LECTURE 8 Eye Assessment.pdf Assessing the eye
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Jul 27, 2024
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About This Presentation
Eye assessment is a comprehensive evaluation of the eyes to detect any abnormalities or disorders. It typically includes a series of tests and examinations to assess vision, eye movement, pupil function, and eye health.
A thorough eye assessment may include:
1. Visual Acuity Test: Measures sharpne...
Slide Content
JOHN BLESS AKORTIAKUMAH
[email protected]
Principles and Practice of Health Assessment
NURC 208
EYE ASSESSMENT
[email protected]
Principles and Practice of Health Assessment
NURC 208
EYE ASSESSMENT
2
Eye Assessment
Eye Assessment
HUMAN EYE
•The eye is the organ of sight.
•The eye has a number of components
which include but are not limited to the
cornea, iris, pupil, lens, retina, macula,
optic nerve, choroid and vitreous.
•The eye is the organ of sight.
•The eye has a number of components
which include but are not limited to the
cornea, iris, pupil, lens, retina, macula,
optic nerve, choroid and vitreous.
THE EYE
PARTS OF THE EYE
•Cornea: clear front window of the eye that
transmits and focuses light into the eye.
•Iris: colored part of the eye that helps regulate
the amount of light that enters.
•Pupil: dark aperture in the iris that determines
how much light is let into the eye.
•Lens: transparent structure inside the eye that
focuses light rays onto the retina.
•Cornea: clear front window of the eye that
transmits and focuses light into the eye.
•Iris: colored part of the eye that helps regulate
the amount of light that enters.
•Pupil: dark aperture in the iris that determines
how much light is let into the eye.
•Lens: transparent structure inside the eye that
focuses light rays onto the retina.
PARTS OF THE EYE
•Retina: nerve layer that lines the back of the eye, senses
light, and creates electrical impulses that travel through
the optic nerve to the brain.
• Macula: small central area in the retina that contains
special light-sensitive cells and allows us to see fine
details clearly.
•Optic nerve: connects the eye to the brain and carries
the electrical impulses formed by the retina to the visual
cortex of the brain.
• Vitreous: clear, jelly-like substance that fills the middle
of the eye.
•Retina: nerve layer that lines the back of the eye, senses
light, and creates electrical impulses that travel through
the optic nerve to the brain.
• Macula: small central area in the retina that contains
special light-sensitive cells and allows us to see fine
details clearly.
•Optic nerve: connects the eye to the brain and carries
the electrical impulses formed by the retina to the visual
cortex of the brain.
• Vitreous: clear, jelly-like substance that fills the middle
of the eye.
Physiology of sight
•The eyes and the brain work together to
make sight possible.
•Light is reflected from objects onto the
front surface of your eye, the cornea. The
cornea bends the light, which then passes
through fluid called the aqueous humor,
through the pupil, and to the lens.
•The eyes and the brain work together to
make sight possible.
•Light is reflected from objects onto the
front surface of your eye, the cornea. The
cornea bends the light, which then passes
through fluid called the aqueous humor,
through the pupil, and to the lens.
Physiology of sight
•The lens, which can change its shape,
helps to focus light onto the retina at
the back of the eye.
•On the retina, light forms an upside-
down image on the cones and rods,
the light sensitive receptors in the eye.
The cones and rods send images to the
brain via the optic nerve.
•The lens, which can change its shape,
helps to focus light onto the retina at
the back of the eye.
•On the retina, light forms an upside-
down image on the cones and rods,
the light sensitive receptors in the eye.
The cones and rods send images to the
brain via the optic nerve.
Physiology of sight
•Shortly after leaving the eye, the optic nerves
from each eye cross and separate, sending their
fibers to receiving and analytical stations in the
brain.
•In effect, the brain receives messages from both
eyes.
•Besides interpreting the visual input, if
movement of both eyes is coordinated, the brain
fuses images from each eye together to form an
image.
•Shortly after leaving the eye, the optic nerves
from each eye cross and separate, sending their
fibers to receiving and analytical stations in the
brain.
•In effect, the brain receives messages from both
eyes.
•Besides interpreting the visual input, if
movement of both eyes is coordinated, the brain
fuses images from each eye together to form an
image.
