1. Special Senses: Eye and Ear
Chapter Fourteen
Special Senses: Eye and Ear
There are five senses; however, taste, touch, and smell are discussed in other chapters.
Mastering Healthcare Terminology/Chapter 14

2. Quote “A beautiful eye makes silence eloquent, a kind
eye makes contradiction an assent, an enraged
eye makes beauty deformed. This little member
gives life to every part about us.”
– Joseph Addison

3. Functions and Specialties/Specialists
Vision (opt/o, optic/o)
Hearing (audi/o, acous/o)
Specialties
Ophthalmology
Optometry
Audiology
Otorhinolaryngology
Specialists
Ophthalmologist
Optometrist
Audiologist
Otorhinolaryngologist
General combining forms for vision are opt/o and optic/o. Combining forms for hearing are audi/o and acous/o.
An ophthalmologist (ophthalm/o = eye + -logist = one who specializes in the study of) is one who specializes in the diagnosis and treatment of disorders and diseases of the eye. The discipline is called ophthalmology. Note that an ophthalmologist is an MD for eye disorders.
An optometrist (opt/o = vision + -metrist = one who specializes in measurement) is a specialist who measures your vision and prescribes corrective solutions as needed. Glasses and contact lenses used to be the main sources of correction, however, surgery is now becoming more of an option.
An audiologist (audi/o = hearing + -logist = one who specializes in the study of) is the healthcare specialist in the diagnosis, treatment, and prevention of hearing disorders. The specialist is an audiologist.
An otorhinolaryngologist (ot/o = ear + rhin/o = nose + laryng/o = voicebox + -logist = one who specializes in the study of) is a medical doctor who specializes in the disorders of the ear, nose, and throat. The specialty is otorhinolaryngology.
Mastering Healthcare Terminology/Chapter 14

4. The Eye (ophthalm/o, ocul/o)
Ocular adnexa
Orbit
Eyebrows
Canthi
Eyelids (palpebr/o, blephar/o)
Palpebral fissure
Conjunctivae (conjunctiv/o)
Vision is accomplished through the eyeball and its adnexa. Use the diagram to explain the names for the parts listed.
The protective, bony socket that holds the eye is called the orbit.
The eyebrows mark the area above the orbit (supraorbital) and help keep the sun and perspiration from getting in one’s eyes.
The corners of the eyes are called the canthi (s. canthus). The lateral canthus is the outer corner and the medial canthus is the corner that is closer to the nose.
The area in which the upper and lower eyelids close is called the palpebral fissure. Palpebr/o and blephar/o are combining forms for the eyelids. The term “fissure” is used throughout medical terminology to mean a deep slit, whether it is between the eyelids, in the skin, or on a bone. The act of blinking is called palpebration, obviously derived from one of the combining forms. Be careful not to confuse palpebrate with palpate or palpitate.
The thin protective mucous membrane that spreads to coat the anterior surface of the eyeball and the eyelids is called the conjunctiva (conjunctivae).
Note that the Joint Commission and the Institute for Safe Medical Practice have designated the abbreviations OD (right eye), OS (left eye), and OU (each eye) as dangerous abbreviations. The recommendation is to write out the full terms.
Ocular adnexa
Mastering Healthcare Terminology/Chapter 14

5. The Eye (cont’d) Glands Extraocular muscles Meibomian
Lacrimal (lacrim/o)
Lacrimation
Lacrimal glands (dacryoaden/o)
Lacrimal sacs (dacryocyst/o)
Nasolacrimal ducts
Extraocular muscles
Rectus
Oblique
There are two types of glands that serve the eyes.
The meibomian glands are sebaceous glands that secrete oil to lubricate the eyelashes, whereas the lacrimal glands, located above the eyeballs, produce tears. The tears have a cleansing as well as a lubricating function. The process of producing tears is termed lacrimation. As tears are produced form the upper outer corners of the orbit, blinking spreads the tears across the surface of the eye. The tears then drain into two small holes (the lacrimal puncta) in the medial canthi, into the lacrimal sacs, then into the nasolacrimal ducts, which carry the tears to the nasal cavity.
The extraocular muscles attach the eyeball to the orbit and on impulse from the cranial nerves move the eyes. These six voluntary (skeletal) muscles are made up of four rectus (straight) and two oblique (diagonal) muscles.
Explain how the nasolacrimal ducts are part of the reason you need to blow your nose when you cry.
Mastering Healthcare Terminology/Chapter 14

6. The Eye (cont’d) The eyeball Outer layer/fibrous tunic
Sclera (scler/o)
Cornea (kerat/o, corne/o)
Limbus
Eyeball
The eyeball is arranged in three layers/tunics.The outer layer/fibrous tunic is composed of the sclera and cornea. The sclera is the outermost lateral and posterior portion of the eye, referred to generally as the white of the eye. The portion of the sclera that covers the anterior section of the eye that is transparent is called the cornea. The border between the two is called the limbus.
Use the diagrams to explain the parts of the layers and the combining forms. Note the use of the kerat/o and scler/o in other chapters with different meanings. Kerat/o means “hard, horny” in the skin chapter and scler/o also means hard in sclerotherapy in the skin chapter.
Be careful not to confuse core/o and corne/o.
Mastering Healthcare Terminology/Chapter 14

7. Did You Know?
The combining form kerat/o means hard or horny and refers to both the skin and the cornea. This is because the cornea is formed from the same tissue as the epidermis.

