Eyes - PowerPoint PPT Presentation


Title: Eyes


1
Eyes Ears
  • BS
  • Chapter 11

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The Senses
  • The sensory system serves to protect an
    individual by detecting changes in the
    environment
  • An external environmental stimuli travels through
    the CNS into a sensory (afferent) nerve and
    leaves through an motor (efferent) nerve to the
    effector (muscle or gland or organ)

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Stimulus
  • The initiation of an impulse in a nerve
  • An excitant or irritant

4
Receptor
  • The part of the nervous system that detects a
    stimulus is called a receptor

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Ophthalmology
  • The health and science dealing with the eye and
    its diseases

6
Ophthalmologist
  • A Physician who specializes in the treatment of
    disorders of the eye

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The Eye Vision
  • In the embryo, the eye is formed as an out -
    pocketing of
  • the brain
  • The eye is very delicate and is
  • greatly protected

8
Protection of the eye
  • The skull bones help form the walls of the eyes
    orbit or cavity
  • The skull protects more than ½ of the dorsal part
    of the eye
  • The eyelid protects the front of the eye. The
    eyelid can be closed and keeps the particles out
    of the eye. Blinking helps to keep the eye
    lubricated

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  • We have a muscle that when it contracts, keeps
    the eye open. In old age, this muscle weakens
    and the eye doesnt stay open, this is called
    Ptosis
  • Eyelashes and eyebrows keep foreign matter out of
    the eye

10
Conjunctiva
  • A thin membrane that lines the eyelid and covers
    the anterior portion of the eyeball
  • You can see the conjunctiva if you pull the lower
    eyelid down, its the pink part
  • Cells within the conjunctiva produce mucus that
    aids in lubricating the eye
  • As the conjunctiva extends from the eyelid to the
    front of the eye, a sac is formed where eye drops
    can be placed

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Conjunctivitis - Pinkeye
  • The membrane that lines the eyelid becomes
    irritated or a pathogen enters
  • The treatment is usually a general eye drop such
    as gentamycin opthalmic drops. Cortisone can be
    added to the drops if there is a great deal of
    itching and burning.
  • Conjunctivitis can be contagious, good
    handwashing and non-sharing of pillow,
    washclothes is encouraged. Enc. Pt NOT to rub
    eyes, infection may spread

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Conjunctivitis
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Pt looking up conjunctiva is seen
  • 1) The Limbus is the junction of the
    conjunctiva and cornea.
  • 2) The conjunctiva
  • 3) The tarsal conjunctiva
  • 4) The tarsus (more
  • conjunctiva)
  • 5) Punctum
  • 6) The marginal conjunctiva is at the eyelid
    margin where the epithelium will begin to be
    keratinized.

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Lacrimal Duct or gland
  • Tears are produced by the lacrimal gland
  • Tears are formed to lubricate the cornea
  • and conjunctiva
  • The actual lacrimal
  • gland is near the outer eyebrow

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Tears
  • Fluid produced by the lacrimal gland to moisten
    the cornea and conjunctiva contain the enzyme
    lysozyme.
  • This enzyme lysozyme, protects against bacterial
    invasion
  • Tears drain into the inner canthus and drain into
    the punctum which is a hole in the inner eye,
    this drains into the nasolacrimal duct

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Where do tears go
  • If tears arent streaming down ones cheeks, they
    are carried into ducts near the nasal corner of
    the eye where they drain into the nose by way of
    the nasolacrimal ducts
  • Once the tears run through these ducts, they
    cause a runny nose. These ducts can be clogged
    at times

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Coats of the eyeball
  • The eyeball has 3 coats or tunics
  • 1. Sclera
  • 2. Choroid
  • 3. Retina

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Sclera
  • This is the white of the eye
  • The sclera is made of tough connective tissue
  • The sclera circles all the way around the back of
    the eyeball and when it reaches the front of the
    eyeball, it becomes the cornea

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Choroid
  • This is the delicate network of connective middle
    layer
  • This choroid layer is laced with blood vessels
    and brown pigment and prevents incoming light
    rays from scattering and reflecting off the inner
    surface of the eye

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CHOROID
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Back of the eye
  • The blood vessels in the back of the eye can
    reveal signs of disease (see picture on pg 185)
  • One can see these vessels by using an
    opthalmascope

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Retina
  • This complex structure has multiple layers and
    the retina is the actual receptor layer of the
    eye
  • The multiple layers contains 10 layers of rods
    and cones which generate the nerve impulses
    associated with vision
  • The rods and cones in the retina requires vitamin
    A. If Vit A is lacking, a person may have
    difficulty seeing in dim light to activate the
    rods. A deficiency in vit. A night blindness

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Rods Cones the receptor cells of the eyes
  • RODS sensitive to light, rods function in dim
    light, images are not sharp, you see in gray.
    There are about 120 million rods in each retina.
    Rods are distributed more towards the front of
    the retina
  • CONES function in bright light, sensitive to
    color such as red, green, blue and give sharp
    images. There are about 6 million cones in each
    retina. Cones are located near the center of the
    retina in a pitted area known as the fovea
    centralis

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Rods Cones in the Eye
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Entering a dark room
  • When you enter a dark movie theatre, you cannot
    see for a moment. Your pupils enlarge so you can
    try and see more clearly.
  • At this time, the rods are beginning to work,
    when you can see again, the images are blurred
    and you can only see objects in gray because the
    rods are not able to differentiate color

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Nerve impulses from rods and cones
  • Nerve impulses from rods and cones flow into
    sensory neurons that eventually form the optic
    nerve
  • The optic nerve, which is the 2nd cranial nerve,
    connects to the retina at the back of the eye and
    is then connected to the occiptial lobe of the
    brain
  • The impulses travel through the optic nerve to
    the visual center of the brain which is the
    occipital lobe

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Lights path through the eye (how does light
travel)
  • As light rays pass through the eye towards the
    retina, the rays travel through a series of
    transparent, colorless parts
  • On the way, the light rays become bent
    (refracted). This refraction of the rays make it
    possible for light from a very large area, to be
    focused on a very small surface to the retina
    where the receptors are located. At this point,
    the rays also become overrefracted (turned
    upside down and backwards), The visual centers of
    the brain must reverse the images

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Light must pass through these parts in order to
see
  • This is from the outside where we see the light
    on into the eye eventually to the retina
  • Cornea
  • Aqueous humor
  • Lens
  • Vitreous body

