Eyes[1]

Physical Assessment

Objectives  At

the end of the discussion the participants will be able to: – identify the structures of the eyes – describe normal findings in the physical assessment of the eyes – describe common abnormalities found in the physical assessment of the eyes – perform the physical assessment of the eyes

Assessing the Eye Structures and Visual Acuity

The Windows of the SOUL Looking Through the Eyes of Every Patient

Anatomy of the Eye Anatomical structures: Conjunctiva Sclera Pupil Iris Lacrimal gland Lens Cornea

Equipments  Opthalmoscope

 Penlight

 Clean

gloves

Equipments  Snellen

Chart, E Chart, Rosenbaum near vision pocket screening card  Vision occluder  Cotton tip applicator

Assessing the Eye Structures and Visual Acuity Examination of the eyes includes: 2. Assessment of external structures 3. Visual acuity 4. Visual fields Eye Ailments:     

Myopia, hyperopia, presbyopia, astigmatism Conjunctivitis, dacryocystitis,hordeolum, iritis Cataracts, glaucoma Ectropion, entropion Mydriasis, miosis

Assessing the Eye Structures and Visual Acuity 1.

Inquire if the client has any history of the following: 

  



Family history of diabetes, hypertension, blood dyscrasia, or eye disease, injury or surgery Client’s last visit to opthalmologist Current use of eye medications Use of contact lenses or eyeglasses, hygienic practices for corrective lenses Current symptoms of eye problems

Assessing the Eye Structures and Visual Acuity 2. Inspect the eyebrows

for hair distribution and alignment 3. Inspect the eyelashes for evenness of distribution and distribution of curl 4. Inspect the eyelids for surface characteristics, position in relation to the cornea, ability to blink

Assessing the Eye Structures and Visual Acuity 5. Inspect the color of the bulbar conjunctiva for color, texture, and presence of lesions 6. Inspect the palpebral conjuctiva by everting the lids 7. Evert the upper lids if a problem is suspected 8. Inspect and palpate the lacrimal gland 9. Inspect and palpate the lacrimal sac and nasolacrimal duct

Assessing the Eye Structures and Visual Acuity 10. Inspect the cornea for clarity and texture 11. Perform the corneal sensitivity test 12. Inspect the anterior chamber for transparency and depth 13. Inspect the pupils, shape and symmetry of size

Assessing the Eye Structures and Visual Acuity 14. Assess each pupil’s direct and consensual reaction to light

Move penlight from the side of the client’s face to eye Shine penlight into the eye and observe response of the opposite pupil

15. Assess each pupil’s reaction to accomodation

Extraocular Muscle Tests 16. Assess six ocular movements to determine eye alignment and coordination

Stand directly in front of the client and hold the penlight at a comfortable distance, 30cm (1ft)

Ask the client to hold the head in a fixed position facing you

Extraocular Muscle Tests Move the penlight in a slow orderly manner through the six cardinal fields of gaze.

2. Lateral Rectus, CN VI

3. Inferior Rectus, CN III 1. Superior Rectus,CN III

Extraocular Muscle Tests

5. Medial Rectus, CN III 4. Superior Oblique, CN IV

6. Inferior Oblique, CN III

Stop the movement of penlight periodically so that nystagmus can be dtected

Extraocular Muscle Tests Hirschberg Test: Assess for location of light reflex by shining penlight on pupil in corneal reflex Cover test: • Have client fixate on a near or far object • Cover one eye and observe for movement in the uncovered eye

Visual Acuity  Assess

near vision : Ask the client to read from a magazine or newspaper held at a distance of 36 cm (14 in) •



a Rosenbaum eye chart may be used

Assess distance vision •

A Snellen or character chart will be used

Visual Acuity • • • •

Stand at 6m (20ft) from the chart Take 3 readings: right eye, left eye, both eyes Record the readings of each eye and both eyes If the client is unable to see even the top line of the chart, perform functional vision tests (light perception, hand movements, counting fingers)

Lifespan Considerations • • • •

• •

Visual acuity is about 20/300 at 4 months and progressively improves Preschool children’s acuity can be checked with picture cards or the E chart Acuity should approach 20/20 by 6 years of age Visual acuity of elders decreases, becomes more opaque and loses elasticity Peripheral vision of elders diminishes Arcus senilis is common

References Kozier & Erb’s, (2008) Fundamentals of Nursing, 4th Edition, Volume II  Ellis, (2003) Basic Nursing Skills, 2nd Edition, Volume II  Daniel’s, (2007) Fundamental’s of Nursing, Volume I  Health Assessment, (2008), 8th Edition, p 341-370  Delmar Learning – Audio Visual  www.imageask.com 