional Hearing Loss
•A functional hearing loss occurs for no organic reason.

The individual does not respond to voice and appears
not to hear. Functional hearing loss is thought to be
caused by emotional or psychologic factors. It occurs
only rarely.
Ear Infections
a. Otitis externa
• is inflammation of the external ear canal

with or without infection and may include
parts of the outer ear.
• It is commonly acute rather than chronic.
Causes:
• The most frequently found

microorganisms are Pseudomonas,
Escherichia coli, and Staphylococcus aureus.
Ear Infections
Symptoms:
• The earliest symptoms are inflammation with swelling,
tenderness, and itching with clear drainage progressing to
purulent drainage and obstruction of the canal.

Physical examination: Examination of middle ear to identify
the primary site of infection.
Bacteria culture test: The sample of the discharge is taken to
check for the causative factor.
Treatment:
• Includes topical antibiotics and steroids
Ear Infections
b. Otitis media
• Is an infection of the middle ear and is the most common infection of

infants and children.
• Otitis media is the leading cause of healthcare visits and drug
prescriptions throughout the world, with 50% occurring in the under 5-
year age group. Most children have one episode by 3 years of age.
Ear Infections
Causes:
Eustachian tube (the tube connecting the middle ear to the back of the
throat) dysfunction leads to fluid retention in the middle ear and may
cause infection. The blockage of the eustachian tube may be because of
various reasons like:
•Allergy
•Common cold
•Flu
•Sinus infection
•Adenoid infection or enlargement - this is usually common in children
•Smoking
The most common pathogens are Haemophilus influenzae, Moraxella

catarrhalis, Streptococcus pneumonia, and Staphylococcus aureus.
Ear Infections

Audiometry: Measures the hearing acuity of the patient.
Tympanometry: To examine the condition of the middle ear.
Acoustic reflex: To indirectly measure the fluids in the middle
ear.
CT scan: Temporal bone CT is performed to visualize the
structure of the ear within the temporal bone.
Tympanocentesis: To identify the infectious agent in the fluid
drained from the middle ear.
Ear Infections
Acute otitis media (AOM)
• is associated with ear pain, fever, irritability, inflamed tympanic

membrane, and fluid in the middle ear.
• The tympanic membrane progresses from erythema to opaqueness

with bulging as fluid accumulates.
Treatment:
• Antimicrobial therapy for AOM, particularly in children 2 years and
younger.
• Reduction in the incidence of AOM has accompanied the widespread

use of bacterial and viral vaccines in young children, including
pneumococcal conjugate and influenza vaccines.
Ear Infections
Chronic otitis media (COM)
• Is persistent or recurring infection of the middle ear.

• Chronic suppurative OM (CSOM) is associated with ear drum
perforation and purulent discharge.
Treatment:
• Placement of tympanostomy tubes is considered when bilateral
effusion persists for 3 months and for significant hearing loss.
• Mastoidectomy combined with tympanostomy ventilation tubes may

be required when there is cholesteatoma (skin growth into the middle
ear associated with perforation of the eardrum).
The Nose
• The nose isthe body’s primary organ of smell and also

functions as part of the body’s respiratory system.
• Air comes into the body through the nose. As it passes over
the specialized cells of the olfactory system, the brain
recognizes and identifies smells. Hairs in the nose clean the
air of foreign particles. As air moves through the nasal
passages, it is warmed and humidified before it goes into the
lungs.
Problems of the Nose
1. RHINITIS/CORYZA
• is irritation and inflammation of the mucous membrane inside the nose.
Causes:
• Viruses
• Bacteria
• Irritants or allergens
1. RHINITIS/CORYZA
SIGNS/SYMPTOMS:
1. RHINITIS/CORYZA
COMMON DIAGNOSTIC PROCEDURES/TESTS:
• Skin tests or blood tests are the most common diagnostic methods used to
determine rhinitis.
• Patient history: Finding the history helps to establish seasonality and determine
the persistence of rhinitis.
• Physical examination: Patient is checked for the presence of the symptoms of

rhinitis.
• Spirometry: Done to detect any signs of asthma in patients with rhinitis.
• Blood test: The presence of eosinophil indicates allergic cause and that of
neutrophil symbolizes infectious rhinitis.
1. RHINITIS/CORYZA
Treatments:
Medications
2nd generation antihistamines: Rapidly relieves itching, sneezing but little effect on nasal
blockage.
Leukotriene modifiers: These are used to treat inflammation of the nasal membrane.
Nonsteroidal anti-inflammatory drugs (NSAIDs): It is a mast cell stabilizer which prevents

asthamatic attacks and allergic reactions.
Intranasal corticosteroids: Also known as nasal steroids, helps reduce the inflammation.
Nasal decongestants: Helps in relieving nasal obstruction. Usually recommended in case of

non-allergic rhinitis
1. RHINITIS/CORYZA
Self-care:
• Keep stuffed toys out of bedroom

