NurseReview.Org - Eyes

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    NurseReview.Org - Eyes - Presentation Transcript

    1. Eyes
    2. External Anatomy
      • Sensory Organ for vision
      • -Situated in bony, orbital cavity for protection
        • Eyelids= shades that add protection form injury, strong light , dust
        • Eyelashes= hairs to filter dust & dirt
    3. External Anatomy External Anatomy
      • Limbus – border b/t the cornea & sclera
      • Palpebral fissures – elliptical open space b/t lids
      • Canthus- corners of the eye where the lids meet, inner & outer
      • Caruncle – sm. Fleshy mass containing sebaceous glands at inner canthus
      • Within the upper eyelid
        • Tarsal plates, connective tissue gives upper lid shape
        • Meibomian glands, in the plates, lubricate the lids, stops overflow of tears, airtight seal when lids closed
      • Exposed part of the eye
        • Conjunctiva, folded envelope b/t eyelids & eyeball
          • thin mucous membrane, transparent protective covering of the exposed part of the eye.
          • Palpebral conjunctiva lines the lids, is clear but has sm .bld. Vessels
          • Bulbar conjunctiva is over eyeball, white sclera show through, merges at limbus with cornea
      • Cornea – clear, covers & protects iris & pupil
    4.  
      • Lacrimal apparatus – irrigates conjunctiva & cornea
        • 3 parts
          • Lacrimal gland, upper, outer corner of eye = tears
          • Puncta= inner canthus, tear drainage
          • Nasolacrimal duct= allows tears to drain from puncta to nasolacrimal sac. Tears then empty into the inferior meatus of the nose
    5.  
    6. Extraoccular muscles
      • 6 muscles
        • Attach eyeball to orbit
        • Straight and rotary movement
        • Four straight muscles
          • Superior rectus
          • Inferior rectus
          • Lateral rectus
          • Medial rectus
      • Two slanting/ oblique muscles
        • Superior
        • Inferior
      • Humans have a Binocular, single – image visual system – Eyes normally move as a pair
      • Eye movement stimulated by Cranial Nerves
        • III Oculomotor
        • IV Trochlear
        • VI Abducens
    7.  
    8.  
    9. Internal Anatomy
      • The eye has 3 layers, the outer & inner layer can be viewed using opthalmascope
          • Sclera (outer layer) tough, protective, white covering connects with the -
            • Cornea – transparent, protects pupil & iris – helps focus light on retina
          • Middle layer
            • Choroid – dark pigmentation to prevent internal light reflection, supplies bld. to retina
            • Pupil – PERRLA
            • Lens – biconvex disc, transparent, thickness controlled by ciliary body, bulges = near; flattens = distant
            • Anterior chamber – posterior to cornea, anterior to iris & lens, has aqueous humor supplies nutrients & drains wastes
      • Inner layer – Retina – visual receptive layer – light waves changed to nerve impulses
        • Retinal structures
          • Optic disc – retinal fibers meet & form optic nerve, nasal side of retina, creamy yellow orange to pink, round or oval shape, physiologic cup inside the disc for bld.vessels to enter & exit
          • Retina vessels – paired arteries & veins
          • Macula – temporal side of fundus, darker pigmented region, surround the fovea centralis
          • Fovea Centralis- area of sharpest & keenest vision, Very sensitive to light
    10.  
    11. Visual Pathways & Fields
      • Objects reflect light
      • Rays refracted by cornea, aqueous humor, lens, vitreous body and onto retina.
      • Light stimulus is changed to nerve impulses, travel thru optic nerve to visual cortex in occipital lobe
      • Image on retina is upside down & reversed. At the optic chiasm retinal fibers cross over. Right side of brain looks at left side of world.
    12.  
    13. Visual reflexes
      • Pupillary light reflex – bright light = constriction
        • Direct light reflex
        • Consensual light reflex
      • Fixation – ability to track an object & keep image on the fovea, can be impaired by drugs, alcohol, fatigue & inattention
      • Accomodation – for near vision = pupil constriction & convergence of eyes
    14.  
    15.  
    16. Subjective data
      • Vision difficulty
      • Pain
      • Strabismus, diplopia
      • Redness, swelling
      • Watering, discharge
      • Past history ocular problems
      • Glaucoma
      • Glasses/ contacts
      • Medications
      • Vision loss- coping mechanisms
      • Self–care behaviors
    17. Objective data The Physical Exam
      • Preparation
        • Position- sitting, head at eye level
      • Equipment
        • Snellen eye chart- visual acuity
        • Handheld visual screener-near vision
        • Opaque card
        • Penlight
        • Applicator stick
        • Ophthalmoscope
    18. Test visual acuity Snellen eye chart
      • Stand 20 ft. from chart
      • Glasses / contacts (Document )
      • Remove eye wear, retest
      • Normal visual acuity is 20/20 – top # is distance person is standing from the chart
      • Vision 20/30 refer to opthalmologist or optometrist
      • If unable to see largest letters, move to 10 feet – record as 10/200
    19. Test for near vision
      • Vision screener
      • People > 40yrs or difficulty reading
      • Test each eye with glasses
      • Hold card 14in. from eyes
      • Normal result 14 / 14
      • Test using any available reading material if no card available
      • Presbyopia is a normal physiological change in near vision occurs with aging = note if the person moves the card farther away