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Cornea
  • Is a forward continuation of the sclera (see
    picture on pg 185)
  • This part is transparent and colorless whereas
    the sclera we can see is white and opaque
  • The cornea has no blood vessels and is well
    nourished by the fluids that constantly wash over
    it
  • The cornea can become scarred d/t injury
    decreased vision. The cornea can be transplanted

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Cornea
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Aqueous Humor
  • A watery fluid that fills much of the eyeball in
    front of the lens
  • The aqueous humor helps maintain the slight
    forward curve of the cornea
  • In the area where aqueous humor is found is where
    glaucoma is found

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Aqueous Humor
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Lens
  • A clear, circular structure made of firm, elastic
    material. The lens has 2 bulging surfaces and is
    described as bi-convex
  • The lens is important in light refraction because
    of the elasticity, the shape of the eye can
    change and its thickness can be adjusted to
    focus light for near or distant vision

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Lens
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Vitreous Body
  • Soft jelly-like substance that fills the entire
    space behind the lens. This jelly IS NOT
    replaceable
  • The vitreous body helps maintain the shape of the
    eyeball as well in aiding in refraction of light

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Eye Anatomy
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Eye Anatomy
  • 1. Cornea in front, in back of eye is sclera
  • 2. Aqueous humor
  • 3. Lens
  • 4. Retina
  • 5. Vitreous body

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Anterior Parts of the Eye
  • 1. Conjunctiva
  • 2. Cornea
  • 3. Cilliary body
  • 4. Lens

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Muscles of the eye
  • Intrinsic Muscles
  • Extrinsic Muscles

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Intrinsic Muscles
  • In general, these are the circular involuntary
    muscles of the eye.
  • These include the muscles around the iris and the
    pupil and this includes the cilliary muscle.

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The ciliary body is a ring of tissue that
encircles the lens. The ciliary body contains
smooth muscle fibers called ciliary muscles that
help to control the shape of the lens. Towards
the posterior surface of the lens there are
ciliary processes which contain capillaries. The
capillaries secrete the fluid (aqueous humor)
into the anterior segment of the eyeball
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Iris
  • This is the colored part of the eye. Some colors
    include shades of blue, brown, green, hazel. In
    the center of the iris is the pupil.
  • The purpose of the iris is to regulate the amount
    of light entering the eye. In the presence of
    bright light, the cilliary muscles of the iris
    contract, reducing the size of the pupil
    constriction

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Cilliary Muscle stretch the lens
  • Is shaped like a flattened ring with a hole the
    size of the outer edge of the iris.
  • The cilliary muscle alters the shape of the lens
    during the process of accommodation adjustment
    or adaption of the eye while its trying to focus
    on something, usually far away

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Draw a circle.
  • Radial muscles are located around where the iris
    is (think of a radial tire and the treads or like
    the spokes of a bike)
  • Circular muscles are around the pupil
  • When circular contract, radial relax

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Accommodation
  • Adjustment or adaption.
  • The adjustment of the eye for various distances
    where it is able to focus the image of an object
    on the retina by changing the curvature of the
    lens
  • For near vision, the ciliary muscle contracts
    causing increased rounding of the lens and the
    pupils contract
  • The ability to accommodate, decreases with age.

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Pupil
  • The contractile opening at the center of the iris
    of the eye
  • The pupil contracts when exposed to light and
    when the focus is on a near object
  • The pupil dilates when in the dark and when focus
    is on a distant object

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Adjustment of the lens
  • Ciliary muscles help the lens get fatter to see
    things up close
  • Or
  • Thin like a pancake in order to see things far
    away

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Extrinsic Muscles
  • These are the 6 ribbon-like voluntary muscles
    attached to the outer surface of the eyeball.
    These muscles coordinate eye movement and the
    opening of the eyelid
  • These muscles pull on the eyeball in a
    coordinated fashion so that both eyes center on
    one visual field at the same time (convergence).
    Convergence is necessary to the formation of a
    clear image on the retina

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Extrinsic Muscles of the Eye
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Nerve supply to the eye
  • 2 nerves supply the eye
  • We will discuss the optic nerve for this ch.

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Optic Nerve
  • Carries visual impulses from the rods and cones
    to the brain
  • Optic nerve starts from the retina toward the
    medial or nasal side of the eye
  • There are no rods or cones in the area of the
    optic nerve but the optic nerve carries impulses
    only from the rods and cones to the brain

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Optic Disc
  • Because there are no cones or rods near or around
    the optic nerve, no images can form on the
    retina around the optic nerve, at this point,
    this is known as the blind spot or optic disc

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Close to the optic disc
  • There is a tiny depressed or pitted area in the
    retina known as the fovea centralis

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Fovea Centralis
  • The fovea is contained within a yellow spot
    called the macula, with age, this macula
    degenerates
  • This yellowish fovea, contains the highest
    concentration of cones
  • This portion of the area near the optic disc in
    the fovea centralis, is the point of sharpest
    vision

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Vision Problems
  • Ptosis drooping of the eyelid related to
    paralysis, can occur after a stroke

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  • Amblyopia otherwise known as lazy eye. Can
    be treated with eyeglasses.
  • The brain and eyes do not work together properly,
    the brain favors one eye.
  • The brain may suppress the visual image from the
    deviating eye to prevent double vision.
  • This accounts for 50 of childhood amblyopia

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Amblyopia
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Strabismus
  • A deviation of the eye that results from lack of
    coordination of the eyeball muscles. The 2 eyes
    do not work together.
  • In children, when the eyes fail to focus on the
    same image, the brain may learn to ignore the
    input from one eye.
  • This loss of vision is called amblyopia, and it
    is frequently associated with strabismus
  • Convergent strabismus is when the eye deviates
    toward the nasal side and gives the appearance of
    being cross-eyed

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Google says
  • Strabismus, more commonly known as cross-eyed or
    wall-eyed, is a vision condition in which a
    person can not align both eyes simultaneously
    under normal conditions. One or both of the eyes
    may turn in, out, up or down. An eye turn may be
    constant (when the eye turns all of the time) or
    intermittent (turning only some of the time, such
    as, under stressful conditions or when ill).
    Whether constant or intermittent, strabismus
    always requires appropriate evaluation and
    treatment. Children do not outgrow strabismus!

