Uploaded by Bob Burkowitz

Eyes Assess NF 111drapp1 (1)

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Eyes
Structure/Function


External

Eyelids

Palpebral fissure: opening between eyelids

Canthus: corner of eye

Limbus: border between the sclera and cornea

Caruncle: small fleshy mass containing sebaceous glands

Lacrimal apparatus: irrigation

Extraocular muscles (CN III, IV, VI)
Internal

Sclera

Cornea

Pupil

Lens
Slide
14-2
External anatomy of eye
Slide
14-3
Direction of Movement
Slide
© Pat Thomas, 14-4
2006.
Subjective Data: What will
you ask?










Vision difficulty
Pain
Strabismus (Crossed eye), diplopia (double vision)
Redness, swelling
Watering, discharge
Allergies
History of ocular problems—injury or surgery?
Glaucoma
Use of glasses or contact lenses
Self-care behaviors—last vision test? Smoker?
Slide
14-5
Objective Data: Assessment

Preparation


Position person standing for vision screening; then sitting
up with head at your eye level
Equipment needed

Snellen eye chart

Handheld visual screener

Opaque card or occluder

Penlight
Slide
14-6
Objective Data: Assessment

Central visual acuity

Snellen alphabet chart is most commonly used and
accurate measure of visual acuity

Abnormalities


Presbyopia: decrease in power of accommodation with aging
Visual Fields

Confrontation Test: peripheral vision; compares person’s
peripheral vision with yours

Abnormalities:

Peripheral vision loss/screening for glaucoma
Slide
14-7
Objective Data: Assessment

Inspect extraocular muscle function

Corneal light reflex, the Hirschberg test


Abnormalities

Esotropia: inward turning of eye

Exotropia: outward turning of eye
Cover test

Abnormalities:


Phoria: mild weakness Tropia: more severe
Diagnostic Positions Test (6 Cardinal Positions of Gaze)

Abnormalities:

CN III, IV, VI

Nystagmus: a fine oscillating movement best seen around iris
Slide
14-8
Diagnostic positions test
Slide
14-9
Objective Data (cont.)

Inspect external ocular structures


General: begin with external points, work inward

Already you will have noted person’s ability to move around
room, with vision functioning well enough to avoid obstacles
and to respond to your directions

Also note facial expression; relaxed expression accompanies
adequate vision
Eyebrows

Look for symmetry between the two eyes

Normally eyebrows are present bilaterally, move
symmetrically as expression changes, and have no scaling or
lesions
Slide
14-10
Objective Data: Assessment

Inspection External Structures

Eyelids/lashes

Periorbital edema: puffy, swollen


HF, renal failure, allergies
Ptsosis: droopy eyelid

Neuromuscular weakness

Upward palpebral slant—in Asians, non-Asians have horizontal
palpebral fissures

Exophthalmos: Protruding eyes

Eyeballs

Conjunctiva and Sclera

Scleral icterus: even yellowing of the sclera

jaundice
Objective Data: Assessment


Pupillary light reflex: normal constriction of pupils when
bright light shines on retina

When one eye exposed to bright light, a direct light reflex
(constriction of that pupil) and a consensual light reflex
(simultaneous constriction of other pupil) occur

CN III
Accommodation: adaptation of eye for near vision

When looking at a distant object: pupils will dilate

When asked to look at object about 3 inches from nose:
pupils will constrict
Objective Data: Assessment

Inspect ocular fundus

Ophthalmoscope: Red reflex

Systematically inspect structures in ocular fundus

Optic disc: nasal side of retina; explore these
characteristics:

Color: creamy yellow-orange to pink Shape: round
or oval

Retinal vessels

General background


Color normally varies from light red to dark brownred
Macula
Slide
14-13
Objective Data:
Developmental Considerations

Infants and children

Eye examination often deferred at birth because of
transient edema of lids from birth trauma or from the
instillation of silver nitrate at birth; eyes should be
examined within a few days and at every well child visit
thereafter

Child’s age determines screening measures used

In newborn, test visual reflexes and attending behaviors

Test light perception using blink reflex; neonate blinks in response
to bright light

Also, pupillary light reflex shows that pupils constrict in response to
light
Slide
14-14
Objective Data:
Developmental Considerations

Infants and children (cont.)

Visual acuity (cont.)

As you introduce an object to infant’s line of vision, note
these attending behaviors:

Birth to 2 weeks: refusal to reopen eyes after exposure to bright
light; increasing alertness to object; infant may fixate on an
object

By 2 to 4 weeks: infant can fixate on an object

By 1 month: infant can fixate and follow light or bright toy

By 3 to 4 months: infant can fixate, follow, and reach for toy

By 6 to 10 months: infant can fixate and follow toy in all
directions
Slide
14-15
Abnormal Findings:
Vascular Disorders of External Eye

Conjunctivitis

Subconjunctival hemorrhage

Iritis (circumcorneal redness)

Acute glaucoma: Intraocular pressure occurs from a
blocked outflow from the anterior chamber; cornea
looks “steamy” pupil is dilated and oval
Slide
14-16
Abnormal Findings:
Retinal Vessels and Background

Arteriovenous crossing, nicking

Narrowed, attenuated, arteries

Diabetic retinopathy


Microaneurysms

Intraretinal hemorrhages
Exudates:

Soft exudates or Cotton wool: fluffy gray-white spots
associated with HTN, DM, and Lupus
Slide
14-17
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