Assessing-the-Eye-Structures-and-Visual-Acuity.pptx

Assessing the Eye
Structures and Visual Acuity
Lourence Copia Gonzales, RN
Clinical Instructor
RLE 101
HEALTH ASSESSMENT

Assessing the Eye Structures and Visual
Acuity
Introduction:
The maintenance of optimum vision is crucial throughout one's
life. Regular eye examinations are recommended to ensure
early detection of potential issues. This report summarizes key
aspects of eye examinations, common refractive errors, visual
acuity testing, and inflammatory visual problems that nurses
may encounter in clients.

Frequency of eye examination
Individuals under 40: Younger individuals generally
experience fewer age-related changes in their eyes. Therefore, a
longer interval between eye examinations (every 3 to 5 years) is
considered appropriate for routine check-ups.
Individuals over 40: As people age, the risk of developing age-
related eye conditions, such as presbyopia, cataracts, and macular
degeneration, increases. Regular eye exams every 2 years are recommended
to monitor and address these potential issues promptly.

Components of Eye Examination
1. Assessment of External Structures:
Examining external structures, such as the eyelids, conjunctiva, and cornea, allows for the
identification of abnormalities or conditions affecting the surface of the eye. It helps in
detecting issues like conjunctivitis, eyelid disorders, or corneal abnormalities, which may have
visible signs.
2. Visual Acuity Assessment:
Measuring visual acuity is fundamental for evaluating the clarity and sharpness of vision. This
assessment is crucial for detecting refractive errors (e.g., nearsightedness, farsightedness, or
astigmatism) and determining the need for corrective lenses.
3. Ocular Movement Examination:
Assessing ocular movement is essential for detecting problems with eye muscle function,
coordination, or nerve control. This examination helps identify conditions like strabismus
(misalignment of the eyes) or other disorders affecting eye movement.

Components of Eye Examination
4. Visual Fields Evaluation:
Examining visual fields involves assessing the entire scope of vision. This is crucial for
detecting peripheral vision loss, which may be indicative of conditions such as glaucoma or
neurological issues affecting the optic nerve.
5. Consideration of Developmental Changes:
Developmental changes in the eyes occur throughout one's life, especially during childhood
and adolescence. Monitoring these changes helps identify vision-related developmental issues
or abnormalities that may require intervention or specialized care.
6. Hygienic Practices for Contact Lens Wearers:
Contact lens wearers are at an increased risk of eye infections and complications if proper
hygiene is not maintained. Regular assessment and education regarding hygienic practices
aim to prevent infections, corneal ulcers, or discomfort associated with contact lens use.
7. Hygienic Practices for Artificial Eyes:
• Rationale: Individuals with artificial eyes need to follow strict hygienic practices to prevent
infections and maintain the health of the eye socket. Regular assessments ensure proper
fitting of the prosthesis and identify any signs of irritation or infection.

Refractive Errors and Corrections:
1. Myopia (Nearsightedness):
Myopia occurs when distant objects appear blurry. The correction is achieved by using concave
lenses in eyeglasses or contact lenses. These lenses diverge light before it reaches the eye, helping
to focus images properly on the retina.
2. Hyperopia (Farsightedness):
Hyperopia causes close-up objects to appear blurry. Convex lenses in eyeglasses or contact lenses
are used to converge light and bring the focus back onto the retina. This correction helps individuals
see clearly at both near and far distances.
3. Presbyopia:
Presbyopia is an age-related condition where the eye's lens loses flexibility, making it difficult to
focus on close-up objects. Bifocals are a common correction method. The upper portion corrects
distance vision, while the lower portion assists with near vision. Progressive lenses provide a
seamless transition between the two.
4. Astigmatism:
Astigmatism results from an irregular shape of the cornea or lens, causing distorted or blurred vision.
Correction involves using cylindrical lenses (astigmatic correction) in glasses or contact lenses. These
lenses compensate for the uneven curvature of the eye's surface.

Refractive Errors and Corrections:
5. Correction Methods - Eyeglasses or Contact Lenses:
Eyeglasses and contact lenses are non-invasive, easily adjustable, and offer effective
correction for various refractive errors. They are the most common and accessible methods for
improving vision and are suitable for a wide range of individuals.
6. Bifocals for Simultaneous Correction:
Bifocals provide a convenient solution for individuals with presbyopia who require correction
for both near and distance vision. The design of bifocals allows users to have a single pair of
glasses for seamless transitioning between different visual distances.
7. Astigmatism Correction - Glasses or Surgery:
Glasses with cylindrical lenses effectively correct astigmatism by compensating for
irregularities in the eye's curvature. Alternatively, surgical procedures such as LASIK or PRK
may be considered for individuals seeking a more permanent solution. These surgeries
reshape the cornea to correct refractive errors.

