Eyes Flashcards
Are projections of stiff hair curving outward along the margins of the eyelids that filter dust and dirt from air entering the eye.
EYELASHES
Are two movable structures composed of the skin and two types of muscle: striated and smooth.
The purpose is to protect the eyes from foreign bodies and limit the amount of light entering the eye.
They serve to distribute tears that lubricate the surface of the eye.
EYELIDS
The point where the 2 eyelids join.
Lateral and Medial
CANTHUS
Is a dense, protective, white covering that physically supports the internal structures of the eye.
It is continuous anteriorly with the transparent cornea (the windows of the eye).
Sclera
A thin, transparent, continuous membrane that is divided into two portions: PALPEBRAL&BULBAR
CONJUNCTIVA
lines the inside of the eyelids
Palpebral
Covers most of the anterior eye, merging with the cornea at the limbus.
BULBAR
Permits the entrance of light, which passes through the lens to the retina.
Supplied with nerve endings making it responsive to pain and touch.
CORNEA
External Structures of the Eye
Eyelashes
Eyelids
Canthus
Sclera
CONJUNCTIVA
CORNEA
A circular disc of muscle containing pigments that determine the eye color.
Muscles in the iris adjust to the control of the pupil’s size which controls the amount of
light entering the eye.
The muscle fiber of the iris also decreases the size of the pupil to accommodate for near
vision and dilate the pupil for far vision.
Iris
Is a biconvex, transparent, avascular structure located immediately posterior to the iris that functions to refract (bend) light rays onto the retina.
Lens
Consists of muscle tissue that controls the thickness of the lens, which must be adapted to focus on objects near and far away
Ciliary Body
Innermost layer that receives visual stimuli and send it to the brain.
Consists of numerous layers of nerve cells (rods and cones – called photoreceptors
because they are responsive to light).
RETINA
are sensitive to light, regulate black & white vision & function in dim light.
Rods
function in bright light and are sensitive to color.
Cones
Vascular necessary for the nourishment to the inner aspect of the eye and prevents light
reflecting internally.
Anteriorly continuous with the ciliary body and the iris.
Choroid
A cream colored, circular area located on the retina toward the medial or nasal side of the
eye.
It is where the optic nerve enters the eyeball.
Optic Disc
- Serve to maintain structure
- Protect against injury
- Transmit light rays
Chambers
located between the cornea and the iris
Anterior Chamber
located between the iris and the lens
Posterior Chamber
- A clear liquid substance produced by the ciliary body
- Helps to cleanse and nourish the cornea and lens
- Maintains intraocular pressure
Aqueous humor
Consists of glands and ducts that serve to lubricate the eye.
LACRIMAL APPARATUS
Two small openings that allow drainage of tears into the lacrimal system.
Puncta
A small fleshy mass that contains sebaceous glands.
Caruncle
• Position the client so he/she is seated comfortably.
• Move close to the client’s face to view the internal eye with an ophthalmoscope.
• Explain to the client that the examination may be slightly uncomfortable.
• Explain in detail what you will be doing to ease client anxiety.
Client preparation
the degree of detail of the eye can discern in an image.
Visual acuity
the area an individual can see when looking straight ahead.
Visual field
VISUAL ACUITY (CRANIAL NERVE II)
a. Ask the patient to stand at a distance of 20 ft. from the Snellen’s chart.
b. Instruct the patient to obstruct the left eye with an occluder and read as many lines in the chart
as possible.
c. Note the number at the end of the last line the patient was able to read.
d. Repeat the test occluding the right eye
Normal findings in visual acuity test
The patient who has a visual acuity of 20/20 is considered normal
Abnormal findings in visual activity
Myopia
Impaired far vision
Myopia
NEAR VISION
a. Have the patient sit comfortably and hold the Rosenbaum card 14 inches from the face without
moving it.
b. Ask the patient to read the smallest line as possible.
Normal findings in near vision
Reading is possible at a distance of 14 inches if a patient is in his late 30’s or 40’s. Normal near vision acuity is 14/14 (with or without corrective lenses).
Abnormal findings in near vision
PRESBYOPIA
impaired near vision; caused by decreased accommodation.
PRESBYOPIA
Test the patient’s ability to identify primary colors (red – green) color deficiencies using the Snellen’s
chart or the Ishihara plates.
COLOR VISION
Normal findings in color vision
The patient is able to identify all six screening Ishihara plates.