8. The Eye (cont’d) Middle layer/vascular tunic
Uvea (uve/o) (choroid, ciliary body, iris)
Iris (ir/o, irid/o)
Pupil (pupill/o, cor/o, core/o)
Ciliary body (cycl/o)
Lens (phac/o, phak/o)
Aqueous and vitreous (vitre/o) humors
The middle layer/vascular tunic is composed of the uvea, which is made up of the choroid, ciliary body, and iris.
The choroid is the vascular supply (blood).
The ciliary body consists of the strands of muscle tissue that hold the lens in place and secrete fluid that forms the aqueous humor.
The iris (pl. irides) is a smooth muscle that contracts and relaxes to moderate the amount of light that enters the eye. Most individuals have a pigmented iris (brown, gray, hazel, blue), but because some individuals lack the pigment (albinism) their irides are reddish-pink because of the blood traveling through the vessels that supply each iris. The pupil is the dark area in the center of the iris in which the light continues its progress through to the lens. The lens is an avascular (a- without + vascul/o = vessel + -ar = pertaining to) structure that is made up of protein and is covered by an elastic capsule. It is held in place by thin strands of muscle that make up the ciliary body. The fluid produced by the capillaries of the ciliary body is called the aqueous humor. It nourishes the cornea, gives shape to the anterior eye, and maintains an optimum intraocular pressure. It normally drains through tiny veins called the canals of Schlemm. The vitreous humor is a jellylike substance that holds the choroid membrane against the retina to ensure an adequate blood supply.
Mastering Healthcare Terminology/Chapter 14

9. The Eye (cont’d) Inner layer/nervous tunic Retina (retin/o) Rods Cones
Macula lutea (macul/o)
Fovea
Optic disk (papill/o)
The inner layer of the eye, called the retina, contains the sensory receptors for the images carried by the light rays. These sensory receptors are either rods, which appear throughout the retina and are responsible for vision in dim light, or cones, which are concentrated in the central area of the retina and are responsible for color vision. (It’s easy to remember that the cones are responsible for color vision, because cones and color both start with C.)
During daylight, the area of the retina on which the light rays focus is called the macula lutea. Macul/o is a combining form meaning “ spot” and is seen in the skin (macules) and also in the utricle and saccule of the labyrinth of the ear. The fovea is an area within the macula that contains only cones and provides the sharpest image. The area that allows a natural blind spot in our vision is the optic disk, where the optic nerve leaves the retina to travel to the brain. There are no light receptors there.
Mastering Healthcare Terminology/Chapter 14

10. Clicker Question A combining form for the lens is: A. palpebr/o
B. phak/o
C. cor/o
D. cycl/o
B. phak/o
Mastering Healthcare Terminology/Chapter 14

11. Terms Related to Eyelid Disorders
Blepharedema
Blepharitis
Blepharochalasis
Blepharoptosis
Ectropion
Entropion
Ectropion
Blepharedema (blephar/o = eyelid + -edema = swelling) is a swelling of the eyelid.
Blepharitis (blephar/o = eyelid + -itis = inflammation) is an inflammation of the eyelid.
Blepharochalasis (blephar/o = eyelid + -chalasis = relaxation, slackening) is a hypertrophy of the skin of the eyelid. Point out that the upper image also is an example of blepharochalasis.
Blepharoptosis (blephar/o = eyelid + -ptosis = drooping) is a drooping of the upper eyelid.
Ectropion (ec- = out + trop/o = turning + -ion = process of) is a turning outward (eversion) of the eyelid, exposing the conjunctiva.
Entropion (en- = in + trop/o = turning + -ion= process of) is a turning inward of the eyelid toward the eye.
Note the difference between -chalasis and –ptosis. (In blepharochalasis the skin has relaxed over the edge of the eyelids while in blepharoptosis the eyelid itself droops to partially cover the eye.)
Use the diagrams to explain the difference between entropion and ectropion.
Entropion
From Seidel: Mosby’s guide to physical examination, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

12. Terms Related to Eyelash Disorders
Chalazion
Meibomian cyst
Hordeolum
Chalazion
Hordeolum
A chalazion is a hardened swelling of a meibomiam gland resulting from a blockage. It is also called a meibomian cyst.
A hordeolum is an infection of one of the sebaceous glands of an eyelash. It is commonly called a stye (also spelled sty).
From Zitelli: Atlas of pediatric physical diagnosis, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

13. Terms Related to Tear Gland Disorders
Dacryoadenitis
Dacryocystitis
Epiphora
Xerophthalmia
Dacryocystitis
From Zitelli: Atlas of pediatric physical diagnosis, ed 5, Mosby
Dacryoadenitis (dacryoaden/o = lacrimal gland + -itis = inflammation) is an inflammation of a lacrimal gland.
Dacryocystitis (dacryocyst/o = lacrimal sac + -itis = inflammation) is an inflammation of a lacrimal sac. Don’t confuse these two! The lacrimal gland (tear gland) is above the eye and produces the tears. The lacrimal sac (tear sac) is below the eye and collects and channels the tears to the nose.
Epiphora is an overflow of tears; excessive lacrimation.
Xerophthalmia (xer/o = dry + ophthalm/o = eye + -ia = condition) is a condition of dry eyes, the lack of adequate tear production to lubricate the eyes. This is usually the result of a vitamin A deficiency.
Note that xer/o is also used with xeroderma (dry skin).
This is also a great opportunity to remind students that when they hear a term starting with a “z” sound, it could begin with an “x.”
Mastering Healthcare Terminology/Chapter 14

14. Terms Related to Conjunctiva Disorders
Conjunctivitis
Ophthalmic neonatorum
Conjunctivitis (conjunctiv/o = conjunctiva + -itis = inflammation) is an inflammation of the conjunctiva, commonly known as the highly contagious disorder, pinkeye.
Ophthalmic neonatorum (ophthalm/o = eye + -ia = condition, neo- = new + nat/o = born + -um = structure) is a severe, purulent (characterized by pus) conjunctivitis in the newborn, usually due to gonorrheal or chlamydial infection. Routine introduction of an antibiotic ophthalmic ointment (erythromycin) prevents most cases.
Conjunctivitis
From Seidel: Mosby’s guide to physical examination, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

15. Clicker Question What is the term for a drooping of the upper eyelid?
A. blepharitis
B. blepharochalasis
C. blepharoptosis
D. entropion
C. blepharoptosis
-ptosis = drooping
Mastering Healthcare Terminology/Chapter 14

