E.N.

T
 Semiology
- Fever - Discharges - Ringging in the ear
- Pain - Rashes
 Diseases;
- Otitis external
- Otitis Media
- Rhinitis
- Sinusitis
- Mumps
- Diphtheria
- Foreign bodies
- Benign or malignant tumour
- Facial trauma
MGT of Conditions
- Pain control
- Post op care
- Mgt of disability regard to body image

DISEASES OF E.N.T
 The diseases of ENT are considered together because these
structures are linked anatomically and are affected by the same
pathological process.

EAR DISORDERS

The symptoms of ear disorder include:-

- Vertigo
- Pain
- Discharge
- Deafness
- Tinnitus

DEAFNESS

This means the pt has hearing lose which may be mild or severe. If
the cause of deafness lies in the outer or middle ear, it may be refers to
as conductive deafness.

If the cause is located in the inner ear that is involving the auditory
nerve, it may be known as sensory neural deafness.

The most common cause is presbycousis that is sensory neural

hearing lose due to degeneration of the nerve tissues.
 PAIN OR EARACHE

It is also refer to as otalgia. It is a very common complication in

children and the elderly. In children otalgia is commonly caused by
acute otitis media. In the adult it is due to otitis externa. The pains may
arise from an adjacent site with a shared nerve disease. The commonest
site for referred pain in the ear is the throat. ie some malignant tumour.

DISCHARGE

A discharge from the ear may be mucoid purulent or bloody. Ear

discharges must be distinguish from escape of wax which is a normal
process. The cause of ear discharges is otitis externa or otitis media.
When an ear discharge is caused by otitis media, a perforation will be
present in the tymphanic membrane.

VERTIGO

This is a form of dizziness when the client is experiencing a form

of spinning sensation. It is a common symptom when the balance of
vestibular system of the inner ear is diseased. It is often accompany by
nausea and vomiting and it is difficult to treat.

TINNITUS

It is a very common complaint. The intensity and quality of

tinnitus vary from a high pitch whistle to the lagging of bells. Tinnitus
may also involve some recognisable snatching of music. It is a
distressing symptom. It may sometime be alleviated but it can rarely be
cured.

DISEASES(DISORDERS) OF THE OUTER EAR

1. Accumulation of Wax (Cerumen)

This is a normal substance produce in the ear canal. It is made up
of keratinized epithelial cells mixed with secretion of cerumenious
gland to the skin of the outer layer. In most people the wax escapes
as it is formed. In some other people it remain in the ear canal
obstructing it and causing deaf ear or deafness.

MGT

Olive oil or liquid parafin eardrop will soften the impacted wax
which is removed by syringing. It is important that water used in ear
syringing should be at body temperature in other not to stimulate the
inner ear and causes dizziness. The stream jet of water is directed
towards the wall of the ear and the wax is washed out. A receiver is held
beneath the ear and the pt’s clothing protected by a mackintosh sheet.

The ear must be dried gently after syringing and examine to exclude any
damage to the tympanic membrane.
 2. Foreign bodies(FB)

These are commonly found in the ear. Sometimes this F.B are
removed by springs or probe. In most cases the child is often frighten
and uncooperative. General anaesthesia may be necessary. The ear must
always be check to expose any underline damage with the external ear
canal or tympanic membrane. An insects in the ear is treated similarly.

3. Otitis Externa
This is an inflammation of the outer ear linned by the skin. It is
also bilateral and the symptoms starts with itching. The pt
scratches the ear which becomes infected, painful and sometimes
blocked by a purulent discharge.

Causes
- Allergy
- Stress factors
- Ear contact with infected water or liquid

Mgt

- Any precipitating cause is removed

- A swab is taken for culture / sensitivity
- The ear canal is cleaned thoroughly and frequently using cotton
balls and a tip of a suitable probe
- Dry the ear by wiping at least 3 times per day.
 Topical ABTS, ear drops may be instilled directly into the
affected area.
4. Boils (Furuncles)
A boil in the outer ear bearing in the ear canal. It is very painful
because they stay at this side. It is firmly attached to the underline
cartilage.
Causes
They are caused by staphilococcus aureus
Mgt
- ABTS if necessary when symptoms are severe
- Analgesics are given to relieve pain. Possibility of underline
diabetes must be excluded.

Tumours

Malignant tumours of the ear are commonest in the outer ear.

Here basal cell carcinoma and squamous carcinoma are found.
Early diagnoses of small lesion may be treated with radiotherapy.
Large lesion will require surgical excision.

2) MIDDLE EAR DISORDERS

 To ensure that sound waves pass via the ossicles, the
pharyngotympanic tube must allow air enter the middle ear from the
nasal pharynx. In children particularly this tube becomes block and this
obstruction is responsible in many conditions in the middle ear.

Serous or secretory otitis media

When the pharyngotympanic tube becomes block the air traps in

the middle ear is absorbs into surrounding tissue and is replaced by
their fluid. In time small glands appear on the lining of the middle ear
and the mucus which they secret, causes heavy loss which now
interferes with hearing. This is often refers to as Glue ear. The
pharyngo tube distension is common in children with URTI including
those with immature muscular tissue. In this condition the hearing loss
may pass un-noticed. However the parent may notice a deterioration
with the child’s school work as he suddenly turns off the radio or TV.
They may also be episode of earache.

An examination of the ear may reveal the presence of fluid. The

presence of fluid between the tympanic membranes. If this condition is
temporal or intermittent nothing need to be done.

In time most children outgrows the conditions. If the condition is

more severe an alternative means of allowing air into the middle ear
must be found. A hole is made in the tympanic membrane
(myringotomy). The hole is prevented from healing by inserting a
 small plastic tube (grommet). Also any underline cause e.g sinusitis or
a large adenoid must be treated. As long as the grommet remain in
place and unblocked the hearing will be normal. However the
grommet may drop out after an average period of 6 months.

It is hope that the pt will have outgrow the problem. On the other
hand a grommet is reinserted if fluid re-accumulate in the middle ear.
The middle ear is in continuity with the naso-pharynx and therefore
very close or prone to infection.

Acute otitis media

The middle ear is in continuity with the naso-pharynx and therefore

very prone to infection. This is particularly so with the presence of
serous otitis media. When a convenient culture medium is available for
the invading bacteria. Here the middle ear mucous membrane becomes
inflamed and the cavity fills with pus which escapes by bulging out via
the tympanic membrane into the external auditory canal. The pt who is
often a child with a cold develops an ear ache which ring severely and
ceases when the membrane ruptures or burst. The perforation usually
heal within 2 – 3 days but this must be checked after a month and the
presence of underline serous otitis media must be excluded.

Rx and Nsg Care

 The pt should be confined in bed by giving analgesics. A covered
hot water bottled applied to the ear which is very healthy.

Warm olive oil drops will sooth the inflamed membrane. If the pt
is seen before the perforation occurs penicillin should be given for at
least five days. A swab should be taken from the discharging ear and
send for culture and sensitivity.

Complications (cxs)

Acute mastoiditis: A condition in which an abscess developed in

the mastoid bone and rupture out behind the ear. this cxs is found in
children whose natural defence mechanism are not functionally normal.

Chronic otitis media

Went the middle ear infections becomes persistent it is called chronic

otitis media. Permanent damage is cause to the membrane and ossicles.
The pt may become deaf with a large central perforation with a
persistent discharge. The discharge is most likely to occur when the pt
has a cold thus the infected secretion pass up to the pharyngo tympanic
tube.

Mgt

An attempt is made to exclude any source of infection in the Nose

or Nasopharynx. The local discharge can be control by regular toileting
or cleaning up that is should dry the ear with cotton ball at least 3 times /
day.

- Roll any clean absorbent substance into wick

- Place the wick in the discharging ear
- Remove the wick when wet and replace with a clean one until
the ear is dry.
- The instillation of ABTS in the eardrum when the ear has been
dried for several months.
- It is suitable if a surgical repair of the perforation is done after
drainage stops.

A piece of fascia (a sheet of connective tissue) excluding muscles

is taken from the surface of temporalis muscle and grafted over the
perforation. The graft may be laid on the inner or outer surface of the
tympanic membrane. The operation is known as myringoplasty.

Similarly any loss of ossicular continuity can be corrected by

repositioning the damage ossicles or by replacing it with a piece of bone
or prosthesis (the putting or fixing of artificial part of the body). Also
this operation is called Tympanoplasty.

In recent years it has become possible to remove the tympanic

membrane and its attached ossicle in one block the cadaver (a dead
body use for dissection).
 These homograft tissues (tissues or organs transplanted from one
individual to another of the same specie) can then be implanted into a
suitable pt. However this operation is technically very difficult.

Cholesteatoma

This is a cyst lined by squamous epithelium and fills with layers of

epithelial scales. The cyst develops from an impacting of the upper
segment of the tympanic membrane into the middle ear cavity. Initially
the epithelial scales escape into the external canal but as the mouth of
the pouch narrow they are retained and accumulated.

The cholesteatoma has the property of eroding the tissues which it

encounters. The content of the cyst becomes infected and the condition
may be regarded as a form of chronic otitis media. damage is
determined by the direction into which cholesteatoma arises.

Often the ossicles are damage but an upward extention may

produce a brain abscess or meningitis. Also a medial extention may
induce facial paralysis or damage to the inner ear.

