2. External anatomy
The orbital bones house the eye
Six extraocular muscles control eye movement
Eyelashes – sense foreign substances approaching
eye and triggers closure of the eyelid
Conjunctiva covers/protects the surface of the eye
3. Tears
Lacrimal glands – tear
glands that are positioned
superior/laterally to the
eye
Lacrimal duct – the inner
corner of the eyelid that
allows the tears to drain
into the nose
4. Globe cavities Globe – eyeball
Vitreous cavity – the larger and
posterior cavity of the eye behind
the lens filled with a clear jellylike
fluid called the vitreous humor
Anterior cavity – the portion of the
eye in front of the lens, filled with
waterlike fluid called aqueous
humor
5. Sclera – outer layer of the eye
Fibrous / protective , also includes a
transparent section called the cornea,
which allows light to pass through
6. Choroid – middle layer of the eye
Vascular layer of the eye, containing the iris
and pupil
Iris – muscle that controls the amount of
light entering the eye through the pupil
Ciliary muscles – change the shape of the
lens to focus light onto the retina
7. Retina – inner layer of the eye
Retina – interprets the image using photo or light-sensing
receptors called rods and cones
Rods - lack color vision but allows vision in darker settings
Cones - color vision but requires adequate lighting
In the presence of light, rods and cones create an impulse that is
sent to the optic nerve and then to the brain for interpretation
8. Medical Conditions of the Eye:
Stye – External hordeolum
A small pustule or lump caused by blockage of the oil glands near
an eyelash
Warm compress and occasionally topical antibiotics are needed
They are uncomfortable, cosmetically unpleasant, and generally
heal on their own
Chalazion – internal hordeolum caused by meibomian glands but
similar s/s and treatment
9. Conjunctivitis
Inflammation or infection of the conjunctiva
Bacterial – “pinkeye” which causes redness,
itching, and excessive drainage from the eye
Very contagious but proper handwashing
limits the spread
Topical antibiotics are usually indicated
Viral – more common but very similar to
bacterial conjunctivitis
Allergy caused – due to allergen and usually
resolves with antihistamines
10. Iritis
Inflammation of the iris and ciliary
muscles most commonly in autoimmune
disease patients
Another form is called choroiditis, and
this affects the posterior choroid (middle
layer of the eye)
Produces blurred vision, floaters,
photosensitivity, redness, and eye pain
Treatment includes protection from light,
analgesia, steroid drops
11. Herpes simplex virus keratitis
Caused by the same family of virus’ that cause cold sores
Causes infection and inflammation of the cornea
Number one cause of corneal blindness in the U.S.
Symptoms include pain, redness, tearing, blurry vison, and
photophobia
Antiviral medications usually given
12. Corneal ulcers
Serious and could lead to blindness if left untreated by antibiotic
or antiviral
Symptoms include redness, pain, tearing, and photophobia
13. Periorbital cellulitis
Cellulitis is soft tissue inflammation usually caused by an
infection
Periorbital cellulitis leads to warm, swollen
eyelids/surrounding tissue to the point that the patient
can't open their eyes
Pain, conjunctivitis, blurred vision, tearing
Potent antibiotics and hospital admission is usually
warranted
14. Orbital cellulitis
Usually caused by sinus
infection or periorbital
cellulitis
Fever, headache, eyelid
edema, increased nasal
discharge, malaise , pain,
conjunctivitis, blurred
vision, decreased ability to
move the eye
Proptosis – bulging of
the eye
Potent antibiotics and often
surgical drainage is
required, this is a true
emergency
15. Hyphema
Blood in the anterior chamber of the eye, true emergency
Most commonly caused by trauma but atraumatic causes are
sickle cell disease, diabetes, and tumors
“Eightball hyphema” fills the entire anterior chamber of the eye
16. Subconjunctival hemorrhage
Blood vessel in the conjunctiva ruptures
Does not fill the anterior chamber like a hyphema would
Generally harmless however EMS should question why this
occurred? Hypertension?
17. Glaucoma
Increase intraocular pressure which can damage the optic
nerve and retina
Second leading cause of blindness in the U.S.