EYE ASSESSMENT/ EXAMINATION
•An eye examination is a series of tests
performed by an ophthalmologist (medical
doctor), optometrist, ophthalmic nurse or
assessing vision and ability to focus on and
discern objects, as well as other tests and
examinations pertaining to the eyes .
•An eye examination is a series of tests
performed by an ophthalmologist (medical
doctor), optometrist, ophthalmic nurse or
assessing vision and ability to focus on and
discern objects, as well as other tests and
examinations pertaining to the eyes .
EYE ASSESSMENT/
EXAMINATION
•Health care professionals often
recommend that all people should have
periodic and thorough eye examinations
as part of routine primary care, especially
since many eye diseases are
asymptomatic.
EXAMINATION
•Health care professionals often
recommend that all people should have
periodic and thorough eye examinations
as part of routine primary care, especially
since many eye diseases are
asymptomatic.
EYE ASSESSMENT/ EXAMINATION
•Eye examinations may detect potentially
treatable blinding eye diseases, ocular
manifestations of systemic disease , or
signs of tumours or other anomalies of the
brain.
•An examination of the eye includes an
external examination, examination by
ophthalmoscope, and an assessment of the
functions of the eye.
•Eye examinations may detect potentially
treatable blinding eye diseases, ocular
manifestations of systemic disease , or
signs of tumours or other anomalies of the
brain.
•An examination of the eye includes an
external examination, examination by
ophthalmoscope, and an assessment of the
functions of the eye.
a. External Examination
•The anterior segment of the eyes and their
appendages can be examined by visual inspection.
1.Note the general appearance of the eyelids,
eyelashes, and lacrimal apparatus. Observe for:
a)Redness around the eye.
b)Discharge or crusting.
c)Growths on eyes or eyelids.
d)Excessive tearing.
2.Position and mobility can be observed by having
the patient rotate the eyes, looking up, down, and to
each side.
•The anterior segment of the eyes and their
appendages can be examined by visual inspection.
1.Note the general appearance of the eyelids,
eyelashes, and lacrimal apparatus. Observe for:
a)Redness around the eye.
b)Discharge or crusting.
c)Growths on eyes or eyelids.
d)Excessive tearing.
2.Position and mobility can be observed by having
the patient rotate the eyes, looking up, down, and to
each side.
b. Pupillary Response.
•Normal pupils are rounded, centrally placed, and generally
equal in size (About 25 percent of normal individuals have
pupils slightly unequal in size.)
1.Reaction to light. Seat the patient in an area with even
lighting and instruct him to fix his gaze on a distant object.
Cover one eye and shine a flashlight in front of the
exposed eye. The pupil should contract (constrict) because
of the light. This response is called a direct reaction. The
covered pupil should also contract. This response is called
a consensual reaction.
•Normal pupils are rounded, centrally placed, and generally
equal in size (About 25 percent of normal individuals have
pupils slightly unequal in size.)
1.Reaction to light. Seat the patient in an area with even
lighting and instruct him to fix his gaze on a distant object.
Cover one eye and shine a flashlight in front of the
exposed eye. The pupil should contract (constrict) because
of the light. This response is called a direct reaction. The
covered pupil should also contract. This response is called
a consensual reaction.
Pupillary Response
2.Near point reaction. When the gaze is
changed from a distant object to an
object close at hand, the pupils should
contract.
2.Near point reaction. When the gaze is
changed from a distant object to an
object close at hand, the pupils should
contract.
Pupillary Response
c. Ophthalmoscopic Examination
•By looking through the various lenses of an
ophthalmoscope, the trained examiner can
view and assess the internal structures of the
eye.
•This examination is routinely performed by the
physician.
•By looking through the various lenses of an
ophthalmoscope, the trained examiner can
view and assess the internal structures of the
eye.
•This examination is routinely performed by the
physician.
An opthalmoscope
d. Functional Examinations
1.Focusing power (power of accommodation) is
tested by placing a line of print close to the eye,
then slowly moving it back to the point at which
the patient is able to read it. The nearest point at
which it is readable is the near point of
accommodation.
