1. Chapter 12
Eyes

2. 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.
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3. 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.

4. Anatomy and Physiology
External structures
Conjunctiva
Palpebral
Bulbar
Canthus
Inner
Outer
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5. Anatomy and Physiology
External structures (cont’d)
Lacrimal apparatus
Extraocular muscles
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6. Anatomy and Physiology
Internal structures
Outer layer
Sclera
Cornea
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7. Anatomy and Physiology
Internal structures (cont’d)
Middle layer
Choroid
Lens
Iris
Pupil
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8. Anatomy and Physiology
Internal structures (cont’d)
Middle layer (cont’d)
Vitreous humor
Anterior chamber
Posterior chamber
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9. Anatomy and Physiology
Internal structures (cont’d)
Inner layer
Retina
Optic disc
Physiologic cup
Macula
Fovea centralis
Cones
Rods
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10. Anatomy and Physiology
Internal structures (cont’d)
Visual pathway
Sensory neurons in the retina
Optic disc
Optic nerve
Optic chiasm

11. Health History
Age
Middle age
Presbyopia
Retinopathy
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12. Health History Age (cont’d) Older Adult (continues) Cataract Glaucoma
Macular degeneration
Entropion, ectropion
Dry eyes
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13. Health History Gender Race Common chief complaints
Changes in visual acuity
Pain
Drainage
Itching
Dryness
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14. Health History Characteristics of chief complaints Location Quality
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing

15. Past Health History Medical history Surgical history Eye specific
Non-eye specific
Surgical history
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16. Past Health History Allergies Medications Injuries and accidents
Special needs
Childhood illnesses
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17. Past Health History Family health history Social history Tobacco use
Travel history
Work environment
Stress
Ethnic background
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18. Past Health History Health maintenance activities Diet
Use of safety devices
Health checkups

19. Examination of the Eye Equipment Ophthalmoscope Penlight Clean gloves
Vision charts
Vision occluder
Cotton-tipped applicator
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20. Examination of the Eye General approach
Greet the patient, explain examination techniques
Lighting
Environment
Compare right to left
Systematic approach

21. Visual Acuity Cranial nerve II Distance vision
Normal finding – vision 20/20
Abnormal findings
Myopia
Amblyopia
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22. Visual Acuity Near vision
Normal finding – patient can read vision card 14 inches from face
Abnormal findings
Presbyopia
Hyperopia
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23. Visual Acuity Color vision Assess in children
Normal finding – able to correctly identify colors
Abnormal finding – unable to see some or all colors

24. Visual Fields Cranial nerve II Confrontation technique
Assess all fields
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25. Visual Fields Normal findings Abnormal findings
Able to see in all visual fields
Abnormal findings
Hemianopsia
Circumferential blindness
Unilateral blindness

26. External Eye and Lacrimal Apparatus
Eyelids
Abnormal findings
Ptosis
Exophthalmos
Entropion, ectropion
Hordeolum
Chalazion
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27. External Eye and Lacrimal Apparatus
Abnormal findings
Dacryoadenitis
Dacryocystitis

28. Extraocular Muscle Function
Corneal light reflex (Hirschberg test)
Abnormal findings
Strabismus
Esotropia, exotropia
Cover/uncover test
Phoria
Esophoria, exophoria
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29. 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

30. 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
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31. Anterior Segment Structures
Sclera
Normal findings
White – without exudate, lesions, or foreign bodies
Abnormal findings
Discoloration – yellow (jaundice) or blue (osteogenesis imperfecta)
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32. 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)

33. Anterior Chamber Examination techniques Iris Pupil Abnormal findings
Narrow angle of anterior chamber
Pupil
Pupils uneven or do not respond to light and accommodation
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34. Anterior Chamber Lens Abnormal findings
Opacity of lens (may indicate cataract)

35. 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
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36. Posterior Segment Structures
Macula
Abnormal findings
Pale retina, macular edema, microaneurysms, blurred macular borders

37. Normal Findings Visual acuity 20/20 Near vision acuity at 14 inches
Able to identify all six colors
Visual fields intact
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38. 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
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39. 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
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40. 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
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41. Normal Findings Pupils are deep, black, round, and of equal diameter
Pupil size is 2–6 mm
Lens is transparent
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42. Normal Findings Red reflex is present Optic disc is pinkish orange
Macula is darker, avascular