OUTLINE except

Renal and Sensorineural Disorders Calcium)

• Hypervolemia
I. Kidney Diseases and Injury
a. Acute Kidney Injury b. Chronic Kidney Disease
b. Chronic Kidney Disease • slow/ progressive irreversible loss in kidney function
c. Polycystic Kidney Disease from all renal cell damage
II. Infections of Renal and Urinary • Usually requires dialysis to excrete sodium and
System water
a. Urinary Tract Infection Primary cause
b. Pyelonephritis • may follow AKI > may progress to CKD
c. Glomerulonephritis • Diabetes
III. Renal Calculi • Hypertension
IV. Disorders of the Eye • Chronic urinary obstruction
a. Macular Degeneration • Recurrent infections
b. Cataracts • Renal artery occlusion
c. Glaucoma • Autoimmune disorders
V. Middle and Inner Ear Disorder
Stages of CKD Estimated GFR (Glomerular
Filtration Rate)
RENAL DISORDERS At risk >90 mL/min
I. KIDNEY DISEASE AND INJURY Mild CKD 60-89 mL/min
a. Acute Kidney Injury Moderate CKD 30-59 mL/min
• rapid loss/ abrupt of kidney Function from renal cell Severe CKD 15-29mL/min
Causes of AKI ESRD (End-Stage <15mL/min
• Prerenal, Intrarenal, Postrenal Renal Disease)

Prerenal (Before the kidney)

