NCM 216 LEC: EENT

PRELIMS – LECTURE 1

2nd SEMESTER | A.Y. 2022 – 2023

EYES b. Bulbar conjunctiva – white in color and

OUTLINE is found at the upper eyelids

I. Anatomy and Physiology of the eyes

II. Assessment
II. Lacrimal Apparatus
III. Diagnostic Tests Lacrimal gland and its lacrimal ducts
IV. Common Pharmacologic Agents
V. Eye Disorders III. Meibomian glands – plays a role in the
production of oils to lubricate eyeballs
ANATOMY AND PHYSIOLOGY OF THE EYES keeping it from drying.
 A multichambered, almost spherical structure IV. Aqueous humor – water-like
V. Vitreous humor – gel-like
 Located in the anterior portion of the orbit
A. External Layer
a. Sclera
- Opaque white tissue
b. Cornea
- Dense transparent layer
- The “window” of the eye
c. Corneoscleral junction
- Also known as LIMBUS
- Transitional zone through which
aqueous humor leaves the eye

B. Middle Layer
– vascular and heavily pigmented; pigmented due
to melanin
a. Choroid
- Dark brown pigmented membrane
- Lines most of the sclera and is
attached to the retina
- Contains many blood vessels
b. Ciliary body
- Connects the choroid with the iris
- Secreted aqueous humor which gives
the eye its shape
c. Iris
- Colored portion
- Located behind the cornea and in front
of the lens
- Has a central opening called PUPIL
 Pupil – control the amount of
FUNCTIONS OF THE EYES
light that enters the eye
 Refraction - Darkness – dilatation (mydriasis)
 Process of bending light rays - Light – constriction (miosis)
 Accommodation  Lens – lies behind the iris
 Ability of the eye to focus on close subjects  Bends the rays of light
 Pupillary constriction entering through the pupil
 Ability of the pupil to regulate the lights

EXTERNAL STRUCTURES
I. Conjunctiva
a. Palpebral conjunctiva – pinkish, and is
found at the lower eyelids

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C. Inner Layer NERVES OF THE EYE
a. Retina  Cranial Nerve II
- Made up of sensory receptors that transmit - Optic nerve (nerve of sight)
impulses to the optic nerve  Cranial Nerve III, IV, VI
- Contains blood vessels and 2 type of - Innervate the muscles around the eye
photoreceptors;
 Rods – work at low light and ASSESSMENT
for peripheral visions
 Cones – active at bright levels ASSESSMENT OF VISION
and provide color and central  Inspection
vision - Appearance of the eye, symmetry, color
 Macula 1. Exophthalmos – proptosis; protrusion of
- Yellow spot near the center of the the eyeball
retina 2. Enophthalmos – sunken eyeballs
- Responsible for central vision 3. Entropion – inversion of lid margin
 Fovea 4. Ectropion – eversion of the lower lid
- Small pit; an indentation in the center 5. Ptosis – drooping of the eyelids
of the macula
 Optic disk  Pupil
- Creamy pink to white depressed area - Check for similarity of shape, size, and
in the retina reaction
- Called “blind spot” 1. Isocoria – equal pupil size
 Vitreous humor 2. Anisocoria – 1 pupil larger than the
- Jell-like substance that maintains the other
shape of the eye - PERRLA (Pupil Equally Round and
Reactive to Light and Accommodation)
EXTERNAL STRUCTURES
 Eyelids and eyelashes  Visual Acuity Test
- Protect the eye from foreign particles - Measures the client’s distance and
 Conjunctiva near vision
a. Palpebral conjunctiva - Snellen chart/ Illiterate E Chart
- Pinks; lines inner surface of eyelids

b. Bulbar conjunctiva

- White with small blood vessels, covers

anterior sclera

 Lacrimal Apparatus (Lacrimal Gland and Its

Ducts and Passages)
- Produces tears to lubricate the eye
and moisten the cornea
 Meibomian glands
- Secrete oily secretions which prevents
the overflow of tears

MUSCLES OF THE EYE - Set patient at 20 feet

Extraocular muscles - Normal vision: 20/20 – 20/50
- Rectus muscles - The client is able to read the
- Oblique muscles procedure at 20 feet what a healthy
- Levator palpebrae eye can read at 50 feet
- 20/200 - legally blind
- if patient cannot see set at 10 ft, then
5 ft