• Cover pillows and beds with allergen-proof covers
• Steam inhalation at least 2 times a day
• Gargle with betadine or salt in warm water
2. Nosebleed/Epistaxis
Common causes:
Nosebleed is not always related to an underlying condition. It may
be caused by:
•Trauma
•Blowing your nose very hard
•Dry air
•Nose picking
•Blood thinners
•High blood pressure
Self-treatment: Self- care steps that may be helpful in some less- serious cases:
•Keep the head higher than the level of the heart

•Stay upright, do not lie down
•Hold the nose for at least five minutes. Repeat if necessary
•Apply ice to the nose
•Pinch all the soft parts of the nose together between the thumb and index
finger
•Blow nose as little as possible and only very gently
•Keep the house humidified
•Follow the instructions that come with nasal decongestants - overusing can
cause nosebleeds
•If child below two years has a nosebleed

•Nosebleeds come and go regularly

•Bleeding for longer than 20 minutes
•Bleeding is heavy and lot of blood is lost
•Difficulty in breathing
•Large amount of blood has been swallowed leading to vomiting
•Nosebleed caused during car crash
•Person is on blood- thinning medicine (anticoagulant) such as warfarin or has a
clotting disorder such as hemophilia and the bleeding doesn't stop.
3. Sinusitis
• is a common condition in which the lining of the sinuses becomes inflamed.

It's usually caused by a viral infection and often improves within two or three
weeks.
Symptoms of sinusitis include:
•a green or yellow discharge from your nose
•a blocked nose
•pain and tenderness around your cheeks, eyes or forehead
•a sinus headache
•a high temperature (fever) of 38C (100.4F) or more
•toothache
•a reduced sense of smell
•bad breath (halitosis)
3. Sinusitis
3. Sinusitis
Common Causes:
• Sinusitis can be caused by infection, allergies, air pollution, or structural

problems in the nose. Most cases are caused by a viral infection. Recurrent
episodes are more likely in persons with asthma, cystic fibrosis, and poor
immune function.
3. Sinusitis
Can help relieve symptoms by:
•taking over-the-counter painkillers such as paracetamol or ibuprofen

•using nasal decongestants – these shouldn't be used for more than a week, as
this might make things worse
•holding warm packs to your face
•regularly cleaning the inside of your nose with a saline solution – you can
make this at home yourself or use sachets of ingredients bought from a
pharmacy
3. Sinusitis
Common Diagnostic test/procedures:
•Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted
through your nose allows your doctor to visually inspect the inside of your sinuses.
•Imaging studies. A CT scan shows details of your sinuses and nasal area. It's not
usually recommended for uncomplicated acute sinusitis, but imaging studies might
help find abnormalities or suspected complications.
•Nasal and sinus samples. Lab tests aren't generally necessary for diagnosing acute
sinusitis. However, when the condition fails to respond to treatment or is worsening,
tissue samples (cultures) from your nose or sinuses might help find the cause, such as
a bacterial infection.
•Allergy testing. If your doctor suspects that allergies have triggered your acute
sinusitis, he or she will recommend an allergy skin test. A skin test is safe and quick
and can help pinpoint the allergen that's causing your nasal flare-ups.
4. Post-Nasal Drip/Upper Airway Cough Syndrome(UACS)
• Accumulation of mucus at the back of the nose and throat causing a

sensation of mucus dripping downward.
Causes:
• Postnasal drip Postnasal drip is commonly caused by allergies such

as hayfever. Postnasal drip is usually caused by certain changes in the
environment or the body. One of the most common causes of postnasal drip is
an allergy.
Signs/Symptoms:
• Postnasal drip Symptoms of sinusitis can include fever, weakness, fatigue,

cough, and congestion. There may also be mucus drainage in the back of the
throat, called postnasal drip.
Treatment:
Self-treatment: Self- care steps that may be helpful in some less- serious cases:
•Sleep with your head slightly elevated
•Stay properly hydrated
•Drink warm fluids such as tea, soup
•Rinse your sinuses
•Postnasal drip is accompanied by fever
•Producing green, yellow or bloody mucus
•Producing mucus that has a strong odor
•Wheezing, losing breath and (or) fainting
5. Nasal Polyps
• are noncancerous growths within the nose or sinuses

