Eye and Ear Assessment Introduction • Importance of eye and ear assessments • Common reasons for conducting assessments Eye Assessment

Physical Examination

1. | Eye and Ear Assessment

by
Sharon Kerr, MSN, RN
Spring 2010

2. + Normal Anatomy of the Eye

Eyelid Pupil
bid a

Sclera
Superior rectus muscle

3. +4 External Eye Exam

Inspect for:

= Symmetry

= Discharge or lesions

« Eyelids: blink, position (ptosis), swelling

= Sclera: should be white (not red or yellow)
= Cornea: assess for opacity or scratch

= Conjunctiva: should be pink

4. + External Eye Exam continued

Pupil -- Check for response to:

= Accomodation
= PERRLA

5. m External Eye Exam continued

Extraocular Muscle Function

= Check eye movement through the six
cardinal directions of gaze.

= Watch for parallel movement

= Nystagmus (involuntary rapid rhythmic
movement)

6. 4 Normal Anatomy of the Eye

= Cornea:
= Clear layer covering
the front of the eye.
= works with the lens
to focus images on
the retina.

7. CL Normal Anatomy of the Eye

= Retina
= internal layer
= receives and
transmits focused
images.
= normally red due to
its rich blood supply.

Retina
Blood vessels —

Lens

Cornea ——

Optic disc —

8. = Can be seen with an
ophthalmoscope

= Allows the examiner
to see through the
pupil and lens to the
retina

= = Called a funduscopic

exam

9. if Retina
= Examination of

a A fundus includes

= Retina
= Optic disc
= Blood vessels.

11. Funduscopic Exam
Ophalmoscope

= Seated in a darkened room

« Examiner projects a beam of light
from an ophthalmoscope through the
pupil to view the back of the eyeball

12. m Using the Ophalmoscope

= Turn on and adjust to round beam of
white light

= Place scope light on dim setting

= Set lens disc to 0 diopters (neutral)

= Keep index finger on lens disc to adjust
during examination

13. m Approaching the patient

= Right hand and right eye to pt. Right
eye
= Left hand and left eye to pt. Left eye

= Hold opthalmoscope firmly against your
bony orbit

= Glasses off (both examiner and patient)
= Contacts are OK

14. m The examination

= Have patient look over your shoulder
and across the room at a specific point
on the wall

= From about 15 inches and 15 degrees
lateral to the patient’s line of vision,
shine the light beam on the pupil

15. m Getting a closer look

= Should see an orange glow (the red
reflex — reflection of light off retina)

= Move in on the 15 degree line toward
the pupil , almost touching the patient's
lashes

16. 4 Finding the optic disk

= On NASAL side of each retina
= Yellowish orange to creamy pink oval or
round

= Follow a blood vessel centrally until you
see it

17. | Inspecting the optic disk

= Clarity — should have sharp margins

= Symmetry of both eyes

18. +4 Inspecting the retina

= Visualize arteries and veins

= Identify any lesions in retina
= Red spots, streaks, light spots

20. Normal Retina - Left Eye
(Photo courtesy of Dr. David Rapaport)

21. 4 Normal Anatomy of the Ear

= external, middle,
and inner structures.

= eardrum and the
three tiny bones
conduct sound from
the eardrum to the
cochlea: malleus,
incus, stapes

22. +4 External Ear Exam

= Symmetry, size, shape

= Position: pinna level with corner of eye
m Lesions

= Drainage

23. Examine Auditory Acuity

= Whisper two syllable word (out of view)
= Weber Test: lateralization of sound..

= Rinne test: bone vs air conduction of
sound

25. 4 Normal Anatomy of the Ear

Tympanic membrane

= The tympanic
membrane, or eardrum
= separates the ear canal

and the middle ear.

= ossicles : can see the
short process of the
malleous, handle of the
malleous, and the incus

= There is a cone of light
that is a reflection of the
otoscope light

26. 4 Otoscopic Examination

= An otoscope

= is an instrument
al used to look into the
at Eardrum ear canal

= ear speculum

= acone-shaped
viewing piece of the
otoscope)

= Use largest size

"ADAM possible

Otoscope

27. +4 Otoscopic Examination

= Dim lights in room
= Patient in sitting position
= Pull ear up and back (down for kids)

= SLOWLY insert otoscope into ear canal
while looking into viewer

28. +4 Otoscopic Landmarks

= Tympanic membrane: should be intact,
pearly gray, translucent, shiny

= Cone of light: right side 4/5 o'clock;
left side 7/8 o'clock

= Malleus short process -- knob

29. +4 Abnormal Findings:

= Perforations

= Bulging

= Retraction

= Blue ,red, or amber coloring
= dullnss

30. ~ light roflex

Photo 1 Normal Eardrum

31. if Otoscopic Examination

= The speculum is angled
slightly toward the
person's nose to follow
the canal.

A light beam extends
beyond the viewing tip
of the speculum.

The otoscope is gently
moved to different
angles to view the canal
walls and eardrum.

32. Photo 2 Soft Yellow Earwax

33. Photo 5 Swimmer's Ear (otitis externa)

34. Photo 4 Swimmers Ear lotitis externa)

35. Photo 7 Hole In Eardrum (perforation)

36. Photo 8 Ear Tube in Eardrum

37. | That's all folk's

The End