Eye Assessment Flashcards
Eyelids
protects eye, filter out dust and dirt
Palpebral Fissure
open space between the eyelids
Limbus
border between cornea and sclera
Canthus
corner of the eye
Caruncle
small fleshy mass at inner corner containing sebaceous glands
Tarsal Plates
strips of connective tissue, contain the meibomian glands, secrete oily lubricating material
Conjunctiva
thin mucous membrane
The conjunctiva includes
palpebral conjunctiva and bulbar conjunctiva
palpebral conjunctiva
lines the lids
bulbar conjunctiva
overlays the eyeball with the white sclera
lacrimal apparatus
provides constant irrigation
puncta
absorb tear drainage (upper and lower lids at the inner canthus)
Extraocular Muscles
6 muscles attach to the eyeball and give the eye movement
2 Types of Extraocular Muscles
rectus and oblique muscles
Rectus Muscles
4 straight
Oblique Muscles
2 slanting
Internal Eye
sphere shaped, consists of 3 layers: sclera, choroid, and retina
Sclera
outer fibrous, protective white covering
Choroid
middle vascular, dark pigmented layer
delivers blood to the retina and prevents light from reflecting internally
Choroid consists 3 parts
pupil, lens (focus) and anterior chamber
anterior chamber of the choroid
continuous flow of fluid
serves to deliver nutrients to surrounding tissues and drains metabolic waste.
Retina
visual receptive layer of the eye
light waves are changed into nerve impulses
Retina includes 2 parts
optic disc, macula and retinal vessels
optic disc
retina fibers converge to form the optic nerve
normal color is yellow-orange to pink
macula
receives and transduces light from the center of the visual field
Cultural Considerations include
palpebral fissures, glaucoma and cataracts
Cultural Considerations: palpebral fissures
narrowed in asian population
Cultural Considerations: glaucoma
more prevalent in african american population and more severe which can lead to blindness
Cultural Considerations: cataracts
more prevalent in caucasians
What information should you get during the history (subjective) portion of the interview?
A. Vision difficulty, decreased visual acuity, blurring, blind spots
B. Eye pain
C. Hx Strabismus, diplopia (double vision)
D. Redness and/or swelling
E. Watering and/or eye d/c
F. Past hx of eye problems (ie.injury or surgery to eye)
G. Hx glaucoma – also include family history of glaucoma
H. Use of glasses and/or contacts
I. Self care behaviors (date of last eye exam)
J. Medications
What information should the nurse assess for during a physical exam?
A. Snellen eye chart B. Near Vision C. Confrontation Test D. Corneal Light Reflex (Hirschberg Test) E. Cover Test F. Diagnostic Positions Test and 6 cardinal positions of gaze G. Inspection of External Eye H. Anterior Eyeball Structures I. Ocular Fundus - ophthalmoscope
Snellen Eye Chart
tests visual acuity
the larger the denominator, the poorer the vision
(Normal 20/20)
Normal 20/20
the top number (numerator) is the distance the person is standing from the eye chart, the bottom number (denominator) is the distance at which a normal eye could have read that line)
Near vision
hand held vision card
Confrontation Test
test visual fields, except the temporal visual field (flapping fingers, both pt and nurse cover 1 eye opposite of each other)
Corneal Light Reflex (Hirschberg Test)
shine light from distance approx. 12-14”
–> at same spot both eyes
Cover Test
test for lazy eye/strabismus
normal response to the cover test is a steady fixed gaze.
If muscle weakness is present, the covered eye will drift into a relaxed position
Diagnostic Positions Test (H) and 6 cardinal positions of gaze
EOM function and test for nystagmus
Inspection of External Eye includes
eyebrows, eyelids and eyelashes, eyeballs, conjunctiva and sclera, eversion of upper eyelid and lacrimal apparatus
Assessing Inspection of External Eye: Eyebrows
symmetrical movement with facial expressions, no lesions, no scaling, etc.
Assessing Inspection of External Eye: Eyelids and Eyelashes
upper lids overlap top of iris, skin intact without redness, swelling, d/c or lesions
Assessing Inspection of External Eye: Eyeballs
alignment, note protrusion or sunken appearance
Assessing Inspection of External Eye: Conjunctiva and Sclera
color, discharge
Assessing Inspection of External Eye: Eversion of Upper Eyelid
not performed in lab
Assessing Inspection of External Eye: Lacrimal Apparatus
palpate with thumb inner eye for lacrimal sac and brow area for lacrimal gland
Anterior Eyeball Structures include
cornea and lens; iris and pupil
Assessing Anterior Eyeball Structures: Cornea and Lens
smoothness and clarity
Assessing Anterior Eyeball Structures: Iris and Pupil
shape, PERRLA
accommodation
distant object, shift to close object - pupils should constrict
Assessing Ocular Fundus
- red reflex
- optic disc
- retinal vessels
- general color/background, lesions
- macula
lens
refracting medium, keeping a viewed object in continuous focus on the retina
iris
mediators of light
Dark skinned people may normally have
small brown macules on the sclera