Eye and Ear Assessment and Procedures
Clinical Procedures Chapter 6
KEY TERM ASSESSMENT
A. Definitions
1. L
9. F
2. J
10. H
3. E
11. B
4. I
12. D
5. C
13. K
6. M
7. G
8. A
B. Word Parts
Directions: Indicate the meaning of each word part in the space provided. List as many
medical terms as possible that incorporate the word part in the space provided.
Word Part
Meaning of Word Part
1. a-
without
2. stigma/a
point
3. -ism
state of
4. audi/o
hearing
5. -meter
instrument used to
measure
6. hyper-
above, excessive
7. -opia
vision
Medical Terms That Incorporate Word
Part
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
8. ot/o
ear
9. -scope
to view, to examine
10. tympan/o
eardrum
11. -ic
pertaining to
EVALUATION OF LEARNING
1. What is the name of the tough white outer layer of the eye?
Sclera.
2. What is the function of the lens?
To focus the light rays on the retina.
3. What is the function of the retina?
Light rays are focused on the retina and transmitted to the brain to be interpreted.
4. What parts of the eye are covered with conjunctiva?
The eyelids and the front of the eye, except for the cornea.
5. What is visual acuity?
Acuteness or sharpness of vision.
6. What type of symptoms might be experienced with myopia?
Squinting and headaches as a result of eye strain.
7. What methods can be used to correct myopia?
Corrective lenses such as eyeglasses and contact lenses; laser eye surgery.
8. What causes an individual with astigmatism to have distorted and blurred vision?
Light rays focusing on two different points on the retina.
9. What are each of the following eye professionals qualified to perform?
a. Ophthalmologist An ophthalmologist is a physician who specializes in diagnosing
and treating diseases and disorders of the eye. An ophthalmologist is qualified to
prescribe ophthalmic and systemic medications and to perform eye surgery.
b. Optometrist An optometrist is a licensed primary health care provider who has
expertise in measuring visual acuity and prescribing corrective lenses. An
optometrist can also diagnose and treat disorders and diseases of the eye and
prescribe ophthalmic medication.
c. Optician An optician is a professional who interprets and fills prescriptions for
eyeglasses and contact lenses.
10. What condition can be detected by measuring distance visual acuity?
Myopia.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
11. What type of patient would warrant use of the Snellen Big E eye chart? (Give two
examples.)
Preschool children, non–English-speaking people, and nonreaders.
12. Explain the significance of the top number and bottom number next to each line of
letters on the Snellen eye chart.
The number above the line represents the distance (in feet) at which the test is
conducted. The number below the line represents the distance from which a person
with normal visual acuity can read the row of letters.
13. List two conditions that can be detected by measuring near visual acuity.
Hyperopia and presbyopia.
14. Explain the difference between congenital and acquired color vision defects.
A congenital color vision defect is inherited and present at birth; an acquired color
vision defect is obtained after birth, resulting from eye or brain injury, disease, or
certain drugs.
15. What is a polychromatic plate?
A polychromatic plate consists of primary colored dots arranged to form a numeral
against a background of similar dots of contrasting colors.
16. List three reasons for performing eye irrigation.
To cleanse the eye, to relieve inflammation, and to apply an antiseptic solution.
17. List three reasons for performing eye instillation.
To treat eye infections, to soothe an irritated eye, to dilate the pupil, and to
anesthetize the eye.
18. What is the function of the ear auricle?
To receive and collect sound waves and to direct them toward the external
auditory canal.
19. What is the function of cerumen?
To lubricate and protect the ear canal.
20. Explain why the external auditory canal must be straightened when viewing it with
an otoscope.
The canal has an S-shaped curve as it leads inward.
21. What is the normal appearance of the tympanic membrane?
Pearly gray semitransparent membrane.
22. What is the purpose of the eustachian tube?
It connects the middle ear to the nasopharynx.
23. What is the function of the semicircular canals?
To maintain equilibrium.
24. What is the range of frequencies for normal speech?
300 to 4000 Hz.
25. List five conditions that may cause conductive hearing loss.
Obstruction in the external ear canal (impacted cerumen, swelling, foreign body,
benign growths such as polyps); fluid (serous otitis media) or infection (acute otitis
media) in the middle ear; a perforated tympanic membrane; and otosclerosis.
26. List four conditions that may result in sensorineural hearing loss.
Hereditary factors, degenerative changes from normal aging process (presbycusis),
intense noise exposure over time, tumors, ototoxicity caused by certain medications,
and infectious diseases (measles, mumps, meningitis).
