Health Assessment of eye Health Physical Assessment in

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Health Assessment of eye Health & Physical Assessment in Nursing, Third Edition Donita D'Amico

Health Assessment of eye Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Eye • Only a small portion of the eye is seen. • Sclera –

Eye • Only a small portion of the eye is seen. • Sclera – Cornea • Choroid – Iris – Pupil § Dim light enlarges (mydriasis) § Bright light decreases (miosis) Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Eye • Retina – Sensory portion – Optic disc § Center is the point

Eye • Retina – Sensory portion – Optic disc § Center is the point at which the vascular network enters the eye – Macula § Responsible for central vision Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 2 Interior of the eye. Health & Physical Assessment in Nursing, Third

Figure 15. 2 Interior of the eye. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Visual Pathways • Light waves must bend to focus correctly on the retina. –

Visual Pathways • Light waves must bend to focus correctly on the retina. – Refractory structures bend light waves onto retina. • Optic fibers of the optic nerve cross over at the chiasm and join temporal fibers from the opposite eye. – Impulse transmitted to occipital lobe of brain for interpretation Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 3 Visual fields of the eye and the visual pathway to the

Figure 15. 3 Visual fields of the eye and the visual pathway to the brain. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Accessory Structures of the Eye • Eyebrows – Protect the eye • Eyelids -Movable

Accessory Structures of the Eye • Eyebrows – Protect the eye • Eyelids -Movable folds of skin that cover and protect the eyes – Palpebral fissure is opening between upper and lower eyelids. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Accessory Structures of the Eye • Eyelids – Meibomian glands § glands that lubricate

Accessory Structures of the Eye • Eyelids – Meibomian glands § glands that lubricate eyes and eyelids • Eyelashes – Project from eyelids and curl outward • Conjunctivae – Prevents foreign objects from entering eye Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Accessory Structures of the Eye • Lacrimal apparatus – Secretes tears that spread over

Accessory Structures of the Eye • Lacrimal apparatus – Secretes tears that spread over conjunctivae when blinking • Extrinsic muscles – Lateral rectus – Medial rectus – Superior rectus – Inferior oblique – Superior oblique Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 4 Lacrimal glands of the eye. Health & Physical Assessment in Nursing,

Figure 15. 4 Lacrimal glands of the eye. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Special Considerations • • Age Developmental level Race Ethnicity Occupation Socioeconomics Emotional well-being Health

Special Considerations • • Age Developmental level Race Ethnicity Occupation Socioeconomics Emotional well-being Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • Infants and children – Visual acuity not as sharp as adults

Lifespan Considerations • Infants and children – Visual acuity not as sharp as adults § Children typically have 20/20 vision by age 7. – At birth, the iris has little color but changes to permanent color by 3 months of age. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • The pregnant female – Dryness of the eyes – Vision changes

Lifespan Considerations • The pregnant female – Dryness of the eyes – Vision changes § Due to shifting fluid in cornea § Blurriness § Distorted vision § Up to 6 weeks postpartum Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • The older adult – Cataracts – Macular degeneration Health & Physical

Lifespan Considerations • The older adult – Cataracts – Macular degeneration Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Psychosocial Considerations • Impact of decreased visual acuity/visual impairment on independence and quality of

Psychosocial Considerations • Impact of decreased visual acuity/visual impairment on independence and quality of life – Children may experience developmental delays. – Stress for families and individuals • Eye contact within culture, age, gender Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Cultural and Environmental Considerations • Changes that occur normally in various races and ethnic

Cultural and Environmental Considerations • Changes that occur normally in various races and ethnic groups • Excessive sun exposure • Medications • Hygiene practices • Trauma or damage Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Focused Interview • Function and structures of the eye • Consider in relation to

Focused Interview • Function and structures of the eye • Consider in relation to expectations based on age, gender, race, culture, environment, health practices, past and current problems, and therapies • Consider patient's ability to participate Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Focused Interview • Focused interview questions – General – Illness or infection – Symptoms,

Focused Interview • Focused interview questions – General – Illness or infection – Symptoms, pain, and behaviors continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment of the Eye • Techniques – Inspection – Palpation – Ophthalmoscope Health &

Assessment of the Eye • Techniques – Inspection – Palpation – Ophthalmoscope Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 7 Testing distant vision. Health & Physical Assessment in Nursing, Third Edition

Figure 15. 7 Testing distant vision. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 8 E chart for testing distant vision. Health & Physical Assessment in

Figure 15. 8 E chart for testing distant vision. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 9 Testing near vision. Health & Physical Assessment in Nursing, Third Edition

Figure 15. 9 Testing near vision. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment of the Eye • Visual acuity of distant and near vision using Jaeger