2.Visual field refers to all that can be seen with
both eyes fixed straight ahead. To perform a gross
examination of visual field, the confrontation
method is used
1.Focusing power (power of accommodation) is
tested by placing a line of print close to the eye,
then slowly moving it back to the point at which
the patient is able to read it. The nearest point at
which it is readable is the near point of
accommodation.
2.Visual field refers to all that can be seen with
both eyes fixed straight ahead. To perform a gross
examination of visual field, the confrontation
method is used
Functional Examinations
•Have the patient and the examiner face each other at a
distance of about 2-3 feet, each focusing his gaze at the
other's nose.
•The examiner should then extend his arm to the side, point
his finger, and slowly move his arm back in, along a plane
half-way between himself and the patient.
•The examiner's finger should appear in the patient's visual
field at the same time the examiner sees it (assuming the
examiner's visual field is grossly normal).
•Have the patient and the examiner face each other at a
distance of about 2-3 feet, each focusing his gaze at the
other's nose.
•The examiner should then extend his arm to the side, point
his finger, and slowly move his arm back in, along a plane
half-way between himself and the patient.
•The examiner's finger should appear in the patient's visual
field at the same time the examiner sees it (assuming the
examiner's visual field is grossly normal).
Confrontation method.
Functional Examinations
3.Color sense is tested by using specially designed
color plates to distinguish reds, greens, and blues.
4.Visual acuity testing is done with the Snellen chart
or one of its modifications. Each eye is tested
separately, both with and without glasses, if worn.
a)Since the distance at which rays of light from an
object are practically parallel and no
accommodation of the lens is necessary to focus the
object, the test is performed at a distance of 6
meters (20 feet),
3.Color sense is tested by using specially designed
color plates to distinguish reds, greens, and blues.
4.Visual acuity testing is done with the Snellen chart
or one of its modifications. Each eye is tested
separately, both with and without glasses, if worn.
a)Since the distance at which rays of light from an
object are practically parallel and no
accommodation of the lens is necessary to focus the
object, the test is performed at a distance of 6
meters (20 feet),
Visual acuity
b)The Snellen chart contains rows of letters
of varying sizes, arranged to that the
normal eye can see them at distances of 6,
9, 12, 18,24 36 and 60 meters. (20, 30,
40, 50, 70, 100, and 200 feet.)
If a patient is seated 6 meters (20 feet) from
the chart and can read the line of letters for
6 meters, his vision is expressed by the
fraction 6/6 (or 20/20).
b)The Snellen chart contains rows of letters
of varying sizes, arranged to that the
normal eye can see them at distances of 6,
9, 12, 18,24 36 and 60 meters. (20, 30,
40, 50, 70, 100, and 200 feet.)
If a patient is seated 6 meters (20 feet) from
the chart and can read the line of letters for
6 meters, his vision is expressed by the
fraction 6/6 (or 20/20).
Visual acuity
c)Vision is expressed by a fraction, the numerator
denoting the distance at which the test was
performed (normally, 6 meters or 20 feet), and
the denominator denoting the smallest line of
letters which could be read at that distance.
•If a patient is seated 6 meters from the chart and
the smallest line of letters he is able to read is the
one that should be read at a distance of 6 meters,
then his vision is expressed at 6/6.
c)Vision is expressed by a fraction, the numerator
denoting the distance at which the test was
performed (normally, 6 meters or 20 feet), and
the denominator denoting the smallest line of
letters which could be read at that distance.
•If a patient is seated 6 meters from the chart and
the smallest line of letters he is able to read is the
one that should be read at a distance of 6 meters,
then his vision is expressed at 6/6.
Snellen’s
testTumbling ‘E
testTumbling ‘E
Visual acuity
d)If the largest letters on the chart cannot
be read at a distance of 6 meters, the
patient is moved toward the chart until he
can read the largest letters.
▪Vision is then expressed as a fraction, with
the numerator denoting the distance at
which the largest line could be read, and
the denominator denoting the number of
the largest line.
d)If the largest letters on the chart cannot
be read at a distance of 6 meters, the
patient is moved toward the chart until he
can read the largest letters.
▪Vision is then expressed as a fraction, with
the numerator denoting the distance at
which the largest line could be read, and
the denominator denoting the number of
the largest line.
Visual acuity
e)If the patient cannot read the largest line
at a distance of one meter, the examiner
tests the patient's ability to see hand
motion in front of his face. If the patient
cannot see the examiner's hand at a
distance of one meter, he is tested for
light perception.
e)If the patient cannot read the largest line
at a distance of one meter, the examiner
tests the patient's ability to see hand
motion in front of his face. If the patient
cannot see the examiner's hand at a
distance of one meter, he is tested for
light perception.
Visual acuity
•The other eye is occluded and light is flashed
from different directions and the patient is
asked from which direction the light appears
and when it goes on and, it goes off.
•If the patient can do this, the examination is
recorded as "light perception present". If no
light perception is present, a person is
technically blind.
•The other eye is occluded and light is flashed
from different directions and the patient is
asked from which direction the light appears
and when it goes on and, it goes off.
•If the patient can do this, the examination is
recorded as "light perception present". If no
light perception is present, a person is
technically blind.
PIN HOLE (PH)
•The pin hole admits only central rays of light which do
not refine refraction by the cornea and lens.
•The client is thus able to resolve fine details on the VA
chart without VA correction.
•If the use of pin hole does not improve the vision, then
it is not a refractive error but other problems.
• Ask client to use PH with occluder the RE and change
over to the LE. Record findings in the folder;
•VR
6
/
6 ć glasses (g/s) VL 6/6 ć glasses (g/s)
•The pin hole admits only central rays of light which do
not refine refraction by the cornea and lens.
•The client is thus able to resolve fine details on the VA
chart without VA correction.
•If the use of pin hole does not improve the vision, then
it is not a refractive error but other problems.
• Ask client to use PH with occluder the RE and change
over to the LE. Record findings in the folder;
•VR
6
/
6 ć glasses (g/s) VL 6/6 ć glasses (g/s)
Functional Examinations
5.These functional examinations are routinely
performed by the physician or eye specialist.
However, it is recommended that nursing
personnel be knowledgeable of these
examinations. To do so will facilitate identification
of visual abnormalities.
•A gross examination using "field expedient
techniques" can be performed when the proper
equipment and personnel are not available. For
example:
5.These functional examinations are routinely
performed by the physician or eye specialist.
However, it is recommended that nursing
personnel be knowledgeable of these
examinations. To do so will facilitate identification
of visual abnormalities.
•A gross examination using "field expedient
techniques" can be performed when the proper
equipment and personnel are not available. For
example:
Functional Examinations
a)Colour sense can be observed by having
the patient identify the color of objects
around him.
b)Gross acuity can be tested by having the
patient read signs posted on the walls.
Use signs of different sizes and position
the patient at varying distances.
a)Colour sense can be observed by having
the patient identify the color of objects
around him.
b)Gross acuity can be tested by having the
patient read signs posted on the walls.
Use signs of different sizes and position
the patient at varying distances.
COUNTING FINGERS (CF)
•If the client is unable to read on the 6/60 line i.e. first
line, then the following steps should be followed:
•The examiner should move one meter away from the
chart towards the client.
•Raise a finger or two at eye level and ask the client to
tell the number of fingers.
•Keep moving towards the client 1 meter each time.
•Record findings indicating the distance e.g.
•VR 6/60 ć PH VL CF @ 2M
•If the client is unable to read on the 6/60 line i.e. first
line, then the following steps should be followed:
•The examiner should move one meter away from the
chart towards the client.
•Raise a finger or two at eye level and ask the client to
tell the number of fingers.
•Keep moving towards the client 1 meter each time.
•Record findings indicating the distance e.g.
•VR 6/60 ć PH VL CF @ 2M
HAND MOVEMENT TEST (HM)
•If the client is unable to identify the fingers
at a distance of 1m, then the following
steps should be followed:
•At 1m, move hand in different directions
•Ask client if he/she can see the directions
or what you are doing.
•VR Hm VL Hm
•If the client is unable to identify the fingers
at a distance of 1m, then the following
steps should be followed:
•At 1m, move hand in different directions
•Ask client if he/she can see the directions
or what you are doing.
•VR Hm VL Hm
PERCEPTION OF LIGHT (PL)
•If the client is unable to see the HM at 1m
ask client to occlude the LE with the LH.