16. Terms Related to Eye Muscle and Orbital Disorders
Amblyopia
Diplopia
Emmetropia
Exophthalmia
Strabismus
Amblyopia (ambly/o = dull, dim + -opia = vision condition) is condition of dull or dim vision due to disuse.
Diplopia (dipl/o = double + -opia = vision) is a condition of double vision.
Emmetropia is a term that means normal vision.
Exophthalmia (ex- = out + ophthalm/o = eye + -ia = condition) is a protrusion of the eyeball from its orbit; it may be congenital or the result of an endocrine disorder.
Strabismus is a general term for a lack of coordination between the eyes, usually due to muscle weakness or paralysis. It is sometimes called a “squint, ” which refers to the patient’s effort to correct the disorder.
Exophthalmia
From Seidel: Mosby’s guide to physical examination, ed 6, Mosby
Mastering Healthcare Terminology/Chapter 14

17. Terms Related to Eye Muscle and Orbital Disorders (cont’d)
Esotropia
Exotropia
Photophobia
● Esotropia (eso- = inward + trop/o = turning + -ia = condition) is a turning inward of one or both eyes (cross eyes).
● Exotropia (exo- = outward + trop/o = turning + -ia = condition) is a turning outward of one or both eyes.
● Warn students about confusing esotropia and exotropia with entropion and ectropion.
● Photophobia (phot/o = light + -phobia = condition of fear) is an extreme sensitivity to light, NOT a fear of light. Here, the word fear means an aversion.
Esotropia
From Zitelli: Atlas of pediatric phsyical diagnosis, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

18. Did You Know?
Photophobia may mean “sensitivity to light” when used to describe the eyes, or “fear of light” when used to describe a psychiatric condition.

19. Terms Related to Refraction and Accommodation Disorders
Myopia
Hyperopia
Astigmatism
Presbyopia
Refraction errors
Myopia (my/o here comes from a little known combining form meaning to shut + -opia = vision condition) is nearsightedness; it is a refractive error that does not allow the eye to focus on distant objects.
Hyperopia (hyper- = excessive + -opia = vision condition) is farsightedness, a refractive error that does not allow the eye to focus on nearby objects.
Astigmatism is a malcurvature of the cornea leading to blurred vision. If uncorrected, asthenopia (weakness of vision) may result.
Presbyopia (presby- = old age + -opia = vision condition) is a progressive loss of elasticity of the lens (it usually accompanies aging), resulting in hyperopia.
Review the common names for myopia and hyperopia.
Use the diagram to explain the first three disorders.
Mastering Healthcare Terminology/Chapter 14

20. Terms Related to Sclera Disorders
Corneal ulcer
Keratitis
Corneal ulcer
From Seidel et al: Mosby’s guide to physical examination, ed 6, Mosby
A corneal ulcer is trauma to the outer covering of the eye resulting in an abrasion.
Keratitis (kerat/o = cornea + -itis = inflammation) is an inflammation of the cornea.
Note the protective nature of the cornea and how these disorders compromise that function.
Mastering Healthcare Terminology/Chapter 14

21. Terms Related to Uvea Disorders
Anisocoria
Hyphema
Uveitis
Anisocoria
Anisocoria (an- = not + is/o = equal + cor/o = pupil + -ia = condition) is a condition of unequally sized pupils, sometimes due to pressure on the optic nerve as a result of trauma or lesion. Use the diagram to explain anisocoria.
Hyphema (hypo- = under + hem/o = blood + -a = noun ending) is blood in the anterior chamber of the eye as a result of hemorrhage due to trauma.
Uveitis (uve/o = uvea + -itis = inflammation) is an inflammation of the uvea (iris, ciliary body, and choroids).
Mastering Healthcare Terminology/Chapter 14

22. Terms Related to Lens Disorders
Aphakia
Cataract
Aphakia (a- = without + phak/o = lens + -ia = condition) is a condition of no lens, either congenital or acquired.
A cataract is a progressive loss of transparency of the lens of the eye.
Explain how cataract surgery can lead to aphakia.
Cataract
From Black and Hawks: Medical-surgical nursing, ed 8, Saunders
Mastering Healthcare Terminology/Chapter 14

23. Terms Related to Lens Disorders (cont’d)
Glaucoma
Glaucoma (glauc/o = gray, bluish green + -oma = mass) is a group of disorders characterized by abnormal intraocular pressure due to obstruction of the outflow of the aqueous humor. Chronic or primary open-angle glaucoma is characterized by an open anterior chamber angle. Angle-closure or narrow-angle glaucoma is characterized by an abnormally narrowed anterior chamber angle. Note that although the suffix is –oma, the original name for the condition (a gray, bluish green mass) is not due to unchecked cell growth, but to an accumulation of fluid.
Use the diagram to explain the reason for the increased intraocular pressure.
Glaucoma
Mastering Healthcare Terminology/Chapter 14

24. Clicker Question What is the term for unequally sized pupils?
A. anisocoria
B. aphakia
C. hyphema
D. glaucoma
A. anisocoria
Mastering Healthcare Terminology/Chapter 14

25. Terms Related to Retina Disorders
Achromatopsia
Age-related macular degeneration (ARMD/AMD)
Achromatopsia (a- = without, chromat/o = color + -opsia = vision condition) is an impairment of color vision. It is characterized by an inability to distinguish between certain colors because of abnormalities of the photopigments produced in the retina. It is commonly called color blindness.
Age-related macular degeneration (ARMD/AMD) is a progressive destruction of the macula, resulting in a loss of central vision. This is the most common visual disorder after the age of 75 years.
Macular degeneration
Mastering Healthcare Terminology/Chapter 14

26. Terms Related to Retina Disorders (cont’d)
Diabetic retinopathy
Hemianopsia
Nyctalopia
Diabetic retinopathy (retin/o = retina + -pathy = disease) is damage of the retina due to diabetes. This is the leading cause of blindness. It is classified according to stages from mild, nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR).
Hemianopsia (hemi- = half + an- = no, not, without + -opsia = vision condition) is the loss of half the visual field, often as the result of a cerebrovascular accident (a stroke).
Even though nyctal/o means night blindness, nyctalopia is the inability to see well in dim light. This may be due to a vitamin A deficiency, retinitis pigmentosa, or choroidoretinitis.
Diabetic retinopathy
Mastering Healthcare Terminology/Chapter 14

