Eyes Chapter 14 Elsevier items and derived items

Eyes Chapter 14 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 14: Eyes Structure and Function Subjective Data—Health History Questions Objective Data—Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -2

Chapter 14: Eyes Structure and Function External anatomy Palpebral fissure Limbus © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -3

Chapter 14: Eyes Structure and Function (cont. ) External anatomy Tarsal plates Meibomian glands Conjunctiva Lacrimal apparatus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -4

Chapter 14: Eyes Structure and Function (cont. ) Extraocular muscles Superior rectus Inferior rectus Lateral rectus Medial rectus Superior oblique Inferior oblique © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -5

Chapter 14: Eyes Structure and Function (cont. ) Internal anatomy Outer layer—sclera Middle layer—choroid Ø Ciliary body and iris Ø Pupil Ø Lens Ø Anterior chamber Inner layer—retina Ø Optic disc Ø Retinal vessels Ø Macula Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -6

Chapter 14: Eyes Structure and Function (cont. ) Visual pathways and visual fields Refraction of light rays Crossing of fibers at optic nerve Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -7

Chapter 14: Eyes Structure and Function (cont. ) Visual reflexes Pupillary light reflexes Fixation Accommodation Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -8

Chapter 14: Eyes Structure and Function (cont. ) Developmental care Infants and children Aging adult Ø Cataracts Ø Glaucoma Ø Macular degeneration Cross-cultural care Racial variations Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -9

Chapter 14: Eyes Subjective Data— Health History Questions Vision difficulty (decreased acuity, blurring, blind spots) Pain Strabismus, diplopia Redness, swelling Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -10

Chapter 14: Eyes Subjective Data— Health History Questions (cont. ) Watering, discharge History of ocular problems Glaucoma Glasses or contact lenses Self-care behaviors Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -11

Chapter 14: Eyes Health History Questions (cont. ) Additional history for infants and children Vaginal infection during delivery Developmental milestones Routine vision testing Safety measures Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -12

Chapter 14: Eyes Health History Questions (cont. ) Additional history for aging adult Visual difficulty Glaucoma test Cataracts Eye dryness Decreased activities Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -13

Chapter 14: Eyes Objective Data— Physical Exam Preparation Ø Position Equipment Ø Snellen eye chart Ø Handheld visual screener Ø Opaque card or occluder Ø Penlight Ø Applicator stick Ø Ophthalmoscope Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -14

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Central visual acuity Ø Snellen eye chart Ø Near vision Visual fields Ø Confrontation test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -15

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Extraocular muscle function—Inspect Corneal light reflex (Hirschberg test) Cover test Diagnostic positions test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -16

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) External ocular structures—Inspect General Eyebrows Eyelids and lashes Eyeballs Conjunctiva and sclera Eversion of the upper lid Lacrimal apparatus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -17

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Anterior eyeball structures—Inspect Cornea and lens Iris and pupil Ø Size and shape Ø Pupillary light reflex Ø Accommodation Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -18

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Ocular fundus—Inspect Use of the ophthalmoscope Red reflex Optic disc Color Ø Shape Ø Retinal vessels Color Ø A: V ratio Ø Caliber Ø General background of the fundus Macula Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -19

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Developmental care Infants and children Ø Ø Ø Ø Ø Visual acuity Visual fields Color vision Extraocular muscle function External eye structures Eyelids and lashes Conjunctiva and sclera Iris and pupils Ocular fundus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -20

Chapter 14: Eyes Objective Data—Physical Exam (cont. ) Developmental care (cont. ) Aging adults Visual acuity Ø Ocular structures Ø Ocular fundus Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -21

Chapter 14: Eyes Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -22

Chapter 14: Eyes Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -23

Chapter 14: Eyes Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -24

Chapter 14: Eyes Abnormal Findings Extraocular Muscle Dysfunction Strabismus Esotropia Exotropia Paralysis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -25

Chapter 14: Eyes Abnormal Findings (cont. ) Abnormalities in the Eyelids Periorbital edema Exophthalmos (protruding eyes) Enophthalmos (sunken eyes) Ptosis (drooping upper lid) Upward palpebral slant Ectropion Entropion Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -26

Chapter 14: Eyes Abnormal Findings (cont. ) Lesions on the Eyelids Blepharitis (inflammation of the eyelids) Chalazion Hordeolum (stye) Dacryocystitis (inflammation of the lacrimal sac) Dacryoadenitis (inflammation of the lacrimal gland) Basal cell carcinoma Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -27

Chapter 14: Eyes Abnormal Findings (cont. ) Abnormalities in the Pupil Unequal pupil size—anisocoria Monocular blindness Constricted and fixed pupils—miosis Dilated and fixed pupils—mydriasis Argyll Robertson pupil Tonic pupil (Adie’s pupil) Cranial nerve III damage Horner’s syndrome Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -28

Chapter 14: Eyes Abnormal Findings For Advanced Practice Visual Field Loss Retinal damage Lesion in globe or optic nerve Lesion at optic chiasm Lesion of outer uncrossed fibers at optic chiasm Lesion R optic tract or R optic radiation Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -29

Chapter 14: Eyes Abnormal Findings (cont. ) Vascular Disorders of the External Eye Conjunctivitis Subconjunctival hemorrhage Iritis (circumcorneal redness) Acute glaucoma Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -30

Chapter 14: Eyes Abnormal Findings (cont. ) Abnormalities on the Cornea and Iris Pterygium Corneal abrasion Hyphema Hypopyon Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -31

Chapter 14: Eyes Abnormal Findings (cont. ) Opacities in the Lens Central gray opacity—nuclear cataract Star-shaped opacity—cortical cataract Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -32

Chapter 14: Eyes Abnormal Findings (cont. ) Abnormalities in the Optic Disc Optic atrophy (disc pallor) Papilledema (choked disc) Excessive cup: disc ratio Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -33

Chapter 14: Eyes Abnormal Findings (cont. ) Abnormalities in the Retinal Vessels and Background Arteriovenous crossing (nicking) Narrowed (attenuated) arteries Vessel nicking Diabetic retinopathy Microaneurysms Intraretinal hemorrhages Exudates Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 14 -34