Assessment of the Eye • Visual acuity of distant and near vision using Jaeger or Rosenbaum charts • Visual fields by confrontation • Six cardinal fields of gaze • Corneal light reflex • Cover/uncover test • Pupils and pupillary response Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment of the Eye • • Accommodation of pupil response Corneal reflex External eye

Assessment of the Eye • • Accommodation of pupil response Corneal reflex External eye Sclera Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 12 Alternative method of testing cardinal field of gaze. Health & Physical

Figure 15. 12 Alternative method of testing cardinal field of gaze. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 13 Testing the corneal light reflex. Health & Physical Assessment in Nursing,

Figure 15. 13 Testing the corneal light reflex. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 14 Cover/Uncover test. Health & Physical Assessment in Nursing, Third Edition Donita

Figure 15. 14 Cover/Uncover test. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 15 Inspecting the cornea. Health & Physical Assessment in Nursing, Third Edition

Figure 15. 15 Inspecting the cornea. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment of the Eye • Ophthalmoscope – Fundus – Advanced skill Health & Physical

Assessment of the Eye • Ophthalmoscope – Fundus – Advanced skill Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 16 Approaching the patient for the ophthalmoscopic exam. Health & Physical Assessment

Figure 15. 16 Approaching the patient for the ophthalmoscopic exam. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 17 Examining the eye using the ophthalmoscope. Health & Physical Assessment in

Figure 15. 17 Examining the eye using the ophthalmoscope. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 18 Use of diopter to adjust for problems of refraction. A. In

Figure 15. 18 Use of diopter to adjust for problems of refraction. A. In the emmetropic (normal) eye, light is focused properly on the retina, and the 0 diopter is used. B. In the myopic eye, light from a distant source converges to a focal point before reaching the retina. Negative diopter numbers are used. C. In the hyperopic eye, light from a near source converges to a focal point past the retina. Positive diopter numbers are used. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Abnormal Findings • Vision • Eye movement • Internal and external structures Health &

Abnormal Findings • Vision • Eye movement • Internal and external structures Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Table 15. 3 Abnormalities of the Eyelids continued on next slide Health & Physical

Table 15. 3 Abnormalities of the Eyelids continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Table 15. 5 Abnormalities of the Fundus continued on next slide Health & Physical

Table 15. 5 Abnormalities of the Fundus continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 15. 44 Cranial nerve III damage. Health & Physical Assessment in Nursing, Third

Figure 15. 44 Cranial nerve III damage. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Abnormal Findings • Disorders of visual acuity – Myopia – Hyperopia – Astigmatism §

Abnormal Findings • Disorders of visual acuity – Myopia – Hyperopia – Astigmatism § Familial condition § Refraction of light spread over a wide area rather than a distinct point on the retina – Presbyopia Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Abnormal Findings • Visual fields – Damage to the retina – Lesions in the

Abnormal Findings • Visual fields – Damage to the retina – Lesions in the optic nerve or chiasm – Increased intraocular pressure – Retinal vascular damage • Cardinal fields of gaze – Strabismus – Esophoria – Exophoria Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

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Eye Tracking Eye tracking follows the eye movementsEye Tracking Eye tracking follows the eye movements
EYE MOVEMENTS EYE MOVEMENTS Eye is moved withinEYE MOVEMENTS EYE MOVEMENTS Eye is moved within
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Eye problems The red eye The dry eyeEye problems The red eye The dry eye
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Conjunctivitis Madras eye Pink eye Eye flu ItConjunctivitis Madras eye Pink eye Eye flu It
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Common eye conditions Red eye Conjunctivitis Dry eyeCommon eye conditions Red eye Conjunctivitis Dry eye
Optics External Eye Eye Globe Eye Structures CorneaOptics External Eye Eye Globe Eye Structures Cornea
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The Eye Human Eye Front of the eyeThe Eye Human Eye Front of the eye
Physical Health What is Physical Health Physical HealthPhysical Health What is Physical Health Physical Health
Comprehensive school eye health programmes Child Eye HealthComprehensive school eye health programmes Child Eye Health
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Together for Eye Health Care National Eye HealthTogether for Eye Health Care National Eye Health
Physical Media PHYSICAL MEDIA Physical Media Physical MediaPhysical Media PHYSICAL MEDIA Physical Media Physical Media
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Chapter 5 PHYSICAL ASSESSMENT 1 HEALTH ASSESSMENT PhysicalChapter 5 PHYSICAL ASSESSMENT 1 HEALTH ASSESSMENT Physical
Introducing VESTIGE EYE SUPPORT IMPORTANCE of Eye HealthIntroducing VESTIGE EYE SUPPORT IMPORTANCE of Eye Health