5. Nasal Polyps
Causes:
•The exact cause is not known. It develops when the mucosal lining of the nose
or sinuses is inflamed. Evidence suggests that people with polyps have a
different immune response and chemical markers compared to normal people.
•The risk factors include:
•Asthma
•Recurring infections
•Allergic fungal sinusitis
•Cystic fibrosis
•Aspirin sensitivity
5. Nasal Polyps
Symptoms:
The patient may not be aware of the presence of polyps. Large polyps or
multiple polyps may block nasal passages.
The common symptoms include:
•Runny nose
•Nasal congestion
•Sneezing bouts
•Breathing throught the mouth
•Headache or facial pain
•Snoring
•Reduced sense of smell
•Loss of sense of taste
5. Nasal Polyps
CT scan: CT scan of nasal cavity can help to look at the size and location of the
polyp.
Endoscopy: An endoscope is used to examine the nasal passages.
Skin scratch test: Allergens are pricked into the skin and signs of a reaction on
the skin are checked.
5. Nasal Polyps
Medication:
Corticosteroids: To reduce inflammation.
Oral corticosteroids: To reduce inflammation.
Antihistamine: To treat allergies.
Antibiotics: To treat infections.
Self-care:
•Avoid allergens like dust
•Wash hands regularly and thoroughly
6. Nasal septal abscess
• is a condition of the nasal septum in which there is a collection of pus

between the mucoperichondrium and septal cartilage.
Causes:
• The most common cause of nasal septal abscess is trauma to the nose
which results in bleeding within the nasal septum. The blood then pools
within the nasal septum resulting in ‘haematoma’. This haematoma over a
period of time gets infected with bacteria eventually resulting in pus
collection (abscess). The most common bacteria implicated in such cases
are Staphylococcus aureus.
Signs/Symptoms:
• An individual with nasal septal abscess generally gives a history of trauma

or nasal surgery. Presence of an abscess within nasal septum is manifested
by increasing nasal blockage, pain and redness over nasal bridge or nasal
tip. As the nasal blockage progresses, it leads to difficulty in breathing.
Fever, headache and malaise are also seen in an individual with nasal septal
abscess.
Treatment:
• Nasal septal abscess A nasal septal abscess is frequently a result of a

secondary bacterial infection of a nasal septal hematoma. Treatment for a
nasal septal abscess is similar to that of other bacterial infections.
Aggressive broad-spectrum antibiotics may be used after the infected area
has been drained of fluids.
Problems of the Throat
1. Tonsilitis
• Is inflammation of the tonsils in the upper part of the throat. Tonsillitis is a

type of pharyngitis that typically comes on fast (rapid onset). Symptoms
may include sore throat, fever, enlargement of the tonsils, trouble
swallowing, and large lymph nodes around the neck. Complications include
peritonsillar abscess.
Causes:
•Tonsillitis is generally caused by a common viral infection such as common

cold or sometimes by a bacterial infection.
•Tonsillitis spreads through:
•Direct contact with infected person
•Droplets from sneezing or coughing
•Contaminated surfaces, objects, utensils, clothes, etc
•Food and water shared with the infected person
•Oral sex
•The risk factors include:
•Age - Children are more prone to infection
•Close contact with infected person
Physical examination: To check for signs of infection of tonsils, nose and ears
and for enlargement of spleen.
Palpating the lymph nodes: Gently feeling the swelling in lymph nodes in the
neck.
Throat culture: Secretion sample from throat examined microscopically.
Complete blood count (CBC): To assess the levels of blood cells and
determine the cause of tonsillitis.
Treatment:
Medication:
Antibiotics: To treat bacterial tonsillitis.
Procedures:
Tonsillectomy: Surgery to remove tonsils in cases of frequent or severe
tonsillitis.
Self-care:
•Wash hands properly .
•Avoid sharing food, water, utensils, etc.
•Do not send the child to school to prevent spread of infection.
•Provide plenty of fluids.
•Make the child gargle with saltwater.
Nutrition
2. Laryngitis
• Laryngitis is inflammation of the larynx (voice box). Symptoms often

include a hoarse voice and may include fever, cough, pain in the front of
the neck, and trouble swallowing. Typically, these last under two weeks.
Causes:
•Caused by over usage of voice box or infections.

