the special senses (eye and ear)
DESCRIPTION
The Special Senses (Eye and Ear). CHAPTER 14. Overview of the Eye. Eye acts much like a camera Lens of eye adjusts to bring object into focus Pupil of eye constricts to allow less light to enter in bright setting or dilates to allow more light to enter in darker setting - PowerPoint PPT PresentationTRANSCRIPT
The Special Senses(Eye and Ear)
CHAPTER 14
2
Overview of the Eye• Eye acts much like a camera
– Lens of eye adjusts to bring object into focus– Pupil of eye constricts to allow less light to
enter in bright setting or dilates to allow more light to enter in darker setting
– Through bending of light rays, image reaches retina• Sensitive nerve cell layer of eye• Image is transmitted to brain for interpretation
3
• Sclera– White portion of eye
• Tough, fibrous membrane• Maintains shape of eyeball• Serves as protective covering for eye
• Iris– Colored portion of eye
• Pupil– Opening in center of eye– Controls amount of light entering eye
Structures of the Eye(Front View)
4
• Conjunctiva– Thin mucous membrane layer that lines anterior part
of eye and inner part of eyelids• Colorless, but appears white because it covers sclera
• Lacrimal gland– Located at upper outer edge of each eye
• Produces tears
• Lacrimal duct– Located at inner edge of eye
• Tears drain from eye through this duct
Structures of the Eye(Front View)
5
Structures of the Eye(Front View)
6
• Eyelids– Continuous with skin and cover the eyeball– Keep surface of eyeball lubricated and protected from
dust and debris through blinking motion• Eyelashes
– Located along edges of eyelids– Help protect eyeball by preventing foreign materials
and/or insects from coming in contact with surface of eyeball
Structures of the Eye(Front View)
7
Structures of the Eye(Cross Section)
• Sclera– “White of the eye”– Thinnest over anterior surface of the eye– Thickest at the back of the eye, near opening
for optic nerve• Cornea
– Continuous with anterior portion of sclera– Transparent, nonvascular layer covering
colored part of the eye
8
• Conjunctiva– Mucous membrane lining inner surfaces of
eyelids and outer surfaces of eye• Choroid
– Vascular middle layer of eye• Just beneath sclera• Contains extensive capillaries that provide blood
supply and nutrients to eye• Contains the iris, ciliary body, and suspensory
ligaments
Structures of the Eye(Cross Section)
9
• Iris– Colored portion of eye
• Can be seen through transparent corneal layer• Pupil
– Located in center of iris• Controls amount of light entering eye
• Lens– Colorless biconvex structure that aids in
focusing images clearly on retina
Structures of the Eye(Cross Section)
10
• Ciliary body– Located on each side of the lens– Contains muscles responsible for adjusting lens to
view near objects• Suspensory ligaments
– Radiate from ciliary body and attach to lens– Hold lens in place– Assist in adjusting shape of lens for proper focusing of
eye
Structures of the Eye(Cross Section)
11
• Retina– Sensitive nerve cell layer
• Changes energy of light rays into nerve impulses• Transmits nerve impulses via optic nerve to brain
for interpretation of image seen by eye– Nerve cells of retina
• Rods are responsible for vision in dim light and for peripheral vision
• Cones responsible for visualizing colors, central vision, and vision in bright light
Structures of the Eye(Cross Section)
12
• Retina – Macula Lutea
• Oval, yellowish spot near center of retina– Fovea Centralis
• Small depression located within macula lutea• Sharpest image is obtained when image focuses
directly on fovea centralis = central vision
Structures of the Eye(Cross Section)
13
• Optic nerve– Receives impulses from retina and transmits
them to the brain• Images are then interpreted as vision
• Optic disc– Contains no rods or cones– Known as the “blind spot” of the eye– Center of optic disc serves as point of entry
for artery that supplies retina
Structures of the Eye(Cross Section)
14
Structures of the Eye(Cross Section)
Lateral Cross Section of the Eye
15
• Anterior cavity of the eye– Anterior chamber