27. Terms Related to Retina Disorders (cont’d)
Retinal tear, retinal detachment
Retinitis pigmentosa
Scotoma
A retinal tear (retinal detachment) is a separation of the retina from the choroid layer. This may be due to trauma, inflammation of the interior of the eye, or aging. A hole in the retina allows fluid from the vitreous humor to leak between the two layers.
Retinitis pigmentosa (retin/o = retina + -itis = inflammation) is a hereditary, degenerative disease marked by nyctalopia and a progressive loss of the visual field.
A scotoma is an area of decreased vision in the visual field. This is commonly called a blindspot.
If an individual stared at the sun, burning his or her retina, which disorder would that be? (scotoma)
Retinal tear detachment
From Monahan et al: Phipps’ medical-surgical nursing, ed 8, Mosby
Mastering Healthcare Terminology/Chapter 14

28. Terms Related to Optic Nerve Disorders
Nystagmus
Optic neuritis
Nystagmus is an involuntary, back and forth eye movement due to a disorder of the labyrinth of the ear and/or parts of the nervous system associated with rhythmic eye movements.
Optic neuritis (opt/o = eye + -ic = pertaining to, neur/o + nerve + -itis = inflammation) is an inflammation of the optic nerve resulting in blindness; it is often mentioned as a predecessor to the development of multiple sclerosis.
Mastering Healthcare Terminology/Chapter 14

29. Terms Related to Benign and Malignant Neoplasms of the Eye
Choroidal hemangioma
Malignant
Intraocular melanoma
Retinoblastoma
A choroidal hemangioma (hemangi/o = blood vessel + -oma = tumor) is a tumor of the blood vessel layer under the retina (the choroid layer). This may cause visual loss or retinal detachment.
Intraocular melanoma (intra- = within + ocul/o = eye + -ar = pertaining to, melan/o = dark, black + -oma = tumor) is a malignant tumor of the choroid, ciliary body, or iris that usually occurs in individuals in their 50s or 60s.
A retinoblastoma (retin/o = retina + blast/o = embryonic, immature + -oma = tumor) is an inherited condition present at birth that arises from embryonic retinal cells.
Retinoblastoma
From Damjanov: Anderson’s pathology, ed 10, Mosby
Mastering Healthcare Terminology/Chapter 14

30. Clicker Question
What is the term for loss of half of one’s visual field?
A. nyctalopia
B. scotoma
C. achromatopsia
D. hemianopsia
D. hemianopsia
Mastering Healthcare Terminology/Chapter 14

31. Age Matters Pediatrics Geriatrics Conjunctivitis ARMD Cataracts
Diabetic retinopathy
Presbyopia
Why is conjunctivitis more prevalent among children? (It is highly contagious and is passed through contact.)
Mastering Healthcare Terminology/Chapter 14

32. Terms Related to Diagnostic Procedures
Amsler grid
Diopters
Fluorescein angiography
Fluorescein staining
Gonioscopy
Ophthalmic sonography
Ophthalmoscopy
An Amsler grid is used to assess central vision and to assist in the diagnosis of age-realted macular degeneration.
Diopters are levels of measurement that quantify the refraction errors, including the amount of nearsightedness (negative numbers), farsightedness (positive numbers), and astigmatism.
Fluorescein angiography (angi/o = vessel + -graphy = process of recording) is a procedure to confirm suspected retinal disease by injection of a fluorescein dye into the eye and use of a camera to record the vessels of the retina.
Fluorescein staining is the use of a dye dropped into the eyes that allows differential staining of abnormalities of the cornea.
Gonioscopy (goni/o = angle + -scopy = process of viewing) is a visualization of the angle of the anterior chamber of the eye; it is used to diagnose glaucoma and to inspect ocular movement.
Ophthalmic sonography (son/o = sound + -graphy = process of recording) is the use of high-frequency sound waves to image the interior of the eye when opacities prevent other imaging techniques. It may be used for diagnosing retinal detachments, inflammatory conditions, vasuclar malformations, and suspicious masses.
Ophthalmoscopy (ophthalm/o = eye + -scopy = process of viewing) is any visual examination of the interior of the eye with an ophthalmoscope (-scope = instrument to view).
Amsler grid showing visual changes
caused by fluid leakage under the retina
From Seidel: Mosby’s guide to physical examination, ed 6, Mosby
Mastering Healthcare Terminology/Chapter 14

33. Terms Related to Diagnostic Procedures (cont’d)
Schirmer tear test
Slit lamp examination
Tonometry
Visual acuity (VA) assessment
Snellen chart
Snellen chart
A Schirmer tear test is done to determine the amount of tear production; it is useful in diagnosing dry eye (xerophthalmia).
A slit lamp examination is part of a routine eye examination; it is used to examine the various layers of the eye. Medications may be used to dilate the pupils (mydriatics), numb the eye (anesthetics), or dye the eye (fluorescein staining).
Tonometry (ton/o = tone, tension + -metry = process of measurement) is a measurement of intraocular pressure (IOP) used in the diagnosis of glaucoma. In Goldmann applanation tonometry, the eye is numbed and measurements are taken directly on the eye. In air-puff tonometry, a puff of air is blown onto the cornea.
Visual acuity (VA) assessment is a test of the clearness or sharpness of vision; it is also called the Snellen test. Normal vision is described as being 20/20. The top figure is the number of feet the examinee is standing from the Snellen chart; the bottom figure is the number of feet a normal person would be from the chart and still be able to read the smallest letters. Thus, if the result is 20/40, the highest line that the individual can read is what a person with normal vision can read at 40 feet.
Mastering Healthcare Terminology/Chapter 14

