EYE EXAMINATION(Linda).pptx

Eye examination procedure for practical and theory exams

1. P resented to : Resp. Kirti ma’am Faculty C ollege of Nursing VMMC & SJH P resented by : T.H Sasiine Linda B.Sc ( H ) Nsg 4 TH year 0045030661 8 EYE EXAMINATION

2. The Human Eye: Eye is an important and one of the most complex organ. It helps in visualizing objects and also helps us in light, color and depth perception. It is spherical in shape. It is about 2.5cm in diameter It is situated in orbital cavity.

3. EYE EXAMINATION : An eye examination is a series of tests performed by an ophthalmologist , optometrist or orthoptist, opticians to assess vision and ability to focus and discern objects as well as other tests and examinations pertaining to the eyes.

4. ASSESSMENT OF EYE DISORDERS OCULAR HISTORY - Q uestions asked during examination : What does the patient perceive to be problem? Is visual ac u ity diminished? Does patient experience blurred, double or distorted vision? Is there pain ? Is it sharp or dull? Is it worse while blinking? Is the discomfort an itching sensation or more of a foreign body sensation? Are both eyes affected? Is there any history of discharges? If so , e nquire about colour consistency and odour.

5. Contd. Describe the onset of problem(sudden or gradual) Is it worsening? What is the duration of the problem? Is there any systemic diseases? What medications are used for treatment? What makes the symptoms improve or worsen? Is there any history of eye surgery? Does any other family members ha ve the same symptoms or condition.

6. VISUAL ACUITY VIS IUAL ACUITY - .Visual a cuit y is tested for both near 14 inches away and distance 20 feet away Vision and is performed on each eye separately with a standardized Snellen’s chart for distance and a Rosenbaum pocket vision screener for near vision. The fraction 20/20 or 6/6 is considered the standard of normal vision

7. EXTERNAL EYE EXAMINATION The Nurse assess for symmetry and placement of eyelids, pupils and muscles . The extraocular movements of the eyes are tested by having the patient follow the examiner‘s finger, pencil or a hand light through the six cardinal directions of gaze Important when screening patients for Ocular trauma or neurologic disorders such a myasthenia gravis

8. Contd. The nurse observes for ptosis (drooping of the eyelids) ectropion (turning out of lower eyelid) entropion(turning in of eyelid) may involve trichiasis (turning in of eyelashes). Eyelids and eyelashes should be free of drainage or scaling. The room should be darkened so that pupils can be examined. The pupillary response is checked with a penlight to determine if pupils are equally reactive and regular.

9. DIAGNOSTIC EVALUATION DIRECT OPHTHALMOSCOPY- A direct ophthalmoscopy is a handled instrument with various plus and minus lenses The lenses can be rotated into place, enabling the examiner to bring the cornea, lens and retina into focus sequentially. The examiner holds the ophthalmoscope in right hand and uses the right eye to examine patient’s right eye. The examiner switches to the patient left hand and left eye when examining patient’s left eye . D uring the examination room should be on same level as examiner eyes. The patient and examiner should be comfortable and both should breath normally.

10. Contd. INDIRECT OPHTHALMOSCOPY- it is used to see large areas of retina although in a unmagnified state. It produces a bright and intense light. The light source is affixed with a pair of binocular lenses mounted on the examiner’s head. The ophthalmoscope is used with a handheld 20 - diopter lens.

11. SLIT LAMP EXAMINATION- It is a binocular microscope mounted on a table. This instrument enables the user to examine eye with magnification of 10-40 times real image. The illumination can be varied from broad to narrow beam of light for different view of eye. By varying width and intensity of light anterior chamber can be examined for signs of inflammation. These structures can be examined eyelid, cornea, sclera, conjunctiva, iris aqueous humor natural crystalline lens.

12. Contd. Once in the examination chair, physician will place instrument in front of patient so as to rest chin and forehead. This helps steady head for exam. Drops containing yellow dye called Fluorescent are put in eye which will wash away tear and make abnormalities on surface of cornea more visible. Additional drops may also be put in eyes to allow pupils to dilate .

13. TONOMETRY It is a procedure to determine intraocular pressure( the fluid pressure inside eye).It is an important test in evaluation of patient’s at risk of glaucoma(Normal IOP=12-22 mmHg).The device used for measuring IOP is an accurately calibrated tonometer which measures the pressure needed to flatter the cornea just a bit. Doctor will adjust the tension until they get a proper reading. Because the probe touches the highly sensitive cornea a topical anaesthetic eye drops is administered prior to test measurement .

14. COLOUR VISION TEST The most common color vision test is performed using Ishihara polychromatic plates On each plate are dots of primary colors that are integrated into a background of secondary colors Patients with diminished color vision may be unable to identify the hidden shapes.

15. AMSLER GRID I t is a test often used for patient with macular problem such as macular degeneration. It consist of geometric grid of i dentical squares with a central fixation point. The grid should be viewed by the patient wearing normal reading glasses. Each eyes is tested separately. The patient is instructed to stare at central fixation spot on the grid and report any distortion in squares of grid itself.

16. FUNDUS PHOTOGRAPHY Fundus photography is used to detect and document retinal lesions. The patient’s pupils are usually widely dilated before procedure. The resulting fundus photographs can be viewed stereoscopically so that elevations such as macular edema can be identified.

17. LASER SCANNING Various scanning techniques use laserlight in diagnostic evaluation of eye disorders . confocal laser scanning ophthalmoscopy provides a 3- dimensional image of optic nerve topography and is used alone or in conjunction with fundus photography to provide comparative data for suspected optic nerve disease such as glaucoma and papilledema (swelling of optic disc due to increased intracranial pressure ICP)

18. ULTRASONOGRAPHY Ultrasonography i s a valuable diagnostic technique especially when the view of retina is obs cur ed by opaque media such as cataract or hemorrhage. An ultrasonography B- scans identifies pathology such as orbital tumors, retinal detachment and vitreous hemorrhage. Ultrasonography A-scans are used to measure axial length for implants prior to cataract surgery.

19. ANGIOGRAPHY Angiography is done by using fluorescein or indocyanine green and contrast agents. Fluorescein angiography is used to evaluate clinically significant macular edema , document macular capillary no n perfusion and identify retinal and chlorodal neovascularization (growth of abnormal new blood vessel). It is an invasive procedure in which fluorescein dye is injected usually into an anticubital vein. Within retinal vessels black and white photographs are taken by retinal vasculature over a period of 10 mins.

20. Contd. Indocyanine green angiography is used to evaluate abnormalities in the choroidal vasculature, which often are seen in macular degeneration. Indocyanine green dye is injected Intravenously and multiple images captured over a period of 30 secs to 20 minutes

21. SUMMARY I ntroduction and D efinition of E ye A ssessment of eye disorders : Ocular history, Visual acuity , external eye examinati on Diagnostic evaluation: opthalmoscopy, slit lamp examination, tonometry, colour vision test, amsler grid, fundus photography, laser scanning, ultrasonography and angiography.