1. The Eyes!
Chapter 14

2. 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

3. 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

4. External Anatomy

5. Internal Anatomy

7. Lacrimal Apparatus

8. Extraocular muscles

9. 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

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

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

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

13. Practice!

14. 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

15. 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

16. 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

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

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

19. Visual Loss with Macular Degeneration

21. Glaucoma= pressure

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

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

25. 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

26. 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

29. 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

30. Asymmetric Corneal Light Reflex
Esotropia
Extropia

31. Eyelid Abnormalities
Ptosis
Blepharitis
Chalazion

32. Pupil Abnormalities
Anisocoria
Monocular Blindness
Mydriasis
Miosis

33. Conjunctivitis
Subconjunctival hemorrhage
Cataracts