Neurological Cardiovascular Respiratory
• Blood loss
• Dehydration • Asterexis • Cardiac • Crackles
• Decreased renal blood flow • Ataxia tamponade • Deep sighing,
Intrarenal (inside the kidney) (alteration in • Cardiomyopathy yawning
• Tubular necrosis gait) • Heart failure • Depressed
• Renal ischemia • Myoclonus • Pericardial cough reflex
• Nephrotoxicity • Lethargy effusion • Kussmaul's
Postrenal (After the kidney) • Paresthesia • Pericardial respirations
• Bladder neck obstruction • Seizures friction rub • Shortness of
• Cancer • Coma • Peripheral breath
• Calculi edema • Tachypnea
• Uremic • Pleural
PHASES OF AKI pericarditis effusion
Onset, Oliguric, Diuretic, Recovery • Pulmonary
edema
Oliguric Diuretic Recovery Phase
Phase Phase
• Decreases • Increased of • Slow Process Gastrointestinal Urinary Integumentary
UO of 4-5 L per day • Complete
<400mL/ per • Dehydration recovery may take • Anorexia • Diluted • Poor skin
day • Tachycardia 1-2 years • Nausea & • Straw-colored turgor
• Fluid • Urine volume vomiting urine • Dry skin
retention goes back to • Changes in • Hematuria • Ecchymosis
• Uremia normal taste acuity • Polyuria, • Pruritus
• Metabolic • Constipation nocturia (early) • Purpura
Acidosis • Diarrhea • Oliguria, • Soft tissue
• Altered • Metallic taste - anuria (late) calcifications
LOC, Coma dysgeusia • Proteinuria • Uremic frost
• Stomatitis
• Uremic colitis,
INTERVENTIONS gastritis
• Monitor VS • Uremic fetor
• Monitoring intake and output (Hourly)
• Daily weight monitoring (same scale) an increase in
weight of 0.5-1 lbs per day indicates fluid retention Musculoskeletal Reproductive
• Monitor neurologic status
• Bone pain • Decreased fertility
• Monitor lung sounds for crackles
• Muscle weakness • Decreased libido
• Diet - Low protein
• Muscle cramping • Impotence
• Prepare for DIALYSIS if prescribed to avoid • Pathological fracture • Infrequent or absence of
AZOTEMIA and METABOLIC ACIDOSIS menses
ASSESSMENTS
• ONSET - begins with precipitating events INTERVENTIONS
• Same as AKI
Oliguric Phase Diuretic Phase Recovery • The most important management is to monitor the
Phase patient in telemetry [ECG] for Hyperkalemia
• Increased • gradual decline of • increases management!
BUN & BUN & Creatinine GFR • Prepare for dialysis
CREATININE • Hypovolemia • stabilize • Management fluids and electrolytes imbalances
• Hyper • Hypo(electrolytes) BUN & • Manage pruritus (avoid soaps) give antipruritus
(electrolytes Creatinine (Antihistamines)
c. Polycystic Kidney Disease Signs and Symptoms
is a genetic disorder that causes fluid-filled cysts to
Lower UTI Upper UTI
develop in the kidneys, leading to kidney enlargement
• Dysuria (pain upon • Malaise
and loss of function over time.
urination) • Fever
• Frequency • Rigors
The two main types of PKD are:
• Haematuria (blood in • Vomiting
Autosomal Dominant PKD (ADPKD) – The most
urination) • Loin and/or back
common form, usually appearing in adulthood, though
• Suprapubic discomfort pain
cysts can develop earlier.
• Burning urgency with • Signs of septicemia
Autosomal Recessive PKD (ARPKD) – A rarer and
urination (shock, if infections
more severe form that often presents in infancy or
• Urine is described as is more severe)
childhood.
cloudy and have an
offensive smell
Symptoms:
• Confusion - present in
High blood pressure
older of frail patient
Kidney pain or back pain
Blood in urine
Frequent urinary tract infections Management:
Kidney stones Urine Dipsticks - a better indication of infection
Progressive kidney failure Leukocytes - a rise of it indicates infection or
inflammation
Causes & Risk Factors: Blood - to check for infections
PKD is caused by mutations in specific genes (PKD1,
PKD2 for ADPKD and PKHD1 for ARPKD). If a parent Treatment for Lower UTI
has ADPKD, there's a 50% chance of passing it to their • 3-7 days oral antibiotics
child. ARPKD requires both parents to carry the mutated • Trimethoprim • Nitrofurantroin
gene. • Amoxicillin
• Treatment for Upper UTI (serious)
Complications: • IV antibiotics (for fever)
Chronic kidney disease (CKD) leading to kidney failure • Oral Antibiotics
Liver cysts
Heart valve abnormalities b. Pyelonephritis
Brain aneurysms (increased risk of stroke) Inflammation to the kidneys resulting from bacterial
infection. The infection affects the renal perlvis (join
Diagnosis: between kidney and ureter) and parechyma (renal
Imaging tests (Ultrasound, CT scan, MRI) tissue)
Genetic testing (for high-risk individuals)
Risk Factors: female sex, structural urological
Treatment & Management: abnormalities, pregnancy, diabetes, vesicoureteral reflux
There is no cure, but treatments help manage
symptoms and slow progression: Signs and Symptoms:
- Blood pressure control (ACE inhibitors, ARBs) • Fever & Chills • Flank pain
- Pain management (Avoid NSAIDs; use • Nausea and Vomiting • Loss of appetite
acetaminophen) • Symptoms of Cystitis (urgency, frequency, dysuria)
- Low-sodium, kidney-friendly diet
- Staying hydrated (but avoiding excess water intake if If any of the following are present in the patient; it is
kidney function declines) considered complicated acute pyelonephritis
- Tolvaptan (a medication that slows cyst growth in • Pregnant • Uncontrolled diabetes
ADPKD) • Kidney Failure • Kidney Transplant
- Dialysis or kidney transplant (for end-stage kidney • Immunocompromised • Extremes of age
failure) • Male

II. INFECTIONS OF RENAL AND URINARY Clinical

SYSTEM • Flank pain
a. Urinary Tract Infections • Costovertebral angle
• An infection in any part of our urinary system, that tenderness - indicates potential
includes kidneys, ureters, bladder, and urethra. kidney stones or pyelonephritis
• Women have a shorter urethra than men, which (between the 12th rib and the spine, there is pain upon
makes for the bacteria easier to enter the urethra. percussion)

Causative Agents: Laboratory

E.Coli, Klebsiella, Enterococcus, Pseudomonas, • Urinalysis - pyuria • Urine Culture
Candida (Fungi)
Treatment
Risk Factors: • Rehydration for nausea and vomiting
Pregnancy, woman, menopause, sexual intercourse, • Antibiotics 7-14 days
catheterization, poor hygiene, vesicoureteral reflux • Oral Fluoroquinolones