• Located in front of lens• Filled with clear, watery fluid called aqueous humor
– Posterior chamber• Located behind lens• Also filled with aqueous humor • Flows back and forth between both chambers
Structures of the Eye(Cross Section)
16
• Posterior cavity of eye– Posterior to lens– Filled with vitreous humor
• Clear, jellylike substance that gives shape to the eyeball
• Not constantly reproduced• Blindness can result if vitreous humor escapes
from eye
Structures of the Eye(Cross Section)
17
Process of Vision• Process begins as light rays enter eye
– Transmitted through cornea, aqueous humor, pupil, lens, and vitreous humor to retina• Sensitive nerve cells of retina transmit image
through optic nerve to brain• Brain interprets image as vision
18
Process of Vision• Refraction
– Process of bending of light rays as they pass through the various structures of the eye to produce a clear image on the retina
• Errors of refraction – Occur when eyeball is abnormally shaped– Occur when lens has lost ability to
accommodate to near vision• Vision will be blurred• Can be adjusted with corrective lenses
PATHOLOGICAL CONDITIONS
The Eye
20
Astigmatism• Pronounced
– (ah-STIG-mah-tizm)• Defined
– Refractive error causing light rays entering the eye to be focused irregularly on the retina due to an abnormally shaped cornea• Correction: contact lenses or eyeglasses to
neutralize defect
21
Blepharitis• Pronounced
– (blef-ah-RYE-tis)• Defined
– Inflammation of the eyelid margins stemming from seborrheic, allergic, or bacterial origin
22
Blepharoptosis(Ptosis)
• Pronounced– (blef-ah-roh-TOH-sis)
• Defined– Occurs when eyelid partially or entirely covers
the eye as a result of a weakened muscle
23
Blepharoptosis
Blepharoptosis
24
Blindness• Pronounced
– (BLINDNESS)• Defined
– Absence of vision or the need for assistive devices and/or assistance from others to accomplish daily activities due to inability to see
25
Monochromatism (Color Blindness) • Pronounced
– (mon-oh-KROH-mah-tizm)• Defined
– Inability to sharply perceive visual colors• Daltonism
– Unable to distinguish greens from reds• Achromatic Vision
– Cannot distinguish any color; perceives only white, gray, and black
26
Cataract• Pronounced
– (KAT-ah-rakt)• Defined
– Lens in the eye becomes progressively cloudy losing its normal transparency• Alters perception of images due to interference of
light transmission to retina
27
Chalazion• Pronounced
– (kah-LAY-zee-on)• Defined
– Cyst or nodule on eyelid resulting from an obstruction of a meibomian gland, which is responsible for lubricating margin of the eyelid
28
Conjunctivitis, Acute• Pronounced
– (kon-junk-tih-VYE-tis acute)• Defined
– Inflammation of mucous membrane lining the eyelids and covering the front part of the eyeball
– Also called “Pinkeye”
29
Corneal Abrasion• Pronounced
– (COR-nee-al ah-BRAY-zhun)• Defined
– Disruption of the cornea’s surface epithelium commonly caused by an eyelash, a small foreign body, contact lenses, or a scratch from a fingernail
30
Diabetic Retinopathy• Pronounced
– (dye-ah-BET-ik reh-tin-OP-ah-thee)• Defined
– Condition that occurs as a consequence of an 8 to 10-year duration of diabetes mellitus in which the capillaries of retina experience scarring
31
Diabetic Retinopathy• Causes of retinal capillary scarring
– Abnormal dilation and constriction of vessels– Hemorrhages– Microaneurysms– Abnormal formation of new vessels causing
leakage of blood into the vitreous humor• Leakage causes permanent decline in sharpness
of vision
32
Ectropion• Pronounced
– (ek-TROH-pee-on)• Defined
– “Turning out” or eversion of the eyelash margins from the eyeball leading to exposure of the eyelid and eyeball surface and lining• Occurs especially in the lower eyelid
33
Entropion• Pronounced
– (en-TROH-pee-on)• Defined
– “Turning in” of the eyelash margins resulting in the sensation similar to that of a foreign body in the eye (redness, tearing, burning, and itching)• Occurs especially in the lower margins
34
Exophthalmia• Pronounced
– (eks-off-THAL-mee-ah)• Defined