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Treatment
  • If these disorders are not corrected early, the
    transmission and interpretation of visual
    impulses to the brain is decreased. Muscles
    become weakened in the eye and muscle restoration
    must be rebalanced, glasses, eye patch or surgery
    may be needed

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Normal Vision
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Hyperopia
  • Farsightedness caused by a short eyeball, the
    light seen hits the back of the eye (can only see
    far away)
  • The focal point is behind the retina because
    light rays cannot bend sharply enough to focus on
    the retina. Objects must be moved far from the
    eye to be seen clearly
  • Farsightedness is common in infants but it
    corrects itself when the child uses the eyes more
    for near vision
  • Treatment glasses with convex lenses to increase
    the refraction of light rays corrects this visual
    disturbance

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Hyperopia Far Sighted
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Myopia
  • Nearsightedness caused by a long eyeball. The
    cornea bends the light rays too sharply so the
    focal point of the light is in front of the
    retina
  • Distant objects appear blurred and may appear
    clear only if the object is brought near the eye
    (can only see things that are near to you)
  • Treatment a concave lens is used

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Myopia-Near Sighted
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Astigmatism
  • This is due to the irregularity in the curvature
    of the cornea or the lens therefore, light rays
    are incorrectly bent causing blurred vision. A
    person usually has myopia or hyperopia along with
    astigmatism
  • Treatment corrective lenses are required. These
    people have difficulty wearing contacts at times.
    Today, surgical procedures such as refractive
    surgery can be used to correct near or
    farsightedness. The cornea is reshaped to change
    the refractive angle of light as it passes through

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Nystagmus
  • Constant, involuntary cyclical movement of the
    eye balls.
  • Similar to spasms of the eyeball
  • Ill show you ?

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Glaucoma
  • Excess pressure of the aqueous humor. The blood
    constantly produces fluid that circulates in the
    eye and then gets reabsorbed into the
    bloodstream. Interference with the normal
    reentry of this fluid into the bloodstream leads
    to increased pressure inside the eyeball
  • This condition occurs slowly, optic nerve damage
    occurs and poor vision is noticed

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Glaucoma
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Normal
Mild Glaucoma
Severe Glaucoma
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Cataracts
  • Is an opacity of the lens or the outer covering
    of the lens
  • Early cataracts causes a gradual loss of
    sharpness or (visual acuity). Untreated
    cataracts complete loss of vision
  • Surgical removal of the lens and placement of an
    artificial lens is successful.
  • Age, diabetes and exposure to UV rays may cause
    cataracts

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Cataract
Normal
  • Cataract

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Caracts
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Diabetic Retinopathy
  • The retina is damaged by blood vessel hemorrhages
    and growth of new vessels. Blood vessels in the
    eye are tiny and get filled with plaque or too
    much sugar d/t uncontrolled diabetes and they
    tear away from the retina and eyeball. Blindness
    can occur

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Diabetic Retinopathy
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Retinal Detachment
  • The retina becomes separated from the underlying
    layer of the eye as a result of trauma or an
    accumulation of fluid or tissue between layers.
    Can occur slowly or suddenly. If left untreated,
    blindness will occur d/t total detachment of
    retina
  • Surgery includes a spot welding with electric
    current or a weak laser beam. A series of
    pinpoint scars (connective tissue) develops to
    reattach the retina. Pt must lay face down for
    up to 48 hours after surgery to heal

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Retinal Detachment
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Macular Degeneration
  • The macula or yellow area of the retina that
    contains the fovea centralis, (the point of
    sharpest vision), changes or becomes distorted.
    Either material accumulates on the retina or
    abnormal blood vessels grow under the retina
    causing it to detach.
  • Surgery may stop the growth of blood vessels and
    delay vision loss. Causes are smoking, exposure
    to sunlight, and high cholesterol diet, can be
    hereditary

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Macular Degeneration
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Severe Macular Degeneration
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Eye Drops used in the Ophthalmologist's office
  • Class
  • Mydriatics used to dilate the pupil for
    opthalmic exams
  • Big word Big pupil
  • The D in this word dilates
  • Atropine eye drops

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Eye Drops used in the Ophthalmologist's office
  • Miotics used to constrict the pupil
  • Little word, little pupil
  • Pilocarpine constricts the ciliary muscles and
    pupil to increase the aqueous humor outflow so it
    wont get stuck

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Ophthalmoscope
  • A lighted instrument, one of the most important
    tools of the physician, used to examine the
    interior of the eye, including the lens, retina
    and optic nerve
  • The ophthalmoscope is equipped with a rotating
    disc of lenses to permit the eye be examined at
    different depths and magnifications. This may be
    enhanced by drugs that dilate the pupil and
    enlarge the opening into the structures within
    the eye.

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Infections of the eye
  • Earlier, we discussed conjunctivitis,
  • Stye this is a localized purulent
    staphylococcal infection. Can occur at any age.
    Causes redness, swelling, pain and formation of
    an abscess.
  • Treatment warm compresses 4xs /day to help drain
    pus, topical ointment or antibiotic eye drop.
    Styes are contagious

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Infections of the eye
  • Trachoma caused by the STD chlamydia, forms
    granules on the eyelid and irritates the cornea,
    causing blindness. Proper hygiene and
    antibiotics are used to treat this

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Opthalmia Neonatorum
  • Caused by gonococcus, Chlamydia or some other
    STD, seen at birth. Instilling erythromycin eye
    drops after delivery rids this

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Injury to the eye
  • The most common injury to the eye is related to a
    laceration or a scratching of the cornea caused
    by a foreign object
  • Scar formation from the laceration or scratch
    causes an area of opacity through which light
    rays cannot pass. If the injury involves the
    central area in front of the pupil, blindness may
    result

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Preventing lacerations
  • It is important to prevent injury, scratching or
    trauma to the eye. Even a tiny scratch can
    become so seriously infected that blindness can
    result
  • Protection by using goggles has decreased severe
    eye injuries

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Enucleation
  • An operation to remove the eyeball due to
    traumatic injury to the eye

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The End of the Eye lecture
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THE EAR
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THE EAR
  • The ear is a sense organ for both
  • Hearing
  • And
  • Equilibrium

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Otoscope
  • A device for examination of the inner ear

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The ear is divided into 3 main sections
  • 1. Outer ear
  • 2. Middle ear
  • 3. Inner ear

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The Outer Ear
  • This includes the outer projection (pinna) or
    (auricle) of the actual ear and a canal
  • The pinna collects and directs sound waves into
    the ear

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External auditory canal or meatus
  • Once you enter the hole to the ear, you enter
    this external auditory meatus.
  • Here, the skin lining this tube extends
    approximately 2.5 cm or more. There are many
    ceruminous glands here where cerumen is made
  • This is where you stick a Q-tip to clean the ear

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At the end of this auditory meatus is
  • The tympanic membrane A.K.A. the ear drum
  • The ear drum serves as a boundary between the
    external auditory canal and the middle ear cavity
    and pressure on either side of this tympanic
    membrane is usually
  • The tympanic membrane vibrates freely as sound
    waves enter the ear
  • The tympanic membrane is usually pink or peach in
    color when not infected

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The Middle Ear
  • This is the air space containing 3 small bones
    called ossicles
  • These 3 ossicles are joined in such a way that
    they amplify the sound waves received by the
    tympanic membrane and then transmit the sounds to
    the fluid in the inner ear

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The 3 Ossicles are named individually
  • 1. Malleus has a handlelike part that is
    attached to the tympanic membrane. The headlike
    part of the malleus bone is attached to the incus
  • 2. Incus the middle of the 3 ossicles, attaches
    the malleus and the stapes. Sometimes called
    anvil
  • 3. Stapes the innermost of the ossicles that is
    shaped like a stirrup. The base of the stapes is
    in contact with a membrane called the oval window
    of the inner ear. This membrane vibrates and
    transmits the sound waves to the fluid of the
    inner ear

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The Eustachian Tube
  • Is an auditory tube that connects the middle ear
    to the throat or pharynx
  • This tube opens to allow pressure to equalize on
    the two sides of the tympanic membrane
  • The valve that closes the tube can be forced open
    by swallowing hard, yawning, or blowing with the
    mouth sealed as is done when one has pressure
    changes while being on an airplane

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Infections in the eustachian tube
  • The mucuous membrane of the pharynx is continuous
    through the eustachian tube into the middle ear
    cavity, and organisms may travel along the
    membrane causing infection of the middle ear
    known as otitis media

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The inner ear
  • This is the most complex of the 3 sections
  • The inner ear contains the sensory receptors for
    hearing and equilibrium and contains fluid
    through which the vibratory sounds travel

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The Inner ear is complex
  • The inner ear is complicated because it contains
    a mazelike area with 3 divisions
  • 1. vestibule
  • 2. Semicircular canals
  • 3. Cochlear
  • All 3 divisions contain fluid that are important
    to the sensory functions of the inner ear

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Hearing
  • The organ of hearing is called the organ of
    corti. It consists of ciliated receptor cells
    located inside the cochlear or cochlear duct

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Hearing
  • Sound waves enter the external auditory canal and
    cause the tympanic membrane to vibrate
  • These vibrations are amplified by the ossicles
    and transmitted to the fluid of the inner ear
  • The sound waves enter the upper chamber of the
    cochlea called the vestibular duct, and travel to
    the top of the duct
  • As the fluid moves through these chambers, they
    set up vibrations in the fluid of the cochlear
    duct
  • These vibrations stimulate the tiny, hairlike
    cilia on the receptor cells setting up nerve
    impulses that travel to the brain in the cochlear
    nerve (a branch of the 8th cranial nerve)

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Equilibrium
  • Takes place in the semicircular canals in the
    inner ear.
  • The semicircular canal contains sensory cells
  • Receptors for the sense of equilibrium are
    ciliated cells. As the head moves, the delicate
    hair like cells bend when the liquid is set in
    motion by the head and body movements and a nerve
    impulse is generated. The nerve impulses are
    sent to the brain to help maintain body balance
    or equilibrium.
  • The semicircular canals have nothing to do with
    the sense of hearing

128
Ear Disorders
  • Otitis Media
  • Otitis Externa
  • Otosclerosis
  • Presbycusis
  • Conduction deafness

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Otitis Media
  • An infection of the middle ear cavity caused by a
    variety of bacteria or viruses
  • Happens most often in children due to their ear
    canal being more horizontal, fluid sits there and
    causes bacteria to form
  • Antibiotics are used to treat Otitis Media

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EAR DROPS
  • In children lt3 years old, pull auricle/pinna down
    and back and place drop in ear. Because their
    ear canal is more horizontal, youll be sure to
    get the drop into the canal
  • In children 3 years old/adults, pull
    auricle/pinna up and back d/t ear canal being sl.
    angled

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Myringotomy
  • Pressure from pus or exudate in the middle ear
    can be relieved only by cutting the tympanic
    membrane (myringotomy) and then the placement of
    ear tubes to allow pressure to equalize and
    prevent further damage to the eardrum

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Otitis Media
  • What treatments would be used for this problem

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Myringotomy
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Otitis Externa Swimmers Ear
  • Inflammation of the skin of
  • the external ear canal and
  • auricle
  • May be acute or chronic
  • Most common in the summer
  • Treatment is over 7 days with antibiotic drops,
    no swimming and possibility of wearing ear plugs
    with further swimming

136
Conductive Hearing Loss
  • This is when there is interference with the
    passage of sound waves from the outside to the
    inner ear
  • There may be an obstruction of the external canal
    caused by wax or a foreign object
  • Blockage of the eustachian tube prevents the
    equalization of air pressure on both sides of the
    tympanic membrane thereby decreasing the ability
    of the membrane to vibrate

137
Otosclerosis
  • A hereditary disease that
  • causes bone changes in
  • the stapes that prevents
  • normal vibration
  • Treatment surgical removal of the diseased
    stapes and its replacement with an artificial
    device allows conduction of sound from the
    ossicles to the oval window and the cochlea

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Presbycusis (pres-be-KU-sis)
  • A slowly progressive hearing loss that often
    accompanies aging
  • The condition involves gradual atrophy of the
    sensory receptors and the nerve fibers in the
    cochlear nerves

139
Hearing Loss
  • Affected person may feel isolated and depressed,
    psychological help may be needed
  • The ability to hear high pitched sounds may be
    lost first
  • It is therefore important to address elderly
    people in clear, low-pitched tones

140
Hard of Hearing Sign
  • H.O.H.
  • Your hospital floor may have pre-made signs
    indicating that a pt has a hearing loss

141
Nerve deafness
  • Disorder of the cochlear nerve or auditory
    portion of the brain
  • Nerve deafness may be caused by prolonged
    exposure to noise, drugs or infection

142
The End
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Title: Eyes


1
Eyes Ears
  • BS
  • Chapter 11

2
The Senses
  • The sensory system serves to protect an
    individual by detecting changes in the
    environment
  • An external environmental stimuli travels through
    the CNS into a sensory (afferent) nerve and
    leaves through an motor (efferent) nerve to the
    effector (muscle or gland or organ)