34. Terms Related to Diagnostic Procedures (cont’d)
Visual field (VF) test
A visual field (VF) test is done to determine the area of physical space visible to an individual. A normal visual field is 65 degrees upward, 75 degrees downward, 60 degrees inward, and 90 degrees outward.
How could this be used to diagnose hemianopsia? (loss of half the visual field)
Assessment of visual fields
From Black and Hawks: Medical-surgical nursing, ed 8, Saunders
Mastering Healthcare Terminology/Chapter 14

35. Clicker Question
Which diagnostic procedure is used to visualize the angle of the anterior chamber of the eye?
A. ophthalmoscopy
B. gonioscopy
C. ophthalmic sonography
D. tonometry
gonioscopy
Goni/o = angle
Mastering Healthcare Terminology/Chapter 14

36. Terms Related to Interventions of the Eyeball and Adnexa
Blepharoplasty
Blepharorrhaphy
Dacryocystorhinostomy
Enucleation of the eye
Evisceration of the eye
Exenteration of the eye
Enucleation
From Swartz: Textbook of physical diagnosis, history and
examination, ed 5, Saunders
Blepharoplasty (blephar/o = eyelid + -plasty = surgical repair) is a surgical repair of the eyelids. It may be done to correct blepharoptosis or blepharochalasis.
Blepharorrhaphy (blephar/o = eyelid + -rrhaphy = suture) is a suture of the eyelids.
Dacryocystorhinostomy (dacryocyst/o = lacrimal sac + rhin/o = nose + -stomy = new opening) is the creation of an opening between the tear sac and the nose.
Enucleation of the eye is the removal of the entire eyeball.
Evisceration of the eye is the removal of the contents of the eyeball, leaving the outer coat (the sclera) intact.
Exenteration of the eye is a removal of the entire contents of the orbit.
Mastering Healthcare Terminology/Chapter 14

37. Terms Related to Refractive, Scleral, and Corneal Procedures
Anterior ciliary sclerotomy
Corneal incision procedure
Astigmatic keratotomy (AK)
Photorefractive keratectomy (PRK)
Corneal transplant
Flap procedure
Laser-assisted in situ keratomileusis (LASIK)
An anterior ciliary sclerotomy (scler/o = sclera + -tomy = incision) is an incision in the sclera to treat presbyopia.
A corneal incision procedure is any keratotomy (incision of the cornea) procedure in which the cornea is cut to change its shape, thereby correcting a refractive error. An astigmatic keratotomy (AK) is a corneal incision process that treats astigmatism by effecting a more rounded cornea. Photorefractive keratectomy (PRK) is a treatment for astigmatism, hyperopia, and myopia that uses an excimer laser to reshape the cornea.
A corneal transplant is the transplantation of corneal tissue from a donor or the patient’s own (autograft) cornea. It may involve either full- or partial-thickness grafts; it is also called keratoplasty.
A flap procedure is any procedure in which a segment of the cornea is cut as a means of access to the structure below, such as LASIK. Laser-assisted in situ keratomileusis (LASIK) is a flap procedure in which an excimer laser is used to remove material under the corneal flap. It corrects astigmatism, myopia, and hyperopia.
LASIK
Mastering Healthcare Terminology/Chapter 14

38. Terms Related to Lens Interventions
Cataract extraction
Intraocular lenses (IOLs)
Phacoemulsification and aspiration of a cataract
Cataract extraction (ex- = out + tract/o = pull + -ion = process of) is the removal of the lens to treat cataracts. It may be intracapsular (ICCE), in which the entire lens and capsule are removed, or extracapsular (ECCE), in which the lens capsule is left in place.
Intraocular (intra- = within + ocul/o = eye + -ar = pertaining to) lenses are artificial lenses implanted behind the iris and in front of the natural abnormal lens to treat nearsightedness and farsightedness. These are also called implantable contact lenses.
Phacoemulsification (phac/o = lens) and aspiration of a cataract is a vision corrective procedure accomplished through the destruction and removal of the contents of the capsule by breaking it into small pieces and removing the pieces by suction (aspiration).
Cataract extraction
Mastering Healthcare Terminology/Chapter 14

39. Terms Related to Iris Interventions
Coreoplasty
Goniotomy
Trabeculotomy
Coreoplasty (core/o = pupil + -plasty = surgical repair) is a surgical repair to form an artificial pupil.
A goniotomy (goni/o = angle + -tomy = incision) is an incision of the Schlemm canal to correct glaucoma by providing an exit for the aqueous humor.
A trabeculotomy (trabecul/o = little beam + -tomy = incision) is an incision of the orbital network (lots of little beams arranged together) of the eye to promote intraocular circulation and decrease intraocular pressure (IOP).
Mastering Healthcare Terminology/Chapter 14

40. Terms Related to Retina Interventions
Retinal photocoagulation
Scleral buckling
Vitrectomy
Retinal photocoagulation (phot/o = light + coagulation = to clot) is a destruction of retinal lesions using light rays to solidify tissue.
Scleral buckling is a reattachment of the retina with a cryoprobe (cry/o = extreme cold) and the use of a silicone sponge to push the sclera in toward the retinal scar; it includes the removal of fluid from the subretinal space.
A vitrectomy (vitr/o = vitreous humor, glassy + -ectomy = removal) is a removal of part or all of the vitreous humor.
Scleral buckling
Mastering Healthcare Terminology/Chapter 14

41. Clicker Question
Which of the following is a procedure to repair the pupil?
A. scleral buckling
B. goniotomy
C. trabeculectomy
D. coreoplasty
D. coreoplasty
Mastering Healthcare Terminology/Chapter 14

42. Pharmacology Antibiotics Antihistamines Cycloplegics Lubricants
Medications to treat glaucoma
Antibiotics are medications used to treat bacterial infections. Examples include gentamicin and ciprofloxacin.
Antihistamines are drugs used to treat allergic conditions such as itchy or watery eyes. Diphenhydramine (Benadryl) is a common over-the-counter (OTC) product used to treat allergies.
Cycloplegics (cycl/o = ciliary body + -plegic = pertaining to paralysis) are pharmaceutical agents that induce paralysis of the ciliary body to allow examination of the eye.
Lubricants are medications that keep the eyes moist, mimicking natural tears.
Medications to treat glaucoma decrease the intraocular pressure by decreasing the amount of fluid in the eye or increasing the drainage. These include carbonic anhydrase inhibitors (dorzolamide), cholinergics (pilocarpine), prostaglandin agonists (latanoprost), beta-blockers (levobunolol), and alpha-2-agonists (brimonidine).
Mastering Healthcare Terminology/Chapter 14