TEST FOR VISUAL FIELDS (CRANIAL NERVE II)
a. Sit or stand approximately 2 to 3 feet opposite the patient.
b. Have the patient cover the right eye with an occluder.
c. Cover you left eye in the same manner.
d. Look directly at each other with your uncovered eye.
e. Hold your free hand at arms length equidistant from you and the patient and move it or a held
object into your and the patient’s field of vision from nasal, temporal, superior, inferior oblique angles.
f. Ask the patient to say NOW when your hand is seen moving into the field of vision.
g. Repeat the procedure to the other eye.
Normal findings in test for visual field
The patient is able to see the stimulus at about 90 degrees temporally, 60 degrees nasally, 50
degrees superiorly and 70 degrees or the client should see the examiner’s finger at the same time the examiner sees it.
Abnormal findings in test for visual field
Hemianopsia
Causes could be:
Tumors or strokes
Neuro diseases
Retinal detachment
TEST FOR EVALUATING VISIONS
Distance vision
Near vision
Color vision
Test for visual field
TEST FOR EVALUATING VISIONS
Distance vision
Near vision
Color vision
Test for visual field
assesses parallel alignment of the eyes
Corneal Light Reflex
Corneal Light Reflex
a. Instruct the patient to look straight ahead.
b. Focus on a penlight on the cornea from a distance of 12-15 inches away at the midline.
c. Shine the light towards the bridge of the nose while the client stares straight ahead.
d. Observe the location of reflected light on the cornea.
Normal finding in corneal light reflex
The reflected light should be seen symmetrically in the center of each cornea or exactly on the same spot
on each eye indicating parallel alignment.
Result of pupillary light reflex
Causes pupils immediately to constrict when exposed to bright light
constriction occurs in the eye exposed to light
Direct reflex
constriction of the pupil in the opposite eye
Consensual reflex
Rationale of pupillary light reflex
Prevent damage to the delicate photoreceptors by excessive light
A functional reflex allowing the eye to focus on near objects
Accommodation
Abnormal findings in accomodation
Esotropia
Exotropia
detects deviation in alignment or strength and slight deviations in eye movement interrupting the fusion
reflex that normally keeps the eye parallel
Cover – Uncover Test
Cover-Uncover Test
a. Ask the patient to look straight ahead and to focus on an object in the distance.
b. Place an occluder over the left eye for several seconds and observe the right eye for movements.
c. As the occluder is removed, observed the covered eye for movement.
d. Repeat the procedure with the same eye
e. Repeat on the other side.
Normal findings in cover-uncover test
If the eyes are in alignment, there will be no movement of either eye. The covered eye should remain
fixed straight ahead after being uncovered.
Abnormal findings in cover-uncover test
Esotropia
Exotropia
Hypertropia
Hypotropia
STRABISMUS
An inward turn of the eye
Esotropia
An outward turn of the eye
Exotropia
An upward turn of the eye
Hypertropia
A downward turn of the eye
Hypotropia
- Constant misalignment of the eyes
- Also called crossed or wall eye
- Caused by weak intraocular muscles or a lesion on the oculomotor nerve
STRABISMUS
Term used to describe misalignment that occurs only when fusion reflex is blocked.
PHORIA
a. Place the patient in a sitting position facing you.
b. Place the non dominant hand just under the patient’s chin to on top of the head as a remainder to
hold the head still.
c. Ask the patient to follow an object with the eyes.
d. Move the object thru the 6 fields of gaze in a smooth and steady manner pausing at a each
extreme position to detect any nystagmus or involuntary movement, and returning to the center after each
field is tested.
e. Note the patient’s ability to move the eyes on each direction.
g. Move the object forward at about 5 inches at the patient’s nose at the midline.
h. Observe for convergence of gaze.
CARDINAL FIELDS OF GAZE
Normal findings in cardinal fields of gaze
Eye movement should be smooth and symmetric throughout all six directions.
Abnormal findings in cardinal fields of gaze
NYSTAGMUS -An oscillating (shaking) movement of the eye may be associated with an inner ear disorder, multiple
sclerosis, brain lesions or narcotic use.
Testing Extraocular Muscles
Corneal Light Reflex
Pupillary light reflex
Accomodation
Cover – Uncover Test
Cardinal Fields of Gaze
Inspect the cornea and lens
CONJUNCTIVA
Shine a light from the side of the eye for an oblique view.
Look through the pupil to inspect the lens.
