examination of eye, Examination by ophthalmoscope, assessment of the functions of eye, . PUPILLARY RESPONSE, FUNCTIONAL EXAMINATION, test for Focusing power, confrontation test, Colour sense test and visual acuity testing procedure etc

1. NURSING ASSESSMENT
Presented by
Neha bharti
M.Sc nursing (medical surgical nursing)
Tutor/clinical instructor
Smvdcon, kakryal

2. EXAMINATION OF EYE
An examination of the eye includes an external
examination:-
• Examination by ophthalmoscope, and
• An assessment of the functions of eye.
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3. A. EXTERNAL EXAMINATION
B. PUPILLARY RESPONSE
C. FUNCTIONAL EXAMINATION
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4. A. EXTERNAL EXAMINATION
• It consist of inspection of the eyelids,
surrounding tissue and palpebral fissure.
• Palpation of the orbital rim may also be
desirable, depending on the presenting signs
and symptoms
• The conjunctiva and sclera can be inspected
by having the individual look up, and shining a
light while retracting the upper or lower
eyelid.
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5. • The cornea and iris may be similarly
inspected.
• The anterior segment of the eye examined by
visual inspection.
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6. • Note the general appearance of the eyelids,
eyelashes and lacrimal apparatus. Observe
for:-
1. Redness around the eye
2. Discharge or crusting
3. Growths on eyes or eyelids
4. Excessive tearing
• Position and mobility can be observed by
having the patient rotate the yes, looking up,
down and each side.
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7. B. PUPILLARY RESPONSE
• Normal pupils are rounded, centrally placed
and generally equal in size (about 25 percent
of normal individuals have pupils slightly
unequal in size.)
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8. REACTION TO LIGHT:- Seat the patient in an
area with even lighting and instruct him to fix
his gaze on the distant object.
• Cover one eye and shine a flashlight in front
of the exposed eye. The pupil should
(constrict) because of the light. This response
is called a direct reaction.
• The covered pupil should also contract. This
response is called a consensual reaction.
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10. NEAR POINT REACTION:- When the gaze is
changed from the distant object to an object
close at hand, the pupils should contract.
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11. C. FUNCTIONAL EXAMINATION
1. Focusing power is tested by placing a line of
print close to the eye, then slowly moving it
back to the point at which the patient is able
to read it. The nearest point of
accommodation.
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13. 3. Colour sense is tested by using specially
designed colour pates to distinguish reds,
greens and blues.
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14. 4. Visual acuity testing is done with Snellen
chart or one of its modifications. Each eye is
tested separately, both with and without
glasses, if worn.
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16. • The test is performed at a distance of 6 meters (20
feet).
• Vision is expressed by a fraction, the numerator
denoting the distance at which the test was
performed (normally, 6 metres or 20 feet), and the
denominator denoting the smallest line of letters
which could be read at that distance.
• If a patient is seated 6 meters from the chart and the
smallest lie of letters he is able to read is the one
that should be read at a distance of 30 meters, then
his vision is expressed at 6/30 (20/100).
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17. • If the largest letters on the chart cannot be
read at a distance of 6 meters, the patient is
moved toward the chart until he can read the
largest letters.
• Vision is then expressed as a fraction, with the
numerator denoting the distance at which the
largest line could be read and the
denominator denoting the number of largest
line.
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18. • If the patient cannot read the largest line at a
distance of one meter, the examiner tests the
patient’s ability to see hand motion in front of his
face.
• If the patient cannot see the examiner’s hand at a
distance of one or two meters, he is tested for light
perception.
• A light is flashed from different directions and the
patient is asked from which direction the light
appears and when it goes on and it goes off.
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19. • If the patient can do this, the examination is
recorded as ‘light perception present’.
• If no light perception is present , a person is
technically blind.
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20. ASSESSING SYMPTOMS
In addition to the examinations mentioned
previously, the patient should be assessed:-
• Discomfort or pain in or around the eye
• Photophobia (abnormal sensitivity to light)
• Nystagmus (involuntary and rapid movement of
eyeball.)
• Strabismus (deviation of eye from the normal
physiological axis: ‘crossed vision’)
• Blurred vision
• ‘Spot 'or ‘light 'in the visual field
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21. EYE TESTS AND EXAMS
OPHTHALMOSCOPY:-
• It is an examination of the back part of the eyeball
(fundus), which includes the retina, optic disc,
choroid and blood vessels. Ophthalmoscope
examination takes about 5 and 10 minutes. There
are different types of ophthalmoscopy.
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22. THERE ARE TWO TYPES:-
DIRECT OPHTHALMOSCOPY
• Patient will be seated in a
darkened room. The health
care provider performs this
common exam by shining a
beam of light through the
pupil using an instrument
called an ophthalmoscope.
• It allows the examiner to
view the back of eyeball.
INDIRECT OPHTHALMOSCOPY
• Patient will lie or sit in a semi
reclined position. The health
care provider holds patient
eye open while shining a very
bright light into the eye using
an instrument worn on the
head.
• Some pressure may be
applied to the eyeball using a
small, blunt tool. Patient will
be asked to look in various
direction.10/19/2018