3
Stimulus
  • The initiation of an impulse in a nerve
  • An excitant or irritant

4
Receptor
  • The part of the nervous system that detects a
    stimulus is called a receptor

5
Ophthalmology
  • The health and science dealing with the eye and
    its diseases

6
Ophthalmologist
  • A Physician who specializes in the treatment of
    disorders of the eye

7
The Eye Vision
  • In the embryo, the eye is formed as an out -
    pocketing of
  • the brain
  • The eye is very delicate and is
  • greatly protected

8
Protection of the eye
  • The skull bones help form the walls of the eyes
    orbit or cavity
  • The skull protects more than ½ of the dorsal part
    of the eye
  • The eyelid protects the front of the eye. The
    eyelid can be closed and keeps the particles out
    of the eye. Blinking helps to keep the eye
    lubricated

9
  • We have a muscle that when it contracts, keeps
    the eye open. In old age, this muscle weakens
    and the eye doesnt stay open, this is called
    Ptosis
  • Eyelashes and eyebrows keep foreign matter out of
    the eye

10
Conjunctiva
  • A thin membrane that lines the eyelid and covers
    the anterior portion of the eyeball
  • You can see the conjunctiva if you pull the lower
    eyelid down, its the pink part
  • Cells within the conjunctiva produce mucus that
    aids in lubricating the eye
  • As the conjunctiva extends from the eyelid to the
    front of the eye, a sac is formed where eye drops
    can be placed

11
Conjunctivitis - Pinkeye
  • The membrane that lines the eyelid becomes
    irritated or a pathogen enters
  • The treatment is usually a general eye drop such
    as gentamycin opthalmic drops. Cortisone can be
    added to the drops if there is a great deal of
    itching and burning.
  • Conjunctivitis can be contagious, good
    handwashing and non-sharing of pillow,
    washclothes is encouraged. Enc. Pt NOT to rub
    eyes, infection may spread

12
Conjunctivitis
13
Pt looking up conjunctiva is seen
  • 1) The Limbus is the junction of the
    conjunctiva and cornea.
  • 2) The conjunctiva
  • 3) The tarsal conjunctiva
  • 4) The tarsus (more
  • conjunctiva)
  • 5) Punctum
  • 6) The marginal conjunctiva is at the eyelid
    margin where the epithelium will begin to be
    keratinized.

14
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16
Lacrimal Duct or gland
  • Tears are produced by the lacrimal gland
  • Tears are formed to lubricate the cornea
  • and conjunctiva
  • The actual lacrimal
  • gland is near the outer eyebrow

17
Tears
  • Fluid produced by the lacrimal gland to moisten
    the cornea and conjunctiva contain the enzyme
    lysozyme.
  • This enzyme lysozyme, protects against bacterial
    invasion
  • Tears drain into the inner canthus and drain into
    the punctum which is a hole in the inner eye,
    this drains into the nasolacrimal duct

18
Where do tears go
  • If tears arent streaming down ones cheeks, they
    are carried into ducts near the nasal corner of
    the eye where they drain into the nose by way of
    the nasolacrimal ducts
  • Once the tears run through these ducts, they
    cause a runny nose. These ducts can be clogged
    at times

19
Coats of the eyeball
  • The eyeball has 3 coats or tunics
  • 1. Sclera
  • 2. Choroid
  • 3. Retina

20
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21
Sclera
  • This is the white of the eye
  • The sclera is made of tough connective tissue
  • The sclera circles all the way around the back of
    the eyeball and when it reaches the front of the
    eyeball, it becomes the cornea

22
Choroid
  • This is the delicate network of connective middle
    layer
  • This choroid layer is laced with blood vessels
    and brown pigment and prevents incoming light
    rays from scattering and reflecting off the inner
    surface of the eye

23
CHOROID
24
Back of the eye
  • The blood vessels in the back of the eye can
    reveal signs of disease (see picture on pg 185)
  • One can see these vessels by using an
    opthalmascope

25
Retina
  • This complex structure has multiple layers and
    the retina is the actual receptor layer of the
    eye
  • The multiple layers contains 10 layers of rods
    and cones which generate the nerve impulses
    associated with vision
  • The rods and cones in the retina requires vitamin
    A. If Vit A is lacking, a person may have
    difficulty seeing in dim light to activate the
    rods. A deficiency in vit. A night blindness

26
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27
Rods Cones the receptor cells of the eyes
  • RODS sensitive to light, rods function in dim
    light, images are not sharp, you see in gray.
    There are about 120 million rods in each retina.
    Rods are distributed more towards the front of
    the retina
  • CONES function in bright light, sensitive to
    color such as red, green, blue and give sharp
    images. There are about 6 million cones in each
    retina. Cones are located near the center of the
    retina in a pitted area known as the fovea
    centralis

28
Rods Cones in the Eye
29
Entering a dark room
  • When you enter a dark movie theatre, you cannot
    see for a moment. Your pupils enlarge so you can
    try and see more clearly.
  • At this time, the rods are beginning to work,
    when you can see again, the images are blurred
    and you can only see objects in gray because the
    rods are not able to differentiate color

30
Nerve impulses from rods and cones
  • Nerve impulses from rods and cones flow into
    sensory neurons that eventually form the optic
    nerve
  • The optic nerve, which is the 2nd cranial nerve,
    connects to the retina at the back of the eye and
    is then connected to the occiptial lobe of the
    brain
  • The impulses travel through the optic nerve to
    the visual center of the brain which is the
    occipital lobe

31
Lights path through the eye (how does light
travel)
  • As light rays pass through the eye towards the
    retina, the rays travel through a series of
    transparent, colorless parts
  • On the way, the light rays become bent
    (refracted). This refraction of the rays make it
    possible for light from a very large area, to be
    focused on a very small surface to the retina
    where the receptors are located. At this point,
    the rays also become overrefracted (turned
    upside down and backwards), The visual centers of
    the brain must reverse the images

32
Light must pass through these parts in order to
see
  • This is from the outside where we see the light
    on into the eye eventually to the retina
  • Cornea
  • Aqueous humor
  • Lens
  • Vitreous body