Lower UTI Upper UTI Chronic pyelonephritis

Urethritis Ureteritis • Recurrent episodes of infection in the kidneys
Prostatitis Pyelonephritis
Cystitis C. Glomerulonephritis
• Inflammation of the glumeruli (tiny units in the kidney
Classification of UTI: that filters blood) and of the small blood vessels.
Uncomplicated - Occurs in • Each kidney has approximately 1 million glomeruli,
healthy individuals with a normal that removes extra fluid, electrolytes and waste from
urinary tract. Typically easy to treat the blood stream.
with antibiotics • If the glumeruli is damaged it can disrupt the proper
Complicated - has a underlying medical conditions, functioning of the kidney unable to remove waste
abnormalities of the urinary tract. and excess fluid efficiently.
• If the blood is not getting filtered, the blood will be • Eat foods high in sodium or sugars (sucrose and
filled with waste, causing AKF, high BP, chronic fructose)
kidney disease. On that matter, the first electrolyte • Take vitamin C supplements
that we need to check is potassium, if it rises it • Have a family history of kidney stones
affects the heart which can cause life-threatening • Have a blockage in your urinary tract
condition • Take certain medication
• Have a certain medical condition: Cystic fibrosis,
Causes: cystinuria, diabetes, gout, high blood pressure, high
Streptococcal infection of the throat calcium level in your urine, IBD, obesity, osteoporosis

Symptoms Complication of kidney stones

• Urine that has traces of blood or appears brown • Blockage that backs pee up into your kidney, causing it
• Fluid buildup (edema) • High BP to swell (Hydronephrosis)
• Low amounts of urine • Fever • Kidney infection (pyelonephritis)
• Acute kidney injury (a type of kidney failure that can be
Diagnosis reversible)
• Urine test - blood and protein • Urinary Tract Infections
• Blood test - GFR, Urea Nitrogren, Creatinine • Chronic Kidney Disease (CKD)
• Kidney biopsy • Imaging tests
SENSORINUERAL DISORDERS
Treatment: IV. DISORDERS OF THE EYE
• Control blood pressure – keep the patient on bed Introduction
• Diet Restriction - sodium, fluid, protein, and potassium Eye health plays a crucial role in maintaining
• Monitor Intake and Output independence and quality of life, especially as we age.
• In worse case kidney transplant Among the most common vision-related conditions
affecting millions worldwide are macular degeneration,
III. RENAL CALCULI glaucoma, and cataracts. Each of these disorders can
Renal Calculi aka Kidney stone/ Nephrolithiasis/ lead to vision loss if left untreated, but they affect the
Urolithiasis eyes in different ways.

• Renal calculi form when crystals build up in the Importance of Eye Health
urine. This can happen when there is too much • Supports daily life: Good vision helps with reading,
waste in the body and not enough liquid to flush it driving, and independence.
out. • Early disease detection: Eye exams can catch
• Often, stones form when the urine becomes conditions like glaucoma, diabetes, and high blood
concentrated, allowing minerals to crystallize and pressure early.
stick together. • Boosts learning: Clear vision is crucial for
• Diet, excess body weight, some medical conditions, children's development and school performance.
and certain supplements, and medication are the • Prevents injuries: Good eyesight reduces the risk
most common cause of kidney stones of falls and accidents.
• Kidney stones can affect any part of the urinary tract. • Improves well-being: Eye strain can cause
From kidney to bladder. headaches and fatigue; vision issues may affect
mental health.
Symptoms
• If kidney stones become lodged in the ureters, it
may block the flow of the urine and cause the kidney
to swell and the ureter to spasm, which can be very
painful. You may experience these symptoms
- Severe, sharp pain in the side and back, below the ribs
- Pain that radiates to the lower abdomen and groin Overview of Common Eye Disorders
- Pain that comes in waves and fluctuates in intensity Macular Degeneration
- Pain or burning sensation while urinating Definition: Damage to the central part of the retina
- Pink, red or brown urine (macula)
- Cloudy or foul smelling urine Symptoms: Loss of central vision, blurry or distorted
- A persistent need to urinate, urinating in small amounts vision
- Nausea and vomiting Treatment: No cure, but treatments can slow it
- Fever and chills if an infection is present down
• Pain caused by a kidney stone may change. For
instance, shifting to a different location or increasing Cataract
intensity as the stone moves through your urinary What it is: Clouding of the eye’s lens
tract Symptoms: Blurry vision, glare, trouble seeing at
night
Types of Kidney stones Treatment: Surgery to replace the lens
- Stones are named for the type of crystal they are made
up of Glaucoma
Definition: Damage to the optic nerve, often from
1. Calcium-oxalate and calcium phosphate stones - high eye pressure
form when you eat high-oxalate or low calcium foods Symptoms: Often no early signs; vision loss in later
and are not drinking enough fluids. The most common stages
type of kidney stones Treatment: Eye drops, medications, or surgery
2. Uric acid stones - eating animal proteins can cause
uric acid stones to form a. Macular Degeneration
3. Struvite stones - bacterial infection can cause this
stone.
4. Cystine stones - an inherited condition called
cystinuria causes cystine stones. It is a substance made
of two cysteine amino acid bound together.

