Weber

Health Assessment in Nursing

Chapter 15: Eyes

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

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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
Accommodation
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Collecting Subjective Data

History of present health concern
Past health history
Family history
Lifestyle and health practices

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Cataract

Opacity or clouding of the eyes lens

Leading cause of blindness worldwide

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Risk Factors
Increasing age
Exposure to ultraviolet B light
Diabetes mellitus
Cigarette smoking
Alcohol use
Diet low in antioxidant vitamins
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Risk Factors (cont.)

High blood pressure
Eye injuries/surgery
Steroid use
Female gender
Persistent diarrhea
Gout
Abdominal obesity
Beta blocker use
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Risk Reduction

Wear sunglasses
Quit smoking
Limit alcohol intake
Avoid eye injuries
Regular eye examination

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.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

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
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Distant Visual Acuity

Snellen chart
Normal acuity is 20/20 with or without
corrective lenses

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Near Visual Acuity

Handheld vision chart

Normal acuity is 14/14 with or without
corrective lenses

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.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Confrontation Test

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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
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Testing Extraocular Muscle Function

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Extraocular Muscle Dysfunction

Corneal light reflex test abnormalities
Pseudostrabismus, strabismus
Test abnormalities
Phobia
Positions test abnormalities
Paralytic strabismus, 6th, 4th, 3rd
nerve paralysis
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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 (Contd)

Palpate the lacrimal apparatus
Inspect the cornea and lens
Inspect the iris and pupil
Test pupillary reaction to light
Test accommodation of pupils
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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 pupils reaction to light
Normally, pupils constrict

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Accommodation

Shifting gaze from far to near

Normally, pupils constrict

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Ophthalmoscope

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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
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Abnormalities of Cornea and Lens

Corneal abnormalities
Corneal scar, pterygium
Lens abnormalities
Nucleus cataract, peripheral cataract

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Abnormalities of Iris and Pupil

Irregularly shaped iris
Miosis
Anisocoria
Mydriasis

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Abnormalities of Retinal Vessels and

Background
Constricted arteriole
Copper wire arteriole
Silver wire arteriole
Arteriovenous nicking
Arteriovenous tapering
Arteriovenous banking
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Abnormalities of Retinal Vessels and

Background (Contd)
Cotton wool patches
Hard exudate
Superficial retinal hemorrhages
Deep retinal hemorrhages
Microaneurysms
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Abnormalities of Optic Disc

Papilledema
Glacoma
Optic atrophy

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Question
Tell whether the following statement is
True or False.
In 3rd nerve paralysis, the eyes cannot
look down when turned inward.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False.
In 3rd nerve paralysis, the eye looks
straight ahead. If the eyes cannot look
down when turned inward it indicates 4th
nerve paralysis.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins