Prehospital Academy Lesson 22.3
HEENT: Common Eye and Ear Diseases
This lesson discusses common non-traumatic eye and ear conditions that EMTs may encounter. While many of these are not immediately life-threatening, they can cause significant discomfort and, in some cases, require urgent medical attention to prevent permanent damage. A basic understanding of these conditions will guide appropriate assessment and supportive care.
Common Eye Disorders
Conjunctivitis ("Pink Eye")
Pathophysiology: Inflammation or infection of the conjunctiva, the transparent membrane lining the eyelid and covering the white part of the eye. Can be bacterial, viral, allergic, or due to irritants/foreign bodies. Highly contagious if bacterial or viral.
Signs and Symptoms: Redness, itching, burning sensation, excessive tearing, discharge (watery with viral/allergic, thick/purulent with bacterial), feeling of grit in the eye. Usually starts in one eye and can spread to the other.
Prehospital Management:
General assessment of vision.
Irrigate with saline if irritant/foreign body suspected.
Advise patient against touching eyes to prevent spread.
Supportive care; transport if vision is affected, pain is severe, or chemical exposure is involved.
Hordeolum (Stye) and Chalazion
Pathophysiology:
Stye: Acute bacterial infection of an oil gland in the eyelid margin, appearing as a red, tender lump.
Chalazion: Chronic, usually painless lump resulting from a blocked oil gland in the eyelid, often following a stye.
Signs and Symptoms: Localized pain, redness, swelling, and tenderness (stye); painless lump (chalazion).
Prehospital Management: Supportive care, warm compresses to alleviate discomfort. Not a life-threatening emergency.
Glaucoma
Pathophysiology: A group of conditions that lead to increased intraocular pressure (IOP), damaging the optic nerve and potentially leading to irreversible vision loss. Acute angle-closure glaucoma is an ocular emergency.
Signs and Symptoms (Acute Angle-Closure): Sudden severe eye pain, blurred vision, halos around lights, headache, nausea, vomiting, reddened eye with a fixed, dilated pupil.
Prehospital Management: Rapid transport to an ophthalmologist or emergency department. Avoid administering medications that dilate pupils.
Contact Lens Complications
Pathophysiology: Can cause irritation, corneal abrasions, or infections if not properly cared for. Chemical burns to the eye require immediate removal of contact lenses.
Prehospital Management: Only remove contact lenses if a chemical burn to the eye is suspected or present. Otherwise, leave them in place unless directed by medical control.
Common Ear Disorders
Otitis Media (Middle Ear Infection)
Pathophysiology: Inflammation and infection of the middle ear, often associated with upper respiratory infections. Common in children.
Signs and Symptoms: Ear pain, fever, irritability (in children), muffled hearing, fluid drainage from the ear if the eardrum perforates.
Prehospital Management: Supportive care, pain management. Transport if fever is high, pain is severe, or in infants/immunocompromised patients.
Otitis Externa ("Swimmer's Ear")
Pathophysiology: Infection of the external ear canal, often due to water exposure or trauma to the ear canal skin.
Signs and Symptoms: Ear pain (worsened by touching the outer ear), itching, redness, swelling, and sometimes discharge.
Prehospital Management: Supportive care, pain management.
Foreign Body in the Ear Canal
Pathophysiology: Objects lodged in the ear canal can cause discomfort, pain, infection, or damage to the eardrum.
Signs and Symptoms: Ear pain, decreased hearing, sensation of fullness, visible foreign object.
Prehospital Management: Do NOT attempt to remove the foreign body unless it is superficial and easily grasped. Attempting to remove it can push it deeper or cause further injury. Transport for removal by a medical professional.
Critical Thinking Questions
A patient complains of sudden, severe eye pain, blurred vision, and sees halos around lights. What is your immediate suspicion, and what specific advice would you give regarding treatment?
You are assessing a patient with a "pink eye" presentation. What key questions would you ask to differentiate between a viral/allergic cause and a potentially contagious bacterial infection?
A child has a small bead lodged deep in their ear canal. What is the most appropriate prehospital management, and what dangers are associated with attempting removal in the field?
How would your management of contact lenses differ for a patient with severe eye irritation versus a patient with a chemical burn to the eye?
Considering the potential for hearing impairment, what communication strategies would be most effective when interacting with a patient experiencing acute otitis media?