43. Pharmacology (cont’d)
Miotics
Mydriatics
Ophthalmics
Topical anesthetics
Miotics are drugs that cause the pupils to constrict. They are often used to treat glaucoma.
Mydriatics are drugs that cause the pupils to dilate. They are used in diagnostic and refractive examinations of the eye. The term mydriatic comes from a Greek word meaning “hot mass.” The Greeks thought that grasping something hot would cause one’s pupils to widen.
Ophthalmics are drugs applied directly to the eye. These may be in the form of solutions or ointments.
Topical anesthetics are mediations used to temporarily anesthetize the eye for the purpose of examination.
Mastering Healthcare Terminology/Chapter 14

44. Clicker Question
Which type of medication is used to dilate the pupil for the purpose of examination of the eye?
A. cycloplegic
B. antihistamine
C. miotic
D. mydriatic
D. mydriatic
Mastering Healthcare Terminology/Chapter 14

45. The Ear (ot/o, aur/o, auricul/o)
Outer ear/external ear
Middle ear
Inner ear/labyrinth (labyrinth/o)
Mastoid process
The ear is divided into three parts: the outer, middle, and inner ear (also called the labyrinth).
Sound is conducted by air, bone, and fluid through these divisions. The majority of the ear is contained within the petrous (hard, stone-like) portion of the temporal bone.
Be careful! Do not confuse oral, meaning pertaining to the mouth, with aural, meaning pertaining to the ear.
The mastoid process is a hard, small projection of the temporal bone that is behind the opening of the auditory canal. Because of its proximity to the ear, it occasionally becomes involved with infections of the middle ear.
Note that the Joint Commission and Institute of Safe Medical Practices have designated the abbreviations AS (left ear), AD (right ear), and AU (each ear) as dangerous abbreviations. The recommendation is to write out the full terms.
The ear
Mastering Healthcare Terminology/Chapter 14

46. The Ear (cont’d) Outer/external ear Pinna/auricle
External auditory canal
Cerumen (cerumin/o)
External auditory meatus (meat/o)
Tympanic membrane (tympan/o, myring/o)
The outer ear serves to gather sound and funnel it into the external auditory canal. The flesh-covered cartilage of the outer ear is called the pinna or auricle.
Earwax, termed cerumen, is secreted by modified sweat glands within the external auditory canal and protects the ear with its antiseptic property and its stickiness, which traps foreign debris and moves it out of the ear.
The opening of the outer ear is the external auditory meatus.
The tympanic membrane (eardrum) marks the end of the external ear and the beginning of the middle ear.
Note the two names for the pinna and the two combining forms for tympanic membrane.
Make sure that students notice the spelling of the combining form for cerumen/cerumin/o (similar to the spelling for abdomen/abdomin/o).
Mastering Healthcare Terminology/Chapter 14

47. The Ear (cont’d) Middle ear Ossicles/ossicular chain (ossicul/o)
Malleus
Incus
Stapes (staped/o)
Oval window
Eustachian tube (salping/o)
The middle ear extends from the tympanic membrane to the oval window.
The eardrum conducts sound to three tiny bones in the middle ear called the ossicles, or the ossicular chain. These ossicles are named for their shapes: the malleus (hammer), the incus (anvil), and the stapes (stirrup). The ossicles transmit sound to the oval window through the stapes.
Be careful! Don’t confuse malleus and malleolus, which is one of the processes on the distal tibia and fibula.
Within the middle ear is the opening for the eustachian tube (also called the auditory tube; don’t confuse this with the auditory canal!). The eustachian tube is a mucous membrane-lined connection between the ears and the throat that equalizes pressure within the middle ear.
Note that salping/o is also used to name the oviducts. The original derivation of the term merely meant a “tube,” but it is most often used for the eustachian and fallopian tubes. Context is used to determine which.
Mastering Healthcare Terminology/Chapter 14

48. The Ear (cont’d) Inner ear/labyrinth (labyrinth/o)
Membranous and bony labyrinth
Perilymph and endolymph
Bony labyrinth
Vestibule (vestibul/o)
Utricle
Saccule
Semicircular canals
Crista ampullaris
The inner ear, called the labyrinth, is composed of two sections: a membranous labyrinth that is enclosed within a bony labyrinth.
Between these two structures, and surrounding the membranous labyrinth, is a fluid called the perilymph. Within the membranous labyrinth is a fluid called the endolymph.
Hair cells within the inner ear fluids act as nerve endings that function as sensor receptors for hearing and equilibrium (a sense of balance).
The outer, bony labyrinth is composed of three parts: the vestibule, the semicircular canals, and the cochlea.The vestibule and semicircular canals function to provide information about the body’s sense of equilibrium. Within the vestibule, the utricle and saccule function to determine the body’s static equilibrium (when not moving). The macula is a specialized patch of epithelium in both that provides information about the position of the head and a sense of acceleration/deceleration. The semicircular canals detect dynamic equilibrium (movement), a sense of sudden rotation through a structure called the crista ampullaris.
Mastering Healthcare Terminology/Chapter 14

49. The Ear (cont’d) Parts of the bony labyrinth Cochlea (cochle/o)
Organ of Corti
Vestibulocochlear nerve/eighth cranial nerve
The third part of the bony labyrinth is the cochlea, which unlike the vestibule and the semicircular canals, serves as an organ of hearing.
The cochlea receives the vibrations from the perilymph and transmits them to the cochlear duct, which is filled with endolymph. The transmission of sound continues through the endolymph to the organ of Corti, where the hearing receptor cells (hairs) stimulate a branch of the eighth cranial nerve, the vestibulocochlear nerve, to transmit the information to the temporal lobe of the brain.
Mastering Healthcare Terminology/Chapter 14