– Abnormal protrusion of the eyeball(s) usually with the sclera noticeable over the iris
– Typically due to an expanded volume of orbital contents
35
Glaucoma• Pronounced
– (glau-KOH-mah)• Defined
– Ocular disorders identified as a group due to the increase in intraocular pressure
36
Glaucoma• Chronic open-angle glaucoma
– Primary disorder– Breakdown in drainage system of the
circulation of aqueous humor• Gradual elevation of internal pressure leads to
decreased blood supply to optic nerve and retina• Peripheral vision is gradually lost when untreated
37
Glaucoma• Acute closed-angle glaucoma
– Mouth of drainage system is narrow and closes completely
– Allowing no flow of aqueous humor• Rapid occurrence characterized by severe pain,
blurred vision, photophobia, redness, and seeing “halos” around light
• If untreated, person can lose his or her sight within several days
38
Hemianopia• Pronounced
– (hem-ee-an-NOP-ee-ah)• Defined
– Loss of vision or blindness in one-half of the visual field
39
Hordeolum (Stye)• Pronounced
– (hor-DEE-oh-lum)• Defined
– Bacterial infection of an eyelash follicle or sebaceous gland
– Originating with redness, swelling, and mild tenderness in margin of eyelash
40
• Pronounced– (high-per-OH-pee-ah)
• Defined– Refractive error in which the lens of the eye
cannot focus on an image accurately– Results in blurred vision due to light rays
focused behind the retina because eyeball is shorter than normal• Also called farsightedness
Hyperopia
41
HyperopiaHyperopia (Farsightedness)
42
Hyphema (Hyphemia)• Pronounced
– (high-FEE-mah)• Defined
– Bleed into anterior chamber of eye – Resulting as a postoperative complication or
from a blunt eye injury
43
• Pronounced– (kair-ah-TYE-tis)
• Defined– Corneal inflammation caused by a
microorganism, trauma to eye, a break in sensory innervation of cornea, hypersensitivity reaction, or a tearing defect
– May be due to dry eyes or ineffective eyelid closure
Keratitis
44
Myopia• Pronounced
– (my-OH-pee-ah)• Defined
– Refractive error in which the lens of the eye cannot focus on an image accurately
– Resulting in blurred distant vision due to light rays focused in front of retina because eyeball is longer than normal• Also known as nearsightedness
45
MyopiaMyopia (nearsightedness)
46
• Pronounced– (nik-tah-LOH-pee-ah)
• Defined– Inadequate vision at night or in faint lighting
following reduction in synthesis of rhodopsin– Compound in rods of retina that enables the
eye to adjust to low-density light
Nyctalopia(Night Blindness)
47
• Pronounced– (niss-TAG-mus)
• Defined– Vertical, horizontal, rotary, or mixed rhythmic
involuntary movements of the eye(s)• Caused by use of alcohol or certain drugs, lesions
on the brain or inner ear, congenital abnormalities, nerve injury at birth, or abnormal retinal development
Nystagmus
48
• Pronounced– (off-THAL-mee-ah nee-oh-nay-TOR-um)
• Defined– Purulent (contains pus) inflammation of
conjunctiva and/or cornea in newborn• Cause of the keratitis and conjunctivitis results
from newborn’s exposure to viral, bacterial, chemical, or chlamydial agents
Ophthalmia Neonatorum
49
Presbyopia• Pronounced
– (prez-bee-OH-pee-ah)• Defined
– Refractive error occurring after age of 40– Lens of the eye(s) cannot focus on an image
accurately due to loss of elasticity • Also called farsightedness due to better clarity of
distant objects
50
• Pronounced– (ter-IJ-ee-um)
• Defined– Irregular growth developing as a fold in the
conjunctiva– Usually on nasal side of the cornea– Disrupts vision if it extends over pupil
• Can be caused by allergies and excessive ultraviolet light exposure
Pterygium
51
PterygiumPterygium
52
Retinal Detachment• Pronounced
– (RET-in-al detachment)• Defined
– Partial or complete splitting away of the retina from the pigmented vascular layer called the choroid, interrupting vascular supply to the retina and thus creating a medical emergency
53
Retinal Tear• Pronounced
– (RET-in-al tear)• Defined
– Opening in retina that allows leakage of vitreous humor
54
• Pronounced– (skleh-RYE-tis)
• Defined– Presence of inflammation in the white,