Risk factors • Macular degeneration, also known as Age-

• People who don’t drink enough fluids Related Macular Degeneration (AMD) is a
progressive eye condition that affects the macula,
 the small but crucial central portion of the retina. The • Fluorescein
macula is responsible for central vision, which is angiography:
needed for activities like reading, driving, watching Helps visualize
TV, and recognizing faces. leaking blood
vessels
As the disease progresses, it can cause distorted or • Indocyanine
blurred vision and eventually lead to the loss of green
central vision, though peripheral (side) vision usually angiography
remains unaffected. may be used for
deeper imaging
Two (2) Types of Macular Degeneration: Treatment • No cure, but • Anti-VEGF
Dry Macular Degeneration AREDS2 injections (e.g.,
• Most common type (about 80–90% of AMD cases) supplements Avastin,
• Caused by the thinning of the macula and the (containing vitamins Lucentis,
gradual accumulation of yellow deposits called C, E, zinc, copper, Eylea): Prevent
drusen beneath the retina. lutein, zeaxanthin) new blood
• Leads to a slow decline in vision over time. may slow vessel growth
• No medical treatment currently exists to reverse progression in and reduce
dry AMD, but progression can be slowed with diet, intermediate/advanc leakage
supplements, and lifestyle changes. ed stages •
• Lifestyle changes Photodynamic
Wet Macular Degeneration like quitting smoking therapy (PDT):
• Less common but more aggressive and severe. and improving diet Light-activated
• Caused by the growth of abnormal blood vessels may help drug (Visudyne)
under the retina that leak fluid or blood, damaging and laser used
the macula. in select cases
• Can lead to rapid and severe vision loss if left • Laser
untreated. photocoagulatio
• Treatable with medications (anti-VEGF injections), n: Rarely used
laser therapy, or photodynamic therapy. now due to
risks and
Dry and Wet AMD Comparison advances in
Types Dry AMD Wet AMD injection
Causes • Accumulation of • Abnormal therapy
drusen (yellow blood vessel Prognosis • Progresses slowly • If treated
deposits) under the growth under over years early, vision can
retina the retina • Often leads to mild stabilize or
• Thinning and aging • to moderate vision improve in
of the macula These vessels loss many patients
• Risk factors: Age leak fluid or • Can progress to • Without
(50+), genetics, blood, wet AMD treatment, it can
smoking, poor diet, damaging the lead to severe
obesity, macula and permanent
cardiovascular • Often vision loss in a
issues develops from short time
untreated or • Requires
progressing dry ongoing
AMD monitoring and
repeat
Symptoms • Gradual blurring of • Rapid onset of injections
central vision vision changes Manageme • Regular eye • Frequent eye
• Difficulty reading or • Distorted nt exams to monitor exams (monthly
recognizing faces vision (straight changes or as advised)
• Colors appear less lines appear • Use of low-vision • Continue
bright wavy) aids (magnifiers, AREDS2
• Straight lines may • Dark or blurry electronic readers) supplements
begin to look slightly spots in the • Healthy lifestyle: • Lifestyle
distorted center of vision diet, exercise, no modifications
• May affect one or • Sudden smoking (smoking
both eyes decrease in Home monitoring cessation, diet,
central visual with Amsler grid blood pressure
acuity control)
• Affects daily • Vision
tasks like rehabilitation
reading, driving services
or seeing faces • Low-vision
Diagnosis • Comprehensive •Comprehensiv tools and
dilated eye exam e eye exam support
• Amsler grid test to • Amsler grid
detect visual test to detect b. Cataract
distortions visual • Cataracts are a condition in which the eye’s natural
• Optical Coherence distortions lens becomes clouded, leading to blurred or dim
Tomography (OCT): • Optical vision. This clouding occurs as proteins in the lens
Imaging to detect Coherence break down and clump together, typically due to
thinning of the retina Tomography aging, and can interfere with the passage of light
or drusen buildup (OCT): Imaging through the lens to the retina.
• Fluorescein to detect
angiography (to rule thinning of the
out wet AMD if fluid retina or drusen
is suspected) buildup
Types of Cataracts: •Phacoemul •Phacoemul •Phacoemul
1. Nuclear Cataracts sification: sification: sification:
