Assessment Of The Eyes

Assessment of the Eyes Techniques 1. Inspection External structures a. Eyebrows

Normal Findings even hair distribution, even alignment, equal movement as facial expression changes

Deviation from Normal absence of the lateral third of the eyebrows (e.g., myxedema) uneven alignment unequal or absent movement as facial expression changes

b. Eyelashes c. Eyelids

scaliness eyelashes present and eyelashes absent or evenly distributed along unevenly distributed the eyelid margins along the eyelid margins skin intact, similar in color lid lag - a rim of sclera to the face, smooth and visible above the corneas uniform and irides no sclera visible above the corneas and irides when the eyelids are open ability to completely close ptosis - drooping of the upper eyelid the eyelids upper eyelid margins at or near the limbus (the border between the cornea and sclera) when the eyelids are open blinking symmetrical, present, at 15 - 20 blinks per minute

epicanthus - vertical fold of skin that lies over the inner canthus

ectropion - margin of the lower eyelid is turned outward

entropion - margin of the lower eyelid is turned inward

periorbital edema swelling and puffiness around the eyelid

blepharitis inflammation of the eyelids

sty (acute hordeolum) redness, tenderness, and swelling around a hair follicle on the eyelid margin

chalazion - beady, nontender nodule on the skin around the eyelid (chronic inflammation of the meibomian gland)

xanthelasma - slightly raised, yellowish, wellcircumscribed plaques on the skin around the eyelid herniated fat - bulging of the lower eyelids, bulging of the inner third of the upper eyelids, or both

retracted eyelid retraction of the upper eyelid which results in a rim of sclera between the upper eyelid and corneas and irides and a wideeyed stare

d. Lacrimal gland and nasolacrimal gland

absence of a bulge in the outer third of the upper eyelids

blinking asymmetrical, absent, less than 15 or greater than 20 blinks per minute dacryoadenitis inflammation of the lacrimal gland characterized by pain, redness, and swelling in the outer third of the

upper eyelid

e. Lacrimal sac and nasolacrimal sac

puncta mucosa pink, nonedematous absence of discharge absence of tearing absence of swelling between the nose and lower eyelids

dacryocystitis inflammation of the lacrimal sac and nasolacrimal duct characterized by pain, redness, and swelling between the nose and lower eyelid

f. Conjunctiva and sclera

bulbar conjunctiva is transparent with tiny vessels visible

Jaundice - sclera yelloworange

sclera is blue-white, shiny, smooth, moist palpebral conjunctiva is pink, shiny, smooth, moist

conjunctivitis - diffuse, dilated, reddened bulbar conjunctival vessels that tend to be maximal in the periphery

subconjunctival hemorrhage - sharpy demarcated, bright red area that fades over days to yellow then disappears.

pterygium - triangular thickening of the bulbar conjunctiva, usually on the nasal side, that grows across the cornea

pinguecula - yellowishwhite, triangular nodule on the bulbar conjunctiva on either side of the iris

g. Cornea, lens and pupil

cornea transparent lens, visible through the pupil, transparent

arcus senilis - thin, grayish-white arc or circle in the cornea, not quite at the edge of the cornea

anterior chamber, visible through the cornea, transparent corneal scar - superficial grayish-white opacity in the cornea

nuclear cataract central grayish-white opacity in the lens peripheral cortical cataract - peripheral grayish-white opacity in the lens that produces spokelike shadows that point inward

hyphema - accumulation of blood in the aqueous fluid of the anterior chamber

hypopyon accumulation of purulent material in the aqueous fluid of the anterior

chamber

monocular blindness shining a penlight into a blind eye produces no pupillary response in the blind or good eye, whereas shining a penlight into the normal eye produces normal pupillary responses in both the blind and good eye mydriasis - dilated, fixed pupils (greater than 7 millimeters)

miosis - constricted, fixed pupils (less than 3 millimeters) anisocoria - slightly unequal pupil size

oculomotor nerve damage - unilateral, dilated pupil that reacts neither to light or accommodation accompanied by deviation of the affected eye downward and ptosis of the eyelid of the affected eye Argyll-Robertson pupil - small, irregular pupils that do not react to light, but react to accommodation

Tonic (Adie's) pupil unilateral, large pupil that has a sluggish or absent reaction to light, and a sluggish reaction to accommodation Horner's syndrome unilateral, small, regular pupil that reacts to light and accommodation accompanied by ptosis of the eyelid of the affected eye and lack of tearing

iritis -ciliary injection of the iris accompanied by moderate, aching, deep pain; decreased vision; absent ocular discharge, and a clear or cloudy cornea irides inconsistent color