outside covering of the eyeball, the sclera• Symptoms include intense redness with dull pain
and possibly some loss of vision
Scleritis
55
Scotoma• Pronounced
– (skoh-TOH-mah)• Defined
– Defined area in one or both eyes– Decreased visual function
56
Strabismus• Pronounced
– (strah-BIZ-mus)• Defined
– Failure of eyes to gaze in same direction due to weakness in muscles controlling position of eye• Most common type is nonparalytic strabismus• Inherited defect in which the eye position of the
two eyes has no relationship
57
Strabismus• Convergent Strabismus
– Also known as “Crosseye” – Also known as “Esotropia”– Affected eye turns inward
• Usually develops in infancy or early childhood
58
Strabismus• Divergent Strabismus
– Also known as “Walleye”– Also known as “Exotropia”– Affected eye turns outward
59
Strabismus
Strabismus(A) Convergent(B) Divergent
60
• Pronounced– (sin-EK-ee-ah)
• Defined– Adhesion in eye that develops as a
complication of trauma or surgery– Secondary condition of one of the following
pathological conditions: cataracts, glaucoma, keratitis, or uveitis• Adhesion causes the iris to adhere to lens or
cornea
Synechia
61
Trachoma• Pronounced
– (tray-KOH-mah)• Defined
– Infectious eye disease caused by Chlamydia trachomatis
– Chronic and will lead to blindness without treatment• Early symptoms include tearing, pain,
photophobia, and inflammation
62
• Pronounced– (yoo-vee-EYE-tis)
• Defined– Inflammation of all or part of middle vascular
layer of eye made up of the iris, ciliary body, and choroid• Characterized by blurred vision, pain, redness,
pupillary constriction, and intense photophobia
Uveitis
DIAGNOSTIC TECHNIQUES, TREATMENTS
AND PROCEDURES
The Eye
64
• Corneal transplant– Surgical transplantation of a donor cornea
(cadaver’s) into the eye of a recipient usually under local anesthesia
• Electronystagmography– Group of tests used in evaluating vestibule-
ocular reflex• Normal reflex produced by stimulation of
vestibular apparatus in which eye position compensates for motion of the head
Diagnostic Techniques, Treatments, and Procedures
65
• Electroretinogram (ERG)– Recording of changes in electrical potential of
retina after stimulation of light• Extracapsular Cataract Extraction (ECCE)
– Surgical removal of anterior segment of lens capsule along with lens allowing for insertion of an intraocular lens implant
Diagnostic Techniques, Treatments, and Procedures
66
• Fluorescein staining– Application of a fluorescein-stained sterile
filter paper strip moistened with a few drops of sterile saline or sterile anesthetic solution to the lower cul-de-sac of the eye to visualize a corneal abrasion
Diagnostic Techniques, Treatments, and Procedures
67
• Gonioscopy– Process of viewing anterior chamber angle of
eye for evaluation, management, and classification of normal and abnormal angle structures
– Intraocular lens implant• Surgical process of cataract extraction and
insertion of an artificial lens in patient’s eye– Restores visual acuity and provides improved depth
perception, light refraction, and binocular vision
Diagnostic Techniques, Treatments, and Procedures
68
• Iridectomy– Extraction of a small segment of the iris to
open an anterior chamber angle and permit the flow of aqueous humor between the anterior and posterior chambers
– Relieves person’s intraocular pressure
Diagnostic Techniques, Treatments, and Procedures
69
• Keratoplasty– Transplantation of corneal tissue from one
human eye to another to improve vision in affected eye• Also called corneal grafting
Diagnostic Techniques, Treatments, and Procedures
70
• Laser in situ Keratomileusis (LASIK)– LASIK procedure is a form of laser vision
correction for nearsightedness (myopia)• Ophthalmoscopy
– Examination of external and internal structures of the eye
– Utilizes an ophthalmoscope
Diagnostic Techniques, Treatments, and Procedures
71
Diagnostic Techniques, Treatments, and Procedures
• Pachymetry– Measures thickness of cornea
• Patient’s eyes are numbed • Uses an ultrasonic-wave instrument to gauge
thickness of each cornea
72