Believed to be caused by the blockage of outflow of
aqueous humor
Acute angle-closure and the more common open-angle
which is chronic
Cloudy vision, halo-like effects around lights,
swelling/hardness of the eye
Acute angle closure – causes intense pain with associated n/v
Treatment - medications and possible surgery
18. Cataract
Clouding of the lens due to breakdown of proteins in the
lens
Risk factors are – diabetes, eye injury, radiation/excessive
UV exposure, and smoking
Cloudy vision, photophobia, diplopia, halo-like visuals
around lights, and decreased color vision (which is more
dependent on ample lighting)
Treatment includes prevention and surgical removal
19. Optic neuritis
Optic nerve inflammation
Caused by autoimmune disease, infections, drug toxicity
Sudden loss of vision or visual disturbance and pain especially
with eye movement
In cases of infection and drug toxicity, vision usually returns
within two to three weeks
Steroids are sometimes required
20. Central retinal artery/vein occlusion
Occlusion of the artery/vein usually caused by plaque
or thrombus resulting in loss of vision to certain parts
of the field of vison
Risk factors – diabetes, a-fib, valvular disease, drug
abuse, hypertension, glaucoma
Treatment may include fibrinolytics
21. Retinal detachment
Many possible causes (ex. Trauma and
diabetes)
Patients report flashes of light in the
periphery, floaters, blurred vision,
possible blindness, visual description of
“a curtain dropping”
Usually requires surgery
22. Diabetic retinopathy
Very common amongst diabetes
mellitus patients
Hyperglycemia damages many cells in
the body especially small blood vessels
The retina microvasculature become
damaged and lead to blurred vision,
floaters, lost field of vision, and
difficulty seeing at night
23. Question 1
This layer of tissue in the eye is responsible for making fluid to
help with function of the eye.
A. Retina
B. Choroid
C. Sclera
D. Optic Nerve
25. External Ear
Auricle (pinna) – the part of the ear we can externally see
External auditory meatus – hole leading towards the middle ear
External auditory canal – “tunnel” leading to the middle ear
Cerumen (earwax) – traps dust and debris
26. Middle Ear –
Tympanic Cavity
As sound waves enter the middle ear,
they create pressure which vibrates
the tympanic membrane and
auditory ossicles
Tympanic membrane – ear drum
Auditory ossicles/bones – malleus,
incus, stapes
Eustachian (auditory) tube – connects
the middle ear to the pharynx to
equalize the pressure caused by
sound waves and the middle ear
Oval window connects the middle
ear to the inner ear
27. Inner Ear
Membranous Labyrinth which are
filled with fluid and protected by
bones
Vestibular complex – the
balance part of the inner ear
Vestibule – chambers that
sense gravity and linear
acceleration
Semicircular canals – tubes
that sense rotation of the
head
Cochlea – spiral shaped and is
the hearing part of the inner
ear
28. Foreign body
Most patients are usually children and are the cause of this
Occasionally insects are the result of the foreign body
Insects create more trauma/infection and break into small
pieces, mineral oil can help to kill the insect in a Hospital
setting
Symptoms – pain and occasionally bleeding
Treatment – in the Hospital, removal via forceps or irrigation
Impacted cerumen – usually symptoms of tinnitus, feeling of
pressure, and pain
Mineral oil, baby oil, commercial drops, detergents, and
hydrogen peroxide may loosen the earwax
29. Otitis externa
Otitis externa – external ear infection/inflammation also called
simmer’s ear
Symptoms – pain, drainage, itching, hearing loss/difficulty
hearing, redness
Treatment – analgesic , topical otic antibiotics, anti-
inflammatory drugs
Malignant otitis externa – when the infection has spread to the
base of the skull, this is serious and requires hospitalization
Additional symptoms are fever, difficulty swallowing, loss of
voice, and if severe, facial weakness
30. Otitis media
Otitis media – middle ear infection, more common in children due to
Eustachian tube anatomy
Causes – allergies, upper respiratory infections, mucus buildup
while teething, irritants
Symptoms – similar to otitis externa, however malaise, fever,
vomiting, diarrhea, and pulling at the ear are common
If condition persists, antibiotic and tympanostomy decompression
tubes may need to be placed
Mastoiditis -the mastoid bone can become infected if antibiotics are
not working
31. Perforated tympanic
membrane
Causes can be trauma,
barotrauma, infection
Symptoms include
decreased hearing, pain,
tinnitus, drainage, bleeding
Usually resolves itself but
protective measures include
topical antibiotics,
protecting the ear, and
analgesia
32. Vertigo vs. Dizziness
Dizziness is a general term associated with vertigo, imbalance,
and near syncope, but does not necessarily equate to a feeling of
the “room spinning”
Vertigo – described as the “room is spinning”
The cause is due to the inner ear and head movement
worsens vertigo
33. Labyrinthitis
Inflammation of the inner ear usually caused by a middle ear
infection, URI, allergies, and certain medications
Symptoms – vertigo, nystagmus (involuntary eye movements),
n/v , tinnitus
Treatment – antiemetics and possibly benzodiazepines for
vertigo symptoms
Meniere disease is similar to labyrinthitis, but it is more of a
chronic condition with stronger symptoms and possibly
associated with dehydration from diuretic use
34. Question 2
What part of the ear is responsible for reorienting our frame of
reference when we turn our heads?