•The possible causes for acute laryngitis are:
•Viral infections
•Overuse or strain on vocal cords
•Bacterial Infections
•Acid reflux
•Fungal infections
•Paralysis of vocal cords
Symptoms:
Some of the common symptoms indicating laryngitis are:

•Hoarseness
•Impaired voice
•Difficulty in speaking
•Dry and sore throat
•Dry cough
•Constant tickling or irritation in throat

Laryngoscopy: To check for a persistent cough, hoarseness, and
inflammation by looking into the back of the throat.
Biopsy: For further examinations, sample is taken from the back of the
throat.
Medication:
Antibiotics: To reduce bacterial infection.
Corticosteroids: To reduce vocal cord inflammation.
Antacids: Reduce acidity of stomach acid, if the cause is acid reflux.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Reduce pain, inflammation and
fever.
Self-care:
•Gargle with warm water
•Give rest to the voice
•Increase the intake of fluids
•Avoid alcohol and caffeine
•Avoid decongestants as these can dry out the throat
•Avoid whispering as it puts more strain on voice than normal speech
3. Throat Cancer
• Refers to cancer of the voice box, the vocal cords, and other parts of the
throat, such as the tonsils and oropharynx. Throat cancer is often grouped
into two categories: pharyngeal cancer and laryngeal cancer. Throat cancer
is relatively uncommon in comparison to other cancers.
Causes:
Throat cancer occurs when cells in your throat develop genetic mutations.
These mutations cause cells to grow uncontrollably and continue living after
healthy cells would normally die. The accumulating cells can form a tumor
in your throat. It's not clear what causes the mutation that causes throat
cancer. But doctors have identified factors that may increase your risk.
Signs/Symptoms:
1. Persistent cough
2. Difficulty swallowing
3. A lump in the mouth, throat or neck
4. Hoarseness or other voice changes
5. Ear or jaw pain
6. White patches or sores in the mouth or throat
7. Difficulty breathing
8. Headaches
9. Unexplained weight loss
10. Swelling of the eyes, jaw, throat or neck
11. Bleeding in the mouth or nose
Diagnosis:
•Physical examination/lab tests. The doctor will feel for any lumps in the neck, lip, gums, and
cheeks. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and
often use a mirror to get a clearer view of these structures. Although there is no specific
blood test that detects laryngeal or hypopharyngeal cancer, several laboratory tests, including
blood and urine tests, may be done to help determine the diagnosis and learn more about
the disease.
•Laryngoscopy. A laryngoscopy can be performed in 3 ways:

• Indirect laryngoscopy. Before this procedure, the doctor often sprays the mouth and
throat with a local anesthetic to numb the area and prevent gagging. The doctor then
uses a small, long-handled mirror to see the vocal folds.
• Fiber optic laryngoscopy. During this procedure, the doctor inserts a flexible, lighted
tube through the person’s nose or mouth and down the throat to view the larynx and
hypopharynx. The nose is often sprayed with a local anesthetic to make the procedure
more comfortable.
Diagnosis:
•Direct laryngoscopy. This procedure is done in an operating room, and the person receives a
sedative or general anesthetic to block the awareness of pain. The doctor then views the larynx
and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy
(see below) is often taken during a direct laryngoscopy. Frequently, the doctor will recommend a
triple endoscopy, a procedure done under general anesthesia to examine the ear, nose, and
throat area, as well as the trachea and the bronchus, which are located next to the lung and the
esophagus.
Treatment:
Radiation therapy
Radiation therapy uses high-energy beams from sources such as X-rays and
protons to deliver radiation to the cancer cells, causing them to die.
Surgery
•Surgery for small throat cancers or throat cancers that haven't spread to
the lymph nodes. Throat cancer that is confined to the surface of the throat
or the vocal cords may be treated surgically using endoscopy. Your doctor may
insert a hollow endoscope into your throat or voice box and then pass special
surgical tools or a laser through the scope. Using these tools, your doctor can
scrape off, cut out or, in the case of the laser, vaporize very superficial cancers.
Surgery to remove all or part of the voice box (laryngectomy). For smaller
tumors, your doctor may remove the part of your voice box that is affected by
cancer, leaving as much of the voice box as possible. Your doctor may be able
to preserve your ability to speak and breathe normally.
Surgery to remove part of the throat (pharyngectomy). Smaller throat