S/S

 The pt complaints of deafness

 Offensive scanty discharge
 Evidence of complications
 An examination of the ear will reveal marginal perforation
  White epithelial cells protruding
Mgt
 Removal of the cyst by surgery
 Radiotherapy
 Chemotherapy

NOSE AND NASAL CAVITY

This is a large and irregular cavity divided into 2 equal parts by a

septum situated in a mid line. Posteriorly the septum is formed by the
plate of the ethmoid bone and the vomer bone. Anteriorly the nasal
cavity consist of hyaline cartilage. The roof of the nasal cavity is
formed by cribiform plate of the ethmoid bone which has numerous
small foramen via which nerve fibres of the olfactory nerve (The nerve
of the sense of smell pass upward from the nasal cavity to the brain on
each side of the nasal cavity, the ethmoid bone present two projections
called the upper and middle conchae.

The roof of the nasal cavity is also formed by the sphenoid, frontal
and nasal bone.

The floor of the nasal cavity is formed by the roof of the mouth
which consist of the hardpalate in front and soft palate behind. The
hard palate consist of maxilla and the palantine bone. The soft palate is
composed of unstripped muscle. The medial wall is formed by the
 septum, the lateral wall formed by the maxilla ethmoid bone and the
inferior conchae. The posterior wall is formed by the posterior wall of
the pharynx.

Opening into the Nasal Cavity

Anterior Nares: There are openings from the exterior into the nasal
cavity.

Posterior Nares: These are openings from the nasal cavity into the
pharynx.

Sinuses: These are cavities in the bones of the face and the cranium
which contain air the nares sinuses include the following.

Maxillary sinuses: This is found in the lateral wall, the frontal and
sphenoidal sinuses in the roof. The ethmoid sinuses in the upper side of
the lateral wall.

Nasolacrimal duct: This membranous canal which is about 2cm long. It

extent from the lower part of the lacrimal sac and open into the nasal
cavity at the level of the inferior conchae.

Linning of the Nasal cavity: Nostrils or nasal cavity is lined is ciliated

columnar epithelium which contains mucus secretary goblet cell and the
anterior nare at the ciliated mucus membrane binds with the skin and
posteriorly extent to the nasal part of the pharynx.
Functions of the Nose

It begins the process by which air is warmed moist and filter. The
incoming air is warmed as it passes over the surface of the nose. The air
is moistened by contact which the moist mucus and it is filter as particles
of dusts and other impurities such as bacteria stick to the mucus. The
cilia of the mucus membrane sweep the mucus towards the throat and it
is swallowed.

Pharynx

Its is a tube 12 – 14 cm in length and extent to the base of the skull

to the 6th cervical vertibrates.

It is behind the nose, mouth and larynx. It is wider at it upper end.

Structures in Association with the pharynx

Superiorly, the inferior surface of the base on the skull inferiorly

the phaynx

SINUSITIS

This is caused by spread of microbes from the nose and parynx to

the mucous membrane lining the paranasal sinuses in the maxillary,
sphenoidal, ethmoidal and frontal bone. The primary viral infection is
followed by a bacterial infection e.g streptococci pyogenous,
streptococci pneumonia, and staphylococcus aureus. The congested
mucosal will block the opening between the nose and the sinuses
draining of the mucus penitent discharge. When there are repeated
attacks or when if recovery is not complete, infection may become
chronic.

The maxillary sinuses is most frequently involve. The frontal, and

ethmoidal sinuses is less frequently involved. The sphenoidal sinus is
seldomly infected. Sinusitis may followed viral infection (cold) allergic
rhinitis or driving all of which interferes with drainage and cause
bacterial contamination of the sinuses with bacteria normally present in
the healthy throat.

Other predisposing factors may be congenital or acquired

obstruction or facial fractures.

S/S

S/S of acute and chronic sinusitis are similar

- The area over the involved sinus may be tender and swollen
- Maxillary sinuses causes pain in the maxillary area toothache
and frontal headache
- Frontal sinusitis produces pain in the frontal area and frontal
headache
- Ethmoidal sinisitis causes pain behind and between the eyes and
a frontal headache that is often described as splitting.
 - Pain from the sphenoid sinuses is less much localized and is
referred to the frontal area.
- They may be malaise
- Fever and chills suggest an extension of the infection beyond
the sinuses
- The Nasal mucous membrane is reddish and leurgescent
- Yellow or green purulent rhinorrhoea which may be present
- The sero-purulent or muco-purulent exudate may be seen in the
middle meatus maxillary, anterior ethmoid and frontal sinusitis
and in the area medial to the middle turbinate in the posterior
ethmoid and the sphenoid sinuses.

Diagnosis

The frontal maxillary sinusitis may be opaque for trans-

illumination but radiography of the paranasal sinuses is more reliable
defined at the site and degree of involvement is view.

Radio–opacity on acute sinusitis may be due to the swollen mucus

membrane or a retained exudate in chronic maxillary sinusitis to exclude
a para-apical abscess

Rx

- Improve drainage and control infection and the ends of therapy

in acute sinusitis
 - Steam inhalation effectively produces nasal vaso constriction
and promote drainage
- Topical vaso constrictor such as ephenilephedrine 0.25% are
effective but should be used for a maximum of 7 days.
- Systemic vaso constrictor such as pseudoephedrine 30mg orally
q 4-6 hrs (Adult are less reliably effective.
- In both acute and chronic sinusitis ABTS(Antibiotics) shall be
given for at least 10 – 12 days.
- In acute sinusitis penG 250mg orally q 6hrs is the initial ABTs
of choice.
- Erythromycin 250mg orally 9 hours is the 2nd choice
- In exacerbation of chronic sinusitis a broad spectrum ABTS
such as AMP. 250-500mg or tetracycline 250mg orally q 6 hrs
is better.
- In chronic sinusitis Antibiotics theraphy for 4 – 6 weeks result
in complete resolution. The sensitivity of pathogen isolated
from the sinus exudates and the pt response quite subsequent
therapy.

Surgical intervention

Sinusitis not responsive to ABTS therapy may required surgical

intervention such as (cald well-Luc operation) for maxillary sinusitis,
ethmodectomy to improve ventilation and drainage and 2 remove
inspissated purulent material, epithelial debris and hyper-trophic mucus
membrane.

Chronic frontal sinusitis is mged with an osteoplastic obliteration.

TONSILITIS

Inflammation of the tonsils (lymph nodes found at the back of the

throat which help protect the body against infections) there are 2 in
number.

Acute tonsillitis

- Inflammation of the tonsil characternised by

- Sore throat
- Fever
- Dysphasia (difficulty in swallowing)

It is a common painful situation which should not be neglected because

of its cxs.

Causative organism.

Haemolytic Strepto cocci is often responsible for sore throat. Also

mixed bacterial or viral infection may occur

Incubation Penod

Incubation period 1 -3 days

Occurance: All ages are affected but less common in children below 3
years. Higher in early childhood that is 5 years above.

Mode of transmission

- By droplet with the organisms inhale from dust and air via other
formites.
- By direct contact points or carriers
- By indirect contact with formites etc

S/S

- Sudden onset
- Soreness in the throat
- Painful swallowing or pain is more marked on swallowing
which radiate or refer to the ear.
- Very young children will not complaint of sore throat may
refuse to eat.
- Higher fever (above 400 C)
- Malaise, Headache and emesis which are common
- Enlarge jaw gland leading to ear pain, mouth breathing, foul
smelling breathe, voice impairment
Diagnosis
- On exam the tonsils are oedematous and hyperaemic
- Collection of swab specimen tonsil and culture done to exclude
certain organisms
 - The may be a purulent evidence from the lesion and a
membrane is white, thin and confined to the tonsils that peels
away without bleeding.

Differential diagnoses

This include Diptheria

- Vincents angina (trench mouth)

- Infectious mononucleosis

In Diptheria the membrane is dirty grey, thick and tough and bleed
if peeled away. It shows coryne bacterium Diptheriae.

Vicents agina is extensed by superficial painful ulcers with

erythematous borders. It is caused by a fusiform bacillus and its
spirochaete that are demonstrable on smell.

Infectious mononucleosis is extentically association with micro-

petechiae of the soft palate.

A typical lymphocyte on smear and a true itetrophil agglutination

confirm the diagnoses of mononucleosis.

CXS

- Otitis media
- Peritonsillar Abscess
- Glomerulonephritis
- Acute rheumatoid arthritis
- Cardiac involvement

Rx and Nsg care

- The pt is treated in isolation

- Bed rest till fever subside
- Diet should be warm and drinkable to soot the throat and other
light food.
- Monitor v/s especially temperature
- Administer ASA(acetyl salicylic acid) and advice on throat
gargle with water and salt(warm).
- In viral tonsillitis symptomatic therapy is indicated and
sensitivity based where the drug of choice is pen V or pen G
250mg orally q.6hrs. and of choice the strepto tonsillitis and
should be continue for 10 days. When possible the throat should
be re culture 5 – 6 days after end of Rx.
- Family members throat should also be cultured initially so that
carriers may be treated immediately. Tonsillectomy should be
considered if despite these precautions acute repeatedly
developed after adequate Rx or chronic tonsilitis and sore throat
persist or are relieve only briefly by ABTS therapy.
INFLUENZA
 Acute and highly infectious viral dse of the respiratory track
causing fever, mental depression and secondary infections.

Causes

Viral found to be of many strains e.g A and B New strain appear

from time to time so that early acquired immunity amongst one new
strain may not be effective against another new strain and the old strain
often disappear.

Immunity after an attack is short live.

Occurrence

- Affect all age group and world wide

- Occurs in epidemic and vary in their clinical features and their
fatality rate.
- Occur as pandemic with high mortality rate as in 1918 when
many people died. Children are more susceptible to this
infection.