• Form in the center (nucleus) of the lens Common Common Common
• Commonly related to aging method method method
• Can initially cause nearsightedness or where the where the where the
improved reading vision (also called “second sight) cloudy lens cloudy lens cloudy lens
• Vision gradually becomes cloudy and yellowed is broken up is broken up is broken up
and and and
2. Cortical Cataracts removed removed removed
• Begin in the outer edges (cortex) of the lens Intraocular Intraocular Intraocular
and progress inward lens (IOL) lens (IOL) lens (IOL)
• Appear as white, wedge-shaped streaks or spokes • • •
• Often cause glare and problems with contrast, implantation: implantation: implantation:
especially at night Replaces Replaces Replaces
natural lens natural lens natural lens
3. Posterior Subcapsular Cataracts Progn • Cataract • Cataract • Cataract
• Develop at the back of the lens, just beneath osis surgery is surgery is surgery is
the capsule that holds it very safe very safe very safe
• Progresses quickly, often in younger people or those and and and
on steroids effective, effective, effective,
• Affects reading vision, causes glare and halos around with a with a with a
lights. success rate success rate success rate
over 95% for over 95% for over 95% for
Comparison between each types: improved improved improved
Types Nuclear Cortical Posterior vision vision vision
Cataracts Cataracts Subcaps • Most • Most • Most
ular people people people
Cataracts regain regain regain
Causes Aging Diabetes Long-term functional functional functional
Oxidative UV light steroid vision and vision and vision and
stress exposure use return to return to return to
Smoking Electrolyte Diabetes normal normal normal
imbalances Radiation activities activities activities
Younger • Prognosis • Prognosis • Prognosis
age onset is best when is best when is best when
Sympto • Gradual • Glare and • Trouble no other eye no other eye no other eye
ms decline in halos around seeing in diseases diseases diseases
vision lights bright light (like macular (like macular (like macular
• Yellowing • Blurry or • Glare degeneratio degeneratio degeneratio
of vision hazy vision • Poor n or n or n or
• Glare Issues with near glaucoma) glaucoma) glaucoma)
sensitivity contrast vision are present are present are present
“Second • Rapid Manag • Regular • Regular • Regular
sight” onset of ement eye exams eye exams eye exams
blurry to monitor to monitor to monitor
vision progression progression progression
Diagnosi Comprehen Comprehen Compreh • UV • UV • UV
s sive eye sive eye ensive protection: protection: protection:
exam exam eye exam Wear Wear Wear
including: including: including sunglasses sunglasses sunglasses
• Visual • Visual : with UV with UV with UV
acuity test acuity test • Visual filters filters filters
• Slit-lamp • Slit-lamp acuity test • Controls • Controls • Controls
examination examination • Slit-lamp chronic chronic chronic
to examine to examine examinati conditions: conditions: conditions:
the lens the lens on to Diabetes, Diabetes, Diabetes,
• Retinal • Retinal examine hypertension hypertension hypertension
exam (often exam (often the lens • Avoid • Avoid • Avoid
after pupil after pupil • Retinal smoking and smoking and smoking and
dilation) dilation) exam excessive excessive excessive
(often alcohol alcohol alcohol
after pupil • Limit • Limit • Limit
dilation) steroid use steroid use steroid use
Treatm Non- Non- Non- (under (under (under
ent surgical surgical surgical medical medical medical
(early (early (early guidance) guidance) guidance)
stages) stages) stages) • Healthy • Healthy • Healthy
• • • diet: diet: diet:
Prescription Prescription Prescription Antioxidants Antioxidants Antioxidants
glasses or glasses or glasses or like vitamins like vitamins like vitamins
contact contact contact C and E may C and E may C and E may
lenses lenses lenses help slow help slow help slow
• Brighter • Brighter • Brighter development development development
lighting, lighting, lighting, ) ) )
magnifying magnifying magnifying
lenses lenses lenses C. Glaucoma
• Sunglasses • Sunglasses • Sunglasses • Glaucoma is an eye condition that damages the
to reduce to reduce to reduce optic nerve. This damage can lead to vision loss or
glare glare glare blindness. The optic nerve sends visual information
from your eye to the brain and is vital for good
