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The eye and ear are special organs of the human body that are designed to detect information about the world around us. In this study session you will learn about the basic anatomy of the eye, how the eye functions, what cataract means, and the common manifestations of cataract.
5.4  Explain how cataracts can be treated, using language that an affected person in your community can understand. 5.5  Describe the main types of eye injuries and what first aid you would give in each case.
5.6  Describe how you would educate people in your community on the prevention of blindness. The eyeball is a small organ in size, only about 2.5 cm in diameter, but it serves a very important function, which is your sight. The cornea is a clear layer at the front of the eye which is continuous with the sclera, as you can see in Figure 5.2. The retina is a complex layer of tissue at the back of the eye, where the image from the light entering the eye is focused. Next we turn to a major cause of blindness all over the world that results from problems in one of the structures you just learned about. Cataracts are changes in clarity (clouding) of the lens in the eye, which interferes with the passage of light into the eye. If less light can reach the retina at the back of the eye through the cloudy lens, then the signals reaching the brain will be weaker and less focused. In 2002 (European calendar) the World Health Organization estimated that there were 37 million people in the world who were totally blind (unable to see with both eyes), and 161 million people with some sort of visual impairment affecting their sight.
You should suspect cataracts are the problem when a person comes to you with complaints of visual changes, such as blurred vision, difficulty in seeing in bright light, inability to see distant objects or scenes, poor colour vision, and difficulty in reading. Cataracts are usually progressive and painless, and not associated with any redness of the eye. Cataracts can sometimes develop in children, but usually the person is above the age of 40 years. You should tell the person with suspected cataracts that after the examination at the hospital or health centre, the doctor will discuss if a solution is possible for their sight problems. Cataracts may be classified based on several factors, including the age of the person when the cataract was first detected, the cause of the cataract and whether it is an inborn (genetic) or acquired problem.
You should also know that deficiency of vitamin A from the food we eat is an important cause of blindness.
Refer to the Immunization Module, Study Session 3 and the Communicable Diseases Module, Study Session 4 for the doses of Vitamin A drops. The purpose of classifying cataracts is to help you understand the different causes, so that you can educate your community about those causes which are preventable. Did you say poorly controlled diabetes mellitus, eye injury, or direct exposure to sunlight, smoke and fumes?
Though there is no really effective way of preventing cataracts at present, interventions such as these can significantly alter the disease burden of cataracts by minimising exposure to factors that promote them to develop.
Taking out the lens improves the person’s sight because light can get all the way to the back of the eye again. So, besides advocating and practicing the preventive measures, you have to facilitate transfer of people affected by cataracts to a hospital or health centre with an eye-care unit. There are several common causes of eye injury, which have different outcomes depending on the extent of the injury and degree of disability that follows.
Penetration of the cornea (or rarely the sclera) can happen due to sharp objects accidentally entering the eye and penetrating the eyeball.
The eye can get injured by a blow, for example in a fight or a fall, without any penetration in the eye structure externally. You may come across someone who has got a cut to the eyelids following a blow or sharp injury.
If you are treating someone with a chemical splash injury, or dust in the eyes, simply rinse the eye with plenty of clean water. If you happen to see a person with injury to the eyelids, or swelling, you should stop the bleeding and help reduce the swelling by applying gentle pressure to the eye using a pad of clean cloth. Trachoma is described in detail in the Communicable Diseases Module, Part 4, Study Session 39. We will briefly mention a very common cause of blindness in Ethiopia – bacterial infection with Chlamydia trachomatis leading to a condition called trachoma.
Next you will be studying about foreign bodies in the ear, which is a common problem in children. As you learned in the Communicable Diseases Module (Study Session 35), children are prone to develop infections of the inner ear, which may have spread from the respiratory tract up the Eustachian tubes into the ears (Figure 5.10).
Figure 5.10  Anatomy of the ear and its connection with the respiratory tract via the Eustachian tubes on each side of the head. Another very common ear problem in children is caused when they put foreign objects into the ear canal (on the left of Figure 5.10) when they are playing. Simple removal of a foreign object from the ear helps to reduce the risk of deafness resulting from chronic (long-term) infection.
Figure 5.12  Foreign object being carefully removed from a child’s ear by a thin blunt instrument. Be careful not to push the instrument too far into the ear, or you may puncture the delicate ear drum! In the next study session you will study another important but often neglected topic for your health promotion and disease prevention practice – oral health and the prevention of dental problems. The eye serves an important purpose of vision and its function is comparable to the function of a camera in taking a photo. The main structures of the eyeball are the sclera, cornea, pupil, iris and lens, all of which have the important function of transmitting light onto the retina at the back of the eye where the image is formed. Cataracts and eye injuries are important causes of blindness worldwide, where cataract alone contributes to 48% of all people who are totally blind.
The early symptoms of cataract are blurred vision, difficulty seeing in bright light and poor colour vision.

