Weber Health Assessment in Nursing Chapter 15 Eyes

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

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

Vision • Visual fields • Visual pathways • Visual reflexes – Pupillary light reflex

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

Cataract • Opacity or clouding of the eye’s lens • Leading cause of blindness

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

Risk Reduction • Wear sunglasses • Quit smoking • Limit alcohol intake • Avoid

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

Answer True. Exposure to ultraviolet radiation increases the risk for development of cataracts. Copyright

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

Distant Visual Acuity • Snellen chart • Normal acuity is 20/20 with or without

Near Visual Acuity • Handheld vision chart • Normal acuity is 14/14 with or

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

Answer False. When testing near visual acuity the client should keep his or her

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

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

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 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 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Accommodation • Shifting gaze from far to near • Normally, pupils constrict Copyright ©

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

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

Abnormalities of Iris and Pupil • Irregularly shaped iris • Miosis • Anisocoria •

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

Abnormalities of Optic Disc • Papilledema • Glacoma • Optic atrophy Copyright © 2010

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