•Flash light from torch on the RE and ask
if he/she can see it/feel it.
•VR PL VL PL
•No perception of light (NPL)
•VR NPL VL NPL
•If the client is unable to see the HM at 1m
ask client to occlude the LE with the LH.
•Flash light from torch on the RE and ask
if he/she can see it/feel it.
•VR PL VL PL
•No perception of light (NPL)
•VR NPL VL NPL
BASIC THINGS TO NOTE
•Lid = Normal or swelling. Is it the upper
eyelid or the lower eyelid?
•Evert and examine the tarsal plate
•Conjunction = Normal or Swelling
•How is the colour? Yellow, Red,
Brownish, enjected.
•Cornea = Clear and transparent (normal)
or abrasion, opacity, Foreign body (FB).
•Lid = Normal or swelling. Is it the upper
eyelid or the lower eyelid?
•Evert and examine the tarsal plate
•Conjunction = Normal or Swelling
•How is the colour? Yellow, Red,
Brownish, enjected.
•Cornea = Clear and transparent (normal)
or abrasion, opacity, Foreign body (FB).
BASIC THINGS TO NOTE
•AC = Aqueous adequate (Normal) swallow
•Iris = Brown (Normal)
•Pupil = Shape (Normal) round, size, reacts to
light central on the eye. Slanguish = abnormal
•Lens = Transparency or Opacities
•Vitreous = Disc margin, vessels macula
•Fundus = Pink or Pale
•AC = Aqueous adequate (Normal) swallow
•Iris = Brown (Normal)
•Pupil = Shape (Normal) round, size, reacts to
light central on the eye. Slanguish = abnormal
•Lens = Transparency or Opacities
•Vitreous = Disc margin, vessels macula
•Fundus = Pink or Pale
Note
•Early eye exams are important because children
need the following basic visual skills for
learning:
•Near vision
•Distance vision: Tumbling E chart, Landolt C
chart
•Eye teaming (binocularity )
•Eye movement
•Accommodation (focusing skills)
•Peripheral vision
•Eye–hand coordination
•Early eye exams are important because children
need the following basic visual skills for
learning:
•Near vision
•Distance vision: Tumbling E chart, Landolt C
chart
•Eye teaming (binocularity )
•Eye movement
•Accommodation (focusing skills)
•Peripheral vision
•Eye–hand coordination
ASSESSING SYMPTOMS
•In addition to the examinations mentioned previously, the
patient should be assessed for the following:
a)Discomfort or pain in or around the eye.
b)Photophobia. (Abnormal sensitivity to light.)
c)Nystagmus. (Involuntary, rapid movement of the eyeball.
May be horizontal, vertical, rotational, or mixed.)
d)Strabismus. (Deviation of the eye from the normal
physiological axis: "crossed eyes.")
e)Diplopia. (Seeing an object in double: "double vision.")
f)Blurred vision.
g)"Spots" or "lights" in the visual field.
•In addition to the examinations mentioned previously, the
patient should be assessed for the following:
a)Discomfort or pain in or around the eye.
b)Photophobia. (Abnormal sensitivity to light.)
c)Nystagmus. (Involuntary, rapid movement of the eyeball.
May be horizontal, vertical, rotational, or mixed.)
d)Strabismus. (Deviation of the eye from the normal
physiological axis: "crossed eyes.")
e)Diplopia. (Seeing an object in double: "double vision.")
f)Blurred vision.
g)"Spots" or "lights" in the visual field.