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
27. How is hearing acuity tested with the gross screening test?
By asking the patient to repeat a simple word or series of numbers whispered from a
distance of 1 to 2 feet from the ear.
28. What are the names of the hearing acuity tests that require the use of a tuning fork?
Weber test and Rinne test.
29. What information is obtained through audiometry?
It provides information on the extent of hearing loss and which frequencies are
involved.
30. What information is obtained through tympanometry?
It helps determine the cause of hearing loss, in particular, fluid in the middle ear
(serous otitis media).
31. List three reasons for performing ear irrigation.
To cleanse the auditory canal to remove cerumen, discharge, or a foreign body; to
relieve inflammation by applying an antiseptic solution, and to apply heat to the
ear.
32. List three reasons for performing ear instillation.
To soften impacted cerumen, to combat infection with antibiotic ear drops, and to
relieve pain.
33. Explain how impacted cerumen is removed from the ear.
First, soften the cerumen by instilling warm mineral oil or hydrogen peroxide; next,
perform an ear irrigation.
34. Explain how to straighten the external auditory canal in an adult and in children 3
years old or younger.
In adults, pull the ear upward and backward. In children, pull the ear downward
and backward.
CRITICAL THINKING ACTIVITIES
A. Measuring Distance Visual Acuity
For each of the following situations, write C if the technique is correct and I if the
technique is incorrect.
1. The patient is not given an opportunity to study the Snellen chart before beginning
the test. C.
2. The Snellen chart is positioned at the medical assistant’s eye level. I.
3. The patient is instructed to use his hand to cover the eye that is not being tested. I.
4. The medical assistant instructs the patient to close the eye that is not being tested. I.
5. The first line that the medical assistant asks the patient to identify is the 20/20 line. I.
6. The medical assistant observes the patient for signs of squinting or leaning forward
during the test. C.
B. Interpreting Visual Acuity Results
1. A patient has a distance visual activity reading of 20/30 in the right eye. Using this
information, answer the following questions:
a. How far was the patient from the eye chart? 20 feet.
b. At what distance would a person with normal acuity be able to read this line? 30
feet.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
2. A patient has a distance visual activity reading of 20/10 in the left eye. Using this
information, answer the following questions:
a. How far was the patient from the eye chart? 20 feet.
b. At what distance would a person with normal acuity be able to read this line? 10
feet.
C. Charting Visual Acuity Results
Properly chart the distance visual acuity results in the spaces provided. In all cases, the
line indicated is the smallest line the patient could read at a distance of 20 feet.
1. The patient read the line marked 20/30 with the right eye with two errors and with the
left eye, he read the line marked 20/30 with one error. The patient was wearing
corrective lenses.
Date, Time; Snellen test, cc: OD 20/30 -2. OS 20/30 -1
2. The patient read the line marked 20/20 with the right eye with one error and with the
left eye, he read the line marked 20/20 with no errors. The patient was wearing
corrective lenses.
Date, Time; Snellen test, cc: OD 20/20 -1. OS 20/20
3. The patient read the line marked 20/40 with the right eye with two errors and with the
left eye, she read the line marked 20/30 with one error. The patient exhibited
squinting and frowning during the test. The patient was not wearing corrective lenses
Date, Time; Snellen test, sc: OD 20/40 -2. OS 20/30 -1. Exhibited squinting and frowning
4. The patient read the line marked 20/15 with the right eye with no errors and with the
left eye, she read the line marked 20/20 with one error. The patient was not wearing
corrective lenses.
Date, Time; Snellen test, sc: OD 20/15. OS 20/20 -1
D. Ear Procedures
Explain the principle for each of the following procedures.
Ear Irrigation
1. Positioning the patient’s head so that it is tilted toward the affected ear To allow
gravity to aid in the flow of solution out of the ear and into the basin
2. Cleansing the outer ear before irrigating To prevent foreign particles from entering
the ear canal during the irrigation
3. Straightening the external auditory canal Permits the irrigating solution to reach all
areas of the canal
4. Injecting the irrigating solution toward the roof of the ear canal To prevent injury to
the tympanic membrane and to aid in the removal of foreign particles
5. Making sure not to obstruct the canal opening Obstruction of the canal opening
may result in patient discomfort and injury to the tympanic membrane.
Ear Instillation
6. Positioning the patient’s head so that it is tilted toward the unaffected ear Gravity
aids in the flow of medication into the ear canal.