A. Inner Ear
B. Cochlea
C. Semicircular Canals
D. Vestibular Nerve
36. Nose anatomy
Cranial nerve I (Olfactory
nerve) in the upper part of
the nose is responsible for
smell
37. Sinus anatomy
Purpose of sinuses:
Lighten the skull
Help decrease trauma like a control
joint/relief cut
Insulate against temperature
changes
Produces mucous for the nose to
trap debris and humidify air
38. Epistaxis
Nosebleeds – caused by low humidity, topical medications,
structural abnormalities, inflammation, tumors, blood disorders,
hypertension , irritation
Kisselbach’s plexus - four arteries in the anteroinferior region of
the nasal septum which is responsible for 90% of nose bleeds
Posterior nosebleeds are generally associated with hypertension
and bleed more than anterior, can also lead to N/V due to blood
entering the stomach
Usually, direct pinching of the nose will stop these nosebleeds
In the hospital they may insert nasal catheter/packing, cauterize,
or topical TXA if direct pressure will not control the bleeding
39. Rhinitis
Inflammation of the nose usually caused by URI or allergies
Treatment includes saline nose drops, bulb suctioning especially
for infants (how do they breathe?) , nasal decongestants (not
recommended for pediatrics) , and antihistamine/steroid if
allergies are the cause
40. Sinusitis
Inflammation of the sinuses
Facial pressure, headache, sore throat, nasal drip, cough, loss of
smell, malaise, possible fever, and possible lymph node swelling
Treatment is similar to rhinitis
41. Question 3
What is the main symptom when sinuses are filled with fluid?
A. Headache
B. Pain
C. Heaviness of face
D. Fevers
43. Oral cavity anatomy
Uvula – blocks the nose during
swallowing
Lingual tonsil – lymph gland at
the back/outer edge of the
throat
Pharyngeal tonsils or adenoids –
lymph glands at the back of the
nasal cavity
44. Teeth
32 total teeth – central to lateral
listed below
Incisors – front and central used
to cut food
Canine/cuspid – sharp and
tear/slash food
Premolars – also tear food
Molars – grind food
45. Salivary glands
On average secrete
1 – 1.5 L of saliva
daily which is
basically water and
amylase, which
helps digest
carbohydrates
46. Also called thrush, a fungal (yeast) infection of the mouth
This yeast is present in most of us, but when antibiotic treatment
is given for a separate bacterial infection, the competition is
destroyed and thus unchallenged growth of yeast, especially in
immunocompromised (AIDS) patients
Coats the tongue white and can cause pain / difficulty swallowing
Antifungal medication may be prescribed
Oral candidiasis
47. Peritonsillar abscess
Usually due to tonsillitis caused by group A strep which can become a true
emergency as it can spread to the airway and chest
Symptoms – facial swelling, oral pain, drooling due to pain while
swallowing/sore throat, tender lymph nodes, headache, muffled voice,
and fever
Airway control is important , pain management, antiemetics
May be beneficial to have the patient self suction because the patient
is less likely to cause trauma as they will be gentle due to pain
Treatment at hospital will be drainage of abscess and antibiotics
48. Ludwig angina
Life threatening emergency due to bacterial cellulitis under the
tongue usually secondary to infection of the roots of the teeth
(dental abscess) or a mouth injury
Symptoms – the tongue, mouth, upper neck can swell to the
point of loss of airway , oral pain, drooling due to pain while
swallowing/sore throat, muffled voice
Don’t hesitate if losing the airway
Antibiotics work but airway control in the Hospital is also the first
step
49. Epiglottitis and Laryngitis
Epiglottitis was covered in airway / pulmonology sections
Laryngitis usually caused by viral infection and leads to fever,
hoarseness/loss of voice
Usually a mild illness that the body will fight off, OTC meds /
humidified air
50. Tracheitis
Usually a bacterial infection with associated deep cough,
dyspnea, fever, and stridor
Airway management is important with these patients
51. TMJ – Temporomandibular joint syndrome
Caused by misalignment of the jaw due to genetics, injury,
misaligned orthodontic appliance, and clenching of the teeth
Symptoms - TMJ pain/popping of the joint when opening/closing
mouth, earache, and headache
Treatment is usually based on the cause
52. Question 4
What is the name of the thing that hangs in the back of the
throat?
A. Utricle
B. Pharynx
C. Thyroid
D. Uvula