Mode of spread

- Droplet infections (sneezing)

- By direct contact with virus

Incubation period

1 – 3 days.
 S/S

- Sudden onset with a picture of common cold and bronchitis

- Pt complaint of chills, fever, backache, malaise
- Nasal obstruction
- Discharging eyes
- Sore throat
- Sneezing
- Dry cough

In some pts sinusitis, bronchitis, bronchopneumonia, pleurisy and

mental depression are occurring as secondary infections

Gastro intestinal symptoms may occur such as nausea, vomiting

abdominal pain and diarrhoea

CXS

- Broncho pneumonia
- Myocarditis
- Meningoecephalitis

Rx and Nsg Care

There is no specific RX. The goals of mgt are

- To relieve symptoms
- To Prevent and treat Complications
 - To ensure bed rest whether in isolation or at home to reduce
spread
- To monitor v/s especially tempt and chart
- Diet is light nourishing
- Encourage much fluids intake to thin the secretion and
decreased fever
- Steam or any vapourizer to humidify house or tents (to avoid
irritation of the mucosa and resp tracks).
- Rx cough with expecturants or antitussive drugs
- Analgesics are given for pain/Headache
- Avoid irritant such as cigarette/alcohol. Will impair ciliary fxn
- ABTs given for 2o infections

Preventions

- Avoid over crowding

- Health edu. 2 pts and relatives on the spread of the disease
- Vaccine are available and are given 2 cardiac / pulmonary
disorder pts but last short live because of new strain.

RHINITIS
The most frequent of the acute URTI is characterised by oedema
and vasodilatation of the nasal mucus membrane and nasal discharge
and obstruction.
 ACUTE RHINITIS

A usual manifestation of common cold (Resp. Viral disease). It

may also be caused by strepto, pneumococci or staph infection.

CHRONIC RHINITIS

May occurs in syphilis, tuberculosis, rhinosclerosis,

rhinospoiridiosis, leishmaniasis Blastomycosis, histophasmosis, and
leprosy.

All condition characterised by granuloma formation and

destruction of soft tissue, cartilage and bone Rhino sclerosis also causes
progressive nasal obstruction from indurated Lamina inflammatory
tissue in the lamina propia. This condition produces nasal obstruction,
purulent rhinorhoea and frequent bleeding.

Rhinosporidiosis is characterised by bleeding polyps

Dx

1) The diagnosis and Rx of acute bacteria Rhinitis are based on

pathogen identification and Antibiotics sensitivity. Topical vaso-
constrictors with a sympathomimetric amine e.g phenylephedrine
0.25% (given q 3-4 hours for not more 7 day provides symptomatic
relief). Sympathomimetric amine such as pseudo ephedrine 30mg
orally q 4 – 6 hrs may be given for vaso constriction of the nasal
membrane. Dx in chronic Rhinitis is based on demonstrating the
 causative organism by culture or biopsy. Rx consists of
chemotherapy appropriate to causative agent

TYPES OF CHRONIC RHINITIS

Atrophic Rhinitis

It is a chronic rhinitis characterised by atropic and sclerotic

mucous membrane abnormal petency of the nasal cavity. Crust
formation and fowl pseudo-stratified columnar epithelium to stratified
squamous epithelium and the lamina propia is decrease in amount and
vascularity. Anosmia results epistaxis may be recurrent and severe.

The aetiology is unknown although bacterial infections plays a

role.

RX

Rx is directed towards reducing the crusting and eliminating the

odour using topical ABTS.

POLYPS

Allergic rhinitis predisposes public polyps formation. It may also

occur in acute and chronic infections.

Pathology

Nasal polyps formed at the site of massive dependent oedema in

the lamina propia of the mucus membrane usually around the astia of the
maxillary sinuses. As a polyps develops it becomes a tear drop when
matured. It resembles a peeled seedless grape. In acute infections polyps
may regress after the infection resolved.

Polyps occur in rhinospodiosis. Unilateral polyps occasionally

occur in association is malignant or neoplasm of the nose or paranasal
sinuses.

RX

Corticosteriod such as Beclomethaxone dipropionate 42mg /spray

or flunisolide 25mcg/spray aerosol 1 or 2 spray in each nasal cavity bid
have reduce or eliminated polyp although surgical removal is still often
required. They should be remove if they obstruct the air way or promote
sinusitis or unilateral polyps that may be absuring, benign or malignant
neoplasm. They turn to reoccur.

Following removal of nasal polyps topical Beclomethaxone

therapy turns to retard their reoccurrence. In severe and reoccuring
cases, maxillary sinusoctomy or ethmiodectomy may be indicated.

MUMPS (Epidemic Parotitis)

Acute contagious generalise viral disease usually causing painful

enlargement of the salivary gland most commonly the parotid.

Etiology and Incidence

 The causative agent paramyxo virus is spread by droplet
infections or direct contacts with materials contaminated with infected
materials or saliva. The virus probably enters via the mouth. It may be
found in the saliva one to six days before the salivary gland swell and
the duration of granular enlargement (usually 5 -9 days).

The paramyxo virus have been isolated from pts blood and urine
and also from CSF in pts with Central Nervous involvement.

It is endemic in heavily populated area but may occur in epidemics

where many susceptible individual are crowded together.
Communicability is less than in measles and chicken pox.

Incidence

The incidence peaks in later winter and early spring. Although the
disease may occur at any age, most cases are in children age 5 to
15years.The disease is unusual in children less than 2 years and infants
up to 1 year ordinarily are immune

One attack usually confers permanent immunity even though only

one parotid has been enlarged. About 25-30 % of cases are clinically

inapparent (do not developed).

S/S and course

 After a 14 – 28 days incubation period onset occurs with chilling
sensation. Headache anorexia malaise and a low moderate fever that
may last 12 – 24 hours before salvary gland involvements noted. These
prodromal symptoms may be absent in mild cases.

Pain on chewing or swallowing especially on swallowing acidic

liquid such as vinegar or lemon juice, is the earliest symptoms of
parotitis.

There is mark sensitivity to pressure over the angle of the jaw.

With development of parotitis the temp. usually frequently rise to

39.5 or 40o C.

Swelling of the gland reaches maximum about the second days and
is associated with tissue oedema extending beyond the parotid in front or
below the ear.

Course (Pathology)

Both parotid gland are involve. Occasionally the sub maxillary and
lingual also swells more rarely. These are the only gland affected.
Swelling of the neck beneath the jaw occurs in such cases or with
maxillary gland involvement, suprasternal oedema may develop. The
oral duct openings of the involved glands are “protruding and slightly
inflamed. The skin over the gland may become tense and shiny.
Involved glands are acutely tender during the 24-72 hours febrile period.
 The WBC count may be normal though a slight leucopenia with a
reduction in granulocyte is usual.

Prognosis

Excellent in uncomplicated mumps but rarely a relapse occur after

about 2 weeks.

Complications

Particularly in post pubertal Pts. The disease may involve organs

rather than salivary gland. Symptoms may proceed, accompanying or
following salivary gland involvement and may also occur without
primary sialadenitis.

- Ochitis occurs in about 20% of post – pubertal male pts and is

usually unilateral. Some testicular atrophy may ensure but
sterility is exceedingly rare, hormonal fxn is not lost. Gonadal
involvement in female (oophoritis) is less commonly
recognised. Is far less painful and has not being associated with
subsequent infertility.
- Meningoencephalitis: Headache, stiff neck, CSF phagocytosis is
common in mumps. CSF glucose levels are usually normal but
occasionally are low between 20 – 40 mg/dl.
 - Mimicking bacterial meningitis. More severe encephalitic signs
occur in about 5 – 10% with confusion that may be abrupt in
onset or even coma. About 30% of CSF.

About 30% of CNS mumps infections occurs without associated

parotitis. The prognosis is favourable in most cases with CNS
involvement and considerably better than in measles encephalitis.
Although permanent sequelae such as unilateral (rarely bilateral nerve
deafness or facial paralysis) may result as in other viral diseases a para
or post infectious form of encephalitis may occur but is rare. Other
unusual manifestation include:

Acute cerebella ataxia

Polyneuritis

Myelitis

Pancreatitis: Towards the end of the 1st week the pt may have severe
nausea and vomiting with abdominal pain that is more severe in the
epigastrium and suggest pancreatitis. These symptoms disappear about a
week later and the pt completely recovers.

Miscellaneous CXS

- Myocarditis
- Mastitis
- Polyarthritis
 - Prostatitis
- Nephritis
- Lacrimal gland involvement are seen occasionally.
Inflammation of the thyroid and thymus gland may cause
oedema and swelling over the sternum but this is more common
and 2o to sub maxillary involvement

Diagnosis

Dx of typical cases during an epidemic is easy but sporadic cases

are more difficult to detect swelling of the parotid or other of the
salivary gland due to mump virus must be distinguish from :

- Bacterial parotid involvement in strepto throat infection,

bacteria or debilitated pt with poor oral and hygiene or typhoid
fever or typhus fever.

Assignment:

- Find out the differential diagnosis of mumps

- Prophylaxis
- Rx and Nsg care

FOREIGN BODIES IN THE NOSE

 Common in young children, this could be grain of corn, bean,
pebbles ( grain of sand, beats. In adult things like insects could
constitute a FB in the nose.)

F.B in the nostrils result in a fowl smell, blood and unilateral

discharge.

Mineral salt are deposited on a long retain FB producing Rhinolith

(accumulation of Rhinorrhoea around the FB).

S/S

- The patient complaints of pain

- Sneezing from time to time

RX

In children removal requires general anaesthesia vaso constriction

with a topically apply sympathomimetric amine e.g phenylephedrine
0.25% may facilitate removal. A blunt hook is placed behind the F.B and
then drawn forward.

