Diseases of the Eyes, Ears, Nose, and Throat- 2

Dr. Maha Al-Sedik

Pathophysiology of the eyes

Path

op

hysi

olo

gy

Burns of eye and adenexa

Conjunctivitis

Corneal abrasion

Foreign body

Inflammation of eye lid

Iritis

Retinal detachment

Hyphema

Burns of the Eye and Adnexa

Causes

Chemicals Heat Light rays

Thermal burns:

Occur when a patient is burned in the face during a

fire.

Bright light:

Generally not painful.

May result in permanent damage.

Chemicals:

According to the substance and its concentration.

Superficial burns of the eye:

• May not be painful initially

• Symptoms include:

Conjunctivitis.

Redness.

Swelling.

Excessive tear production.

Assessment and management:

Assess for and treat life-threats.

May be difficult if eyes are closed

o Open the eye and irrigate with sterile water or

sterile saline solution.

o Pain may have to be managed before assessment.

Cover an eye burned by ultraviolet light with:

o Sterile, moist pad

o Eye shield

Transport in a supine position.

Chemical burns require immediate irrigation.

o Direct as much fluid as possible.

o Do not allow contaminated fluid to enter the eye.

o Irrigate for at least five minutes.

Morgan lens (eye irrigation device)

Use of the Morgan lens (eye irrigation device):

Administer a topical anesthetic.

Connect the lens to the IV bag, and let it

drip.

Slide the Morgan lens under the eyelids.

Run the fluid at the desired rate.

To remove a hard lens, use a small suction cup.

To remove soft lens, pinch between thumb and index

finger and lift off eye.

How to deal with contact lens?

Conjunctivitis

Conjunctiva becomes inflamed and red.

Often starts in one eye and spreads to the other eye.

Often caused by bacteria, viruses, allergies, or

foreign bodies.

Assessment and management:

Perform general assessment of vision.

Viral conjunctivitis resolves on its own.

Bacterial conjunctivitis: topical antibiotic.

Allergic conjunctivitis: topical antihistamine.

Corneal Abrasion

Painful.

Due to superficial trauma to

the cornea.

If discomfort does not resolve,

patient should be seen in the

emergency department.

Management:

Invert the eyelids to expose the source.

Look for a foreign body in the eye.

A topical anesthetic may relieve symptoms.

If movement of the eye causes discomfort, cover

both eyes.

Foreign Body

• Can cause significant pain.

Assessment and management

Evaluate the entire eye using a light.

Examine the undersurface of the upper eyelid.

• If you spot a foreign object on the surface,

attempt to remove it with a moist, cotton-tipped

applicator.

To assist with dislodging:

• Irrigate the eye with a sterile saline solution.

• Transport the patient to the hospital.

Do not remove an impaled foreign body.

Stabilize in place.

Cover with a moist, sterile dressing.

Place a protective barrier over the object.

Cover unaffected eye.

Transport promptly.

Inflammation of the Eyelid (Chalazion and Hordeolum)

Oil glands and oil ducts may

become blocked, causing:

• Chalazion: swollen bump on the

external eyelid.

• Hordeolum (stye): red tender

lump in the eyelid or the lid

margin because of inflammation

of the lash root.

Assessment and management:

Often painful especially if stye.

Treat inflammation with a warm washcloth.

Transport to the emergency department.

Iritis:

Inflammation of the iris

Acute causes include:

• Trauma.

• Irritants.

• Infection.

Chronic causes include:

• Autoimmune diseases.

Assessment and management

Red area surrounding the iris, cloudy vision, or an

unusually shaped pupil.

Focus on history.

Acute iritis: may respond to topical

corticosteroids.

Chronic iritis: should be referred to a specialist.

Retinal Detachment and Defect

Potential result of blunt eye trauma

Assessment and management:

• Generally painless

• Produces:

Flashing lights

Specks

“Floaters”

• Requires immediate medical attention.

Hyphema

Bleeding into the anterior

chamber of the eye

◦ Obscures vision

◦ Blood clotting is a concern.

◦ Can cause a rise in

intraocular pressure

Assessment and management:

Pain and blurred vision is likely.

Blood may be visible.

If rupture of the globe is suspected, take

spinal motion restriction precautions.

If no contraindications, transport upright.

Other medications with antiplatelet

effects should be avoided.

An anxiolytic may facilitate transport.

THANK YOU