Chapter 12 Eyes

Competencies Identify the structures of the eyes. Discuss the system-specific history for the eyes. Describe normal findings in the physical examination of the eyes. (continues)

Competencies Describe common abnormalities found in the physical examination of the eyes. Explain the pathophysiology of common abnormalities of the eyes. Perform a physical examination of the eyes.

Anatomy and Physiology External structures Conjunctiva Palpebral Bulbar Canthus Inner Outer (continues)

Anatomy and Physiology External structures (cont’d) Lacrimal apparatus Extraocular muscles (continues)

Anatomy and Physiology Internal structures Outer layer Sclera Cornea (continues)

Anatomy and Physiology Internal structures (cont’d) Middle layer Choroid Lens Iris Pupil (continues)

Anatomy and Physiology Internal structures (cont’d) Middle layer (cont’d) Vitreous humor Anterior chamber Posterior chamber (continues)

Anatomy and Physiology Internal structures (cont’d) Inner layer Retina Optic disc Physiologic cup Macula Fovea centralis Cones Rods (continues)

Anatomy and Physiology Internal structures (cont’d) Visual pathway Sensory neurons in the retina Optic disc Optic nerve Optic chiasm

Health History Age Middle age Presbyopia Retinopathy (continues)

Health History Age (cont’d) Older Adult (continues) Cataract Glaucoma Macular degeneration Entropion, ectropion Dry eyes (continues)

Health History Gender Race Common chief complaints Changes in visual acuity Pain Drainage Itching Dryness (continues)

Health History Characteristics of chief complaints Location Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing

Past Health History Medical history Surgical history Eye specific Non-eye specific Surgical history (continues)

Past Health History Allergies Medications Injuries and accidents Special needs Childhood illnesses (continues)

Past Health History Family health history Social history Tobacco use Travel history Work environment Stress Ethnic background (continues)

Past Health History Health maintenance activities Diet Use of safety devices Health checkups

Examination of the Eye Equipment Ophthalmoscope Penlight Clean gloves Vision charts Vision occluder Cotton-tipped applicator (continues)

Examination of the Eye General approach Greet the patient, explain examination techniques Lighting Environment Compare right to left Systematic approach

Visual Acuity Cranial nerve II Distance vision Normal finding – vision 20/20 Abnormal findings Myopia Amblyopia (continues)

Visual Acuity Near vision Normal finding – patient can read vision card 14 inches from face Abnormal findings Presbyopia Hyperopia (continues)

Visual Acuity Color vision Assess in children Normal finding – able to correctly identify colors Abnormal finding – unable to see some or all colors

Visual Fields Cranial nerve II Confrontation technique Assess all fields (continues)

Visual Fields Normal findings Abnormal findings Able to see in all visual fields Abnormal findings Hemianopsia Circumferential blindness Unilateral blindness

External Eye and Lacrimal Apparatus Eyelids Abnormal findings Ptosis Exophthalmos Entropion, ectropion Hordeolum Chalazion (continues)

External Eye and Lacrimal Apparatus Abnormal findings Dacryoadenitis Dacryocystitis

Extraocular Muscle Function Corneal light reflex (Hirschberg test) Abnormal findings Strabismus Esotropia, exotropia Cover/uncover test Phoria Esophoria, exophoria (continues)

Extraocular Muscle Function Cardinal fields of gaze Normal findings Eyes move symmetrically in 6 fields of gaze Eyes converge on held object as it moves toward the nose Abnormal findings Nystagmus

Anterior Segment Structures Conjunctiva Normal findings Bulbar conjunctiva – transparent; no swelling, injections, exudates, or foreign bodies Palpebral conjunctiva – pink and moist; no swelling, lesions, injection, exudates, or foreign bodies Abnormal findings Exudates, discharge Pterygium Subconjunctival hemorrhage (continues)

Anterior Segment Structures Sclera Normal findings White – without exudate, lesions, or foreign bodies Abnormal findings Discoloration – yellow (jaundice) or blue (osteogenesis imperfecta) (continues)

Anterior Segment Structures Cornea Normal findings Surface is moist and shiny No discharge, cloudiness, opacity, or irregularities Abnormal findings Ulceration Arcus senilis Laceration Scar Cloudy (may indicate glaucoma)

Anterior Chamber Examination techniques Iris Pupil Abnormal findings Narrow angle of anterior chamber Pupil Pupils uneven or do not respond to light and accommodation (continues)

Anterior Chamber Lens Abnormal findings Opacity of lens (may indicate cataract)

Posterior Segment Structures Examination techniques Retinal structures Abnormal findings Absent red reflex, white pupil, pale optic disc, optic atrophy, disc edema, deep retinal hemorrhages, neovascularization, coloboma (continues)

Posterior Segment Structures Macula Abnormal findings Pale retina, macular edema, microaneurysms, blurred macular borders

Normal Findings Visual acuity 20/20 Near vision acuity at 14 inches Able to identify all six colors Visual fields intact (continues)

Normal Findings Eyelids symmetrical; no drooping, infections, or tumors No enlargement, swelling, or redness of the lacrimal apparatus Light reflex is symmetrical in the center of each cornea (continues)

Normal Findings Eyes aligned on cover/uncover test Extraocular eye movements intact in all six fields Bulbar conjunctiva is transparent Palpebral conjunctiva is pink and moist (continues)

Normal Findings Sclera are white, without exudate, lesions, or foreign bodies Cornea is moist, shiny, without discharge, cloudiness, or opacities Entire iris is illuminated Color of iris is evenly distributed (continues)

Normal Findings Pupils are deep, black, round, and of equal diameter Pupil size is 2–6 mm Lens is transparent (continues)

Normal Findings Red reflex is present Optic disc is pinkish orange Macula is darker, avascular