Nota Bena

Attempt at grasping smoothing firm F.B with forceps turns to push

them further posteriorly. Rhinolith are difficult to remove because their
shape turns to conform the contour of the nasal passage.
 Initially a simple F.B like insects can be removed by closing one
side of the nostrils and blowing with force via the other side that will
dislodge with force the insects which was entangled with rhinolith.

FRACTURES OF THE TEMPORAL BONE

Ecchymosis in the post auricular skin that suggest a fracture of the

temporal bone.

Bleeding from the ear following a skull injury is a sign of a

temporal bone fracture. The bleeding may be medial to an intact
tympanic membrane may come from the middle ear via a ruptured
tympanic membrane or may come from a fracture line in the ear canal.

A haemotympanic gives the ear drum a blue black colour. CSF,

otorrhoea signifies a communication between the middle ear and
subarachnoid space. Fracture longitudinal to the petrous pyramid extents
to the middle ear and ruptures the tympanic membrane they produce
facial paralysis in about 15% of cases and a profound sensory-neural –
hearing lose in about 35% cases. The Middle ear damage may include
disruption of the ossicular chain.

Transverse fractures cross the fallopian canal and cochlear and

nearly always produce partial paralysis and a permanent hearing loss.

The hearing can be assess initially with the weber and Remin
tuning fork test and subsequently with audiometry.
 With C.T scan of the head with special attention on the temporal
bone, the fracture can be demonstrated

RX

Surgery:

Tympanoplasty with repair of the ossicular chain is carried out

weeks or months later meanwhile persistent facial paralysis requires
decompression of a nerve. To prevent any infection eg bacterial
infection, a broad spectrum antibiotics e.g of the Penicillin family is
given 6 hourly for 7 – 10 days. This will prevent bacterial meningitis.

FRACTURE OF THE NOSE

The Nasal bones are fractured more frequently than the other facial
bones. The fracture usually include the ascending process of the maxilla,
and open the septum. The torn mucous membrane result in most
bleeding. Soft tissue swelling develops promptly and may obscured the
breathe, septal haematoma may occur between the perichondrium and
the quadrilateral cartilage and may become infected. Abscess formation
led to a vascular and septic necrosis of the cartilage with a saddle
deformity of the nose.
 Diagnosis

A fracture should be suspected if body injury causes bleeding of

the nose. It can ordinarily be established by gentle palpating the dorsum
(bridge of the nose for deformity, disability, crepitus and point
tenderness and this is confirmed by x-ray or C.T head scan.

The most common deformity is the displacement of the dorsum in

one direction and depression of the nasal bone and ascending process of
the maxilla of the other side.

RX

Nasal fractures in adult may be reduced under local anaesthesia.

Children require general anaesthesia. The fracture is manipulated into a
good position by internal and external traction. The blunt elevator is
placed under the depressed nasal bone and the depressed bone is lifted
anteriorly and internally while pressure is applied to the other side of the
nose, in other to bring the nasal dorsum to the mid line.

The position of the nose may be stabilised by internal packing

done by external splinting. Septal haematoma must be immediately
incised and drained. Septal fractures are difficult to hold in position and
often required nasal septual surgery later.

NASAL TUMOUR

There are two types of tomour;

 1) Benign tumour: e.g Adenoid cyst and nasal polys.
They present as a mass of the dorsum of the nose. This tumour can
block a sinus passage leading to inflammatory process in the sinus
and alter to drainage.
These tumours both benign and malignant can either obstruct the
nose laterally. Also nasal pharyngeal inflammation can block
either one or both nostrils. If the tumour is malignant, metastasis
can easily get to other part of the body. Carcinoma of the maxillary
or ethmoid sinuses may appear via the adjacent nasal wall. They
often bleed easily hence careful and early excision can be done
with minimal deformity with nil metastasis.

JUVENILE ANGIOFIBROMA

A beningn tumour arising from the connective tissue in the

nasopharyngeal vault and occurring almost exclusively in male during
puberty.

The Angiofibroma is rare and firm, composed of fibrous tissue and

numerous thin wall vessel without contractile tissues.

S/S

Epistaxis is the major symptoms.

 Angiofibroma may obstruct the nasal cavity and they encircles
upon the para-nasal sinuses and invade the orbit and cranial cavity.

The pterygo maxillary tissue is frequently widened by the

extension of the tumour into the intra-temporal fossa.

The widening of the tissue may be determined radiographically.

The extent of the tumour may be determined with C.T scan.

The source of the blood supply and the presence of the intra cranial
extentions are determined with bilateral selective internal and external
carotid Angiography.

RX

Although angiofibroma usually subside with maturity Rx is usually

necessary. To control recurrent massive bleeding, oestrogen therapy
with diethylstilbestiol 5mg orally tid for 6 weeks prior to excision
reduces the size and vascularity of the tumour.

Angiographic embolisation followed by excision is the most

definitive method of Rx but radiation therapy is the Rx of choice for pt
with intra-cranial and orbital extensions.

JUVENILE PAPILLOMAS

This is benign tumour of the larynx that may grow so exorbitantly

at multiple sites that tracheostomy is required to maintain adequate air
way. They are thought to be of viral aetiology and they may appear as
early as 1 year of age and occur in epidemics

Rx

This is by periodic excision or lesser vaporisation. Recurrence is

common and regression usually occur spontaneously in puberty.

ACOUSTIC NEURINOMA

They are derived from Schwann cells. They arise twice as often
from the vestibular division of the 8th cranial nerve as from the auditory
division and accounts for approximately 70% of all intra cranial
tumours. As the tumour increases in size, it projects from the internal
auditory meatus into the cerebelloposline angle and begins to compress
the cerebellum and the brain stem. The fifth and later the seventh cranial
nerve becomes involves.

S/S AND DIAGNOSIS

A hearing lose and tinnitus are early symptoms although the pt

complaint of dizziness and unsteadiness. True vertigo is not usually
presence. The sensory neural hearing lose is characterised by greater
impairment of speech discrimination than would be expected with a
cochlear lesion.
 Acoustic reflex decay and absence of wave forms and increased in
the latency of the 5th wave in the brain stem response audiometry
provide further evidence of a neural lesion.

As a role caloric testing demonstrate mark vestibular hypoactivity

(canal paresia).

Each diagnoses is based on audiologic assessment particularly

brain stem response audiometry and air contrast computed
systermography.

Rx

Small tumour may be removed by/with micro-surgical technique

that allows preservation of the facial nerve. Using a needle crania fossa
route to preserve the remaining hearing or a trans-labyrinthine, if no
useful hearing remains. Large tumours are removed by a combination
trans-labyrinthine and the sub-occipital approach.

LARYNGITIS

It is an inflammation of the mucous membrane of the larynx. It

may be acute or chronic.

Acute laryngitis

- Acute infectious fever especially measles, diphtheria and

influenza (cold common)
- Acute tracheitis
- Irritants e.g smoke, dust that causes allergic reaction thereby
resulting to inflammatory process of the larynx.
- Excessive use of the voice e.g during prolong singing, crying
for long.

S/S - Slight hoarsness of the voice to complete loss of the voice

- Irritation in the throat accompanying a dry cough

- General signs of infection e.g malaise, fever, headache

Dx

- Hx of crying or singing maybe for the past 2 days or so

- Examination of the mouth to identify koplik’s spots as in the
case of measles
- Throat swab examination to identify the organism

Rx

- Steam inhalation
- Treatment is symptomatic
- Bed rest
- Diet should be light with a lot of hot drinks for soothing
- Avoid talking to raise the vocal cord.
- Avoid irritating factor that is smoking, dust etc
- Cough syrup in case of any cough
 - Antibiotics in case of bacteria causes

Chronic Laryngitis

Causes: - Repeated causes of acute laryngitis

- Long over use of voice as in singing

- Excessive cigarette smoking
- TB laryngitis and malignant disease of the larynx

S/S

- Progressive hoarsness of the voice and complete loss

- Dry, harsh cough with persistent urge of clearing the throat.

Dx

- Laryngoscope and biopsy to exclude malignancy

- Full blood count

RX: Nsg. Care

- RX is symptomatic
- Long rest for pt due to the over use of voice
- TB laryngitis treated with TB drugs
- Steam inhalation
- Remove iritants or stop smoking
In malignant laryngitis, operation and radium therapy, but if wide
spread, palliative Rx is given especially sedative.
OPHTHALMOLOGIC PATHOLOGIES
THE NORMAL EYE
Introduction
Is referred to as the eyeball or globe. It is round like a ball and is
embedded in the bony socket know as the orbit. The eye is held in
position by ocular muscles and connected to the brain by the optic nerve.
Anteriorly, the eye is covered by the eyelids (upper and lower) with eye
lashes along its rims.
THE EYEBALL
A)Consist of three layers
 An outer protective layer
- Cornea
- Sclera tough
- Conjunctive
 A middle vascular layer called uvea
- Jris
- Ciliary body form the uvea
- Choroid
 An innermost layer
- Retina (visual layer)
B) The eyeball is ÷ ed into 2 segments
1) The anterior segment (front part)
2) The posterior segment (back part)
Both segment are ÷ (separated) by the lens and the structure that hold it
in place.
The anterior segment – can readily be seen especially with a good light.
The posterior segment – requires special instruments to visualize
The cavity of the eyeball is filled with fluids called aqueous humour and
vitreous humour. The lens is also a content of the cavity
THE CORNEA
The cornea is transparent, clear like glass and looks like the glass cover
of the face of a wrist watch. In the front (anterior) part of the eye. From
afar, it looks black, but the darkness reflects from the lris which lies
behind the cornea.
- The cornea focuses light in to the eye
- Has three layers – epithelium, endothelium – Struma.
THE SCLERA
Is white, tough, thick and opaque, made of collagen fiber.