Inspect the cornea and the lens
Normal findings in CONJUNCTIVA (Inspection of the cornea and lens)
Cornea is transparent with no opacities
Bulbar
a. Separate the lid margins with the fingers.
b. Have the patient look up, down, and to the right and left.
c. Inspect the surface of the bulbar conjunctiva for color, redness, swelling, exudate, or foreign
bodies.
d. With the thumb, gently pull the lower lid toward the cheek and inspect the surface of the bulbar
conjunctiva for color, inflammation, edema, lesions, or foreign bodies
Normal findings in bulbar
The bulbar conjunctiva is transparent, with small blood vessels visible in it. It should appear white except for a few blood vessels, which are not normal. No swelling, exudates, injection, foreign bodies or lesions.
PALPEBRAL
a. Explain the procedure to the patient to alleviate the fear of pain or damage to the eye.
b. Don gloves. Have the patient look down to relax the levator muscle.
c. Gently pull the eyelashes downward and place a sterile, cotton-tipped applicator about 1 cm
above the lid margin.
d. Gently exert downward pressure on the applicator while pulling the eyelashes upward to evert the
lid.
e. Inspect
f. Return the lid to its normal position by instructing the patient to look up and pulling the eyelid
outward and removing the cotton-tipped applicator.
g. Ask the patient to blink.
Abnormal findings in inspection of cornea and lens
CONJUNCTIVITIS
PTERYGIUM
PINGUECULA
SUBCONJUNCTIVAL HEMORRHAGE
ACUTE ALLERGIC CONJUCTIVITIS
NEVUS
PAPILLOMA
Abnormal findings in inspection of cornea and lens
CATARACT
ARCUS SENILIS
- Opacities of the lens
- Tend to occur in individuals over 65 years old
- May also occur in infants due to a malformation of the lens if the mother contracted rubella in the
first trimester of pregnancy.
CATARACT
Common among the older clients that appear white area around the limbus.
ARCUS SENILIS
Normal findings in sclera
Sclerae should be white with some small, superficial vessels and without exudate, lesions or foreign
bodies for light skinned individuals. In dark-skinned individuals, the sclerae may have tiny brown patches of melanin or grayish blue or “muddy” color.
Abnormal findings in sclera
JAUNDICE
BLUE SCLERA
DIFFUSE EPISCLERITIS
a. Stand in front of the patient
b. Shine a penlight directly on the cornea.
c. Move the light laterally and view the cornea from that angle, noting color, discharge and lesions.
Test for Cornea
Normal findings in cornea
Corneal surface should be moist and shiny, with no discharge, cloudiness, opacities or irregularities.
Abnormal findings in cornea
ROUGH CORNEA
CORNEAL SCAR
CORNEAL LACERATION
CORNEAL ABRASION
ARCUS SENILIS
ASTIGMATISM
- An uneven curvature of the cornea that prevents horizontal and vertical rays from focusing on the
retina. - May be corrected with glasses or surgery.
Astigmatism
That compartment of the eye found between the cornea and the iris
a. With the penlight, inspect the iris for color, nodules and vascularity
Anterior Chamber
Normal findings in anterior chamber
Color is evenly distributed over the iris. It is normally smooth and without apparent
vascularity.
Normal findings in Iris
flat and round
Abnormal findings in Iris
HYPHEMA
HYPOPYON
Iritis
Bulging toward the cornea
Black eyes
- Blood in anterior chamber
- Trauma or intraocular hemorrhage
HYPHEMA
- Pus
- Corneal ulcer or other infection
HYPOPYON
Contusions or hematomas resulting from injury
“Black Eyes”
Increase IOP
Bulging toward the cornea
inflammation of the iris that manifests as cloudy or reddened iris with constricted pupil.
Iritis
Normal findings Pupil
The pupil should be deep black, round smooth borders and of equal diameter.
Pupil
a. Stand in front of the patient in a darkened room.
b. Note the shape and size of pupils in mm.
c. Move a penlight from the side to the front of one eye without allowing the light to shine on the
other eye.
DIRECT LIGHT REFLEX
d. Observe the pupillary reaction in that eye. Note the size of the pupil receiving light stimulus and
the speed of pupillary response to light.
CONSENSUAL LIGHT REFLEX
e. Move the penlight in front of one eye, and observe the other eye for pupillary constriction.
Abnormal findings in pupil
ANISOCORIA
Mydriasis
Miosis
unequal pupils
ANISOCORIA
- enlarged pupils
- may indicate injury or glaucoma or result from certain drugs (atropine, cocaine, amphetamines).
