1. Eye and Ear Assessment by
Sharon Kerr, MSN, RN
Spring 2010

2. Normal Anatomy of the Eye

3. External Eye Exam Inspect for: Symmetry Discharge or lesions
Eyelids: blink, position (ptosis), swelling
Sclera: should be white (not red or yellow)
Cornea: assess for opacity or scratch
Conjunctiva: should be pink

4. External Eye Exam continued
Pupil -- Check for response to:
Light
Accomodation
PERRLA

5. External Eye Exam continued
Extraocular Muscle Function
Check eye movement through the six cardinal directions of gaze.
Watch for parallel movement
Nystagmus (involuntary rapid rhythmic movement)

6. Normal Anatomy of the Eye
Cornea:
clear layer covering the front of the eye.
works with the lens to focus images on the retina.

7. Normal Anatomy of the Eye
Retina
internal layer
receives and transmits focused images.
normally red due to its rich blood supply.

8. Retina Can be seen with an ophthalmoscope
Allows the examiner to see through the pupil and lens to the retina
Called a funduscopic exam

9. Retina
Examination of fundus includes
Retina
Optic disc
Blood vessels.

11. Funduscopic Exam Ophalmoscope
Seated in a darkened room
Examiner projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball

12. Using the Ophalmoscope
Turn on and adjust to round beam of white light
Place scope light on dim setting
Set lens disc to 0 diopters (neutral)
Keep index finger on lens disc to adjust during examination

13. Approaching the patient
Right hand and right eye to pt. Right eye
Left hand and left eye to pt. Left eye
Hold opthalmoscope firmly against your bony orbit
Glasses off (both examiner and patient)
Contacts are OK

14. The examination
Have patient look over your shoulder and across the room at a specific point on the wall
From about 15 inches and 15 degrees lateral to the patient’s line of vision, shine the light beam on the pupil

15. Getting a closer look
Should see an orange glow (the red reflex – reflection of light off retina)
Move in on the 15 degree line toward the pupil , almost touching the patient’s lashes

16. Finding the optic disk On NASAL side of each retina
Yellowish orange to creamy pink oval or round
Follow a blood vessel centrally until you see it

17. Inspecting the optic disk
Clarity – should have sharp margins
Symmetry of both eyes

18. Inspecting the retina Visualize arteries and veins
Identify any lesions in retina
Red spots, streaks, light spots

21. Normal Anatomy of the Ear
external, middle, and inner structures.
eardrum and the three tiny bones conduct sound from the eardrum to the cochlea: malleus, incus, stapes

22. External Ear Exam Symmetry, size, shape
Position: pinna level with corner of eye
Lesions
Drainage

23. Examine Auditory Acuity
Whisper two syllable word (out of view)
Weber Test: lateralization of sound..
Rinne test: bone vs air conduction of sound
Weber Test: Place vibrating tuning form on top of head or middle of forehead. Client should hear tone equally in both ears.
Rinne test: compares air and bone conduction of sound. Place vibrating tuning fork on mastoid process (bone conduction) and ask client to indicate when he can no longer hear sound. Then quickly move tuning fork in front of auditory meatus (air conduction). Have client indicate when sound ends. Air conduction should be twice as long as bone conduction.

25. Normal Anatomy of the Ear
The tympanic membrane, or eardrum
separates the ear canal and the middle ear.
ossicles : can see the short process of the malleous, handle of the malleous, and the incus
There is a cone of light that is a reflection of the otoscope light

26. Otoscopic Examination
An otoscope
is an instrument used to look into the ear canal
ear speculum
a cone-shaped viewing piece of the otoscope)
Use largest size possible

27. Otoscopic Examination
Dim lights in room
Patient in sitting position
Pull ear up and back (down for kids)
SLOWLY insert otoscope into ear canal while looking into viewer

28. Otoscopic Landmarks
Tympanic membrane: should be intact, pearly gray, translucent, shiny
Cone of light: right side 4/5 o’clock; left side 7/8 o’clock
Malleus short process -- knob

29. Abnormal Findings: Perforations Bulging Retraction
Blue ,red, or amber coloring
dullnss

31. Otoscopic Examination
The speculum is angled slightly toward the person's nose to follow the canal.
A light beam extends beyond the viewing tip of the speculum.
The otoscope is gently moved to different angles to view the canal walls and eardrum.

37. That’s all folk’s
The End