    20. Test visual fields Confrontation test
      • Compares peripheral vision with a tester who has normal peripheral vision
      • 2 ft. apart, eye level
      • Tester & client cover opposite eyes
      • Tester advances finger in the periphery
        • Superiorly ( 50 degrees )
        • Inferiorly ( 70 degrees )
        • Temporally ( 90 degrees )
    21.  
    22. Inspect Extraoccular Muscle Function
      • Corneal light reflex
      • Cover test
      • Diagnostic positions test
        • 6 Cardinal Positions of Gaze
    23. Inspect Extraocular Muscle Function
      • Corneal Light Reflex ( The Hirschberg Test) assesses parallel eye alignment
        • Shine light toward person’s eyes
        • Tell to stare directly ahead
        • Hold light 12 in. away
        • Light should reflect on both corneas in same spot
      • Cover Test- detects deviated alignment
        • Stare straight at examiner’s nose
        • Cover 1 eye of the person being examined with opaque card
        • Normally the uncovered eye should maintain a steady, fixed gaze
        • Covered eye- should stare straight ahead when covered & then uncovered. If muscle weakness exists the covered eye will relax and then jump to fixed position when uncovered..
    24. Diagnostic Positions Test
      • 6 cardinal positions of gaze –
        • Determines muscle weakness during movement
        • Person must hold head steady
        • Follow movement of object (examiner’s finger, pen etc) only with eyes
        • Hold object 12 in. from person
        • Move thru each position, clockwise, hold , then back to center
        • Normal response= parallel tracking with both eyes
    25.  
      • During this test be aware of Nystagmus- fine jerky movement seen around the iris
      • Mild nystagmus in extreme lateral gaze is normal but not normal in any other position
    26. Inspect External Structures
      • General – movement & facial expression (squinting?)
      • Eyebrows – 2(bilateral), symmetrical (look the same; move the same)
      • Eyelids & Lashes – present, approximate when closed, no redness, swelling, discharge, lesions?
      • Eyeballs- alignment, ? Protrusion? Sunken?
      • Conjunctiva & Sclera – moist, glossy, clear, white sclera
      • Eversion of the upper eyelid FYI – we will not do this examine in lab see pg. 312 for technique – usually done for complaint of eye pain due to foreign body
    27.  
    28.  
      • Lacrimal Apparatus
        • Person looks down
        • Using thumbs, slide outer part of upper lid along bony orbit
        • Note redness or swelling
        • Press index finger against lacrimal sac at inner canthus
        • Normal response is slight eversion of lower lid, no tearing or discharge
    29.  
    30. Anterior Eyeball Structures
      • Cornea & lens
      • Iris & pupil
        • Size & shape
        • Pupillary light reflex
        • Accommodation
    31. Cornea & Lens
      • Shine light from side across cornea
      • Check smoothness, clarity
      • Normally no opacities
    32. Iris and Pupil
      • Iris = flat, round, regular, even color bilaterally.
      • Pupils = PERRLA
        • Resting size norm = 3-5mm
        • 5% population have pupils of 2 diff. Sizes called Anisocoria
      • Pupillary Light Reflex
        • Darken room
        • Person gazes straight ahead
        • Advance light from the side
          • Direct light reflex
          • Consensual light reflex
        • Measure pupil size before & after light reflex
        • Measurement R3/1 L3/1 =both pupils measure 3mm in resting state & 1mm with light
      • Accomodation
        • focus on distant object -dilatation of pupils
        • Shift gaze to near object – pupils constrict & converge
      • Record the normal response to these tests as
      • PERRLA = Pupils Equal, Round, React to Light and Accomodation
    33. Ocular Fundus (internal surface of retina)
      • Use Opthalmoscope- try keeping both eyes open- practice looking at a ring on your finger. Become familiar with the instrument before you examine your partner’s eyes
      • Diopter of opthalmoscope
        • Black numbers = +diopter, focus on near objects
        • Red numbers = - diopter, focus on further objects
      • Use ophthalmoscope in darkened room = dilates pupils
      • Remove examiner’s and person’s eyeglasses but contact lenses may be left in.
      • Select lg. White aperture light
      • Person should focus on a distant object and try & remain still
      • Examiner hold ophthalmoscope in Right hand to right eye to eamine person’s right eye
      • Begin 10in away at 15 0 lateral angle & advance
      • Keep sight of red reflex
      • Adjust lens to +6 as you advance till your foreheads almost touch. Adjust diopter to focus.
        • Normal vision set at 0. Nearsighted use red #s. Farsighted use black.
    34.  
    35. Retinal background
      • Light – dark red normally
      • Note Lesions
        • Size, shape, color, distribution
    36. Macula & Fovea Centralis
      • Last in Funduscopic exam
        • 1 DD in size
        • Darker than rest of fundus
        • Foveal light reflex
        • Exam last
    37.  
    38. Retinal Vessels Inconspicuous absent Bright LIGHT REFLEX Larger Smaller 2/3 to 4/5 diam. Of veins SIZE Dark red Light red COLOR Veins Arteries
    39. Read Aging & Developmental Considerations Review Abnormalities of the Eyes
    40. 3 most common causes of decreased visual functioning in the older adult
      • Cataract (lens opacity)
      • Glaucoma (increased ocular pressure) = loss of peripheral vision
      • Macular degeneration (breakdown of cells in the macula lutea) = loss of central vision

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