7. Instructing the patient to lie on the unaffected side after the instillation Lying on the
unaffected side prevents the medication from running out and allows complete
distribution of the medication.
8. Placing a cotton wick in the patient’s ear Prevents the medication from running out
when the patient stands or sits up.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
E. Dear Gabby
G. Eye and Ear Conditions
1. You and your classmates work at a large clinic. It is National Eye and Ear Week. The
physicians at your clinic ask you to develop informative, creative, and colorful
brochures about eye and ear conditions. Choose a condition and design a
brochure using the blank Frequently Asked Questions (FAQ) brochure provided on
the following page. Each student in the class should select a different topic. On a
separate sheet of paper, write three true/false questions related to the information
in your brochure.
2. Present your brochure to the class. After all the brochures have been presented,
each student should ask his or her three questions to the entire class to see how well
the class understands eye and ear conditions. (Note: You can take notes during the
presentations and refer to them when answering the questions.)
Eye
1. Amblyopia (lazy eye)
2. Age-related macular degeneration
3. Astigmatism
4. Blepharitis
5. Cataracts
6. CMV retinitis
7. Corneal ulcer
8. Corneal abrasion
9. Strabismus (cross-eyed)
10. Diabetic retinopathy
11. Drooping eyelids (ptosis)
12. Dry eyes
13. Floaters and spots
14. Glaucoma
15. Keratoconus
16. Ocular hypertension
17. Presbycusis
18. Retinal detachment
19. Retinitis pigmentosa
20. Stye
Ear
1. Acute mastoiditis
2. External otitis
3. Meniere’s disease
4. Noise-induced hearing loss
5. Serous otitis media
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
APPLY YOUR KNOWLEDGE
Choose the best answer to each of the following questions.
1. A.
2. D
3. B
4. D
5. B
6. A
7. B
8. B
9. D
10. A
VIDEO EVALUATION FOR CHAPTER 6: EYE AND EAR ASSESSMENT AND PROCEDURES
Name:
Directions:
a. Watch the indicated videos.
b. Mark each true statement with a T and each false statement with an F. For each false
statement, change the wording of the question so that it becomes a true statement.
Video: Procedure 6-1: Assessing Distance Visual Acuity
____F___1.
The distance visual acuity test is performed to screen for the presence of
hyperopia.
____T___2.
Preschool children, non–English-speaking people, and nonreaders are
tested using a Snellen Big E chart.
____F___3.
The Snellen eye test is performed at a distance of 10 feet.
____T___4. The patient should be instructed to wear his glasses or contact lenses for a
distance visual acuity test unless they are for reading.
____F___5.
The occluder should be placed over the eye being tested.
____T___6. Squinting in the eye being tested can temporarily improve vision leading to
inaccurate test results.
____T___7.
During the test, you should check for squinting, head tilting and eye
watering.
____T___8. If the patient misses more than three letters on a line, the previous line is
recorded.
____T___9. Chart whether or not the patient is wearing corrective lenses during the test.
____F___10. The abbreviation for the right eye is OS.
Video: Procedure 6-2: Assessing Color Vision
____T___1. The Ishihara test is a convenient and accurate method to detect congenital
color blindness and red-green blindness.
____T___2. Patients with color vision defects see no number at all or a different number
on the plates.
____F___3.
Using natural lighting may change the shades of the colors on the plates,
and this could cause an inaccurate reading.
____T___4. The first plate is a practice plate that is designed to be read correctly by
everyone.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
____F___5.
Hold the first plate 60 inches away from the patient at a right angle to the
patient’s line of vision.
____F___6.
The patient should be given 15 seconds to identify each plate.
____T___7. Do not allow the patient to touch the plate with his fingers as any dirt or
grime on the fingers can alter the colors over time.
____F___8.
Chart an “X” if the patient reads a plate correctly.
____T___9. Chart “Traceable” if the patient could correctly trace a winding line.
____T___10. Store the book in a closed position to keep light from fading the colors on
the plates.
Video: Procedure 6-3: Performing an Eye Irrigation
____T___1. An eye irrigation involves washing the eye with a flowing solution.
____T___2. An eye irrigation may be performed to wash away foreign particles, ocular
discharges, or harmful chemicals.
____F___3.
If both eyes are to be irrigated, one set of equipment is used to prevent
cross-infection from one eye to the other.
____T___4. Normal saline, also known as sodium chloride, usually is used to irrigate the
eye.