23. 2. APPLANATION METHOD
• This eye test helps
doctors to diagnose
glaucoma by measuring
the amount of pressure
needed to flattern a
portion of the cornea.
• This is done by taking a
thin strip of paper
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24. 3. CORNEAL TOPOGRAPHY
• Corneal topography is a computer assisted diagnostic tool
that creates a three-dimensional map of the surface
curvature of the cornea.
• The cornea (the front window of the eye) is responsible for
about 70 percent of the eye’s focusing power. An eye
with normal vision has an evenly rounded cornea, but if the
cornea is too flat, too steep, or unevenly curved, less than
perfect vision results.
• The greatest advantage of corneal topography is its ability to
detect irregular conditions invisible to most conventional
testing.
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25. • This is an eye test used to evaluate the blood
circulation in the retina. It is useful in helping
diagnose diabetic retinopathy and retinal
detachment.
• During this eye test, a special dye called fluorescein,
is injected into a vein in the arm and it quickly travels
to blood vessels inside the eye.
• When it reach to the eye a specialized camera is
used to the photograph the fluorescein as it
circulates through the blood vessels in the back of
the eye.
• This will enable the doctor to diagnose any
circulation problems, swelling, leaking or abnormal
blood vessels.10/19/2018

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27. 4. PUPILLARY DILATION TEST
• During this eye test, the eye doctor places
special drops (Tropicamide) in the eye that
cause the pupil to dilate. By dilating the
pupils, doctor can examine retina for any signs
of disease.
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28. 5. REFRACTION TEST

29. • This is measures the ability to see objects at
special distances. Often doctors will ask the
patient to look at a chart usually 20 feet away
and try to read it while looking through a
special; instrument know n as a phoropter.
• The eye test is useful in helping to diagnose
presbyopia (long-sightedness ), hyperopia
(nearby objects are blurry), myopia (lose
objects appear clearly, but far ones don't.)
and astigmatism (eye does not focus light
evenly).
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30. 6. FLUORESCEIN ANGOGRAPHY
• Fluorescein angiography, fluorescent
angiography, or fundus fluorescein
angiography is a technique for examining the
circulation of the retina and choroid using a
fluorescent dye and a specialized camera.
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31. 7. COLOR FUNDUS PHOTOGRAPHY
• Fundus camera to record color images of the
condition of the interior surface of the eye, in order
to document the presence of disorders and monitor
their change over time.
• A fundus camera or retinal camera is a specialized
low power microscope with an attached camera
designed to photograph the interior surface of the
eye, including the retina, retinal vasculature, optic
disc, macula, and posterior pole (i.e. the fundus).
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32. • The retina is imaged to document conditions
such as diabetic retinopathy, age related
macular degeneration, macular edema and
retinal detachment.
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33. 8. SLIT- LAMP EXAM
• Once patient in the examination
chair, the doctor will place an
instrument in front of patient on
which to rest chin and forehead.
• This helps steady head for the
exam. Doctor may put drops in
eyes to make any abnormalities
on the surface of cornea more
visible.
• The drops contain a yellow dye
called fluorescein, which will
wash away the tears. Additional
drops may also be put in eyes to
allow pupils to dilate, or get
bigger.10/19/2018

34. • The doctor will use a low-powered microscope, along
with a slit lamp, which is a high-intensity light. They
will look closely at eyes. The slit lamp has different
filters to get different views of the eyes. Some
doctor’s offices may have devices that capture digital
images to track changes in the eyes over time.
• During the test, the doctor will examine all areas of
your eye, including the:- eyelids, conjunctiva, iris,
lens, sclera, cornea, retina and optic nerve.
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35. 9. TONOMETERY
• Tonometry is the
procedure eye care
professionals perform
to determine the
intraocular pressure,
the fluid pressure inside
the eye. It is an
important test in the
evaluation of patients
at risk from glaucoma.
• (normal pressure range
is 12 to 22 mm Hg)10/19/2018

36. • Before the tonometry test, eye doctor will put
numbing eye drops in eyes so that patient
don’t feel anything touching them.
• Once eye is numb, doctor may touch a tiny,
thin strip of paper that contains orange dye to
the surface of eye to stain it. This helps
increase the accuracy of the test.
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37. • Doctor will then put a machine called a "slit-
lamp" in front of patient. Patient will rest chin
and forehead on the supports provided.
• The lamp will then be moved toward eyes
until just the tip of the tonometer probe
touches cornea. By flattening cornea just a bit,
the instrument can detect the pressure in eye.
Doctor will adjust the tension until they get a
proper reading.
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38. • Because eyes are numb, patient will feel no
pain during the procedure. Tonometry is
extremely safe. However, there’s a very
minimal risk that cornea could be scratched
when the tonometer touches eye.
• Even if this happens, however, it will normally
heal itself within a few days.
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39. 10. ULTRASOUND BIOMICROSCOPY
• Ultrasound bio microscopy
is a type of ultrasound eye
exam that makes a more
detailed image than regular
ultrasound. High-energy
sound waves are bounced
off the inside of the eye and
the echo patterns are
shown on the screen of an
ultrasound machine
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40. 11. ELECTRORETINOGRAPHY
• Electroretinography
measures the electrical
responses of various
cell types in the retina,
including the
photoreceptors, inner
retinal cells, and the
ganglion cells.
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41. OTHER TEST
12. VISUAL ACUITY TEST (SNELLEN CHART)
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