4. 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
Technique
1. elevate the eyebrows with your index & thumb
2. ask client close the eyes
5. Inspect the conjunctiva:
1. Bulbar conjunctiva (over sclera) for color,
2. Palpebral conjunctiva, lining eyelids.
texture & presence of lesion
Technique
Technique
• 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
6. Inspect and palpate Lachrimal glands and nasolacrimal
duct for edema and pain.
7. Inspect the Cornea for clarity & texture
Technique
• 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
8. Inspect Pupils for color, shape & symmetry of
size by Using the pupil chart ----the pupils are
normally black, equal in size, round, and smooth.
Assess the pupils for their reaction to light and
accommodation and for convergence
Technique of pupil reaction
1. Darken the room
2. Approaching light from the side of the other pupil
3. Note reaction and speed in both eyes
4. Observe whether the pupil constricts for direct
(same side) and consensual (opposite side)
response.
9. Technique
of accommodation, and Convergence
Hold your finger about 6” to
8” from the bridge of the
patient’s nose.
Move your finger toward
the patient’s nose to assess
convergence
11. Test visual acuity
Distance 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.
12. 3. Test colour vision
Ask the patient to identify the
numbers of the shapes
13. 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.
14. Extraocular Movements
Up Side Down
Down Side Up
Smooth, conjugate (parallel) movement of eyes in all directions, Extraocular muscle intact.
Nystagmus or horizontal jerking eye movements noted only in extreme lateral gaze.
15. III- Assessing the Internal Eye
Equipment used is ophthalmoscope
Detachable head
(contains magnifying lens)
Red-free filte Small white aperture
Wheel
Body (contains light source)
Grid Large white aperture
16. 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
17. • 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).
19. Otoscope with the largest speculum to fit comfortably
into the patient’s ear
Watch with a second-hand
Tuning fork
Sitting position
20. I- Inspect and palpate the auricles
• color
• symmetry of size
• Angle of
attachment
Palpating the ear • Drainage: Pulling helix forward
cerumen
texture
elasticity
tenderness
Palpating the tragus
Palpating the mastoid
21.
22. Otoscope examination
1.
Otoscope insertion with handle up Otoscope insertion with handle down
2. 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).
23. 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 of
5. 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
24. Alert
Always inspect the external canal for foreign objects
before inserting the otoscope. Otherwise, you may
inadvertently 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 the
temporal bone and are very sensitive.
25. Tunning fork test
1. WhisperTick Test
2. Watch Test
TTeecchhnni 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
26. Hearing and Equilibrium Tests
• Perform Weber’s test
• Perform the Rinne test
• Perform the Romberg test
27. 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 tuning
longer 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.
