The Eyes! Chapter 14

Objectives Identify the internal & external anatomical features of the eye Describe the health history pertaining to the eyes Demonstrate the following techniques: Basic vision testing Extra ocular muscular functioning Pupillary response External eye inspection Fundoscopic exam

More objectives Describe normal eye assessment findings Describe abnormal findings of the eye Discuss health promotion practices that are pertinent to the eyes Explain age-related changes in the eye Document findings of the eye assessment

External Anatomy

Internal Anatomy

Lacrimal Apparatus

Extraocular muscles

Health History Vision Difficulty Pain Strabismus or diplopia Redness or swelling Watering or discharge History of Ocular problems Glaucoma Use of glasses/CL Self-care behaviors

Talk the Talk OD = right eye OS = left eye Myopia = nearsighted Hyperopia = farsighted Presbyopia = “old man’s vision” Amblyopia = lazy eye

Assessment techniques& Tools Snellen Eye Chart Confrontation Test Corneal Light Reflex Cover Test Diagnostic Positions Test Amsler Grid Pen light Opthalmoscope

Snellen Eye Chart Measures visual acuity Distance Vision Near Vision 20 feet from patient Cover one eye Documentation! Near Vision Jaeger Card 14 inches

Practice!

Confrontation Test Measures peripheral vision Face the patient with 2 feet between you Patient covers one eye (examiner covers eye opposite eye) Patient indicates when they can see your hand

Corneal Light Reflex (Hirschberg Test) Indicates a muscle imbalance Need a pen light Hold 12 inches away from patient Note the reflection Should be symmetrical Asymmetry indicates an imbalance

Cover Test Indicates a muscle imbalance Phoria vs tropia Patient stares at a fixed point Cover one eye at a time Normal = no movement in uncovered eye Abnormal= if the uncovered eye “jumps” it was not fixated on the point to begin with As you uncover the opposite eye, if it “jumps” it was not fixated

Diagnostic Positions Test Elicits muscle weakness during movement Head stays steady; only eyes move Don’t move your hand too fast! Nystagmus

Amsler Grid Detects Macular Degeneration If present, the disease will distort the lines on a grid

Visual Loss with Macular Degeneration

Glaucoma= pressure

Inspection of External Structure General Eyebrows Eyeballs Exophthalmos Enophthalmos Conjunctiva & Sclera Scleral icterus Lacrimal Apparatus

Inspection of Anterior Eyeball Structures Cornea & lens Arcus senilis Iris & pupil Anisocoria Pupillary light reflex Accommodation PERRLA Pupils Equal Round Reactive to light (with)

Inspect the Ocular Fundus Internal surface of the retina Tools & Process Opthalmoscope Diopter 0= normal vision - # = myopia + # = hyperopia Darken the room for dilation Have the patient focus Look thru the pupil

Findings of the ocular fundus Red Reflex Opacities Optic disk Color : creamy yellow-orange to pink Shape: Round or oval Margins: Distinct & sharply demarcated Cup-disc ratio: Brighter area in center- should not exceed ½ of the diameter

Ocular Fundus Continued Retinal vessels Number Color A:V ratio Caliber A-V crossing Tortuosity Pulsations Macula Same size as the disc Darker than the disc, but color is even

Asymmetric Corneal Light Reflex Esotropia Extropia

Eyelid Abnormalities Ptosis Blepharitis Chalazion

Pupil Abnormalities Anisocoria Monocular Blindness Mydriasis Miosis

Conjunctivitis Subconjunctival hemorrhage Cataracts