Surgical Surgical Surgical vision. Damage to the optic nerve is often related to
 high pressure in the eye. But glaucoma can happen low oxygen levels. It is also the one that stimulates the
even with typical eye pressure. growth of new blood vessels that blocks the drainage of
aqueous humor which results in the increase intraocular
pressure.
Types If you have neovascular glaucoma, you may notice:
Each type of glaucoma is different, but most have no • Pain or redness in your eye • Vision loss
early symptoms — so it’s important to get tested
regularly, especially if you’re at higher risk. This type of glaucoma can be hard to treat. Doctors
need to treat the underlying cause (like diabetes or high
PRIMARY GLAUCOMAS blood pressure) and use glaucoma treatments to lower
Primary glaucoma occurs without any other underlying your eye pressure.
eye disease or condition. It is considered a "primary"
condition, meaning it develops independently. The exact 2. Pigmentary Glaucoma
cause is usually unknown but is believed to involve a • Pigmentary glaucoma happens when the pigment
buildup of intraocular pressure (IOP) due to impaired (color) from your iris (the colored part of your eye) flakes
drainage of the eye's aqueous humor (fluid inside the off and blocks fluid from draining out of your eye.
eye). • Young, white men who are near-sighted are more likely
1. Open-angle glaucoma to get pigmentary glaucoma. If you have this condition,
• Open-angle glaucoma is the most you may have blurry vision or see rainbow-colored rings
common type in the United States, around lights, especially when you exercise.
where 9 in 10 people with glaucoma
have the open-angle type. Many people 3. Exfoliation Glaucoma
don’t have any symptoms until they start • Exfoliation glaucoma (sometimes called
to lose their vision, and people may not pseudoexfoliation) is a type of
notice vision loss right away. secondary open-angle glaucoma caused
- Open angle glaucoma may be caused by pressure by exfoliation syndrome (XFS), a
building up in your eye. If the fluid in your eye can’t drain systemic condition where abnormal protein-like material
fast enough, it creates pressure that pushes on the optic accumulates on the lens, iris, and trabecular meshwork.
nerve in the back of your eye. The optic nerve is the one This buildup blocks the eye's drainage system, leading
that carries visual information to the brain. The to increased intraocular pressure (IOP) and optic nerve
trabecular meshwork (a spongy tissue at the drainage damage.
angle of the eye) does not drain aqueous humor (fluid in • Recent research shows that genetics may play a role in
the eye) efficiently. Unlike closed-angle glaucoma, where exfoliation glaucoma. You’re at higher risk if someone
drainage is suddenly blocked, open-angle glaucoma has else in your family has exfoliation glaucoma.
a partially open but dysfunctional drainage system. • This type of glaucoma can progress faster than primary
open-angle glaucoma, and often causes higher eye
2. Angle Closure Glaucoma pressure. This means that it’s especially important for
• also called narrow-angle or acute people who are at risk to get regular eye exams to
glaucoma. In this type of glaucoma, the protect their vision.
outer edge of the iris (the colored part of
your eye) blocks fluid from draining out of SYMPTOMS:
the front of the eye. • Often asymptomatic in early stages
• It is a medical emergency so go to the • Gradual loss of peripheral vision
doctor or emergency room immediately if you suddenly • May notice difficulty with vision if pressure is high
have: • Sometimes presents only when vision is already
significantly lost.
• Intense eye pain • Upset stomach (nausea)
• Red eye • Blurry vision 4. Uveitic Glaucoma
Uveitic glaucoma can happen in people
3. Congenital Glaucoma who have uveitis, a condition that causes
A baby is born with abnormal swelling and inflammation in the eye.
development of the eye's drainage About 2 in 10 people with uveitis develop
system, leading to increased uveitic glaucoma.
intraocular pressure (IOP) and potential optic nerve
damage. It is usually diagnosed in infants or young Comparison of the types of glaucoma
children, typically before age 3. Congenital glaucoma is Feature Primary Secondary
rare, only about 1 in 10,000 babies born in the United Glaucoma Glaucoma