____T___5. Check the solution label three times.
____T___6. If the solution is outdated, it may produce undesirable effects.
____F___7.
Warm the solution to room temperature.
____T___8. Palm the label of the container to prevent the solution from dripping on the
label and obscuring it or loosening the label.
____F___9.
Ask the patient to tilt her head to the side in the direction of the
unaffected eye.
____F___10. Before irrigating, cleanse the eyelids from the outer to the inner canthus.
____T___11. Instruct the patient to keep both eyes open during the procedure.
____T___12. Gently release the solution onto the eye at the inner canthus.
____F___13. Direct the solution toward the cornea of the eye.
____T___14. Do not allow the tip of the syringe to touch the eye as this can cause an
injury.
____T___15. Following the procedure, dry the eyelids with a gauze pad.
Video: Procedure 6-4: Performing an Eye Instillation
____T___1. An eye instillation involves the dropping of a liquid into the lower conjunctival
sac of the eye.
____T___2. An eye instillation may be performed to treat infection, soothe irritation,
dilate the pupil, or anesthetize the eye during examination or treatment.
____F___3.
Never place a medication in the eye unless it says otic or eye to avoid
injury to the eye.
____F___4.
If the patient wears contact lenses, they can be left in for the procedure.
____T___5. If the medication requires mixing, roll or shake the container well.
____F___6.
Ask the patient to look down to keep the dropper from touching the
cornea and to keep the patient from blinking when the drops are instilled.
____F___7. Invert the eye dropper container and hold the tip of the dropper
approximately 2 inches above the eye sac.
____T___8. Placing the drops directly on the eyeball can be uncomfortable for the
patient.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
____T___9. Ask the patient to close his eyes gently and move the eyeballs to distribute
the medication over the entire eye.
____F___10. The abbreviation for a drop is dp.
Video: Procedure 6-5: Performing an Ear Irrigation
____F___1.
Ear irrigation is washing of the inner ear with a flowing solution.
____T___2. Ear irrigations are performed to cleanse the external auditory canal to
remove cerumen, discharge, or a foreign body.
____F___3.
Impacted cerumen can be softened by instilling warm salt water into the
ear.
____T___4. Normal saline, also known as sodium chloride, typically is used to irrigate the
ear.
____T___5. Ear irrigation should never be performed if the tympanic membrane is
perforated.
____T___6. If the irrigating solution is too hot or too cold, it might stimulate the inner ear
and make the patient dizzy.
____F___7.
Remove the cap of the irrigating solution container and place it on a flat
surface with the open end facing downward to prevent contamination of
the cap.
____F___8.
Pour the solution into the basin at a height of approximately 12 inches to
reduce splashing.
____T___9. The patient should be asked to tilt her head toward the affected ear to
allow gravity to help the solution flow out of the ear and into the basin.
____T___10. Expel air from the syringe to avoid forcing air into the patient’s ear, which
can be uncomfortable for the patient.
____F___11. To straighten the ear canal of an adult or a child over age 3, gently pull
the ear downward and backward.
____T___12. Make sure the tip of the syringe does not obstruct the canal to prevent
patient discomfort and possible injury to the tympanic membrane.
____F___13. Inject the irrigating solution directly onto the tympanic membrane.
____T___14. The patient may experience a minimal amount of dizziness, fullness, and
warmth as the ear solution comes in contact with the tympanic
membrane.
____T___15. After the procedure, ask the patient to lie with the affected side
downward to allow any remaining solution to drain out.
Video: Procedure 6-6: Performing an Ear Instillation
____F___1.
An ear instillation involves the dropping of a liquid into the middle ear.
____T___2. Ear instillations are performed to soften impacted cerumen, to combat
infection with the use of antibiotic ear drops, and to relieve pain.
____T___3. The medication label must bear the word otic or ear drops indicating it is for
the ear.
____F___4.
Position the patient in a prone position.
____F___5.
Warm the ear drops to body temperature by placing the medication
container in hot water.
____T___6. If the drops are too cold or too warm, they may stimulate the inner ear
causing the patient to become dizzy.
____T___7. If the medication requires mixing, shake the container well.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
____T___8. Tilt the patient’s head in the direction of the unaffected ear to allow gravity
to help the medication flow into the ear canal.
____T___9. Straighten the external ear canal to permit the medication to reach all areas
of the canal.
____T___10. After the procedure, instruct the patient to keep her head tilted toward
the unaffected side for 2 to 3 minutes to prevent the medication from
running out of the ear.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.