33
Cornea
  • Is a forward continuation of the sclera (see
    picture on pg 185)
  • This part is transparent and colorless whereas
    the sclera we can see is white and opaque
  • The cornea has no blood vessels and is well
    nourished by the fluids that constantly wash over
    it
  • The cornea can become scarred d/t injury
    decreased vision. The cornea can be transplanted

34
Cornea
35
Aqueous Humor
  • A watery fluid that fills much of the eyeball in
    front of the lens
  • The aqueous humor helps maintain the slight
    forward curve of the cornea
  • In the area where aqueous humor is found is where
    glaucoma is found

36
Aqueous Humor
37
Lens
  • A clear, circular structure made of firm, elastic
    material. The lens has 2 bulging surfaces and is
    described as bi-convex
  • The lens is important in light refraction because
    of the elasticity, the shape of the eye can
    change and its thickness can be adjusted to
    focus light for near or distant vision

38
Lens
39
Vitreous Body
  • Soft jelly-like substance that fills the entire
    space behind the lens. This jelly IS NOT
    replaceable
  • The vitreous body helps maintain the shape of the
    eyeball as well in aiding in refraction of light

40
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41
Eye Anatomy
42
Eye Anatomy
  • 1. Cornea in front, in back of eye is sclera
  • 2. Aqueous humor
  • 3. Lens
  • 4. Retina
  • 5. Vitreous body

43
Anterior Parts of the Eye
  • 1. Conjunctiva
  • 2. Cornea
  • 3. Cilliary body
  • 4. Lens

44
Muscles of the eye
  • Intrinsic Muscles
  • Extrinsic Muscles

45
Intrinsic Muscles
  • In general, these are the circular involuntary
    muscles of the eye.
  • These include the muscles around the iris and the
    pupil and this includes the cilliary muscle.

46
The ciliary body is a ring of tissue that
encircles the lens. The ciliary body contains
smooth muscle fibers called ciliary muscles that
help to control the shape of the lens. Towards
the posterior surface of the lens there are
ciliary processes which contain capillaries. The
capillaries secrete the fluid (aqueous humor)
into the anterior segment of the eyeball
47
Iris
  • This is the colored part of the eye. Some colors
    include shades of blue, brown, green, hazel. In
    the center of the iris is the pupil.
  • The purpose of the iris is to regulate the amount
    of light entering the eye. In the presence of
    bright light, the cilliary muscles of the iris
    contract, reducing the size of the pupil
    constriction

48
Cilliary Muscle stretch the lens
  • Is shaped like a flattened ring with a hole the
    size of the outer edge of the iris.
  • The cilliary muscle alters the shape of the lens
    during the process of accommodation adjustment
    or adaption of the eye while its trying to focus
    on something, usually far away

49
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50
Draw a circle.
  • Radial muscles are located around where the iris
    is (think of a radial tire and the treads or like
    the spokes of a bike)
  • Circular muscles are around the pupil
  • When circular contract, radial relax

51
Accommodation
  • Adjustment or adaption.
  • The adjustment of the eye for various distances
    where it is able to focus the image of an object
    on the retina by changing the curvature of the
    lens
  • For near vision, the ciliary muscle contracts
    causing increased rounding of the lens and the
    pupils contract
  • The ability to accommodate, decreases with age.

52
Pupil
  • The contractile opening at the center of the iris
    of the eye
  • The pupil contracts when exposed to light and
    when the focus is on a near object
  • The pupil dilates when in the dark and when focus
    is on a distant object

53
Adjustment of the lens
  • Ciliary muscles help the lens get fatter to see
    things up close
  • Or
  • Thin like a pancake in order to see things far
    away

54
Extrinsic Muscles
  • These are the 6 ribbon-like voluntary muscles
    attached to the outer surface of the eyeball.
    These muscles coordinate eye movement and the
    opening of the eyelid
  • These muscles pull on the eyeball in a
    coordinated fashion so that both eyes center on
    one visual field at the same time (convergence).
    Convergence is necessary to the formation of a
    clear image on the retina

55
Extrinsic Muscles of the Eye
56
Nerve supply to the eye
  • 2 nerves supply the eye
  • We will discuss the optic nerve for this ch.

57
Optic Nerve
  • Carries visual impulses from the rods and cones
    to the brain
  • Optic nerve starts from the retina toward the
    medial or nasal side of the eye
  • There are no rods or cones in the area of the
    optic nerve but the optic nerve carries impulses
    only from the rods and cones to the brain

58
Optic Disc
  • Because there are no cones or rods near or around
    the optic nerve, no images can form on the
    retina around the optic nerve, at this point,
    this is known as the blind spot or optic disc

59
Close to the optic disc
  • There is a tiny depressed or pitted area in the
    retina known as the fovea centralis

60
Fovea Centralis
  • The fovea is contained within a yellow spot
    called the macula, with age, this macula
    degenerates
  • This yellowish fovea, contains the highest
    concentration of cones
  • This portion of the area near the optic disc in
    the fovea centralis, is the point of sharpest
    vision

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62
Vision Problems
  • Ptosis drooping of the eyelid related to
    paralysis, can occur after a stroke

63
  • Amblyopia otherwise known as lazy eye. Can
    be treated with eyeglasses.
  • The brain and eyes do not work together properly,
    the brain favors one eye.
  • The brain may suppress the visual image from the
    deviating eye to prevent double vision.
  • This accounts for 50 of childhood amblyopia

64
Amblyopia
65
Strabismus
  • A deviation of the eye that results from lack of
    coordination of the eyeball muscles. The 2 eyes
    do not work together.
  • In children, when the eyes fail to focus on the
    same image, the brain may learn to ignore the
    input from one eye.
  • This loss of vision is called amblyopia, and it
    is frequently associated with strabismus
  • Convergent strabismus is when the eye deviates
    toward the nasal side and gives the appearance of
    being cross-eyed

66
Google says
  • Strabismus, more commonly known as cross-eyed or
    wall-eyed, is a vision condition in which a
    person can not align both eyes simultaneously
    under normal conditions. One or both of the eyes
    may turn in, out, up or down. An eye turn may be
    constant (when the eye turns all of the time) or
    intermittent (turning only some of the time, such
    as, under stressful conditions or when ill).
    Whether constant or intermittent, strabismus
    always requires appropriate evaluation and
    treatment. Children do not outgrow strabismus!

