Health Assessment

1. Eye assessment
Prepared by :Ahmed Gamal

2. Testing visual acuity
 Distant vision
Position the client exactly 20 feet ( 6.1 meter )
from the snellen chart
If client uses corrective lenses or eye glasses
for distance vision ,test first with eye glasses
,then without glasses
Normal vision 20/20 in each eye
Frowning ,leaning forward and squinting
indicate visual or reading difficulty
Inability to see objects at a distance is myopia

3. Snellen chart

4. The biggest letter on an eye
chart often represents an
acuity of 20/200 (6/60), the
value that is considered
"legally blind."

5. Near vision
 Client is sitting with a rosenbaum chart held
a distance of 12 -14 inch ( 30-35 cm )
 Normal result 14/14 in each eye
 Inability to see objects at close range is
called hyperopia (Farsighted)
 Presbyopia ,the inability to a accommodate
for near vision ,is common in persons over 45
years of age

6. Testing visual fields by confrontation
 Client should be sitting 2 to 3 feet ( 0.6 to
0.9 m ) from you at eye level
 Testing peripheral vision

8. Testing the six cardinal field of gaze
 Stand about 2 ft ( 0.6 m ) in front of the
client
 Testing eye movements and the muscles of
eye
 Use letter ( H ) method or wagon wheel
method to assess the clients ability to follow
your movements with eyes
 Nystagmus ,rapid fluttering of the eye ball
due to weakness in the extra ocular muscles
or cranial nerve 3

11. Corneal light reflex
 shine light into the eyes from a distance of
12 inches ( 30.5 cm )
The reflection of light should appear in the
same spot on both pupils ,this appears as a
(twinkle ) in the eye
If reflection of light is not symmetrical ,there
could be a weakness in the extra ocular
muscle

12. Cover test
 This test determine the balance mechanism (
fusion reflex ) that keeps the eye parallel
 If there is weakness in one of the eye
muscles ,the fusion reflex is blocked .

13. Inspection of pupil
 Shine light through pupil into retina
 Cranial nerve III stimulated
 Observe for pupillary constriction
 Observe for accomodation
 Pupils: black, round, regular, equal in size(3-7
mm )
 PERRLA = Pupils equal, round, reactive to
light, accommodation

14. Pupils
 Cloudy pupil: cataracts
 Dilated pupil: glaucoma, trauma, neurologic
disorder
 Constricted pupil: drug use
 Pinpoint pupil: opioid intoxication

15. Test for accomodation of pupil response
 Lack of convergence ( turning inward of the
eye ) and failure of pupils to constrict
indicates dysfunction of cranial nerves 3,4,6

16. Testing for corneal reflex
 Test for nerve stimulation of cornea
 Use a sterile cotton ball and twist it into a
very thin strand and gently touch the cornea
on the outer aspect of each eye
 The client will react by blinking the eyes and
may tearing occur
 Fail to response ( cranial nerve 5 is sensory
for this reflex and cranial nerve 7 is motor )

17. Inspection of external eye
 Eyebrows should be symmetrical in shape
 Eyelashes free of drainage
 Eye lids symmetrical
 Conjunctiva should be moist ,clear with small blood
vessels
 Ptosis –eyelid dropping caused by dysfunction of
cranial nerve 3 dysfunction
 Eyes that protrude –hyperthyroidism
 Edema of eyelids can be caused by allergies ,heart
disease or kidney disease
 Inability to move eyelids indicate dysfunction of
nervous system

18. Palpation of the eye
 Palpate the lacrimal sac, the eyelids and the
eyeballs
 Swelling may be a symptom of infection
,cardiovascular problem or renal problem
 Less than firm eyeballs can be an indication
of dehydration

19. Examination of the conjunctiva
 Inspecting the conjunctiva of the lower
eyelid and from upper eyelid
 The conjunctiva should be clear showing pink
of the underlying tissue with no tenderness
 Inflammation and edema of the conjunctiva
indicate an infection or possible foreign body

20. Inspection 0f the fundus with the 0pthalmoscope
 Fundus :inner deep parts of eye
 See the red reflex ( reflection of light off the
retina )
 Absence of red reflex may indicate a
cataract ( opacity of lens )
 Look for optic disc ,blood vessels ,retina and
macula ( area of central vision )

22.  Optic disc normally looks alike around or oval
yellow –orange
 Observe of abnormalities of the retinal structures
as dark or opaque spots on the retina ,an
irregularly shaped optic disc ,and lesions or
hemorrhages on the fundus

23. Abnormal finding
Myopia hyperopia

24. Astigmatism
 is an optical defect in which vision is blurred
due to the inability of the optics of the eye
to focus a point object into a sharp focused
image on the retina

25. Chalazion
 Firm ,non tender nodule on the eyelid

26. Cataract

27. Glaucoma
 Result of increase in intraocular pressure
resulting from blocked flow of fluid from the
anterior chamber

28. Conjunctivitis
 Infection due to bacteria ,virus and chemical
exposure

29. Stye ( hordeolum )
 Staphylococcal infection of hair follicles on
the margin of the lids

30. Iritis
 Redness around the iris and cornea
Absent pigmentation ( pink color ),little ( blue ),more
pigmentation green ,light brown ,dark brown

31. Ectropion
 Is aversion of the lower eye lid caused by
muscle weakness ,the conjunctiva is exposed

32. Entropion
 Inversion of the lid and lashes caused by
muscle spasm of the eye lid

33. Retinal detachment
and diabetic retinopathy

34. Strabismus
 is a condition in which the eyes are not
properly aligned with each other