eye assessment

1. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health Assessment
Assessment of eye
Presented by:
Maria Ch
Trainee teacher

2. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Eye
• Only a small portion of the eye is seen.
• Sclera
– Cornea
• Choroid
– Iris
– Pupil
 Dim light enlarges (mydriasis)
 Bright light decreases (miosis)

3. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Eye
• Retina
– Sensory portion
– Optic disc
 Center is the point at which the vascular
network enters the eye
– Macula
 Responsible for central vision

4. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.2 Interior of the eye.

5. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Visual Pathways
• Light waves must bend to focus
correctly on the retina.
– Refractory structures bend light waves
onto retina.
• Optic fibers of the optic nerve cross
over at the chiasm and join temporal
fibers from the opposite eye.
– Impulse transmitted to occipital lobe of
brain for interpretation

6. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.3 Visual fields of the eye and the visual pathway to the brain.

7. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Accessory Structures of the Eye
• Eyebrows
– Protect the eye
• Eyelids
-Movable folds of skin that cover and
protect the eyes
– Palpebral fissure is opening between
upper and lower eyelids.

8. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Accessory Structures of the Eye
• Eyelids
– Meibomian glands
 glands that lubricate eyes and eyelids
• Eyelashes
– Project from eyelids and curl outward
• Conjunctivae
– Prevents foreign objects from entering
eye

9. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Accessory Structures of the Eye
• Lacrimal apparatus
– Secretes tears that spread over
conjunctivae when blinking
• Extrinsic muscles
– Lateral rectus
– Medial rectus
– Superior rectus
– Inferior rectus
– Inferior oblique
– Superior oblique

10. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.4 Lacrimal glands of the eye.

11. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Special Considerations
• Age
• Developmental level
• Race
• Ethnicity
• Occupation
• Socioeconomics
• Emotional well-being

12. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Lifespan Considerations
• Infants and children
– Visual acuity not as sharp as adults
 Children typically have 20/20 vision by
age 7.
– At birth, the iris has little color but
changes to permanent color by 3
months of age.
continued on next slide

13. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Lifespan Considerations
• The pregnant female
– Dryness of the eyes
– Vision changes
 Due to shifting fluid in cornea
 Blurriness
 Distorted vision
 Up to 6 weeks postpartum

14. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Lifespan Considerations
• The older adult
– Cataracts
– Macular degeneration

15. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Psychosocial Considerations
• Impact of decreased visual
acuity/visual impairment on
independence and quality of life
– Children may experience developmental
delays.
– Stress for families and individuals
• Eye contact within culture, age, gender

16. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Cultural and Environmental
Considerations
• Changes that occur normally in various
races and ethnic groups
• Excessive sun exposure
• Medications
• Hygiene practices
• Trauma or damage

17. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Focused Interview
• Function and structures of the eye
• Consider in relation to expectations
based on age, gender, race, culture,
environment, health practices, past and
current problems, and therapies
• Consider patient's ability to participate

18. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Focused Interview
• Focused interview questions
– General
– Illness or infection
– Symptoms, pain, and behaviors
continued on next slide

19. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Assessment of the Eye
• Techniques
– Inspection
– Palpation
– Ophthalmoscope

20. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.7 Testing distant vision.

21. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.8 E chart for testing distant vision.

22. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.9 Testing near vision.

23. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Assessment of the Eye
• Visual acuity of distant and near vision
using Jaeger or Rosenbaum charts
• Visual fields by confrontation
• Six cardinal fields of gaze
• Corneal light reflex
• Cover/uncover test
• Pupils and pupillary response

24. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Assessment of the Eye
• Accommodation of pupil response
• Corneal reflex
• External eye
• Sclera

25. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.12 Alternative method of testing cardinal field of gaze.

26. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.13 Testing the corneal light reflex.

27. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.14 Cover/Uncover test.

28. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.15 Inspecting the cornea.

29. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Assessment of the Eye
• Ophthalmoscope
– Fundus
– Advanced skill

30. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.16 Approaching the patient for the ophthalmoscopic exam.

31. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.17 Examining the eye using the ophthalmoscope.

32. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.18 Use of diopter to adjust for problems of refraction. A. In the emmetropic (normal) eye, light is
focused properly on the retina, and the 0 diopter is used. B. In the myopic eye, light from a distant source
converges to a focal point before reaching the retina. Negative diopter numbers are used. C. In the hyperopic
eye, light from a near source converges to a focal point past the retina. Positive diopter numbers are used.

33. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Abnormal Findings
• Vision
• Eye movement
• Internal and external structures

34. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Table 15.3 Abnormalities of the Eyelids
continued on next slide

35. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Table 15.5 Abnormalities of the Fundus
continued on next slide

36. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Figure 15.44 Cranial nerve III damage.

37. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Abnormal Findings
• Disorders of visual acuity
– Myopia
– Hyperopia
– Astigmatism
 Familial condition
 Refraction of light spread over a wide
area rather than a distinct point on the
retina
– Presbyopia

38. Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
All Rights Reserved
Abnormal Findings
• Visual fields
– Damage to the retina
– Lesions in the optic nerve or chiasm
– Increased intraocular pressure
– Retinal vascular damage
• Cardinal fields of gaze
– Strabismus
– Esophoria
– Exophoria