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68
Treatment
  • If these disorders are not corrected early, the
    transmission and interpretation of visual
    impulses to the brain is decreased. Muscles
    become weakened in the eye and muscle restoration
    must be rebalanced, glasses, eye patch or surgery
    may be needed

69
Normal Vision
70
Hyperopia
  • Farsightedness caused by a short eyeball, the
    light seen hits the back of the eye (can only see
    far away)
  • The focal point is behind the retina because
    light rays cannot bend sharply enough to focus on
    the retina. Objects must be moved far from the
    eye to be seen clearly
  • Farsightedness is common in infants but it
    corrects itself when the child uses the eyes more
    for near vision
  • Treatment glasses with convex lenses to increase
    the refraction of light rays corrects this visual
    disturbance

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72
Hyperopia Far Sighted
73
Myopia
  • Nearsightedness caused by a long eyeball. The
    cornea bends the light rays too sharply so the
    focal point of the light is in front of the
    retina
  • Distant objects appear blurred and may appear
    clear only if the object is brought near the eye
    (can only see things that are near to you)
  • Treatment a concave lens is used

74
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75
Myopia-Near Sighted
76
Astigmatism
  • This is due to the irregularity in the curvature
    of the cornea or the lens therefore, light rays
    are incorrectly bent causing blurred vision. A
    person usually has myopia or hyperopia along with
    astigmatism
  • Treatment corrective lenses are required. These
    people have difficulty wearing contacts at times.
    Today, surgical procedures such as refractive
    surgery can be used to correct near or
    farsightedness. The cornea is reshaped to change
    the refractive angle of light as it passes through

77
Nystagmus
  • Constant, involuntary cyclical movement of the
    eye balls.
  • Similar to spasms of the eyeball
  • Ill show you ?

78
Glaucoma
  • Excess pressure of the aqueous humor. The blood
    constantly produces fluid that circulates in the
    eye and then gets reabsorbed into the
    bloodstream. Interference with the normal
    reentry of this fluid into the bloodstream leads
    to increased pressure inside the eyeball
  • This condition occurs slowly, optic nerve damage
    occurs and poor vision is noticed

79
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81
Glaucoma
82
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83
Normal
Mild Glaucoma
Severe Glaucoma
84
Cataracts
  • Is an opacity of the lens or the outer covering
    of the lens
  • Early cataracts causes a gradual loss of
    sharpness or (visual acuity). Untreated
    cataracts complete loss of vision
  • Surgical removal of the lens and placement of an
    artificial lens is successful.
  • Age, diabetes and exposure to UV rays may cause
    cataracts

85
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87
Cataract
Normal
  • Cataract

88
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89
Caracts
90
Diabetic Retinopathy
  • The retina is damaged by blood vessel hemorrhages
    and growth of new vessels. Blood vessels in the
    eye are tiny and get filled with plaque or too
    much sugar d/t uncontrolled diabetes and they
    tear away from the retina and eyeball. Blindness
    can occur

91
Diabetic Retinopathy
92
Retinal Detachment
  • The retina becomes separated from the underlying
    layer of the eye as a result of trauma or an
    accumulation of fluid or tissue between layers.
    Can occur slowly or suddenly. If left untreated,
    blindness will occur d/t total detachment of
    retina
  • Surgery includes a spot welding with electric
    current or a weak laser beam. A series of
    pinpoint scars (connective tissue) develops to
    reattach the retina. Pt must lay face down for
    up to 48 hours after surgery to heal

93
Retinal Detachment
94
Macular Degeneration
  • The macula or yellow area of the retina that
    contains the fovea centralis, (the point of
    sharpest vision), changes or becomes distorted.
    Either material accumulates on the retina or
    abnormal blood vessels grow under the retina
    causing it to detach.
  • Surgery may stop the growth of blood vessels and
    delay vision loss. Causes are smoking, exposure
    to sunlight, and high cholesterol diet, can be
    hereditary

95
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96
Macular Degeneration
97
Severe Macular Degeneration
98
Eye Drops used in the Ophthalmologist's office
  • Class
  • Mydriatics used to dilate the pupil for
    opthalmic exams
  • Big word Big pupil
  • The D in this word dilates
  • Atropine eye drops

99
Eye Drops used in the Ophthalmologist's office
  • Miotics used to constrict the pupil
  • Little word, little pupil
  • Pilocarpine constricts the ciliary muscles and
    pupil to increase the aqueous humor outflow so it
    wont get stuck

100
Ophthalmoscope
  • A lighted instrument, one of the most important
    tools of the physician, used to examine the
    interior of the eye, including the lens, retina
    and optic nerve
  • The ophthalmoscope is equipped with a rotating
    disc of lenses to permit the eye be examined at
    different depths and magnifications. This may be
    enhanced by drugs that dilate the pupil and
    enlarge the opening into the structures within
    the eye.

101
Infections of the eye
  • Earlier, we discussed conjunctivitis,
  • Stye this is a localized purulent
    staphylococcal infection. Can occur at any age.
    Causes redness, swelling, pain and formation of
    an abscess.
  • Treatment warm compresses 4xs /day to help drain
    pus, topical ointment or antibiotic eye drop.
    Styes are contagious

102
Infections of the eye
  • Trachoma caused by the STD chlamydia, forms
    granules on the eyelid and irritates the cornea,
    causing blindness. Proper hygiene and
    antibiotics are used to treat this

103
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104
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105
Opthalmia Neonatorum
  • Caused by gonococcus, Chlamydia or some other
    STD, seen at birth. Instilling erythromycin eye
    drops after delivery rids this

106
Injury to the eye
  • The most common injury to the eye is related to a
    laceration or a scratching of the cornea caused
    by a foreign object
  • Scar formation from the laceration or scratch
    causes an area of opacity through which light
    rays cannot pass. If the injury involves the
    central area in front of the pupil, blindness may
    result

107
Preventing lacerations
  • It is important to prevent injury, scratching or
    trauma to the eye. Even a tiny scratch can
    become so seriously infected that blindness can
    result
  • Protection by using goggles has decreased severe
    eye injuries

108
Enucleation
  • An operation to remove the eyeball due to
    traumatic injury to the eye

109
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110
The End of the Eye lecture
111
THE EAR
112
THE EAR
  • The ear is a sense organ for both
  • Hearing
  • And
  • Equilibrium

113
Otoscope
  • A device for examination of the inner ear

114
The ear is divided into 3 main sections
  • 1. Outer ear
  • 2. Middle ear
  • 3. Inner ear

115
The Outer Ear
  • This includes the outer projection (pinna) or
    (auricle) of the actual ear and a canal
  • The pinna collects and directs sound waves into
    the ear