cancers may require removing only small parts of your throat during surgery.
Parts that are removed may be reconstructed in order to allow you to swallow
food normally.
Surgery to remove cancerous lymph nodes (neck dissection). If throat cancer

has spread deep within your neck, your doctor may recommend surgery to
remove some or all of the lymph nodes to see if they contain cancer cells.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells.
Chemotherapy is often used along with radiation therapy in treating throat
cancers. Certain chemotherapy drugs make cancer cells more sensitive to
radiation therapy. But combining chemotherapy and radiation therapy
increases the side effects of both treatments.
Targeted drug therapy

Targeted drugs treat throat cancer by taking advantage of specific defects in
cancer cells that fuel the cells' growth.
As an example, the drug cetuximab (Erbitux) is one targeted therapy approved
for treating throat cancer in certain situations. Cetuximab stops the action of
a protein that's found in many types of healthy cells, but is more prevalent in
certain types of throat cancer cells.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Your body's
disease-fighting immune system may not attack your cancer because the
cancer cells produce proteins that help them hide from the immune system
cells. Immunotherapy works by interfering with that process.

Care For Clients With Eye, Ear

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Care For Clients With Eye, Ear

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Care for Clients with

(EYES, EARS, Nose, and

• Ptosis can affect one or both eyes. It may

1. Ptosis crutch is a nonsurgical option that involves adding an

Nursing management/ Treatment:

• Intense Burning feeling in the • You experience allergic conjunctivitis when

Chronic Bacterial Conjunctivitis- conjunctivitis most commonly is caused by Staphylococcus

Nursing management/ Treatment:

• Red or Pink eye

• Clinical; sometimes viral cultures or immunodiagnostic testing is indicated

5. Warm compress to the effected eye to relieve symptoms.

•is usually a benign suppurative conjunctivitis

• It is spread by contaminated genital secretions and

Symptoms of chlamydial conjunctivitis usually develop slowly. One or

•Some of the main symptoms of a chlamydial eye infection include:

•If you have chlamydia or chlamydial conjunctivitis, your sexual partner(s)

Disorders of the Cornea

• The cornea is prone to a variety of injuries by virtue of its

• Very painful, tearing, foreign body sensation

1. Applying a cycloplegic medication, antibiotic ointment, and a patch (unless a

• Keratitis refers to inflammationof the cornea. It can be caused by

• Staphylococcus aureus is the most common bacterial infection.

• Common symptoms include photophobia, pain, and lacrimation.

Antifungal eye drops: To treat fungal keratitis.

Antivirals: To prevent the causative virus from reproducing.

Eye examination: To check for visual acuity (clarity of vision).

• is the deviation of one eye from the other when

• The deviation may be upward, downward,

•Diplopia (double vision) is the primary symptoms

•Cover/uncover test: to measure the deviation and movement of the eyes.

Other treatments may include medicines and eye exercises.

Two Major forms:

1. Pendular nystagmus- is characterized by a regular

2. Jerk nystagmus- one phase of the eye movement is

•Congenital that is passed from parents

• Is a reduction or dimness of vision related to altered development of

• The condition is treatable using corrective glasses, eye patches, eye

Anticholinergics: Given in the form of mild drops to blur vision in the

Optical penetrating keratoplasty: Replace part of the cornea with corneal

Blind spot is not always related to an underlying condition. It may

•Directly viewing the sun

• It may appear as a blind spot, a dark spot, a light spot, a flickering

• The diagnosis of this disease usually begins with a physical

See a doctor if you notice:

See a doctor immediately if you notice:

• Is a cloudy or opaque area in the ocular lens and leads

Risk factors associated with cataract development (after infancy)are:

•Ageing -people above 55 years of age are at higher risk

Cataracts usually progresses gradually. Most age-related cataracts may

•Clouded or blurred vision

Common tests & procedures:

• Cataracts can be removed completely through surgery.

• A condition where the eye’s optic nerve, which provides

The other causes may include:

Initially the condition remains asymptomatic but the gradual progression

Common tests & procedures:

Tonometry: To measure the inner pressure of the eye.

Trabeculectomy: Conventional surgery for glaucoma done to remove the

• is a common cause of visual impairment and blindness. Risk factors

Rhegmatogenous retinal detachment (full thickness retinal breaks

•Risk factors include:

•Sudden appearance of many floaters