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 - if patient cant still see procced to : - The dye outlines the corneal
a. Counting numbers (CF) – if (-) irregularities that are not visible
b. Hand Movement (HM) – if (-)
COMMON PHARMACOLOGIC AGENTS
c. Negative light perception (NLP)
1. Mydriatic agents
- Cause pupillary dilatation
 Extraocular Muscle Function
- Used in requiring pupil to be dilated
- E.g., Scopolamine (Isopto Hyoscine);
Cyclopentolate (Cyclogyl);
Tropicamide (Mydriacyl);
Phenylephrine (AKDilate, Mydfrin)
2. Miotic Agents
- Cause intense miosis and contraction
of the ciliary muscle
- Decrease intraocular pressure
- Used/ for treatment of glaucoma
- E.g., Acetylcholine (Miochol);
Carbachol (ISO carbachol, Niostat);
Pilocarpine (Pilocar, Isopto Carpine)
3. Osmotic Diuretics
 Test for Color Vision
- Used for reduction of IOP or before
- Shihara Chart
ocular surgery
- Use of polychromatic plates
- Mannitol (Osmitrol); Glycerin
- Each eye is tested separately
(Glycerol)
- Sensitive for the diagnosis of red/
4. Ophthalmic Anti-Infectives
green blindness
- Used for treatment of ophthalmic
infections
DIAGNOSTIC TESTS FOR THE EYE
- E.g., Tobramycin (Tobramycin,
 Fundoscopy
Tobrex); Gentamycin (Garamycin,
- Used to examine the health of the
Genoptic); Bacitracin (AK-Tracin)
retina and vitreous humor
5. Ophthalmic steroid antiinflammatory
- Pupils should be dilated prior to the
- To relieve pain
procedure
- Suppress other inflammatory
- Set ophthalmoscope 6 inches away
processes of the conjunctiva, cornea,
from patient’s eye
lid, and interior segment of the globe
- Look for RED REFLEX that indicates
- Dexamethasone (Maxidrex,
reflection of light in the retina
Decadron); Fluorometholone (FML,
 Tonometry
Flarex)
- Measures IOP by determining the
6. Carbonic anhydrase inhibitors
amount of force needed to indent a
- Used in combination regimen to treat
portion of the anterior globe
glaucoma and postoperative rise in
- Principle: a soft eye is easier to indent
IOP
than a hard eye
- Acetazolamide (Diamox);
- Normal IOP – 11-21 mmHg
Methazolamide (Neptazane)
 Slit Lamp
- Allows examination of the anterior DISORDERS OF THE EYE
ocular structures under microscopic
magnification INFECTIOUS AND INFLAMMATORY CONDITIONS
- Help detect disorders of the anterior OF THE EYE
portion of the eye
 Conjunctivitis
 Corneal Staining
a. Inflammatory
- Consist of placing fluorescein or other
- Due to allergens
topical dye into conjunctival sac
- non-contagious
- A blue light is directed in the eye
- treated with vasoconstrictors/
corticosteroid

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 b. Infectious - Instruct in the use of cool compresses
- Due to staph, chlamydia, Neisseria - wear dark glasses for photophobia
- Contagious - Instruct the child to avoid rubbing the eye
- Treated with broad spectrum - D/C use of contact lenses & to obtain new lenses
antibiotics to eliminate the chance of re-infection
- Instruct patient that eye make-up should be
Signs and symptoms
discarded & replaced
1. Itching, burning or scratchy eyelids
2. Redness CORNEAL DYSTROPHIES
3. Conjunctival edema - rare conditions in which the cornea is altered
4. Excessive tearing without the presence of any inflammation,
5. Discharge infection or other eye disease
- Runs in families
 Blepharitis
- Inflammation of the eyelid margins TYPES
- Itchy, red, burning eyes, flaking I. Epithelial: epithelial layer of the cornea
- Warm compress
a. Meesman: occasional 'foreign body'
 Hordeolum (Stye)
sensation
- Chalazion
- Acute suppurative infection of the b. Epithelial membrane (COGAN’S
follicle of an eyelash dystrophy):painful 'foreign body'
- Usually due to Staphylococcus sensations
- Redness and pain c. Reiss buckler: light sensitivity and
- Purulent discharges 'foreign body' sensations
- Antibiotics/ I & D
II. STROMAL DYSTROPHIES
- Warm compress 4-5 times a day
a. Granular: grey-ish dots can be seen through a
microscope.
b. Macular : Irregular, cloudy areas
c. Lattice: 'foreign body' sensation and a slight
deterioration in vision

III. ENDOTHELIUM: innermost layer of the cornea

1. Fuch’s: begins at 40 painless deterioration of vision

and glare - next stage, painful episodes

2. Kerotoconus: - conical or cone-shaped cornea

 Keratitis
- Inflammation of the cornea
- S/S: pain, reduced vision, cloudy lens,
photophobia, difficulty opening the
eye, abrasion, ulceration,
- May be temporary or permanent

NURSING CARE
- Instruct in infection control measures
- Administer antibiotic or antiviral
- Administer antihistamines
- Child should be kept home from school until
antibiotic eye drops have been administered for 24
hrs

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