The conjunctiva: is clear and transparent. It is a member that covers the

anterior part of the sclera and folds over to cover the inner eyelids where
it forms pockets known as the upper and lower fornices (forniceal
conjunctiva). The palpebral conjunctiva covers the globe bulba
conjunctiva the lids.

THE MIDDLE LAYER

The Uvea (the lris, ciliany body, choroid. (grape in latin)

- Contain: pigment cell with very good bld supply especially the
choroid. Also, had musdefibres. In blacks, the colour of the lris is
black or brown. In whites the colour may be blue or blush green.
- The Pupil
 Is a round black hole at the centre of the ills which controls the
amount of light entry the eye. In bright light the pupil constricts to
allow less light to be to see.

In dim or done places the pupil dilates copent to allow more light into
the eye.

Anterior chambers (commonly called Ac)

- The cavity behind the cornea and front of the lens, antains dear
aqueous fluid which escapes from the eye the small opening at the
base of the lris and cornea called anterior chamber angle. This
escape helps to control the press inside the eye.
- Poor drainage – IOP – glaucoma (Intraocular pressure TOP).

THE LENS

Is suspended behind the lris and pupil by suspensony ligaments

(zonules) attached to the ciliary body. The lens is transparent and allows
light to pass through it focusing the light onto the retina. It has the ability
to alter its shape to allow us to look at things far and near.
VITREOUS HUMOUR

The fluid that fills the space and the lens and the retina. It is clear, thick
and jelly – like and helps to guie the eyeball its round shape.

The innermost layer

THE RETINA – visual layer.

It is the ligh sensitive mb at the posterior part of the eye which can only
be seen with the aid of special instrument e.g. ophthalmoscope –
contains rods and cones which are the light – secsitive nerve cells that
responds to light and colour.
Rods: helps us to see at night

Cones: help us to see things in detail and colors.

The nerve carry information of things we see to the brain and his
happens through the optic nerve which connects the eye to the brain.

External eye muscles

Six in number attached to the eyeball

- 2 horizontal - lateral rectus

medical
- 2 vertical – superior rectus
Inferior
- 2 obligue – superioe oblique

Inferior

The muscles control the movement of the eyeball, which can move
to look superiorly (upwards, inferiorly, laterally, medically all the
movement refer to the direction of Gaze.

Each muscle has specific and independent froms in moving the eye ball.
Both eye balls are aligned that they move in unisum so that they look at
the same object. The brain therefore perceives a binouilar image i.e.
same image from both eyes.

Eyelid/ lacrimal system

Eyelids – protects the eye

- Keep the cornea healthy and most

Have eye lashes that are directed away from the globe, special muscles.
 - Obbiculcuis oculi: for closure of the eyes
- Lavatory palpebrea superioris: for opening of the eyes when you
blink the cornea and conjunctiva are covered and there by spread
tear film to moisten the eye and clean away dirt and particles.
- Eye lashes: trap particles of dirt and FB though they can
themselves be FB. On the medical side of the eyelid is a tiny
opening the PUNCTUM. Where tears producrd by the lacrimal
glands drain through and down the nose. (tear passages)

In a normal healthy eye

 The eyelids open and close properly

 The white part of the eye is white
 The cornea is clear
 The pupil is black and gets smaller in bright light.
 This is good vision.

HOW DO WE SEE? (Accomodation)

Light travels from the outside world through the cornea, the pupil, lens
and into the retina which is like a screen for receiving pictures. The
pictures are then carried by the optic nerve to the brain which tells us
what we are seeing.

The eye is designed to make sure that light from the outside world
is efficiently focused unto the retina so that we can see a clear picture of
what we are looking at. A healthy eye can also change its focus so that
one moment we use something nearby clearly. This is done by the
action of the lens in the eye. In order to make sure that the light falls
properly on the retina, the light gets refracted or bent as it passes
through the different layers of the eye.
 SEMIOLOGY

Complaints people tell about the eye:

Symptoms

Itchy eyes Swelling color blindness

Blurred vision blood in the eye long sightedness

Tearing Subconjuctival Short sighted

Sandy sensation Hyperaemia Eye ache

Pain Double vision headache.

Definition :
Semiology in ophthalmology deals with system of ocular condition.

Common ocular symptoms (manifestation)

Introduction
A basic understanding of ocular symptomatology is necessary for
performing a proper ophthalmic examination.

Ocular symptoms can be divided into 3 basic categories:-

1) Abnormality of visions (loss or alteration vision)

2) Abnormalities of ocular appearance
3) Abnormalities of ocular sensation (pain and discomfort).
CHARACTERISTICS OF OCULAR PATHOLOGIES

Ocular symptoms and complains should be fully characterized

- E.g. was the onset gradual, rapid or asymptomatic?

- Was the duration brief or has the symptoms continued until the
present visit?
- If the symptom was intermittent, what was the frequency?
- Is the location focal or diffuse? And its involvement unilateral or
bilateral?
- Is the degree characterized by the patient as mild moderate or
severe ?
- Know the circumstance surrounding the onset of the condition.
- Ask for any associated symptom and signs and their description
e.g
- Discharge, color, consistency, infection
- Visual or refractive problems
- Signs of inflammation: redness, pain, heat- trauma or infection
- Have similar instances (episodes occurred )
- Has the patient identified circumstances that triggered (start off)
or worsen the symptoms?
- Ask (determine) what therapeutic measure have been tried and to
what extent they have helped.
- If there has been relief or exacerbation (worsening)
- Note and record current and past ocular disorders
- Use the patients to describe the symptoms and during physical
assessments and note down signs.

Over view of Ocular complaints and representative examples of

some causes.
ABNORMALITIES OF VISION

Disturbances and loss of vision could be transient or permanent, partial

or complete.

Locations:

- Disturbances or loss of vision could occur anywhere along the

optical and neurological visual pathway
- Consider the following:
1) Refractive (focusing error)
2) Lid ptosis (drooping eyelid)
3) Clouding or interference from ocular media i.e cornea, iris,
aqueous humour, lens, vitreous humour and retina for e.g. cornea
oedema, cataract, vitreous haemorrhage or aqueous phase,
malfunction of the retina (macula) optic nerve or intra-cranial
visual pathway.
4) Circulatory changes along the neurologic pathway from the retina
to occipital cortex usually cause transient loss of vision.
5) The degree of visual impairment varies under different
circumstances
- Uncorrected near-sighted refractive error may seem worse in
the night (dark environment because pupillary dilatation allows
more misfocus rays to reach the retina increasing the blurredness).
- A central focal cataract may seem worse in sunlight. In this case,
pupillary constriction prevents more rays from entering and
passing around the lens opacity.
- Blurred vision from corneal oedema may improve as the day
progressess owing to corneal dehydration from surface
evaporation.
 - Dazzling: is difficulty seeing in bright light may be caused by
opacity in the cornea of the lens.
- Haloes: Rainbow – coloured rings around bright light, caused
either by early opacity in the lens or by cornea oedema. Very
small drops of fluid in the cornea, have split white light into the
colours of the spectrum. Example people who also have
uncorrected refractive error.
- Excessive dilation of the pupils
- Hazy (cloudy) -occurred media are:corneal oedema, cataract,
scratches on spectacle lenses.
- Photophobia: It is discomfort caused by bright light. It is usually a
sign of inflammatory eye disorder; especially corneal ulcer. It is
sometimes a symptom of anxiety.
- Floating sports (floaters) are spots or shadows which float in
the front of the eyes and are usually caused by small opacities in
the vitreaous body which cast a shadow on the retina.e.g –vitreous
strands(vitreous syneresis) or vitreous separation; Pigment of
blood or inflammatory cells: The patient says that he sees flies,
insects etc that move or are static.
- Distortion of shapes usually indicates a disturbance of the retina
around the macula. The pt complains of
1) A regular pattern of dimness
2) Wavy jaggerred lines.
3) Image magnification or minification

Cause of distortion
- Optical distortion from strong corrective lenses
- Aura of migraine
- Lesions of optic nerves and macula
 Visual field defect caused by disorder in the optic nerves or
visual pathways:
 Oscillopia – shaking field of vision due to lid twitching or certain
forms of nystagmus (dancing or rolling eyeball).
 Diplopia: (double vision – ghost images) can be mono,binocular.
Disappears when one eye is covered.Can have several causes
depending on whether it is mono or binocular
- Monocular diplopia – the cause is uncorrected refractive error
(astigmatism).
- Focal medical abnormality, cataract, corneal irregularities,
corneal scar or keratoconus (conned shaped cornea)
- Binocular diplopia cause by: neuromuscular dysfunction.
- Mechanical restriction of the globe. (eyeball unable to move)
- Childhood strabismus (squint) (cunny eye)

No Acute loss of vision Gradual loss of vision

1 Acute angle closure glaucoma Cataract, pterygium, chronic simple
(AACG) glaucoma, Macular degeneration,
optic atrophy
2 Cerebro-vascular accidents Abnormalities of ocular appearance
(CVA)
Thrombosis
Embolus – central retinal artery or
vein occlusion.
Trauma – accidental
Surgery – man made
3 Optic neuritis (demyelinating )
caused by HSV (herpes simples
virus)
TB neuritis, multiple sclerosis.

ABNORMALITIES OF OCULAR APPEARANCE

Must be investigated to determine the type

a) Redness of the lid and periocular layer as in inflammation of the

cornea
b) Redness of the globe due to;
- Sub – conjunctiva hygiene. viral infection and hygiene
- Vascular congestion of the conjunctiva, sclera, episclera due to; -
external surface inflammation e.g. conjunctiva or keratitis
Or - intra- ocular, inflammation of the iris as in iritis, uveitis,
acute glaucoma

Main causes of redness

- Conjuctivitis, FB, acute uveitis, acute glaucoma
- Fatigue
- Alcoholism
- Traumatic eyes
- After use of traditional eye medication (TEM)
- Emotional state

Other colour abnormalities

- Jaundice
 - Hyper pigmented spots on the iris or other ocular surfaces e.g.
brown eyes from allergies
- Blue sclera

Other changes in appearance of the eye;

a) Lids and periocular tissues

- Oedema
- Redness
- Swollen (focus growth and lesion)
- Discharge
- Tearing
- Ptosis - Drooping of the upper eyelid caused by muscle paralysis
and weakness
- Abnormal different shape of the lid contours

b) Globe
- Focal growth of occular surface e.g pterygium pingueculum,
- Ca [tumour of conjunctiva]
- Anisocaria[-asymmetry of pupil size]
- Proptosis [bulging of the glole] or
- Displacement of globe of both proptosis and displacement of
globe as in exophthalmos.

ABNORMALITIES OF OCULAR SENSATION

- Discomfort or pain
 This is usually a symptom of inflammation of the eye, or of the
structure, surrounding the eye.
 The conjunctiva is not very sensitive to pain. Typically,
conjunctivitis presents with discomfort, irritation or grittiness
rather than pain.
  The iris and cornea are both very sensitive to pain. Iritis, corneal
ulcers and acute glaucoma are three common eye conditions which
are characterized by moderate or severe pain.
 Inflammation of the choroid (choroiditis) or optic nerve (optic
neuritis) usually produces sensation of dull pain behind the eye.

Ocular pain

Can be acute, chronic, sharp or dull, super focal or deep.

Specific pain

- Periocular pain e.g. tenderness of the – lid

-tear sac
- sinuses
- temporal artery
- Ocular (the eye itself) form the surface or deeper within the
globe.
- Retrobulbar (behind the eye) due to orbital inflammation of
any kind e.g. – orbital myositis
- Optic neuritis
- Both produce pain on movement of the eyeball.

Ocular pain

- Can be superficial or deep.

Superficial: pain is stinging or burning or pricking due to corneal

epithelial damage and is xterised by sharp superficial pain or FB(foreign
body) sensation, exacerbated by blinking.

- Chemical

Deep pain
 - Deeper internal acting pain (throbbing) is seen in
- Acute glaucoma
- Iritis
- Endophthalmitis
- Sideritis

Brow ache occurs from reflex spasm of ciliary muscle and iris sphincters
in cases of iritis and keratitis. Brow ache here is often associated with
painful “photophobia” (light sensitivity).

Non specific pain is poorly localized and is due to:

- Eyes strain and tiredness of the eye (common with students

who are having difficulties with their studies)
- pulling
- Pressure
- Fullness
- Certain kinds of headaches

The causes are;

- Fatigue from ocular accommodation- (physiology) the

automatic adjustment in focal length of the natural lens of the
eye.
- Binocular fusion
- Referred discomfort from monocular muscle tension or
fatigue

Eye irritation

Superficial ocular discomfort usually results from surface abnormalities.

Itching is a symptom, is often a sign of allergic sensitivity symptom of
Dryness, burning, grittiness and mild foreign body sensitivity can occur
 with dry eyes or other types of mild corneal irritation. Tearing is usually
due to irritation of the ocular surface in contact to chronic watering and
“epiphora” rolling down the cheek may indicate abnormal lacrimal
drainage. Ocular secretions are often diagnostically non- specific.

Severe quantity of discharge that causes the lids to the glued shut upon
awakening usually indicate viral or bacterial conjunctivitis. More scant
amounts of mucoid discharge also be seen with allergic and non
infectious irritations. Dried matter and crust on the lashes may occur
acutely with conjunctivitis or chronically with blepharitis (inflammation
of the lid margin).

STYE (HORDEOLIUM)
Are either internal or external hordeolium. This is an infection of the
root of the eye lashes usually caused by staphylococci. It is a disease that
resembles a chalazion.

Differentiation and resemblances

No Stye Chalazion

1 It is painful at the eyelid along the eye It is a hard painful swelling away
root from the edge of the lid

2 Localized redness Long duration about 1 month

and +

3 It may contain pus Lacks inflammatory signs

4 Durations less than one week Recurrent common

5 Recurrent common Can be multiple

6 Can be multiple

Mgx/Rx

Medical or surgical depending on the severity

- Psycho – preparation and preparation of materials

- Ask the pt to close the affected eye
- Apply warm water compresses 4 times a day for 4-7days

hot spoon bathing

- Apply tertracyclin ointment or chloramphenicol eye ointment

4 time a day for 6 days
- Refer to nearest eye clinic if not improved after 3 days

NB

Do not incise at home

Internal hordeolium

Prevention

If there’s frequent recurrent refer pt, it might be an indication of a

systemic disorder for example diabetes.

Conjunctivitis
Infection or inflammation of the conjunctiva. It is the most common eye
disease and this is because it is exposed to germs and dust particles.
 The foreign particles cause the blood vessels to enlarge and the eye
looks red. It is also common in hot climates because:- microorganisms
survives in warm humid climate.

- Dust and smoke, solar radiation acutely cause irritation.

- Insect vectors that carry infection from eye to eye.
- Overcrowding poor ventilation and poor hygiene spread
infection from person to person.

Causes of conjunctivitis

1) Bacterial
- Staphylococcus
- Gonococcus
- Meningoccocus
- Streptococcus
- Haemophilus influenzas
2) Viral
- Measles
- Herpes
- Adenosines
- Molluscum
3) Allergy
- Hay fever
- Drugs
- Cosmetics
- Veneral conjunctivitis (affect young children)
4) Physical and chemical irritants
- Dust
- Smoke
- FB (foreign bodies)
- UV rays
 - Snake venom
- Insects
5) Others
- Nutritional, like a deficiency
- Endogenous
- Rosacea, ocular pemphigus
- Kerato conjunctivis sicca (KCS) dry eyes

20 causes

- A disease called dacryocystitis – inflammation of the

lacrimal sac
- After trichiasis – friction as irritation of the cornea due to the
eyelashes growing inwards
- Entropion Ectropion – inversion or eversion of an eyelid so
that the lashes rub against the eyeball
- Facial palsy

s/s
- Sticky eyelids on waking
- Purulent discharge or watery discharge
- Normal or swollen eye lids
- Redness of conjunctiva

On examination

- Vision is usually affected

- The eyelids are swollen
- There may be some discharge
- The eyes are red
 - The cornea is clear

RX

- Will different as to the cause but note this,

- wash your hands
- Explain what you’re about to do the pt
- Ask pt to sit down
- Clean the eyes with soft cotton wool and water or normal
saline
- Make sure water does not run down the pt’s face when
cleaning
- Do this until eyes are clean
- Do not pad the eyes
- It promotes infection
- Give tetracycline or chloramphenicol CFl or refer if severe

Prevention

- Through good hygiene

- Do frequent face washing
- Washing of hands after touching an infection eye
- Avoid using common towel, hand kerchief, face cloth in case
of FB or irritants, irrigate.
- Use tetracycline

Conjunctivitis of the newborn (ophthalmic neonatorum)

Signs

- Red eyes usually bilateral

- Swollen eye lids and conjunctiva
 - Excessive milky white discharge

Mgx.

- This is an emergency for fear of the baby losing his sight

- Wash eyes carefully with water or saline and cotton wool
- Apply eye ointment (tetracycline)
- Do not pad
- Teach mother how to clean and apply eye ointment. Refer to
eye clinic
- Refer the parents to Dr. for Rx of sexually STI as applicable

Prevention

- Clean eyes as soon as the head is born.

- Apply antibiotics tetracycline eye ointment 1% stat by the
time the eyes are open.
- Pregnant woman with vaginal discharge to seek Rx promptly.

NB: no application of breast milk, palm wine etc.

TRACHOMA
Definition

Is a chronic inflammation of the conjunctiva caused by an organism

called Chlamydia trachomatis. Repeated infections leads to deformity of
the eyelids which in turn damages the cornea and causes blindness. This
kind of blindness can be prevented.

Occurrence
It is mostly found in poor communities with lack of water supply and
dirty environmental sanitation e.g. exposed human and animal faeces,
often children are seen with running noses and eye discharge containing
the (trachomatis)which is transmitted from eye to eye by the 4 ‘F’ which
are; fingers, flies, feaces, formites. This is found in dry hot sandy, windy
places e.g. the north of Cameroon. It is also seen in overcrowded homes.

Adult inclusion conjunctivitis is transmitted sexually.

Symptoms (what the pt complains of)

- Irritation
- Some discomfort in the eye and
- Irritation and gritty feeling.

Signs (what you see on exam)

- Red eye
- Watery eye
- Discharge (watery)
- Sticky eyelids if infected with bacteria as well
- Slight yellowish discharge

Grading of trachoma

There are different stages of the discharge which indicates the

extent or duration (how long the discharge has been and how serious the
infection is). The extent of seriousness ranges from the stage of
inflammation to eyelid deformities (dysfunction) and severe scarring of
the cornea.

Stages
TF (trachoma follicles) is an inflammation

Small translucent circular spot (like sugar granules on the conjunctiva of

the eyelid

TI (trachoma Intense)

Inflammation - Red, rough, thick lid conjunctiva. Cannot see blood

vessel of lid conjunctiva

TS (trachomatous scarring)

White lines, bands or sheets of scars

TT (Trachomatous Trichiasis )

Eye lashes rub on the eyeball or there is evidence of pulled – out lashes
rubbing on the cornea and causing scarring.

Co (corneal Opacity)

Actual scarring or cloudiness of the cornea.

Mgx

- Clean the eyes

- Apply tetracycline eye ointment
- Refer pt immediately to the specialist (to prevent blindness)

Control and prevention of Blindness

You must practice and teach SAFE strategy i.e.

S – Surgery for TT

A – Antibiotic for TF and TI

F – Facial cleanliness

E – Environmental sanitation

Rx of trachoma depends on the stage of the disease surgeries are, lid

surgery and lid rotation (Trabut).

CATARACT
Definition

Cataract is an opacity of the lens in the eye.

Classification

The classification could be from the type of cataract, the age and
morphology (site of occurrence)

1. According to type

The classification could be from the type of cataract, the age and
morphology (site of occurrence)

i. Immature with early cataract or early lens opacity (ELO)

ii.A mature cataract

iii. A hypermature cataract
2. Age (age related cataract)
i. Congenital cataract: this is seen at birth.
ii. Infantile cataract: this occurs within the 1st year of life
iii. Juvenile cataract: this occurs from the 1st – 15th year of life
iv. Developmental cataract: occurs within 15th – 30years of life
v. Penile cataract: occurs from 30 – 50 years of life
 vi. Senile catatract: 50+
3. Morphology
i. Cortical,nuclear and posterior subcapsular.
Cortical cataract: most common site of opacity. It is develops in
the outer layer of the lens.
Posterior sub capsular: often more than one type of opacity are
present

Prevalence

- Common in all communities especially in the elderly. It is the

cause of ½ of the blindness in the world.
- It is more common and occurs at an earlier age in hot
climates.
- It is also 6 times more common in a typical developing
tropical country than in a developed country with temperate
climate.
- No racial or sex evidence to the susceptibility of the cataract.

Theories why cataract is common in hot climate

1) Episodes of severe dehydration in early life

Severe dehydration, acute fever, gastro enteritis damage lens fiber
(osmotic shock).
2) Solar radiation damages tissue enzymes and protein molecules of
the lens leading to opacity.
3) Diet – Vit C deficiency
4) Heat – glass glower who work in hot furnaces.

Causes (General)

1) Age
 This is the most important factor that causes cataract, usually
cataract is a disease of the old because as one is getting old, the
lens fibers undergoes changes due to aging process.
2) Diabetes
May occur in younger people with diabetes than in non diabetics.
When the blood sugar rises one is liable to vision problems.
3) Chronic renal failure
See the risk of cataract. Waste products affect the lens
4) Drugs e.g steroids
Like dexa and Betamethazone; prolonged use of systemic oral/
parenteral steroid even topical steroids.
5) Other disease
- Hypoparathyroidism
- Down syndrome
- Myotonic dystrophy
- Smoking and drinking is thought to have the risk of cataract
6) Local causes
Local causes are those causes in the eye that can cause you to have
cataract.

1. Injury
- Perforating injury involving the lens
- Penetrating injury
- Intraocular surgery
2. Uveitis (inflammation of the uvea)
3. Glaucoma (increased Intra-ocular pressure, optic nerve
destruction)
4. Myopia refractive error (cannot see far)
5. Radiation from radiotherapy: infra red rays

Symptom
 - Gradual painless loss of vision (painless because it is not an
inflammatory disease) looking through a smoked screen
which progress until the pt will barely preclude light.
- Haloes: rainbow coloured rings around bright light.
- Refractive changes; (Tendency to develop myopia)
- Multiple images ( Ghosting, sees one or more blurred ‘ghost’
images together with the true images)
- Dazzling ( Glare) – scattered light

Signs

- The centre of the eye is white

- Cornea is ‘clear’
- The pupil is white instead of black and corneal scar.
 Differentiate between cataract and corneal scare

NB: white pupil is either a cataract or a retino blastoma or retrolental

fibroplasia.

Mgx

- Blindness from cataract is usually treatable

- Refer the pt to an Eye Specialist
- The Rx is usually surgical especially for mature cataract
- Encourage the pt to accept surgery
- You should know where to send the pt to
- You can escort the pt to the health unit.
- Know the condition including cost and give full information
to pts and family.

Pre – Operative preparation

- Counseling
 - Consent
- Ensuring rest
- Face preparation
- Change of clothing
- Accompanying guardians

Remember post Operation follow up.

- Eye dressing (strictly aseptic) because of fear of

endophthalmitis which is a disaster.
- Instillation of medication
- Vision testing
- Including all other nursing care procedures
 Follow up on discharge
- Home visit
- Help administer drug
- Train family member to do this
- Encourage hospital visit on appointment days
- Teach how to assess abnormalities like pain, discharge,
redness, swelling and the necessary action to be taken.

DIFFERENTIATE BETWEEN CATARACT AND CORNEAL SCARS

Corneal cataract Cornea scars

Cornea clear Cornea opaque

Whiteness at the back inside Cannot see the rest of the eye at
the surface

Pupil dilates Pupil can not be seen

 ONCHOCERCIASIS (RIVER BLINDNESS)

Defination

A tropical disease common in habitats along river banks with fast

flowing streams where the black fly breeds (endemic)

Cause

BY a filarial warm called the Onchocercia vulvolus , Wuchereria

bancrofti, loaloa.

Transmission

Is by the bite of the black fly (Simulium damnosum) from one infected
person to another.

Life Cycle

When the female black fly bites man, it injects some filaria,if they bite
another man after one week they infect that person and the filarial
develops into adult worms, male and female and reproduce more filarial
( young worms)

S/S

SKIN –Intense itching and skin rash

_Noddles

_Deep pigmentation of the skin especially over the shine

_Skin is extremely dry and wrinkled or folds that hang loosely in the
groin or anal region

EYE

Red eye,irritation or tearing

Cloudiness of the cornea which starts from the edges and spreads
towards the centre.

Night blindness due to dysfunction of the retina (Chororetinopathy-

destruction of the the retina)

Reduced visual acquity

Complications(cx)

BLINDNESS

Visual imput is the major CX of Onchocerciasis. All of the eyes would

be affected.

CONJUCTIVITIS

Conjuntivitis and photophobia as early signs

_PUNCTATE KERATITIS

I.e inflammatory infiltration surrounding the cornea “ Snow flakes”.

_SCLEROSING KERATITIS

This could be mild or severe. When severe, it leads to onchocercial

blindness, more frequent in the savanna type than in the forest type.
Begins at the limbs and progresses inward leading to irreversible visual
impairment

ANTERIOR UVEAL THREATS

 Anterior uveitis
 Iridocyclitis(intermediate)
 Uveal threats involvement could lead to secondary glaucoma
 Chorio-retinal lesions
 Athrophy of the retinal pigments epithelium and the
choriocapillaries
 Hyper-pigmentation of the pigments epithelial layer.
Chorio-retinal lesions are most frequently the cause of blindness
in the rain forest area.

OPTICAL NERVE LESIONS; lesions of the optic nerve occur

mostly as acting following diethyl carbamazine therapy (Notezine)
ACTION
 Mectizan
 Suramine
 Notezine
Drug of choice Ivermectin ( mectizan) which kills young
worms.
Onchocerciasis is a community base disease and the
strategy for control is the CDTI which means ,community
directed treatment with ivermectin in affected endemic
communities.
The RX is given every 6 mths to 1yr by trained community
directed distributors (CDDs )
 RX
With Ivermectin depends on the size of the pt as shown in the
tabulation.

Height of pt Tablet per person

1 tablet (3mg)
90_119cm
2 tabs (6mg)
120_139cm
3 tabs(9mg)
140_158cm
4 tabs(12mg)
More than 159cm

CAUTION

Donot RX the following categories of people

 Children less than 5years old or ≤ 90cm in height

 Pregnant women
 Lactating women during 1st week of breastfeeding
 Severely ill people
NOTE
All other members of the community are to be RXed

SIDE EFFECT OF IVERMECTIN

o itching, rashes, joint and muscle pain and fever
 Headaches ,nausea, vomiting, dizziness, fainting
 Bronchospasm resulting in difficulty in breathing
ACTION YOU TAKE
  Reassure, give aspirin or paracetamol
 If dizziness, lay pt to rest
 If vomiting and diarrhea rehydrate with ORS
 If side effects are severe refer immediately to the hospital.
Children below 5years shouldn’t be given ivermectin

TESTING OF VISUAL ACUITY

Def; How well a person can see
CLASSIFICATIONS ; GRADES
1. Good /satisfactory vision 6/6 – 6/18
2. Low vision 6/24 - 3/60
3. Blindness 3/60 - NPL = no perception of light