CONDITIONS THAT AFFECT THE
EYELID
•Stye cause (Staphylococcal infection)
•Blepharitis cause (Staphylococcal infection)
•Entropion cause (chlamydial trachoma)
•Lagothalmos cause (leprosy)
•Ptosis (drooping of the eyelid)
•Internal hordelum cause (staphylococcal infection)
•Chalazion cause (blockage of meibomain gland orifice)
EYELID
•Stye cause (Staphylococcal infection)
•Blepharitis cause (Staphylococcal infection)
•Entropion cause (chlamydial trachoma)
•Lagothalmos cause (leprosy)
•Ptosis (drooping of the eyelid)
•Internal hordelum cause (staphylococcal infection)
•Chalazion cause (blockage of meibomain gland orifice)
CONDITIONS THAT AFFECT THE
EYELID
•Molliscum contagiosum
•Cancrum
•Ectropion
•Eyelid retraction
•Eyelid Tumours
•Preseptal Orbital cellulites
•Postseptal
•Madarosis
EYELID
•Molliscum contagiosum
•Cancrum
•Ectropion
•Eyelid retraction
•Eyelid Tumours
•Preseptal Orbital cellulites
•Postseptal
•Madarosis
CONDITIONS THAT AFFECT THE
CONJUCTIVA
•Bacterial conjunctivitis
•Viral conjunctivitis
•Adenovirus conjunctivitis
•Granulomatous
conjunctivitis
•Allergic conjunctivitis
•vernal conjunctivitis
•Hay fever conjunctivitis
•Phlyctenular conjunctivitis
•Endogenous conjunctivitis
•Kerato conjunctivitis
CONJUCTIVA
•Bacterial conjunctivitis
•Viral conjunctivitis
•Adenovirus conjunctivitis
•Granulomatous
conjunctivitis
•Allergic conjunctivitis
•vernal conjunctivitis
•Hay fever conjunctivitis
•Phlyctenular conjunctivitis
•Endogenous conjunctivitis
•Kerato conjunctivitis
CONDITIONS THAT AFFECT THE
CONJUCTIVA
•Ocular pemphigoid
•Stevens – Jonson
Syndrome
•Rosacea
•Traumatic conjunctivitis
•Phychological causes of
conjunctivitis
•Neonatal conjunctivitis
(Ophthalmia neonaton)
•Pinguecula
•Pteryginm
•Concretions
•Conjunctival tumours
CONJUCTIVA
•Ocular pemphigoid
•Stevens – Jonson
Syndrome
•Rosacea
•Traumatic conjunctivitis
•Phychological causes of
conjunctivitis
•Neonatal conjunctivitis
(Ophthalmia neonaton)
•Pinguecula
•Pteryginm
•Concretions
•Conjunctival tumours
CONDITIONS THAT AFFECT THE
CORNEA
•Herpes simplex corneal
ulcers
•Corneal anesthesia
•Stromal keratitis
•Perforation corneal ulcer
•Suppurative keratitis
•Corneal scars
•Bacterial keratitis
•Fungal keratitis
•Phlyctens
•Marginal infiltrates
•Peripheral ulcerative
keratitis
CORNEA
•Herpes simplex corneal
ulcers
•Corneal anesthesia
•Stromal keratitis
•Perforation corneal ulcer
•Suppurative keratitis
•Corneal scars
•Bacterial keratitis
•Fungal keratitis
•Phlyctens
•Marginal infiltrates
•Peripheral ulcerative
keratitis
CONDITIONS THAT AFFECT THE
CORNEA
•Mooren’s ulcer or ring
ulcer
•Exposure corneal ulcer
•Neuroparalytic keratitis
•Superficial puntate
keratitis
•Keratoconns
•Fuchsn dystrophy
•Arcus senilis
•Solar keratopathy
•Band keratopathy
•Trachoma
•Xerophthalmia
•Onchocerciasis
CORNEA
•Mooren’s ulcer or ring
ulcer
•Exposure corneal ulcer
•Neuroparalytic keratitis
•Superficial puntate
keratitis
•Keratoconns
•Fuchsn dystrophy
•Arcus senilis
•Solar keratopathy
•Band keratopathy
•Trachoma
•Xerophthalmia
•Onchocerciasis
CONDITIONS THAT AFFECT THE
EXTRAOCULAR MUSCLES
•Squint
•Facial palsy
•Epicanthus
•Tumours
•Cysts
•Inflammatory orbital masses
•Vascular lesions
EXTRAOCULAR MUSCLES
•Squint
•Facial palsy
•Epicanthus
•Tumours
•Cysts
•Inflammatory orbital masses
•Vascular lesions
trachoma
onchocerciasis
keratitis Ophthalmia neonatarium
onchocerciasis
keratitis Ophthalmia neonatarium
Facial palsy
squint
ectropion ptosis
squint
ectropion ptosis
End
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