Health assessment on examination of the eyes

1. HEALTH ASSESSMENT
EXAMINATION OF THE EYES
PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY, ASELLA, ETHIOPIA,
EAST AFRICA.

2. THE EYES
In examining the eyes,
Will inspect and palpate the external eye structures,
Assess vision,
And examine the internal eye structures.

3. -For convenience, you may wish to perform some cranial
nerve testing along with the eye exam
(e.g.,
corneal reflex,
pupillary reaction,
accommodation,
and extraocular movements).

4. EXTERNAL STRUCTURES OF THE EYE
Normal eyelid margins are moist and pink
with short lashes that are evenly spaced and
curl outward.

5. LOWER EYELID MARGIN
The lower eyelid margin appears at the bottom edge
of the iris,
 The upper eyelid covers half the upper iris.

6. CONJUNCTIVA
The conjunctiva is smooth,
with minimal blood vessels present.
There should be
No pallor,
Dryness, or edema.

7. ABNORMAL FINDINGS ON THE
EYELIDS:
Crusting,
scales, or swelling of the lid is associated with
infection of the eyelids or eyelashes.

8. -A pterygium is a growth or thickening of conjunctiva from the
inner canthus toward the iris.

9. ECTROPION
-Ectropion, an everted eyelid, is commonly seen in older adults
secondary to loss of skin tone.
It can lead to excessive dryness of the eyes.

10. ENTROPION
■ Entropion,
an inverted eyelid, can lead to corneal damage.

11. PTOSIS, OR DROOPING OF THE LID,
Ptosis, or drooping of the lid, may be seen in
clients
Who have experienced --
A stroke (cerebrovascular accidentm [CVA]) or
Bell’s palsy (paralysis of the facial nerve).

12. PTOSIS, OR DROOPING OF THE LID,

13. SCLERA AND CONJUNCTIVA
Sclera and Conjunctiva Associated disorders may include
Infection,
Allergies,
Injuries,
And liver disorders.

14. For example,
yellow (icteric) sclera may be seen with an elevated
bilirubin.

15. SUB CONJUNCTIVAL HEMORRHAGE
Blood visible in the sclera is known as a
sub conjunctival hemorrhage.
and may be related to
Trauma or
Hypertension.

16. LENS AND CORNEA
-The lens and the cornea, or outermost layer of the
eyeball, are
Transparent,
Smooth,
And moist.

17. Roughness or irregularity of the cornea is seen with
Trauma or
Corneal abrasion.

18. LENS OPACITIES
Lens opacities, known as cataracts,
are frequently seen in older adults and may
impair vision.

19. PUPILS
The pupils should be
Uniform in color,
Equal in size,
And round.

20. They should accommodate equally;
The pupils constrict and the eyes converge (cross)
As a person attempts to focus on an object
moving toward him.

21. PERRLA
This is charted as PERRLA:
Pupils equal,
Round,
Reactive to light and accommodation.

23. PUPILLARY ABNORMALITIES
Sluggish accommodation may be caused by
anticholinergic drugs or
advanced age.

24. -Failure of one or both pupils to accommodate may reflect a
cranial nerve III problem or exophthalmos .
(associated with hyperthyroidism).

25. Congenital cataracts, although rare, may be seen in
infants and are checked during an eye exam using the “red
reflex.”
Congenital cataracts cause “lazy eye” or amblyopi and can
lead to other eye problems such as nystagmus, strabismus
and inability to fix a gaze upon objects.

26. CATARACTS
-Cloudy pupils,
a finding related to cataracts,
are commonly seen in older adults.

27. MYDRIASIS
Mydriasis (enlarged pupils) may be seen with
glaucoma,
 An increase in intraocular pressure.

28. MYDRIATICS
-Many medications affect pupil size.
(e.g., mydriatics are used to dilate the pupil to
allow better visualization of the internal eye
during examination.

29. MIOSIS
Miosis (constricted pupils)
often results from medications to treat
glaucoma.

30. ANISOCORIA
Anisocoria (unequal pupils) may be seen with central
nervous system disorders such as
stroke,
headtrauma,
or cranial nerve injuries.
In some individuals, anisocoria may be normal.