• Phacoemulsification– Removing a lens by using ultrasound
vibrations to split up lens material into tiny particles that can be suctioned out of the eye
• Photo Refractive Keratectomy– Surgical procedure in which a few layers of
corneal surface cells are shaved off by an “excimer laser beam” to flatten cornea and reduce myopia or nearsightedness
Diagnostic Techniques, Treatments, and Procedures
73
• Retinal Photocoagulation– Surgical procedure using an argon laser to
treat conditions such as retinal detachment, and diabetic retinopathy• Retinal Detachment – argon laser used to create
an area of inflammation, which will develop adhesions, causing a welding of the layers
• Diabetic Retinopathy – argon laser used to seal microaneurysms and areas of leakage, and to reduce risk of hemorrhage
Diagnostic Techniques, Treatments, and Procedures
74
Diagnostic Techniques, Treatments, and Procedures
• Slit-Lamp exam– Examination of external and internal
structures of the eye using a low power microscope combined with a high-intensity light source focused to shine as a slit beam• Also known as biomicroscopy
75
• Tonometry– Process of determining intraocular pressure
by calculating resistance of eyeball to an applied force causing indentation
• Trabeculectomy– Surgical excision of a portion of corneoscleral
tissue to decrease intraocular pressure in persons with severe glaucoma
Diagnostic Techniques,Treatments, and Procedures
76
• Trabeculoplasty– Surgical creation of a permanent fistula used to
drain fluid (aqueous humor) from the eye’s anterior chamber
– Usually performed under general anesthesia• Laser trabeculoplasty is an outpatient plastic
surgery approach used in management of glaucoma
Diagnostic Techniques, Treatments, and Procedures
77
Overview of the Ear• Two important functions of the ear
– Enables us to hear– Sensory organ of balance or equilibrium
• Location of one ear on each side of head produces binaural hearing– Hearing from both sides
78
• External ear– Visible portion not contained within the head– Auricle or pinna
• Cartilaginous flap or ear lobe– External auditory canal
• Tube leading from auricle to the middle ear• Lined with tiny hairs called cilia to aid in transmitting
sound waves inward– Tympanic membrane (eardrum)
• Separates external ear from middle ear
Structures of the Ear
79
• Middle ear– Three tiny bones known as auditory ossicles– Malleus
• Resembles shape of a hammer• Connected to tympanic membrane and transmits
sound vibrations to second auditory ossicle– Incus
• Resembles shape of an anvil• Transmits sound vibrations from malleus to third
auditory ossicle
Structures of the Ear
80
• Middle ear – Stapes
• Shaped like a tiny stirrup• Transmits sound vibrations from incus to inner ear
– Eustachian tube• Connects middle ear to pharynx• Auditory tube
– Oval window• Separates middle ear from inner ear• Base of stapes fits into oval window
Structures of the Ear
81
• Inner ear– Vestibule
• Central portion of inner ear• Located next to stapes and between cochlea and
semicircular canals• Contains utricle and saccule-membranous
pouches or sacs that aid in maintaining balance– Cochlea
• Snail-shaped bony structure• Contains endolymph and perilymph• Auditory fluids that aid in transmission of sound
vibrations
Structures of the Ear
82
• Inner ear – Organ of Corti
• True organ of hearing• Contained within the cochlea• Here, sound vibrations are converted into nerve
impulses that are transmitted to the brain for interpretation as hearing
– Semicircular canals• Located behind the vestibule• Three bony, fluid-filled loops that help to maintain
one’s balance
Structures of the Ear
83
Structures of the Ear
84
The Process of HearingPathway of soundvibrations
PATHOLOGICAL CONDITIONS
The Ear
86
Cholesteatoma• Pronounced
– (koh-lee-stee-ah-TOH-mah)• Defined
– Slow-growing cystic mass made up of epithelial cell debris and cholesterol found in the middle ear• Occurs as a congenital defect or as a result of
chronic otitis media
87
Deafness, Conductive• Pronounced
– (Deafness kon-DUK-tiv)• Defined
