Inspection Inspect the eye for symmetry and parallel alignment inspect the eyebrow for hair distribution even/equal, alignment symmetry and movement equal inspect the eyelashes for distribution and position of Curl outward Inspect the Eyelids for color, equal coverage of the eyeball and any edema, or lesion Technique1. elevate the eyebrows with your index & thumb2. ask client close the eyes
Inspect the conjunctiva:1. Bulbar conjunctiva (over sclera) for color,2. Palpebral conjunctiva, lining eyelids. texture & presence of lesion TechniqueTechnique• Retract lower lids, Evert both eyelid with thumb & index. Ask pt. look up,• Gently retract the lower lidsupper & lower bony orbits Exert pressure over with index• Evert the upper lids ifdown& from side to side. Ask pt. look up, problem is suspected Inspecting the bulbar conjunctiva Rolling eyelid up Inspecting palpebral conjunctiva
Inspect and palpate Lachrimal glands and nasolacrimalduct for edema and pain.
Inspect the Cornea for clarity & textureTechnique• Ask client to look straight.• hold penlight at an oblique angle to the eye• move the light slowly across the corneal surface Perform the corneal sensitivity (reflex) test (5th cranial nerve) 1. Ask client to keep both eyes open 2. Look straight ahead 3. Approach from behind and beside the client. 4. Lightly touch the cornea with a corner of the gauze note blinking and tearing 5. Blink reflex: Brush your index finger across patient’s eyelashes and note blinking
Inspect Pupils for color, shape & symmetry ofsize by Using the pupil chart ----the pupils arenormally black, equal in size, round, and smooth.Assess the pupils for their reaction to light andaccommodation and for convergenceTechnique of pupil reaction1. Darken the room2. Approaching light from the side of the other pupil3. Note reaction and speed in both eyes4. Observe whether the pupil constricts for direct (same side) and consensual (opposite side) response.
Technique of accommodation, and ConvergenceHold your finger about 6” to8” from the bridge of thepatient’s nose.Move your finger towardthe patient’s nose to assessconvergence
Test visual acuityDistance vision Near vision■ Have patient stand 20 ft • Have patient hold newsprint from chart. about 14 inches away and■ Test each eye separately, read. having patient cover • Adult reads newsprint easily opposite eye being tested, at a distance of 14 inches then together with and • (recorded as 14/14 OS, OD, without corrective lenses. and OU).■ Note smallest line of print patient is able to read with no more than two mistakes.
3. Test colour visionAsk the patient to identify thenumbers of the shapes
Visual Fields• Stand in front of patient, face to face about 2 ft apart.• Ask patient to fix gaze straight ahead and cover one eye.• Bring a pen or wiggle your finger in from the periphery from four different fields (superior, inferior, temporal, and nasal).• Have patient say “now” once fingers or object are seen.• Measure degree of peripheral vision using patient’s fixed gaze as a base.• Alternate method: Compare your patient’s peripheral vision with yours.• Peripheral vision intact in both eyes and all fields.• Diminished visual fields: Chronic glaucoma or stroke.
Extraocular Movements Up Side Down Down Side UpSmooth, conjugate (parallel) movement of eyes in all directions, Extraocular muscle intact.Nystagmus or horizontal jerking eye movements noted only in extreme lateral gaze.
III- Assessing the Internal Eye Equipment used is ophthalmoscopeDetachable head(contains magnifying lens) Red-free filte Small white aperture WheelBody (contains light source) Grid Large white aperture
TECHNIQUE• Darken the room• Allow time for the patient’s pupils to dilate.• Sit facing the patient and ask him/her to look straight ahead during the examination.• Keep both eyes open while looking through the ophthalmoscope viewer.• Use your right hand and eye to examine the patient’s right eye, and your left hand and eye for the patient’s left eye.• Shine the light on the pupil and observe the round red or orange glow ( the red reflex)• Rotate the lens wheel until internal eye structures are sharp and clear.• Follow blood vessels toward the midline to locate the optic disc; and central area (physiologic) cup
• Follow blood vessels outward to each of the four quadrants, Superior assessing color, size and Fovea pattern. centralis Optic• Ask the patient to look up, disc down, and from side to side, assessing the characteristics of the retina. Nasal Temporal• Locate the macula by first Physiologic locating the optics disc and cup then looking for a small Macula circular structure near the disc; note color, characteristics, and area of Vein Artery reflected light (fovea Inferior centralis).
Otoscope with the largest speculum to fit comfortablyinto the patient’s earWatch with a second-hand Tuning forkSitting position
I- Inspect and palpate the auricles • color • symmetry of size • Angle of attachment Palpating the ear • Drainage: Pulling helix forward cerumen texture elasticity tendernessPalpating the tragus Palpating the mastoid
Otoscope examination 1. Otoscope insertion with handle up Otoscope insertion with handle down2. For better visualization straighten the ear canal by gently pulling the pinna up and back.3. Support your insertion hand on the patient’s head for stabilization (children).
If you cannot visualize the TM, do not move the otoscope.4. Instead, apply more traction, pull on the ear, or carefully adjust the angle of the otoscope more toward the patient’s nose. Do not release the traction on the ear until the speculum of5. the otoscope has been removed from the ear. Remove the peculum in the same angle as it was inserted, and then release the traction to the pinna. The ear canal should be smooth and pinkish.6. The tympanic membrane should be intact, translucent, shiny, and gray malleou umbo
Alert Always inspect the external canal for foreign objectsbefore inserting the otoscope. Otherwise, you mayinadvertently push an object farther up the canal. Insert the otoscope only in the outer third of the canal.The inner two-thirds of the ear canal are over thetemporal bone and are very sensitive.
Tunning fork test1. WhisperTick Test 2. Watch TestTTeecchhnni iqquueess ■ Have patient cover opposite ear being tested.■ Have patient cover opposite ear being tested. ■ Hold ticking watch within 12 cm from ear.■ Stand about 1–2 ft behind patient, and whisper. ■ Note patient’s ability to hear sound.■ Note patient’s ability to hear sound.■ Patient repeats hears words whispered in each Normal=Patient most tick of a watch in each ear at a distance of 1–2 ft. ear
Hearing and Equilibrium Tests• Perform Weber’s test• Perform the Rinne test• Perform the Romberg test
4. Rinne Test 3. Weber Test T e Romberg’ssTest (Tests Inner Ear Vestibular 5. c h n i q u e Techniques■Function) Place vibrating tuning fork on the mastoid process. ■E C H N I Q Ufork by patient can no longer hear Hold tuning E until stem.■TCount the time S■■Immediatelyfork prongs on palm of fork eyes opened, ■ Tap tuning bring vibrating tuning yourin front of ear. Have patient stand with feet together, hand.■■Continue to note the lengthin the middle patientpatient’s and then eyes closed. fork of time until of the no Place vibrating tuninglonger hears sound. caseof patient’s head. forehead or on the top patient loses balance. ■ Stand close by in■■The length of time hears the vibrations by AC is normally ■ Note patient’s ability to hear sound; note lateralization Note patient’s ability to maintain balance. ofPatient stands with ■ sound.twice as long as for BC.feet together and eyes closed.■Normal= VibrationsBC is minimalin bothNegative Romberg. The ratio of AC to should be felt or heard equally in both Maintains balance with similar sway. ears. ears.of balance: Inner ear disorder Loss ■ Negative lateralization.