Eye Medications:
Drops
Always wash hands prior to administering drops and you should wash again after
Gently pull the lower lid down to create a pocket
Put drops in the conjunctival sac, not directly on the eyeball
Gently close eyes, do not rub or squeeze
Apply firm but gentle on the inner canthus (tear duct) for 1-2 minutes to apply pressure to the
area (note: would limit the absorption of prescription medication)
Ointments: apply a thin "strip" (about ½ inch) inside the lower lid from inner canthus to the
outer canthus
Tell the patient to gently close their eye and roll their eyeball to disperse the ointment over the
surface of the eye
Ear Medications:
Warm the medication (colds drops can cause dizziness)
Turn head to side or lay down on unaffected ear
Pull ear:
Up and back (for adults)
Down and back (for children who are 3)
Drop medication into the ear canal (do not touch ear with the dropper)
Do not move for 2 -3 minutes
Cotton may be put in the ear to absorb excess medication if needed, but do not pack the ear
Pre/Post-op Care for Cataract Surgery Patients
Pre-op:
-NPO per schedule
-Administer drops: pupil dilating drops (mydriatics, could be atropine).
-Prepare the patient and their family stating the patient will not be able to drive home after
surgery and need someone to escort them to home.
-Stated surgery is expected to be painless, rapid (i.e., say under local anesthetic).
Post-op:
-Don't rub the eye and don't strain (do not lift over 10 lbs, exaggerated bending over and
forcibly sneezing)
-Use an eye shield when sleeping.
-Take prescribed drops (aka antibiotic drops and or steroid drops)
-Expect mild discomfort, but report severe pain, loss of vision or floaters.
-Review education on complications (infection, increased intraocular pressure, and retinal
detachment).Post-op:
Do not rub the eye or strain it (i.e. heavy lifting (no lifting> 10 lbs), bending over, or sneezing
forcefully).
Wear an eye shield while sleeping.
Use the prescribed eye drops (antibiotics/steroids).
You may have mild discomfort, but report any severe pain, vision loss, or floaters.
You will receive education on signs of complications: infection, increased intraocular pressure,
and retinal detachment.
Glaucoma
Definition: Group of eye conditions where increased intraocular pressure (IOP) damages the
optic nerve, leading to vision loss.
Open-Angle Glaucoma (Chronic)
Definition: A set of eye conditions where an increase in intraocular pressure (IOP) causes
damage to the optic nerve and results in vision loss.
Most common. Drainage canals gradually become blocked.
Painless gradual loss of peripheral vision - "tunnel vision".
Treatment: Eye drops to decrease IOP (beta-blockers, prostaglandin analogs); laser or surgery.
Closed-Angle Glaucoma (Acute)
Rapidly occluded drainage canals.
Emergency!
Effects: eye pain, headaches, nausea, blurry vision, halos around lights, red eye.
Management: immediate medications to drop IOP, then laser or surgical treatment.
Care and Education: Macular Degeneration & Diabetic Retinopathy
Macular Degeneration (AMD):
Affected central vision (macula).
Dry AMD= gradual breakdown of macular cells.
wet AMD= abnormal blood vessels leak fluid/blood.
Education:
Encourage bright lighting and magnifiers.
Encourage use of Amsler grid to monitor.
Nutritional support: Vitamins C, E; zinc; lutein.
wet AMD: Anti-VEGF injections (e.g. ranibizumab).
Diabetic Retinopathy:
Caused by damage to retinal blood vessels from poorly controlled diabetes.
Education:
●​ Strict blood glucose control.
●​ Regular dilated eye exams.
Ear and Hearing Assessments
External ear assessment for lesions, drainage, shape.
Palpation of tenderness.
Otoscope Exam: Examine the tympanic membrane (should be pearly gray).
Whisper Test: Stand behind the patient while whispering words for repetition.
Weber Test: Place tuning fork on forehead and should be equal heard in both sides, left
or right.
Rinne Test: Compares air conduction vs. bone conduction (air should be longer).
Audiometry: Measures hearing sensitivity; detects type of hearing loss.
Meniere’s Disease
Definition: Chronic inner ear disease that presents with:
sensorineural hearing loss severe episodes of vertigo tinnitus (ringing)
Diagnostics:
Audiometry (sensorineural hearing loss).
MRI (to eliminate other possible issues).
Electrocochleography (to check for excess fluid).
Medical Treatment plan:
Diet:
Low sodium (<1500 mg/day) to minimize fluid retention.
Avoid caffeine, alcohol or smoking.
Medications: Diuretics (e.g. hydrochlorothiazide) to reduce excess fluid.
Antivertiginous agents such as meclizine.
Antiemetics e.g. ondansetron, promethazine.
Benzodiazepines for short term vertigo.
Surgical Treatment only in severe/refractory cases:
Endolymphatic sac decompression: decreases pressure.
Vestibular nerve (section) - reduces vertigo while allowing hearing.
Labyrinthectomy - removes ear's balance function (usually complete loss of hearing
patients).
Gentamicin injections - chemically ablate ear function.