Eye Assessment Flashcards
Palpebral fissure
Almond shaped open space between eye lids
Function of eyelids
Loose mandible folds of skin that cover the eye, protect it from foreign bodies, regulate light entrance, distribute tears
Limbus
Border between the cornea and sclera
Conjunctiva
Thin mucous membrane that lines the inner eyelid and also covers the sclera
Lacrimal apparatus
Consist of the lacrimal gland, punctum, lacrimal sac, nasolacrimal duct
Protects and lubricates the cornea and conjunctiva by producing and draining tears
Superior rectus
Elevates the eye upwards and adducts and rotates the eye medially
Inferior rectus
Rotates the eye downward and adducts and rotates the eye medially
Lateral rectus
Moves the eye laterally (toward the temple)
Medial rectus
Moves the eye medially
Superior oblique
Turns the eye downward and abducts and rotates the eye laterally
Inferior oblique
Turns the eye upward and abducts and turns the eye laterally
Eye has three layers of tissue
- Outer fibrous layer contains sclera and cornea
- Vascular middle composed of iris, ciliary body and choroids
- Inner neutral layer is the retina
Sclera
Helps maintain the size and shape of the eye
Cornea
Allows light rays to enter the eye
Iris
Regulates the amount of light that enters the pupil
Pupil
Opens and closes to allow light into the eye
Pupil size can range from
3-5 mm
Lens
Sits directly behind the pupil, refracts and focuses the light on to the retina
Ciliary body
Produces aqueous humor and contains muscle that controls the shape of the lens
Choroids
Network of blood vessels to the eye
Covers recessed portion of the eye
Interior eye has three chambers
Anterior, posterior and vitreous
Anterior chamber
Space between the cornea in the front and iris and lens in the back
Contains aqueous humor; produced by ciliary body amount varies to maintain eye pressure
Posterior chamber
Starts behind the iris and goes to the lens
Filled with aqueous humor to help nourish the cornea and lens
Vitreous chamber
Adjacent to the inner retinal layer and the lens
Filled with vitreous fluid, gel like, holds retina in place and maintains shape of the eyeball
Retina
Innermost layer of eye, receives and transmit visual stimuli to the brain for processing.
Contains photoreceptors; rods and cones
Rods
Outer edge of retina, primary responsible for vision in low light and varying shades of black and white
Cones
Concentrated centrally
Adapted to bright light and produces color and sharp images
Optic disc
Opening for the optic nerve head
Macula
Area with greatest concentration of cones
Pregnant women
Common problem is
dry eyes due to decreased conjunctival capillaries
Corneal curvature increases, loss of accommodation
Visual field changes may occur possibly the pituitary gland affecting the optic nerve
Decreased inter ocular pressure is significant if the woman has glaucoma
Chloasma may result from increased progesterone levels
Newborn and infants
Visual system is least matured compared to others
Vision reaches adult level by 4-5 years old
Newborns are sensitive to light and often keep eyes closed
Limited ability to focus but able to track at 3 months
In infants the pupils are?
Reactive to light
Blink reflex is intact
Corneal reflex is easily stimulated
Reflex tearing is present at birth but emotional tearing is present by?
3 months
Visual acuity ranges from ?
20/20 to 20/40 normally
Depth perception develops throughout childhood
How does the eye structure and vision change in older adults?
Eyelids droop
Eyes sit further back in orbit due to loss of subcutaneous fat
Conjunctiva are thinner and may appear yellow
Iris may have irregular pigmentation
Tearing decreases
Because pupil is smaller is older adults, there is a loss of?
accommodation, decreased night vision, and decreased depth of perception
In older adults, the lens?
Enlarges and transparency decreases, making vision less acute
Does gradual vision loss require emergent medical attention?
No, but is significant
Rapid assessment of the eye includes assessing for?
Foreign bodies, lacerations, hyphema, testing extraocular movements and examine the optic disc
Risk factors for eye problems?
Family history, trauma, illnesses, occupational hazard
Leading causes of new cases of blindness
Age related macular degeneration Glaucoma Diabetic retinopathy Cataracts Optic nerve atrophy
Diabetes mellitus increases risk for?
Diabetic retinopathy, glaucoma, cataracts
Common eye symptoms
Pain, trauma, visual change, blind spots,floaters, halos, discharge, change in ADLs
Loss of night time vision is associated with?
Optiathrophy, glaucoma and vitamin A deficiency
Discharge in eyes is associated with?
Inflammation or infection
Ophthalmoscope
Used to inspect interior ocular structures
In what order do you examine infected eye?