States have it. Definition Glaucoma that Glaucoma
• If your child is born with glaucoma, you can usually happens on its caused by
notice the signs right away. Children with congenital own, usually another
glaucoma: due to genetics condition, injury,
• Have cloudy eyes • Are sensitive to light or age. or medication.
• Make extra tears Types 1. Primary 1. Neovascular
• May have eyes that are larger than normal Open-Angle Glaucoma:
Glaucoma Caused by
SECONDARY GLAUCOMAS (POAG): Slow abnormal blood
Secondary glaucoma results from another underlying drainage, vessel growth
condition or factor that leads to an increase in IOP. It is causing a (e.g., from
called "secondary" because it is the result of an external gradual diabetes).
cause or condition. increase in eye 2. Pigmentary
1. Neovascular glaucoma pressure. Glaucoma:
Neovascular glaucoma happens when the 2. Primary Pigment from the
eye makes extra blood vessels that cover Angle-Closure iris blocks
the part of your eye where fluid would Glaucoma drainage.
normally drain. It’s usually caused by (PACG): 3. Exfoliation
another medical condition, like diabetes or high blood Sudden Glaucoma: A
pressure. Diseases like diabetic retinopathy, central blockage of protein-like
retinal vein occlusion (CRVO), or ocular ischemic fluid drainage, material clogs the
syndrome reduce oxygen supply to the retina. In causing a rapid drainage system.
response, retina releases varcular endothelial growth pressure 4. Uveitic
factor which is a protein produced by cells in response to increase. Glaucoma:
 3. Congenital Caused by eye V. Middle and Inner Ear Disorders
Glaucoma: inflammation Middle and inner ear disorders can affect hearing and
Present at birth (uveitis). balance, often leading to symptoms such as hearing
due to loss, dizziness, tinnitus (ringing in the ears), and ear
abnormal eye pain. Below is an overview of common disorders
development. affecting these parts of the ear.
Causes -aging -Diabetes
-genetics - Eye injury Middle Ear Disorders
-eye anatomy - Long-term The middle ear contains the eardrum and ossicles (tiny
problems steroid use bones) that transmit sound vibrations to the inner ear.
- Eye
inflammation 1. Otitis Media (Middle Ear Infection)
Symptoms POAG: No Neovascular: Cause: Bacterial or viral infections, often following a cold
symptoms at Red, painful eye, or respiratory infection.
first, but vision vision loss. Symptoms: Ear pain, fluid buildup, hearing loss, fever,
gradually Pigmentary: and possible ear drainage.
worsens. Blurry vision, Treatment: Antibiotics (if bacterial), pain relievers, and
PACG: Severe halos around sometimes drainage (myringotomy).
eye pain, lights.
headache, Exfoliation: 2. Otosclerosis
nausea, blurred Often no early Cause: Abnormal bone growth around the stapes (a
vision. symptoms, later middle ear bone), preventing sound transmission.
Congenital: leads to vision Symptoms: Gradual hearing loss, tinnitus, and
Cloudy eyes, loss. dizziness in some cases.
light sensitivity, Uveitic: Red, Treatment: Hearing aids or surgery (stapedectomy).
excessive painful eye with
tearing. blurred vision. 3. Tympanic Membrane Perforation (Eardrum
Diagnosis - Eye pressure - Same as Rupture)
test (tonometry) primary Cause: Trauma, infections, sudden pressure changes
- Checking the glaucoma (barotrauma).
drainage angle - Plus tests for Symptoms: Sudden pain, hearing loss, possible
(gonioscopy) the underlying drainage.
- Eye nerve and cause (e.g., Treatment: Usually heals on its own, but surgery
vision tests diabetes check, (tympanoplasty) may be needed.
eye inflammation
test) 4. Cholesteatoma
Treatment -Eye drops to NEOVASCULAR: Cause: Abnormal skin growth in the middle ear due to
lower pressure Treat the cause repeated infections or eardrum perforations.
- Laser therapy (e.g., control Symptoms: Persistent ear drainage, hearing loss,
or surgery if diabetes, stop dizziness, and facial muscle weakness in severe cases.
needed steroids) Treatment: Surgery to remove the growth.
Reduce VEFG
Same treatments 5. Eustachian Tube Dysfunction (ETD)
as primary Cause: Blocked or swollen Eustachian tubes due to
glaucoma to allergies, infections, or sinus issues.
lower eye Symptoms: Muffled hearing, ear fullness, popping
pressure sounds, and occasional pain.
Surgery if IOP is Treatment: Decongestants, nasal sprays, or surgical
still uncontrolled. interventions.