Cataract progression can be slowed by preventing eye injury, strict control of blood sugar, and avoiding exposure to smoke from cigarettes and indoor fires.
Common causes of eye injury are scratches, chemical splashes, penetrating and blunt injuries, and cuts to the eyelids.
Damage to the cornea by the eyelashes turning inwards and scratching it is an important cause of blindness. Children often insert small foreign objects into their ears, which can lead to problems of ear infection and deafness. Careful removal of foreign objects from the ears prevents ear infection, which is an important cause of deafness, especially in children. Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions.
Which structures of the eye are serving the purpose of defending the eye, and which ones are for transmission of light into the eye?
Mr Worku, a 75-year-old man from your village, complains of having blurred vision and difficulty seeing in the bright sunlight whenever he goes to the market. Why do you think that children and young adults are more likely than older people to suffer an injury to one eye that results in long-term damage? Injuries to one eye usually result from chemical splashes, accidental scratches, penetration by sharp objects, or non-penetrating blows. A three-year-old child was brought to you with earache, pulling her external ear now and then, and you can see a whitish-yellow ear discharge.
Any impairment of function in these two organs is experienced as a big problem, particularly by people in rural communities. You will also be learning how to deal with common types of eye and ear injuries, and how to provide emergency care for these problems. Knowing this will help you understand about the different causes of blindness, such as cataract. They protect the eye from foreign matter, such as dust, dirt and other debris that might damage the eyes. The lens focuses the light as it passes through the eye onto the retina at the back of the eye. The cataract will gradually impair the quality of the person’s vision and result finally in blindness, when light can no longer get through the lens. Cataracts are the most common cause of blindness worldwide, contributing to 48% of the 37 million people who cannot see at all. As cataracts continue to progress and the lens become more opaque, the person will say they feel like they are looking through cloudy glass.
When you look at a person with advanced cataract you can see the clouding or milky appearance of the lens, which is particularly obvious if you shine a light into the eye (Figure 5.5). If someone complains of these problems, you should suspect cataract and refer this person to the nearest hospital or health centre. A simple surgical treatment could transform their vision from not seeing well to being able to see much better again. Some of the causes include physical injury to the eye, long-term exposure to very bright sunlight, or to the fumes and smoke from household cooking fires, cigarette smoking, poor control of diabetes mellitus (the high sugar levels in the blood damages the eye), and so on. To prevent blindness from vitamin A deficiency, infants are given a supplement of vitamin A drops with measles vaccine, repeated every six months until the age of five years. More details of blindness due to nutritional deficiency are given in the Nutrition Module, Study Session 5. A healthy lifestyle might also help, just as it helps prevent other non-communicable diseases: eat a balanced diet, get regular exercise and rest, and do not smoke or drink much alcohol. Once it is detected at the early stage, the initial treatment is to slow down the clouding of the lens by following the preventive measures described in the previous section.
However, without a lens to focus the light, the restored vision is more blurred than before the cataracts developed.
You should tell the person you refer about the big transformation of life after the treatment of cataract blindness (Case Study 5.1), so that the person will decide on travelling for treatment. His daughter recently gave birth to his first grandson, but he was very depressed when he realised that he cannot see the baby because he is blind from cataracts in both eyes. We hope that it does, as you know it is a great blessing for anyone to reach the age of having grandchildren and great-grandchildren. This causes intense pain, redness and excessive weeping of tears from the eye and can lead to permanent sight problems. The surface of the eye looks very red, due to bleeding from tiny blood capillaries in the sclera.
Foreign bodies which are not attached to the eye, or do not cause penetration to the eyeball, can simply be removed with the edge of a clean piece of cloth. The infection causes inflammation of the conjunctiva, the thin transparent membrane covering the eyeball and the inner surface of the eyelids. Over 80 million people suffer from trachoma worldwide, and in Ethiopia there are estimated to be more than 238,000 people who are blind because of it (Figure 5.9).
Trachoma scarring can be reduced or prevented by simple eye surgery to turn the eyelashes outwards so they don’t scratch the eye.
They often put small objects such as beans, peas, rice, beads, fruit seeds or small stones into their ears. Shine a torch into the child’s ear and if the foreign object is visible, try to remove it by using a thin blunt instrument (Figure 5.12) – the end must not be sharp! Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting.
The sclera, cornea, pupil, iris and the lens serve the purpose of light transmission onto the retina at the back of the eye.
He very frequently holds his hands above his eyes to shade them from the sun, and he finds it difficult to see who is approaching him when he meets people in the village.
Explain to him that if his cataracts progress to the stage where his sight has almost gone, he can get surgical treatment to remove the cloudy lenses and restore his sight – at least to some extent. This type of injury is most likely to happen during jobs such as welding or stone work, or during fights or play with sharp objects such as sticks or stones. The parents also report that the child is not hearing well when they speak to her in a normal voice. At three years old she is too young to be able to tell you if she has put something into her ear.

But this does not always mean that people with eye or ear problems are totally disabled and cannot contribute anything to help themselves or the community at large.
As you read the following descriptions, see if you can identify the structures in Figure 5.1, which intentionally has no labels. When you blink, the eyelids also help spread tears over the surface of the eye, keeping it moist and comfortable. The brain interprets these signals and turns them into information about what the eye is seeing. The diagnosis that cataract is the cause of the visual problems will be confirmed by examination with a special instrument called a slit-lamp microscope (or simply ‘eye microscope’) to look into the eye. For late-stage cataract with blindness, the best intervention is surgical treatment to remove the cloudy lens (Figure 5.6). Cataract surgery may be available that includes replacing the cloudy lens with an artificial one, which restores good sight. At times cataract operation campaigns may come to your village and you should take part in actively mobilising affected people in the community to come for treatment. As a Health Extension Practitioner, you recognised several years ago that Mr K’s sight problems were due to his cataracts, but he would not take your strong advice to go to the health centre for assessment and possible treatment. This can be painful at the time it happens, and cause the eye to ‘water’ as a way of flushing the dirt out of the eye. The objects causing the injury can be fragments of wood, metal or stones, and such accidents often happen at work (Figure 5.7). The eye may swell and vision may be affected, but usually the swelling will go down and the blood will be absorbed into the body over several days or weeks. Getting the chemicals, dirt or other foreign body out of the eye quickly protects it from further damage. The upper eyelid is particularly affected and over time it becomes so swollen and scarred that the eyelashes turn inwards and scratch across the surface of the cornea every time the person blinks.
If these foreign bodies remain in the ear for a long time, they make it more likely that the child will develop an ear infection.
If the ear drum is broken or scarred by infection, the child could suffer some permanent hearing loss in that ear. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module. These types of activities are more likely to involve children and young adults than older people.
Difficulties in seeing or hearing can seriously interfere with normal daily life, but you can help by organising some form of rehabilitation for affected people and their families.
Each eye gathers light and transforms it into signals to your brain, which interprets what you see as a picture or image. Damage to any of the structures of the eye due to physical injury or infection, or their gradual wearing out due to age, reduces the quality of vision.
The susceptibility to develop cataracts can also be transmitted in the genes from parent to child.
When you went to his house for a visit after his grandson was born, you again encouraged him to travel for cataract surgery.
If the foreign body is difficult to remove because it is attached to the eye, or if there is penetration or injury to the eyeball (Figure 5.8), cover the eye with clean cloth and transfer the person to the health centre or hospital. The cornea is damaged by the scratching eyelashes and it gradually becomes opaque (unable to transmit light). The bacteria are transmitted mainly by flies landing on the face and carrying the infected discharge from the eyes to another person, or the bacteria are transferred on dirty hands or cloths used to wipe the sore eyes. If you don’t see a foreign object when you look into the ear with a torch, transfer the child to the nearest health facility for specialist help.
The whitish-yellowish discharge from her ear tells you that it is infected and she needs medical treatment with antibiotics. Both the eye and the camera have lenses to focus the incoming light so that the image formed will be clear and understandable.
Regular washing of faces and hands, disposing of rubbish and other waste to keep flies away from houses, and penning animals away from homes at night, are all ways to reduce the risk of trachoma. You should suspect the possibility of something foreign in a child’s ear if the child complains of pain in the affected ear, a bad smell or discharge comes from the ear (Figure 5.11), or the parents or school teacher tell you that the child doesn’t seem to hear them talking if they speak into that ear. If there is any discharge from the ear, the child will need medical treatment with antibiotics. Similar to an eggshell surrounding an egg and giving its shape, the sclera surrounds the eye and gives the eye its shape.
The central opening in the ring-shaped muscular tissue of the iris is called the pupil, and the amount of light that enters the eye, can be altered by the iris changing its shape. The sclera is also attached to small muscles around the eye, which, in turn, move the eye left and right, up and down, and diagonally. The outcome was successful and when he came back to the village he prepared a big feast to celebrate his ability to see his new grandson. When you look at yourself in the mirror the white part of your eye that you see is the front part of the sclera. This will be sent to a laboratory for testing to find out whether your ear infection is caused by a bacterial or fungal infection.
These are usually prescribed as ear drops but your GP may prescribe tablets if you have widespread infection or you’re at risk of having a severe infection. You may need to have your ear cleaned and any discharge or wax removed by your doctor or nurse before using ear drops to treat an infection. You may be asked to lie down or tilt you head to the side with your affected ear facing upwards when you use ear drops. Sometimes, it’s advised to keep still for ten minutes after using ear drops or a spray.
Trying to remove ear wax yourself can also cause an ear infection, as you may damage the skin of your ear canal.
Ear syringing itself carries a risk of ear infection and isn’t recommended as a treatment if your ear canal has been previously inflamed or damaged.

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