Last
Optic nerve II
Visual acuity
Visual fields
Fundoscopic examination
Optic nerve III
Occulomotor
Cordial fields of gaze
Eyelid inspection
Pupil reaction
Cranial nerve IV
Trochlear
Cardinal fields of gaze
Cranial nerve VI
Abducens
Cardinal fields of gaze
Visual acuity test include?
Near vision, distance vision, peripheral vision, and color vision
Abnormal finding in Snellen’s chart
Leaning forward, squinting, hesitation, misidentification or more than three of seven objects, or more than two line difference in eyes,larger number on bottom indicates diminished distance vision
Near vision is assessed with?
Jaeger test, or if it isn’t available have the r dad magazine or newspaper
Color vision is assessed with?
Ishihara cards or color bars on Snellen’s chart
Visual field
What in the environment is visual when the eye fixates on a stationary object
Confrontation test
Static or kinetic
Used to screen for visual field defects
Visual field is divided into four quadrants
Three basic test allows for examination of extraocular muscles
Corneal light reflex
Cover test
Cardinal fields of gaze
Corneal light reflex test for?
Strabismus
Cover test for?
Presence and amount of ocular deviation
6 cardinal fields of gaze
Allows nurses to detect muscle defects that cause misalignment or uncoordinated eye movement
Ptosis
Drooping eyelids
If patient reports dry eyes or eye fatigue, inspect?
Lacrimal apparatus
Suspect conditions for enlarged lacrimal gland?
Sarcoidosis disease or Sjögren’s syndrome
Pterygium
Abnormal thickening of conjunctiva from limbus over the cornea
Scleral abnormalities include?
Jaundice, bluing, mad drainage
Cloudiness of lens can indicate?
Cataract which is associated with age, smoking, alcohol intake, and sunlight exposure
Binocular vision develops between?
3 and 7 months
How do you assess vision in infants?
Testing for pupillary light reflex and observing behavior
How do you assess a toddlers visual acuity?
Allen’s test
Normal finding in toddlers is 20/200 bilaterally
How do you assess vision in preschool age?
(3-5 years)
Snellen’s E chart
Normal finding is 20/40
Arcus senilis
Grey/white circle that circumscribes the limbus and results from deposition of lipid is common cloudiness that appear around the corneas
Asthenopia
Eye strain
Common symptoms
fatigue, red eyes, eyes strain, pain in or around the eyes, blurred vision, headaches, rarely, double vision
Astigmatism
Abnormal curvature of the cornea prevents light from focusing on the retina. Images appear blurred
Myopia
Can see objects close up but difficulty seeing distant objects
Hyperopia
Distant objects are seen clear and close up objects are blurry
Presbyopia
Natural part of aging and affects near vision
Nystagmus
Involuntary rhythmic wobbling of the eyes
Strabismus
Cross eyed or wall eyed
Condition in which a person cannot align both eyes simultaneously
Jaundice
Yellowing of sclera, indicates liver disease
Iris Nevus
Affects one side, abnormalities in iris, pain and decreased vision may also have glaucoma on same side
Hyphema
Blood in anterior chamber of eye, blunt trauma
Bleparitis
Inflammation of the margin of the eyelid, anterior or posterior
Chalazion
Cyst in the eyelid
Bacterial conjunctivitis
Should be suspected if there is yellow/green discharge, numerous follicles, constant burning, photophobia
Allergic conjunctivitis
Usually bilateral
Common with ectopic conditions
Slightly watery discharge and itching of the eye
Glaucoma
Disease of the optic nerve that involves loss of retinal ganglion cells. Significant risk factor is inter ocular pressure
Primary
Secondary
Developmental
Amblyopia
Lazy eye
Vision in one eye is reduced because the eye and brain are not working together
Exophthalmos
Protrusion of the eyeball anteriorly out of the socket, commonly from graves disease
Cataracts
Opacity of the crystalline lens of the eye
Hordelum
Caused by a blockage and infection of sebaceous gland at the base of the eyelash
Osteogenesis imperfecta
Blue sclera
Anisocoria
Unequal pupils
Argyle Robertson
Bilateral pupils accommodate but do not dilate
Key hole pupil
Gap appears in the iris
Horner’s syndrome
Constricted pupil and dilation lag on affected side
Adie’s pupil
Pupils are fixed, dilated, and tonic. Direct and consensual pupil reactions are weak or absent
Miosis
Pupils are constricted and fixed
Occurs with eye drops for glaucoma, iritis, brain damage to pons, narcotic drug use
Mydriasis (dilated fixed pupil)
Usually from stimulation of sympathetic nerves as a consequence of CNS injury, cardiac arrest, deep anesthesia, acute glaucoma, or recent trauma
Oculomotor damage
Unilateral dilated pupil has no reaction to light or accommodation