50. Clicker Question
Which of the following combining forms names a structure in the middle ear?
A. cochle/o
B. meat/o
C. staped/o
D. mastoid/o
staped/o
For the stapes, the third ossicle in the middle ear
Mastering Healthcare Terminology/Chapter 14

51. Terms Related to Symptomatic Disorders
Otalgia/otodynia
Otorrhea
Tinnitus
Vertigo
Otalgia (ot/o = ear + -algia and –dynia = pain) is an earache, pain in the ear. It is also called otodynia.
Otorrhea (ot/o = ear + -rrhea = discharge) is a discharge from the auditory canal; it may be serous (watery), bloody, or purulent (filled with pus).
Tinnitus is an abnormal sound heard in one or both ears caused by trauma or disease. It may be a ringing, buzzing, or jingling. Make sure students realize that this is NOT an inflammation—the correct spelling is tinnitus, not tinnitis.
Vertigo is dizziness; there is an abnormal sensation of movement when there is no movement, either of oneself moving or of objects moving around oneself. It may be caused by middle ear infections or by the toxic effects of alcohol, sunstroke, and certain medications.
Mastering Healthcare Terminology/Chapter 14

52. Terms Related to Outer Ear Disorders
Impacted cerumen
Macrotia
Microtia
Otitis externa
Impacted cerumen is a blockage of the external auditor canal with cerumen.
Macrotia (macro- = large + ot/o = ear + -ia = condition) is a condition of abnormally large auricles.
Microtia (micro- = small) is a condition of abnormally small auricles.
Otitis externa (ot/o = ear + -itis = inflammation, externa = outer) is an inflammation of the outer ear and the ear canal. It is also called swimmer’s ear.
Mastering Healthcare Terminology/Chapter 14

53. Terms Related to Middle Ear Disorders
Cholesteatoma
Infectious myringitis
Mastoiditis
Otitis media (OM)
Otosclerosis
A cholesteatoma (chol/e = bile + steat/o = fat + -oma = tumor) is a cystic mass composed of epithelial cells and cholesterol. The mass may occlude (block) the middle ear and destroy adjacent bones. It is not classified as a tumor, but as a mass.
Infectious myringitis (myring/o = eardrum + -itis = inflammation) is an inflammation of the eardrum due to a bacterial or viral infection.
Mastoiditis is an inflammation of the mastoid process of the temporal bone. This may be caused by a middle ear infection that has spread.
Otitis media (ot/o = ear + -itis = inflammation, media = middle) is an inflammation of the middle ear. Suppurative OM is characterized by a pus-filled fluid. Secretory OM is characterized by a clear fluid discharge.
Otosclerosis (ot/o = ear + -sclerosis = condition of hardening) is the development of bone around the oval window with resulting ankylosis (stiffness, often accompanied by fusion) of the stapes to the oval window; it usually results in progressive deafness.
Mastoiditis
From Stone and Garbach: Atlas of infectious diseases, Saunders
Mastering Healthcare Terminology/Chapter 14

54. Clicker Question A condition of abnormally large auricles is:
A. macrotia
B. microtia
C. otosclerosis
D. cholesteatoma
macrotia
Macro- means large
Mastering Healthcare Terminology/Chapter 14

55. Terms Related to Inner Ear Disorders
Labyrinthitis
Meniere disease
Ruptured tympanic membrane
Labyrinthitis (labyrinth/o = labyrinth (inner ear) + -itis = inflammation) is an inflammation of the inner ear that may be due to infection or trauma; symptoms may include vertigo, nausea, and nystagmus.
Meniere disease is a chronic condition of the inner ear characterized by vertigo, hearing loss, and tinnitus. The cause is unknown.
A ruptured tympanic membrane is a tear (perforation) of the eardrum due to trauma or disease process.
Tympanic membrane perforation
From Zitelli: Atlas of pediatric physical diagnosis, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

56. Terms Related to Hearing Loss Disorders
Anacusis
Paracusis
Presbycusis
Conductive hearing loss
Sensorineural hearing loss
Anacusis (an- = no, not, without + -acusis = hearing) is the general term for hearing loss or deafness.
Paracusis (para- = abnormal + -cusis = hearing) is any abnormality of hearing.
Presbycusis (presby- = old age + -cusis = hearing) is loss of hearing common in old age.
Conductive hearing loss is hearing loss resulting from damage to or malformation of the middle or outer ear.
Sensorineural hearing loss is hearing loss resulting from damage to the inner ear (cochlea) or the auditory nerve.
Mastering Healthcare Terminology/Chapter 14

57. Terms Related to Benign Neoplasms of the Ear
Acoustic neuroma
Ceruminoma
Acoustic (acous/o = hearing + -tic = pertaining to) neuroma (neur/o = nerve + -oma = tumor) is a benign tumor of the eighth cranial nerve (vestivulocochlear) that causes tinnitus, vertigo, and hearing loss. It is also called a vestibular schwannoma.
A ceruminona (cerumin/o = cerumen, earwax + -oma = tumor) is a benign adenocarcinoma of the glands that produce earwax.
Note that there are no malignancies!
Mastering Healthcare Terminology/Chapter 14

58. Clicker Question Which term is a loss of hearing common in old age?
A. anacusis
B. paracusis
C. presbycusis
D. Meniere disease
C. presbycusis
Presby- = old age
Mastering Healthcare Terminology/Chapter 14

59. Age Matters Pediatric Geriatrics Otitis media Hearing loss Presbycusis
Not every state requires hearing tests for newborns. Instructors might ask students if they think this should be required.
Mastering Healthcare Terminology/Chapter 14