31. VISUAL ACUITY
-Visual acuity is a measure of the eye’s ability to detect the
details of an image.
When testing visual acuity, will assess
Distant,
Near,
Peripheral, and
Color vision.

33. -Other testing is performed by nurses in advanced or
specialty practice or by an optometrist or
ophthalmologist as needed.

34. DISTANCE VISION
Use the Snellen chart from a distance of 20 feet to
assess distance vision.
Assess each eye separately, and then assess both eyes
together.

35. Normal vision is a measure of clear vision
At 20 feet (20/20) in the
Right eye, left eye, and both eyes.

36. -If a patient hesitates when reporting the letters or
symbols he sees on the Snellen chart, document
“with hesitation.”

37. -If the person misses one or two items in
a line, record the number of items
missed.

38. MYOPIA,
OR DIMINISHED DISTANT VISION
-Myopia, or diminished distant vision,
is associated with a smaller fraction.

39. -For example,
20/100 vision means that to see text a person with
normal vision can read at 100 feet, the client has to
stand just 20 feet from the Snellen chart.

40. -A child’s distance vision does not reach 20/20
until around 6 or 7 years of age.

41. NEAR VISION
-Test near vision by having the client read newsprint
from a distance of 35.5 cm (14 in.).

42. -A client with normal near vision will be able to
read the newsprint without hesitation with either
eye and both eyes.

43. HYPEROPIA,
OR DIMINISHED NEAR VISION,
-Hyperopia, or diminished near vision, the client must
hold the paper more than 35.5 cm (14 in.) away.

44. -As we age, the lens of the eye naturally loses some
ability to accommodate to near objects.

45. PRESBYOPIA.
-In clients older than 45 years of age,
diminished near vision is known as
presbyopia.

46. COLOR VISION
Color vision is the ability to detect color.
Color blindness may be genetically inherited
 It may result from macular degeneration
 Other diseases that affect the cones of the eye.

47. -Use the color bars at the base of the
Snellen chart to test color vision.

48. ISHIHARA CARDS
-Ishihara cards are specialized cards
that enable thorough testing for color
blindness.

49. They contain embedded figures within a field of
color.
A person with normal color vision will be able to
successfully identify the figures in the cards or the
bars on the base of the Snellen chart;
one who is color blind will not.

50. VISUAL FIELD
-Visual field is the area the eye is able to
observe.
-It is related to peripheral vision and extra
ocular muscle (EOM) function.

51. VISUAL FIELD ABNORMALITIES
-Visual field abnormalities may be caused by
problems with
-cranial nerves III, IV, and VI or with the retina.

52. Poorly controlled diabetes,
Cataracts,
Macular degeneration,
And advanced glaucoma are other disorders that
limit the visual field.

53. PERIPHERAL VISION
-Peripheral vision describes the
boundaries of the visual field while the
eye is in a fixed position.

54. -The common phrase, “I see you out of the corner
of my eye,” refers to peripheral vision.

55. The EOMs control the movement of the eye and eyelids
and allow you to track movement.
Three cranial nerves (CN) innervate the EOM.

56. They are CN III (oculomotor), CN IV (trochlear), and CN
VI (abducens).
CN III also works together with CN II (optic) to control
the pupillary reaction to light.

57. STRABISMUS
Strabismus (crossed eye) is a condition in which one or
both eyes deviate from the object they are looking at.
It is normal during the first 1 or 2 months of life.

58. -After that,
it may be caused by weak intraocular muscles or a lesion on
the oculomotor nerve.

59. -Constant strabismus of one eye may result in amblyopia
(“lazy eye”),
in which the brain does not fully acknowledge the images seen
by the amblyopic eye.

60. -This creates reduced vision in that eye, not
correctable by glasses or contact lenses.

61. INTERNAL STRUCTURES OF THE EYE
-Use an ophthalmoscope to visualize the
internal structures of the eye.
(-the optic disc,
-physiological cup,
-retinal vessels,
-retinal background, and macula).

62. -This is an advanced assessment technique;
however,
advanced practice nurses and registered nurses on
specialty units do perform it with training.

63. -Advanced practice nurses use this technique to gain
information about certain diseases that affect the eye, such as
hypertension and diabetes.

64. THANKING YOU