REQUIREMENTS

A. Snell’s Chart –‘E’ chart (use for illiterate)

-Alphabets
-Sheridan-Gardner (suitable for children b/c of
drawing of objects e.g orange etc)
B. Hand-held occular (palm could be used as substitute)
C. Pointer
D. Distance of 6 meters
E. Tape to measure distant
F. Instructions for self testing
Area with good lighting
G. Contrast (Background)
H. Eye level (height of chart on the wall) (chart place at eye level)
I. Touch light
J. Pin-hole (occluder with a hole in its center to guid light to the
refind)if the vision can be improved by glasses.
K. Pts’ cooperation
L. Observation of pt during procedure
METHOD
- Explain procedure to gain cooperation
- Make the pt sit or stand 6m away from the chart
- Pt should close the left eye with the left palm and ask the person
to read. (UNAIDED VISION)
- Record the reading for that eye
- Do the same for the right eye
- Find out if the person uses glasses (constant wear)
- .If yes test both eyes using them to know if he/she sees well
with the glasses.
- After using the chart you Grade – Right $ left
Signs of visual problems
- Rubbing the eyes repeatedly to clear the vision
- Hold the head at an angle while reading
- Excessive frowning, squinting or blinking
- Shutting or covering one eye to focus
- Hold the book close to the eyes eg like Albinos
- Hold book at arms length (at a far distance)
- Using fingers as a place mark while reading
- Confusing similar words.
- Avoiding close work – will not want to read or sew, watch
repairing, threading a needle. Such people suffer from
Presbyopia. His lense are becoming weak. Lens can no longer
 focus. There are some children who not interested in book .They
are hyperopics. This is because their pupils are too small
- Performing below performances
- Complains of headache after reading
- Failing to recognize the same words repeated on a page
- Showing difficulty learning new material
- Writing in a crooked and poorly spaced manner
- Comprehending less and less as reading continues
- Losing interest quickly. some text books are poorly printed
- Day dreaming
Cleaning of Eyelids
N.B: practical ophthalmic procedures
B4 performing any eye procedures
1. Always explain to the pt what ur going to do
2. Position the pt comfortably with head supported
3. Ensure good lighting first wash your hand and afterwards too
4. Avoid distractions for yourself and the pt
Cleaning of the Eyelids
Indications
1. Basic eye hygiene
2. To remove any discharge b4 instillation of drops or application of
oitments.
3. Post-op eye dressings
REQUIREMENTS
1. Sterile gauze swabs or cotton buds. Don’t use large cotton wool
bud as this can leave fragments on eyelid margin which becomes
an irritant and may even cause CXs.
2. Normal saline solution or salt or NAHCO3
3. Teaspoon
4. Gallipot
PROCEDURE

1. Take a folded gauze swab or cotton bud and moisten with prepared
solution
2. Ask the pt to close both eyes
3. With the swab or bud, clean gently along the eye lashes in one
movement from inner to outer canthus always from in to out
4. Discard the swab or bud after use
5. If the eyelashes need further cleaning, use a new swab or bud
6. Ask the pts to look up with one hand take a moisten sterile swab or
bud
7. With the index finger of the other hand gently hold down the lower
lid
8. With the swab or bud gently clean along the lower eyelid
movement in one margin from inner to outer cantus
9. Discard the swab or bud after use (10) If the lower eye lid margin
need further cleaning use a new swab or bud
10. Ask pt to look down, with hand take a moisten sterile swab
or bud
11. With a thumb or finger of the other hand gently cleanse the
upper eyelid up against the orbital rim (just below the eyebrow)
12. With the swab or bud, clean gently along the upper eyelid
margin in one movement from inner to outer canthus.
13. Discard the swab or bud after use
14. If upper eyelid margin needs further cleaning use a new swab
or bud
15. Extra case is needed when cleaning the upper eyelid
16. Try to keep the cornea in view throughout and to avoid
touching it with the gauze swab or cotton bud
17. It may be necessary to repeat any part of the above procedure
if the eyelids are very sticky until all debris/discharges is removed
Remember always use a new swab or bud each time
INSTILLING EYE DROPS
Indications
1. To prevent eye conditions eg ABT drops
2. To aid examination eg dilating the pupil
3. To aid dx.eg staining the cornea
REQUIREMENTS
1. Clean swab or tissue paper
2. Prescribed eye drops
Preparations
- Check that the drops are not expired
- Check the pts name and make sure the eye drop is in the
prescription
- Do not use if drop is discolored.
Procedure
1. Ask pt to look up, with the index finger of one hand take a folderd
swab or tissue paper to gently hold down the lower eye lid
2. Do not make the eyelid turn out too much as instilled drugs may
fall out on the checks
3. With the both in the other hand on thumb and index finger. Resist
the side of the hand against the pts forehead above the affected eye
4. With the dropper 5cm above the eye, squeeze the bottle or pipette
rubber and allow the one or two drop to fall inside the centre part
of the lower front (eyelid)
5. Do not allow the drop to fall on the cornea as this can be painful
and may alarm the pt and cause loss of confidence
6. Do not allow the bottle or pipette to touch the eyelid skin or eye
lashes as it will cease to be sterile and need to be discarded.
7. Wipe away any surplus fluid which may emerge when the pt closes
the eye
 8. Secure the bottle top
Application of eye Ointments
Indications
 To deliver longer-acting topical medication eg in the case of a
child
 Overnight following medication by drop instillation during day
time
 When an eye needs to be padded for long periog
 To px a superficial corneal injury with ABTS
REQUIREMENTS
- Clean swab or proper tissue
- Prescribed eye ointment – pdad in varying spes and colours of tube
Preparations
- Check that the ortmentis not expired
- Check the pts mane and eye ointment against the prescription
- Remove the cop from the noirrle
- Ask the pt to look up
Method
- With the index finger one hand, take a folded swab or tissue to
gently hold down the lower lid
- With the other hand, take the tube of ointment and direct nizzle
forward the inner canthus
- Squeeze the tube slowly to allow abt 1cm to emerge in a thin line
along the inside of the lower eyelid (rather like putting tooth paste
on a tooth brush)
- Do not touch the eye with the norrle
- Do not touch the eyelid skin or eye lashes with tube norrle
- It will cease to be sterile and needs to be discarded
 - Wipe away any surplus ointment which may emerge when the pt
closes the eye
- Secure the nozzle cap
HOW TO WASH YOUR EYES
An eye that has been in contact with a foreign by fly, soil, sand etc
or burnt by a x’cal must be washed immediately and continuously for 15
minutes
1. Make the pt lie down with his head thrown back. Ask someone to
hold his eyelids open. Gently pow clean H 2O into his eyes for 15
minutes
2. You can hold the pts head under a tap or water pump. Hold the ryrs
open Run the eyes gently for about 15minutes
HOW TO REMOVE A FOREIGN BODY
1. 1st try to wash the foreign body out with clean H 2o as explained
above
2. If the FB is not washed out and it is under the eyelids, gently pull
down the lower eyelid or turn over the upper eyelid to remove the
foreign body
3. Use a damp cloth or cotton – tipped stick to wipe the lid to remove
the FB
4. If the FB is on the cornea and it is not washed out refer
immediately
5. Apply an eye bandage
EYE BANDAGE
Indications
 To give extra protection or pressure over an eye pad
 To arrest tear
 To reduce swollen after eyelid trauma
 Following local anaesthesia
 Following eye surgery
Requirement
- SCM WIDE
- Adhesive tape
- Safety pin
- Scissor
METHODS
- Apply the eye pad
- Hold the rolled bandage in one hand with the open end hold by the
other hand on the forehead above the affected eye
- Take the bandage directed away from the affected eye twice
around the head firmly but not tightly
- On the 2nd circuit, bring the bandage below the eye and up over the
eye and around the head again
- Place the index to hold up the bandage just above the eye brow
- Take the bandage around the head and then below the eye and up
over the eye again
- Each time making sure it does not obscure the other eye as
explained above
- Finish the bandage on the forehead and secure with adhesive
Tap or safety pin
- Do not use a safety pin if the pt is a young child or an elderly
person
Participation in the rehabilitation of the blind
Rehabilitation of the blind
The blind are children or adult who cannot recognize people,
objects, or see light partially or totally and have been checked and
confirmed blind by an eye health worker. The community base health
worker (B.H.W) will be responsible for identifying the blind and also
those who need to be trained in different skills.
 These will include children for special schools for the blind who
would be taught how to use the Braille.
Blind adults can learn a trade such as sewing, weaving, singing,
poultry keeping, running small shops, Carpentry, telephone operating,
typing etc in order to generate income. Or severely visually impaired
persons should be taught how to recognize their immediate environment,
protect and organize themselves.
The cost of re-habilitating the blind is more than the cost of
preventing a person from going blind but the cost of blindness is the
highest.
PREVENTION OF BLINDNESS
- Rehabilitation
- Blindness
Counseling the blind and visually impaired
- Counseling is a way of advising pts and relatives, identifying their
fears and problems and giving explanation and infos.
- Put up a positive attitude and tolerance and ability to communicate.
- Counseling involves a lot of time.
- Never be in a hurry.
- To be able to communicate with the participant, one should bear
the following in mind:
1) All children and blind adults have the PO to live a fulfilling
happy life.
2) A negative attitude towards the blind under minds their will
power.
3) Pts and relatives have certain expectations which include; rapid
referral of cases to the Ophthalmologist.
Treatable Preventable blindness Untreatable blindness
blindness
-Cataract -Ochocerciasis -Macular degeneration
 -Glaucoma -Optic atrophy
-Corneal scar

Problems Concern a C.B.H.W may face

As a C.B.H.W you must do well to organize frequent educational
opportunities to enable you educate your community members about the
harmful practices and how to avoid them. You have the crucial role here
to play in promoting this aspect of eye care.
These are some of the concerns and difficulties that community
health workers like the may be confronted with as I carry out eye health
promotion programs.
Consider the following issues for discussion amongst your colleges and
try and find practical solutions or approaches in solving them.
Information
- Do I have enough information to disseminate to people in my
community?
- Can I make effective use of key people like village leaders,
community councils? Administrative authorities, pupils as well as
individuals households to disseminate this information?
Education
- Am I capable of raising the awareness of the community that the
majority of the blinding diseases are either preventable or curable?
- Can I instruct community members on personal and environmental
hygiene, nutrition, maternal and child health, sanitation and
protection of eyes?
Community participation
- Can I stimulate individuals and community participation in
activities to prevent blindness?
- Can I monitor and supervise activities of the community?
 - Can I encourage the community to look after its blind members,
even pay for surgery for a poor member?
Referral
- Do I have enough information as to which of the eye diseases or
injuries I can handle?
- Are there referral facilities available that are accessible and
affordable to the people?
Discourage couching (local surgery of the eye).