60. Terms Related to Hearing Tests
Audiometric testing
Audiometer
Audiogram
Audiometric (audi/o = hearing + -metric = pertaining to measurement) testing is a measurement of hearing, usually with an instrument called an audiometer (audi/o = hearing + -meter = instrument to measure). The graphic representation of the results is called an audiogram (audi/o = hearing + -gram = a record, recording).
Compare normal hearing with conductive hearing loss, high-frequency hearing loss, and sensorineural hearing loss, as shown in the diagram provided.
Audiograms
Mastering Healthcare Terminology/Chapter 14

61. Terms Related to Hearing Tests (cont’d)
Pure tone audiometry
Speech audiometry
Rinne tuning fork test
Weber tuning fork test
Pure tone audiometry is a measurement of the perception of pure tones with extraneous sound screened out.
Speech audiometry is the measurement of the ability to hear and understand speech.
The Rinne tuning fork test is a method of distinguishing conductive from sensorineural hearing loss.
The Weber tuning fork test is a method of testing auditory acuity by conductive ability only and is especially helpful when hearing loss is more pronounced in one ear.
A, Weber test. B, Rinne test
From Seidel: Mosby’s guide to examination, ed 6, Mosby
Mastering Healthcare Terminology/Chapter 14

62. Terms Related to Hearing Tests (cont’d)
Otoscopy
Otoscope
Tympanometry
Tympanogram
Otoscopy (ot/o – ear + -scopy = process of viewing) is a visual examination of the external auditory canal and the tympanic membrane using an instrument called an otoscope (ot/o = ear + -scope = instrument to view).
Tympanometry (tympan/o = eardrum + -metry = process of measuring) is the measurement of the condition and mobility function of the eardrum. The resultant graph is called a tympanogram (tympan/o = eardrum + -gram = a record, recording).
Otoscopy
From Seidel: Mosby’s guide to examination, ed 6, Mosby
Mastering Healthcare Terminology/Chapter 14

63. Terms Related to Hearing Tests (cont’d)
Universal newborn hearing screening (UNHS)
Otoacoustic emissions (OAEs)
Auditory brainstem response (ABR)
Universal newborn hearing screening is a test that uses otoacoustic emissions, measured by the insertion of a probe into the baby’s ear canal, and the auditory brainstem response, which involves the placement of four electrodes on the baby’s head to measure the change in electrical activity of the brain in response to sound while the baby is sleeping.
Mastering Healthcare Terminology/Chapter 14

64. Terms Related to Therapeutic Interventions
Cochlear implant
Hearing aid
Mastoidectomy
Otoplasty
Stapedectomy
A cochlear (cochle/o = cochlea + -ar = pertaining to) implant is an implanted device that assists those with hearing loss by electrically stimulating the cochlea.
A hearing aid is an electronic device that amplifies sound.
A mastoidectomy (mastoid/o = mastoid + -ectomy = removal) is a removal of the mastoid process, usually to treat intractable mastoiditis.
Otoplasty (ot/o = ear + -plasty = surgical repair) is a surgical or plastic repair and/or reconstruction of the external ear.
A stapedectomy (staped/o = stapes + -ectomy = removal) is a removal of the third ossicle, the stapes, from the middle ear. After removal of the stapes, a prosthetic replacement is inserted. The procedure is usually done to correct otosclerosis. .
Cochlear implant
Mastering Healthcare Terminology/Chapter 14

65. Terms Related to Therapeutic Interventions (cont’d)
Tympanoplasty
Tympanostomy/ myringostomy
Tympanotomy/ myringotomy
A tympanoplasty (tympan/o = eardrum + -plasty = surgical repair) is a surgical repair of the eardrum, with or without ossicular chain reconstruction. Some patients may require a prosthesis (an artificial replacement) for one or more of the ossicles.
A tympanostomy (tympan/o and myring/o = eardrum + -stomy = new opening) is the surgical creation of an opening through the eardrum to promote drainage and/or allow the introduction of artificial tubes to maintain the opening. It is also called a myringostomy.
A tympanotomy (tympan/o = eardrum + -tomy= incision) is an incision of the eardrum. It is also called a myringotomy.
Tympanostomy tube in place
From Zitelli: Atlas of pediatric physical diagnosis, ed 5, Mosby
Mastering Healthcare Terminology/Chapter 14

66. Clicker Question
Which of the following is a surgical or plastic repair of the external ear?
A. otoplasty
B. cochlear implant
C. tympanoplasty
D. stapedectomy
A. otoplasty
Mastering Healthcare Terminology/Chapter 14

67. Pharmacology Antibiotics Ceruminolytics Decongestants Otics
Antibiotics are drugs that are used to treat bacterial infections. A commonly used oral agent to treat ear infections is amoxicillin (Amoxil).
Ceruminolytics (cerumin/o = cerumen/earwax + -lytic = pertaining to breaking down) are medications used to soften and break down earwax. An example is carbamide peroxide (Debrox).
Decongestants are drugs used to relieve congestion associated with a cold, allergy, or sinus pressure. These drugs may be available as ear drops, a nasal spray, or an oral product. Examples include pseudoephedrine (Sudafed) and oxymetazoline (Afrin, Visine LR).
Otics are drugs applied directly to the external ear canal. These may be administered in the form of solutions, suspensions, or ointments.
Mastering Healthcare Terminology/Chapter 14

68. Clicker Question
Which type of medication is administered to break down earwax?
A. antibiotic
B. ceruminolytic
C. decongestant
D. otic
ceruminolytic
Cerumin/o = earwax + -lytic = pertaining to breaking down
Mastering Healthcare Terminology/Chapter 14

69. Sort these terms into their correct categories
1. diopters
2. tympanometry
3. canthus
4. stapes
5. xerophthalmia
6. otalgia
7. scleral buckling
8. cochlear implant
Categories
__ A+P
__ Pathology
__ Diagnostic Procedures
__ Therapeutic Interventions
A+P --canthus, stapes
Pathology--xerophthalmia, otalgia
Dx --diopters, tympanometry
Tx --scleral buckling, cochlear implant

70. Parting Thought “Become the change you want to see—those
are words I live by.”
–Oprah Winfrey
What kind of change do you want to see?
Mastering Healthcare Terminology/Chapter 14