– Hearing loss caused by breakdown of the transmission of sound waves through the middle and/or external ear
88
Deafness, Sensorineural• Pronounced
– (Deafness sen-soh-ree-NOO-ral)• Defined
– Hearing loss caused by inability of nerve stimuli delivered to brain from inner ear due to damage in auditory nerve or cochlea
89
Impacted Cerumen• Pronounced
– (Impacted seh-ROO-men)• Defined
– Excessive accumulation of waxlike secretions from glands of external ear canal
90
Labyrinthitis• Pronounced
– (lab-ih-rin-THIGH-tis)• Defined
– Infection or inflammation of the labyrinth or the inner ear
– Specifically, the three semicircular canals in the inner ear
– Fluid-filled chambers and control balance
91
Mastoiditis• Pronounced
– (mass-toyd-EYE-tis)• Defined
– Inflammation of mastoid process– Usually an acute expansion of an infection in
the middle ear – Otitis media
92
Ménière's Disease• Pronounced
– (may-nee-ARYZ dih-ZEEZ)• Defined
– Chronic inner ear disease– Over accumulation of fluid in the labyrinth– Characterized by recurring episodes of
vertigo, hearing loss, feeling of pressure or fullness in the affected ear, and tinnitus
93
Otitis Externa (O.E.) (Swimmer’s Ear)
• Pronounced– (oh-TYE-tis eks-TER-nah)
• Defined– Inflammation of outer or external ear canal
• Result of growth of bacteria or fungi in external ear• Major symptom is pain, especially when the ear is
tugged on, along with a red swollen ear canal
94
Otitis Media, Acute (A.O.M.)• Pronounced
– (oh-TYE-tis MEE-dee-ah)• Defined
– Middle ear infection– Predominately affects infants, toddlers, and
preschoolers
95
Serous Otitis Media (S.O.M.)• Pronounced
– (SEER-us oh-TYE-tis MEE-dee-ah)• Defined
– Collection of clear fluid in middle ear that may follow acute otitis media or be due to an obstruction of eustachian tube
96
• Pronounced– (SOO-per-ah-tiv oh-TYE-tis MEE-dee-ah)
• Defined– Purulent collection of fluid in the middle ear– Person may experience pain (possibly
severe), an elevation in temperature, dizziness, decreased hearing, vertigo, and tinnitus
– Also called acute otitis media
Suppurative Otitis Media
97
Otosclerosis• Pronounced
– (oh-toh-sklair-OH-sis)• Defined
– Condition in which footplate of stapes becomes immobile and secured to oval window
– Results in a hearing loss
98
Perforation of Tympanic Membrane
• Pronounced– (per-for-AY-shun of the tim-PAN-ik
membrane)• Defined
– Rupture of tympanic membrane or eardrum
DIAGNOSTIC TECHNIQUES, TREATMENTS,
AND PROCEDURES
The Ear
100
Diagnostic Techniques, Treatments, and Procedures
• Audiometry – Process of measuring how well an
individual hears various frequencies of sound waves
• Otoscopy– Use of an otoscope to view and examine
tympanic membrane and various parts of outer ear
101
• Tuning Fork Test (Rinne Test)– Examination that compares bone
conduction and air conduction• Tuning Fork Test (Weber Test)
– Examination used to evaluate auditory acuity as well as discover whether a hearing deficit is a conductive loss or a sensorineural loss
Diagnostic Techniques, Treatments, and Procedures
102
• Otoplasty– Removal of a portion of ear cartilage to bring
pinna and auricle near head• Stapedectomy
– Microsurgical removal of stapes diseased by otosclerosis
– Typically under local anesthesia
Diagnostic Techniques, Treatments, and Procedures
103
• Hearing aids– Devices that amplify sound to provide
precise perception and interpretation of words • In-canal style – fits completely into ear canal• In-ear style – worn in external ear• Behind-ear style – placed behind ear• Body hearing aid – sound delivered to ear canal
by way of microphone
Diagnostic Techniques, Treatments, and Procedures
104
• Myringotomy– Surgical procedure with insertion of a small
ventilation tube into inferior segment of tympanic membrane
• Tympanotomy– Also called a myringotomy
Diagnostic Techniques, Treatments, and Procedures
105
• Myringoplasty– Surgical repair of the tympanic membrane
with a tissue graft after a spontaneous rupture that results in hearing loss
• Tympanoplasty– Also called a myringoplasty
Diagnostic Techniques, Treatments, and Procedures