116
External auditory canal or meatus
  • Once you enter the hole to the ear, you enter
    this external auditory meatus.
  • Here, the skin lining this tube extends
    approximately 2.5 cm or more. There are many
    ceruminous glands here where cerumen is made
  • This is where you stick a Q-tip to clean the ear

117
At the end of this auditory meatus is
  • The tympanic membrane A.K.A. the ear drum
  • The ear drum serves as a boundary between the
    external auditory canal and the middle ear cavity
    and pressure on either side of this tympanic
    membrane is usually
  • The tympanic membrane vibrates freely as sound
    waves enter the ear
  • The tympanic membrane is usually pink or peach in
    color when not infected

118
The Middle Ear
  • This is the air space containing 3 small bones
    called ossicles
  • These 3 ossicles are joined in such a way that
    they amplify the sound waves received by the
    tympanic membrane and then transmit the sounds to
    the fluid in the inner ear

119
The 3 Ossicles are named individually
  • 1. Malleus has a handlelike part that is
    attached to the tympanic membrane. The headlike
    part of the malleus bone is attached to the incus
  • 2. Incus the middle of the 3 ossicles, attaches
    the malleus and the stapes. Sometimes called
    anvil
  • 3. Stapes the innermost of the ossicles that is
    shaped like a stirrup. The base of the stapes is
    in contact with a membrane called the oval window
    of the inner ear. This membrane vibrates and
    transmits the sound waves to the fluid of the
    inner ear

120
The Eustachian Tube
  • Is an auditory tube that connects the middle ear
    to the throat or pharynx
  • This tube opens to allow pressure to equalize on
    the two sides of the tympanic membrane
  • The valve that closes the tube can be forced open
    by swallowing hard, yawning, or blowing with the
    mouth sealed as is done when one has pressure
    changes while being on an airplane

121
Infections in the eustachian tube
  • The mucuous membrane of the pharynx is continuous
    through the eustachian tube into the middle ear
    cavity, and organisms may travel along the
    membrane causing infection of the middle ear
    known as otitis media

122
The inner ear
  • This is the most complex of the 3 sections
  • The inner ear contains the sensory receptors for
    hearing and equilibrium and contains fluid
    through which the vibratory sounds travel

123
The Inner ear is complex
  • The inner ear is complicated because it contains
    a mazelike area with 3 divisions
  • 1. vestibule
  • 2. Semicircular canals
  • 3. Cochlear
  • All 3 divisions contain fluid that are important
    to the sensory functions of the inner ear

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125
Hearing
  • The organ of hearing is called the organ of
    corti. It consists of ciliated receptor cells
    located inside the cochlear or cochlear duct

126
Hearing
  • Sound waves enter the external auditory canal and
    cause the tympanic membrane to vibrate
  • These vibrations are amplified by the ossicles
    and transmitted to the fluid of the inner ear
  • The sound waves enter the upper chamber of the
    cochlea called the vestibular duct, and travel to
    the top of the duct
  • As the fluid moves through these chambers, they
    set up vibrations in the fluid of the cochlear
    duct
  • These vibrations stimulate the tiny, hairlike
    cilia on the receptor cells setting up nerve
    impulses that travel to the brain in the cochlear
    nerve (a branch of the 8th cranial nerve)

127
Equilibrium
  • Takes place in the semicircular canals in the
    inner ear.
  • The semicircular canal contains sensory cells
  • Receptors for the sense of equilibrium are
    ciliated cells. As the head moves, the delicate
    hair like cells bend when the liquid is set in
    motion by the head and body movements and a nerve
    impulse is generated. The nerve impulses are
    sent to the brain to help maintain body balance
    or equilibrium.
  • The semicircular canals have nothing to do with
    the sense of hearing

128
Ear Disorders
  • Otitis Media
  • Otitis Externa
  • Otosclerosis
  • Presbycusis
  • Conduction deafness

129
Otitis Media
  • An infection of the middle ear cavity caused by a
    variety of bacteria or viruses
  • Happens most often in children due to their ear
    canal being more horizontal, fluid sits there and
    causes bacteria to form
  • Antibiotics are used to treat Otitis Media

130
EAR DROPS
  • In children lt3 years old, pull auricle/pinna down
    and back and place drop in ear. Because their
    ear canal is more horizontal, youll be sure to
    get the drop into the canal
  • In children 3 years old/adults, pull
    auricle/pinna up and back d/t ear canal being sl.
    angled

131
Myringotomy
  • Pressure from pus or exudate in the middle ear
    can be relieved only by cutting the tympanic
    membrane (myringotomy) and then the placement of
    ear tubes to allow pressure to equalize and
    prevent further damage to the eardrum

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133
Otitis Media
  • What treatments would be used for this problem

134
Myringotomy
135
Otitis Externa Swimmers Ear
  • Inflammation of the skin of
  • the external ear canal and
  • auricle
  • May be acute or chronic
  • Most common in the summer
  • Treatment is over 7 days with antibiotic drops,
    no swimming and possibility of wearing ear plugs
    with further swimming

136
Conductive Hearing Loss
  • This is when there is interference with the
    passage of sound waves from the outside to the
    inner ear
  • There may be an obstruction of the external canal
    caused by wax or a foreign object
  • Blockage of the eustachian tube prevents the
    equalization of air pressure on both sides of the
    tympanic membrane thereby decreasing the ability
    of the membrane to vibrate

137
Otosclerosis
  • A hereditary disease that
  • causes bone changes in
  • the stapes that prevents
  • normal vibration
  • Treatment surgical removal of the diseased
    stapes and its replacement with an artificial
    device allows conduction of sound from the
    ossicles to the oval window and the cochlea

138
Presbycusis (pres-be-KU-sis)
  • A slowly progressive hearing loss that often
    accompanies aging
  • The condition involves gradual atrophy of the
    sensory receptors and the nerve fibers in the
    cochlear nerves

139
Hearing Loss
  • Affected person may feel isolated and depressed,
    psychological help may be needed
  • The ability to hear high pitched sounds may be
    lost first
  • It is therefore important to address elderly
    people in clear, low-pitched tones

140
Hard of Hearing Sign
  • H.O.H.
  • Your hospital floor may have pre-made signs
    indicating that a pt has a hearing loss

141
Nerve deafness
  • Disorder of the cochlear nerve or auditory
    portion of the brain
  • Nerve deafness may be caused by prolonged
    exposure to noise, drugs or infection

142
The End
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