Inflammatory Visual Problems:
Conjunctivitis:
Conjunctivitis, or pink eye, is a common inflammation of the conjunctiva, often caused by
infections, allergies, or irritants. It is important to highlight conjunctivitis as it is highly prevalent and
can be easily transmitted. It's essential for individuals to recognize the symptoms and seek
appropriate treatment.
Dacryocystitis:
Involves inflammation of the tear sac, usually due to blockage of the nasolacrimal duct. This
condition is emphasized because it can lead to pain, swelling, and discharge, and it may require
intervention to address the underlying cause.
Hordeolum (Stye):
is a localized infection or inflammation of the eyelid glands. It is a common and often painful
condition that can result from a bacterial infection. Educating individuals about the causes and
symptoms of a stye helps in early recognition and appropriate management.
Iritis:
is an inflammation of the iris, and it can be associated with various systemic conditions or occur
independently. Given its potential impact on vision and the fact that it may be a sign of underlying
health issues, highlighting iritis is essential.

Inflammatory Visual Problems:
Dysfunction:
This term may refer to a broad range of issues affecting the normal functioning of the eyes. It
could encompass various conditions affecting eye movement, focusing, or coordination.
Recognizing dysfunction is crucial for appropriate diagnosis and management.
Neuromuscular Disease:
can impact the muscles controlling eye movement, leading to conditions such as strabismus or
diplopia. Highlighting this category draws attention to the diverse range of conditions that can
affect the neuromuscular control of the eyes.
Ectropion and Entropion:
refer to eyelid malposition Ectropion involves the outward turning of the eyelid, while entropion
involves the inward turning. These conditions are highlighted as they can lead to ocular surface
issues and may require surgical intervention for correction.
Association with Scarring Injuries or Aging:
Many of the mentioned eye issues are associated with scarring injuries or aging. Injuries may lead
to structural changes, while aging can affect the elasticity and function of ocular tissues. This
information emphasizes the importance of preventive measures, regular eye check-ups, and
prompt management of injuries to mitigate long-term consequences.

Acuity
PLANNING
Place the client in an appropriate room for assessing the
eyes and vision. The nurse must be able to control natural
and overhead lighting during some portions of the
examination.

Acuity
Equipment
• Millimeter ruler
• Penlight
• Snellen or E chart
• Opaque card

Acuity
DELEGATION
Due to the substantial knowledge and skill required, assessment of the
eyes and vision is not delegated to UAP. However, many aspects are
observed during usual care and may be recorded by individuals other
than the nurse. Abnormal findings must be validated and inter-preted
by the nurse.
INTERPROFESSIONAL PRACTICE
Assessing the eyes and vision may be within the scope of practice
of other health care providers. Although these providers may verbally
communicate their findings and plan to other health care team mem-
bers, the nurse must also know where to locate their documentationin
the client’s medical record.

Acuity
IMPLEMENTATION
Performance
1. Prior to performing the procedure, introduce self and verify the client’s identity using agency
protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can
participate. Discuss how the results will be used in planning further care or treatments.
2. Perform hand hygiene, apply gloves, and observe other appropriate infection prevention
procedures.
3. Provide for client privacy.
4. Inquire if the client has any history of the following: family history of diabetes, hypertension,
blood dyscrasia, or eye disease, injury, or surgery; client’s last visit to a provider who specifically
assessed the eyes (e.g. Ophthalmologist or optometrist);current use of eye medications; use of
contact lenses or eye-glasses; hygienic practices for corrective lenses; current symptoms of eye
problems (e.g., changes in visual acuity, blurring of vision, tearing, spots, photophobia, itching, or
pain).

Acuity
5. Inspect the eyebrows for hair distribution and alignment and skin quality and movement (ask client
to raise and lower the eyebrows).
Normal Findings
Hair evenly distributed; skin intact Eyebrows symmetrically aligned; equal movement
Deviations from Normal
Loss of hair; scaling and flakiness of skin Unequal alignment and movement of eyebrows
6. Inspect the eyelashes for evenness of distribution and direction of curl.
Normal Findings
Equally distributed; curled slightly outward
Turned inward known as "esotropia.” = the eyes do not point in the same direction

Acuity
7. Inspect the eyelids for surface characteristics (e.g., skin quality and texture), positionin relation to
the cornea, ability to blink, and frequency of blinking. Inspect the lower eyelids while the client’s
eyes are closed.
Normal Findings
Skin intact; no discharge; no discoloration
Lids close symmetrically
Redness, swelling, flaking, crusting, plaques, discharge, nodules, lesions Lids close
asymmetrically, incompletely, or painfully
8. Inspect the bulbar conjunctiva (that lying over the sclera) for color, texture, and thepresence of
lesions.
Normal Findings
Transparent; capillaries sometimes evident; sclera appears white (darker or yellowish and
with small brown macules in dark skinned clients)
Jaundiced sclera (e.g., in liver disease); excessively pale sclera (e.g., in anemia); reddened
sclera (marijuana use, rheumatoid disease); lesions or nodules (may indicate damage by
mechanical, chemical, allergenic, or bacterial agents)

Acuity

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