1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 15: Eyes Weber Health Assessment in Nursing

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins External Structure of the Eye Eyelids Lateral and medial canthus Eyelashes, conjunctiva Lacrimal apparatus Extraocular muscles

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure of Eye

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Internal Structure of the Eye Sclera, cornea, iris, ciliary body, Pupil, lens, choroid, retina, optic disc Physiological cup, retinal vessels Anterior chamber, posterior chamber

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is True or False. The lens flattens to focus on close objects and bulges to focus on far objects.

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The lens bulges to focus on close objects and flattens to focus on far objects. This is possible due to the refractive ability of the lens.

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision Visual fields Visual pathways Visual reflexes –Pupillary light reflex –Accommodation

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Collecting Subjective Data History of present health concern Past health history Family history Lifestyle and health practices

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cataract Opacity or clouding of the eye’s lens Leading cause of blindness worldwide

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors Increasing age Exposure to ultraviolet B light Diabetes mellitus Cigarette smoking Alcohol use Diet low in antioxidant vitamins

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors (cont.) High blood pressure Eye injuries/surgery Steroid use Female gender Persistent diarrhea Gout Abdominal obesity Beta blocker use

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Reduction Wear sunglasses Quit smoking Limit alcohol intake Avoid eye injuries Regular eye examination

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is True or False. Exposure to ultraviolet radiation increases the risk for development of cataracts.

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Exposure to ultraviolet radiation increases the risk for development of cataracts.

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Collecting Objective Data Preparing the client Equipment –Snellen or E chart –Hand-held Snellen card or near vision screener –Penlight –Opaque cards –Ophthalmoscope

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Distant Visual Acuity Snellen chart Normal acuity is 20/20 with or without corrective lenses

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Near Visual Acuity Handheld vision chart Normal acuity is 14/14 with or without corrective lenses

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is True or False. When testing near visual acuity the client should be asked to remove his or her glasses.

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. When testing near visual acuity the client should keep his or her glasses on.

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Confrontation Test

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Testing Extraocular Muscle Function Corneal light reflex test: use penlight to observe parallel alignment of light refection on corneas Cover test: use opaque card to cover an eye to observe for eye movement Positions test: observe for eye movement

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Testing Extraocular Muscle Function

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Extraocular Muscle Dysfunction Corneal light reflex test abnormalities –Pseudostrabismus, strabismus Test abnormalities –Phobia Positions test abnormalities –Paralytic strabismus, 6 th, 4 th, 3 rd nerve paralysis

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins External Eye Structures Inspect the eyelids and eyelashes Observe the position and alignment of the eyeball in the eye socket Inspect the bulbar conjunctiva and sclera Inspect the palpebral conjunctiva Inspect the lacrimal apparatus

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins External Eye Structures (Cont’d) Palpate the lacrimal apparatus Inspect the cornea and lens Inspect the iris and pupil Test pupillary reaction to light Test accommodation of pupils

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of External Eye Ptosis, exophthalmos Entropion, chalazion Blepharitis, ectropion Conjunctivitis Hordeolum, diffuse episcleritis

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pupillary Reaction to Light Darkened room Have client focus on a distant object Shine light obliquely into the pupil and observe the pupil’s reaction to light Normally, pupils constrict

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Accommodation Shifting gaze from far to near Normally, pupils constrict

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Ophthalmoscope

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Internal Eye Structures Inspect the optic disc Inspect the retinal vessels Inspect retinal background Inspect fovea and macula Inspect anterior chamber

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Visual Field Defects Unilateral blindness Bitemporal hemianopia Lesion in optic nerve Lesion of optic chiasm Left superior quadrant anopia Right visual field loss

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of Cornea and Lens Corneal abnormalities –Corneal scar, pterygium Lens abnormalities –Nucleus cataract, peripheral cataract

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of Iris and Pupil Irregularly shaped iris Miosis Anisocoria Mydriasis

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of Retinal Vessels and Background Constricted arteriole Copper wire arteriole Silver wire arteriole Arteriovenous nicking Arteriovenous tapering Arteriovenous banking

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of Retinal Vessels and Background (Cont’d) Cotton wool patches Hard exudate Superficial retinal hemorrhages Deep retinal hemorrhages Microaneurysms

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormalities of Optic Disc Papilledema Glacoma Optic atrophy

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is True or False. In 3 rd nerve paralysis, the eyes cannot look down when turned inward.

38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. In 3 rd nerve paralysis, the eye looks straight ahead. If the eyes cannot look down when turned inward it indicates 4 th nerve paralysis.