Chapter 15: Eyes

Question 1

What are the cranial nerves that affect the eyes?

Answer 1

CN II = Optic
CN III = Oculomotor
CN IV = Trochlear
CN VI = Abducens

Question 2

Presbyopia

Answer 2

Common to the aging adult; lens lose elasticity, affecting the eye’s ability to change shape –> farsightedness

Question 3

Cataracts

Answer 3

Affects predominantly the aging population; protein build up in the lens; looks cloudy

Question 4

Glaucoma

Answer 4

Increased pressure in the eye; complication of diabetes

Question 5

Subjective Data

Answer 5

Ask the patient about history of or recurring:
Vision difficulty/changes
Pain
Strabismus, diplopia
Redness, swelling
Discharge (color, thickness, smell)
Use of glasses/contacts
Last eye exam
Environmental exposures, eye protection, smoking

Question 6

Common Eye Symptoms (reasons people come in)

Answer 6

Pain
Trauma, surgery
Visual changes
Blind spots, floaters, halos
Discharge
Changes in ADLs

Question 7

How do we assess CN II (optic)?

Answer 7

Snellen eye chart; based at 20 feet from chart (the larger the bottom number, the worse the vision)

Question 8

How do we assess visual fields (peripheral vision)?

Answer 8

Confrontation (this assesses a person’s peripheral vision);
Stand in front of the patient and cover one of your eyes…have the patient mirror you. Stare at each and slowly bring finger from the outside (side of covered eye) into the field of vision…have patient tell you when they see your finger (should be at the same time as you)

Question 9

How do we assess CN III (oculomotor), CN IV (trochlear), and CN VI (abducens)?

Answer 9

These are the CNs that innervate eye muscles (EOMs = extra ocular muscle movement);

1) Corneal light reflex = tests for strabismus; dim the lights to dilate the patient’s eyes…have them stare straight ahead. Bring a pen light into view of one eye…both pupils should constrict to the same size at the same time. Repeat on both sides

2) Cardinal fields of vision = assesses alignment and coordination of eye movement; have the patient stare straight ahead. Have the patient follow your finger with JUST their eyes as you move it through the SIX cardinal fields of vision

Question 10

Inspection

Answer 10

Eyebrows (symmetry)
Eyelashes
Eyelids (swelling, drooping)
Eye shape (symmetry, swelling, bulging)
Conjunctiva (pink), sclera (white)

Question 11

How do we assess pupils (PERRLA)?

Answer 11

Pupils Equal, Round, React to Light, Accommodating;

Accommodating = have the patient stare ahead at a distant object so that they dilate…then have them follow your finger as you bring it in towards their nose…their eyes should cross and their pupils should constrict equally

Question 12

Strabismus

Answer 12

Exotropia = cross outward
Esotropia = cross inward

Question 13

Periorbital edema

Answer 13

Swelling around the eyes

Question 14

Exophthalmos

Answer 14

Protruding eyes (hyperthyroidism)

Question 15

Ptosis

Answer 15

Drooping upper eyelid

Question 16

Upward palpebral slant

Answer 16

Common in people with Down Syndrome

Question 17

Conjunctivitis

Answer 17

Infection/inflammation of the conjunctiva

Question 18

Jaundice

Answer 18

Yellowing of the eyes; common in people with liver disease