Weber
Health Assessment in Nursing
Chapter 15: Eyes
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External Structure of the Eye
• Eyelids
• Lateral and medial canthus
• Eyelashes, conjunctiva
• Lacrimal apparatus
• Extraocular muscles
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Structure of Eye
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Internal Structure of the Eye
• Sclera, cornea, iris, ciliary body,
• Pupil, lens, choroid, retina, optic disc
• Physiological cup, retinal vessels
• Anterior chamber, posterior chamber
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Question
Tell whether the following statement is
True or False.
The lens flattens to focus on close
objects and bulges to focus on far
objects.
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Answer
False.
The lens bulges to focus on close objects
and flattens to focus on far objects. This
is possible due to the refractive ability of
the lens.
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Vision
• Visual fields
• Visual pathways
• Visual reflexes
– Pupillary light reflex
– Accommodation
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Collecting Subjective Data
• History of present health concern
• Past health history
• Family history
• Lifestyle and health practices
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Cataract
• Opacity or clouding of the eye’s lens
• Leading cause of blindness worldwide
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Risk Factors
• Increasing age
• Exposure to ultraviolet B light
• Diabetes mellitus
• Cigarette smoking
• Alcohol use
• Diet low in antioxidant vitamins
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Risk Factors (cont.)
• High blood pressure
• Eye injuries/surgery
• Steroid use
• Female gender
• Persistent diarrhea
• Gout
• Abdominal obesity
• Beta blocker use
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Risk Reduction
• Wear sunglasses
• Quit smoking
• Limit alcohol intake
• Avoid eye injuries
• Regular eye examination
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Question
Tell whether the following statement is
True or False.
Exposure to ultraviolet radiation
increases the risk for development of
cataracts.
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Answer
True.
Exposure to ultraviolet radiation
increases the risk for development of
cataracts.
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Collecting Objective Data
• Preparing the client
• Equipment
– Snellen or E chart
– Hand-held Snellen card or near
vision screener
– Penlight
– Opaque cards
– Ophthalmoscope
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Distant Visual Acuity
• Snellen chart
• Normal acuity is 20/20 with or without
corrective lenses
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Near Visual Acuity
• Handheld vision chart
• Normal acuity is 14/14 with or without
corrective lenses
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Question
Tell whether the following statement is
True or False.
When testing near visual acuity the
client should be asked to remove his or
her glasses.
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Answer
False.
When testing near visual acuity the
client should keep his or her glasses on.
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Confrontation Test
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Testing Extraocular Muscle Function
• Corneal light reflex test: use penlight
to observe parallel alignment of light
refection on corneas
• Cover test: use opaque card to cover
an eye to observe for eye movement
• Positions test: observe for eye
movement
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Testing Extraocular Muscle Function
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Extraocular Muscle Dysfunction
• Corneal light reflex test abnormalities
– Pseudostrabismus, strabismus
• Test abnormalities
– Phobia
• Positions test abnormalities
– Paralytic strabismus, 6th, 4th, 3rd
nerve paralysis
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External Eye Structures
• Inspect the eyelids and eyelashes
• Observe the position and alignment of
the eyeball in the eye socket
• Inspect the bulbar conjunctiva and
sclera
• Inspect the palpebral conjunctiva
• Inspect the lacrimal apparatus
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External Eye Structures (Cont’d)
• Palpate the lacrimal apparatus
• Inspect the cornea and lens
• Inspect the iris and pupil
• Test pupillary reaction to light
• Test accommodation of pupils
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Abnormalities of External Eye
• Ptosis, exophthalmos
• Entropion, chalazion
• Blepharitis, ectropion
• Conjunctivitis
• Hordeolum, diffuse episcleritis
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Pupillary Reaction to Light
• Darkened room
• Have client focus on a distant object
• Shine light obliquely into the pupil and
observe the pupil’s reaction to light
• Normally, pupils constrict
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Accommodation
• Shifting gaze from far to near
• Normally, pupils constrict
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Ophthalmoscope
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Internal Eye Structures
• Inspect the optic disc
• Inspect the retinal vessels
• Inspect retinal background
• Inspect fovea and macula
• Inspect anterior chamber
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Visual Field Defects
• Unilateral blindness
• Bitemporal hemianopia
• Lesion in optic nerve
• Lesion of optic chiasm
• Left superior quadrant anopia
• Right visual field loss
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Abnormalities of Cornea and Lens
• Corneal abnormalities
– Corneal scar, pterygium
• Lens abnormalities
– Nucleus cataract, peripheral cataract
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Abnormalities of Iris and Pupil
• Irregularly shaped iris
• Miosis
• Anisocoria
• Mydriasis
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Abnormalities of Retinal Vessels and
Background
• Constricted arteriole
• Copper wire arteriole
• Silver wire arteriole
• Arteriovenous nicking
• Arteriovenous tapering
• Arteriovenous banking
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Abnormalities of Retinal Vessels and
Background (Cont’d)
• Cotton wool patches
• Hard exudate
• Superficial retinal hemorrhages
• Deep retinal hemorrhages
• Microaneurysms
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Abnormalities of Optic Disc
• Papilledema
• Glacoma
• Optic atrophy
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Question
Tell whether the following statement is
True or False.
In 3rd nerve paralysis, the eyes cannot
look down when turned inward.
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Answer
False.
In 3rd nerve paralysis, the eye looks
straight ahead. If the eyes cannot look
down when turned inward it indicates 4th
nerve paralysis.
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