PIGMENTARY: Inner Ear Disorders

IOP-lowering eye The inner ear contains the cochlea (responsible for
drops hearing) and the vestibular system (responsible for
Laser balance).
trabeculoplasty
Laser peripheral 1. Meniere’s Disease
iridotomy Cause: Fluid buildup in the inner ear, potentially due to
Surgery circulation problems, allergies, or autoimmune
responses.
EXFOLIATION: Symptoms: Episodes of vertigo, tinnitus, hearing loss,
Medications and ear fullness.
Laser Treatment: Low-sodium diet, diuretics, vestibular
trabeculoplasty rehabilitation, and sometimes surgery.
Surgery
2. Labyrinthitis
UVEITIC Cause: Viral or bacterial infections causing inflammation
Control of the inner ear (labyrinth).
inflammation Symptoms: Severe vertigo, nausea, hearing loss, and
Lower the IOP balance issues.
Surgery Treatment: Antiviral or antibiotic medications,
Prognosis Vision loss is Can be corticosteroids, and vestibular therapy.
permanent if reversible if the
untreated but cause is treated 3. Vestibular Neuritis
can be early; otherwise, Cause: Viral infection leading to inflammation of the
managed with it may cause vestibular nerve.
early treatment. permanent Symptoms: Sudden vertigo, nausea, vomiting, and
damage. balance problems without hearing loss.
Treatment: Rest, anti-nausea medications, steroids, and
vestibular rehabilitation therapy.
4. Noise-Induced Hearing Loss (NIHL)
Cause: Exposure to loud noises damaging the hair cells
in the cochlea.
Symptoms: Progressive high-frequency hearing loss
and tinnitus.

Treatment: Prevention (ear protection), hearing aids if

necessary.

5. Presbycusis (Age-Related Hearing Loss)

Cause: Degeneration of inner ear structures due to
aging.
Symptoms: Gradual hearing loss, difficulty
understanding speech, tinnitus.
Treatment: Hearing aids and assistive listening devices.

6. Acoustic Neuroma (Vestibular Schwannoma)

Cause: A benign tumor on the vestibular nerve.
Symptoms: Gradual hearing loss in one ear, tinnitus,
imbalance, and facial numbness in severe cases.
Treatment: Observation, radiation therapy, or surgical
removal.

7. Perilymph Fistula
Cause: Abnormal leakage of inner ear fluid due to
trauma, barotrauma, or surgery.
Symptoms: Dizziness, motion sensitivity, ear fullness,
and fluctuating hearing loss.
Treatment: Rest, activity restrictions, and sometimes
surgery.