Mydriasis
- Constricted pupils
- An inflammation of the iris or result from such drugs as morphine/heroin and other narcotics,
barbiturates or pilocarpine.
Miosis
Normal findings in lens
Lens is transparent in color.
Lens
a. Stand in front of the patient.
b. Shine a penlight directly on the pupil. The lens is behind the pupil.
c. Note the color.
Abnormal findings in lens
CATARACT
Common Refractive Errors of the Lens
Myopia
Hyperopia
Presbyopia
(nearsightedness)
Myopia
(farsightedness)
Hyperopia
(loss of elasticity of the lens and thus loss of ability to see close objects)
Presbyopia
Inspect the Eyelids and Eyelashes
A. Position
B. Appearance
C. Turnings
D. Color
E. Swelling
F. Lesions
G. Discharges
A. Position and width of palpebral fissures normal findings
The upper lid margin should be between the upper margin of the iris and the upper margin of the pupil.
The lower lid margin rests on the lower border of the iris.
No white sclera is seen above or below the iris.
Palpebral fissures may be horizontal.
A. Position and width of palpebral fissures abnormal findings
PTOSIS
B. Assess ability of eyelids to close normal findings
The upper and lower lids close easily and meet completely when closed.
Failure of the lids to close completely puts client at risk for corneal damage.
C. Note the position of the eyelids in comparison with the eyeballs normal findings
The lower eyelid is upright with no inward or outward turning.
Eyelashes are evenly distributed and curve outwards along the lid margins.
eversion, an outturning of the eyelid
Ectropion
inversion, inturning of the eyelid
Entropion
Abnormal findings in eyelids
ECTROPION
ENTROPION
Xanthelasma
Raised yellow plaques located most often near the inner canthus, normal variations associated with aging
and high lipid levels.
Xanthelasma
D. Observe for redness, swelling, discharges or lesions normal findings
Skin on both eyelids is without redness, swelling or lesion
D. Observe for redness, swelling, discharges or lesions abnormal findings
Blepharitis
Hordeolum (sty)
CHALAZION OR CYSTS
Crusting or redness along the lid margins caused by Staphylococcus aureus
Blepharitis
An infection of the hair follicle causing redness, swelling and tenderness.
Hordeolum (sty)
An infection of the meibomian gland (located in the eyelid) that produces swelling of the lid,
moderate redness, but minimal pain.
CHALAZION OR CYSTS
E. Observe the position and alignment of the eyeball in the eye socket
Eyeballs are symmetrically aligned in sockets without protruding or sinking.
E. Observe the position and alignment of the eyeball in the eye socket abnormal findings
XEROPHTHALMUS
Sunken appearance of the eyes
Protrusion of the eyeballs with the lid margins retracted
XEROPHTHALMUS
F. Inspect the bulbar conjunctiva & sclera
Clear, moist and smooth. Underlying structures are clearly visible. Sclera is white.
F. Inspect the bulbar conjunctiva & sclera abnormal findings
CONJUNCTIVITIS
PINGUECULA
EPISCLERITIS
Yellowish nodules on the bulbar conjunctiva that is common in older adults
PINGUECULA
A local, non-infectious inflammation of the sclera.
EPISCLERITIS
G. Inspect the palpebral conjunctiva normal findings
Free of swelling, foreign bodies or trauma
EVERTING THE EYELID
Ask the client to look down with the eyes slightly open.
Gently grasp the client’s upper eyelashes and pull the lid downward.
Place a cotton tipped applicator app.1 cm. above the eyelid margin and push down with the applicator
while still holding the eyelashes.
Hold the eyelashes against the upper ridge of the bony orbit just below the eyebrow, to maintain the
everted position of the eyelid
EVERTING THE EYELID normal findings
Conjunctiva is free of swelling, foreign bodies or trauma.
H. Inspect the lacrimal meatus normal findings
No swelling or redness should appear over areas of the lacrimal gland. The puncta is visible
without swelling or redness and is turned slightly toward the eye.
I. Palpate the lacrimal apparatus
Put on disposable gloves to palpate the nasolacrimal duct to assess for blockage.
I. Palpate the lacrimal apparatus normal findings
No drainage should be noted from the puncta
Abnormal findings in lacrimal gland
Swelling may be caused by blockage, infection or inflammatory condition.
Abnormal findings in Superior lacrimal gland
Excessive tearing may indicate a nasolacrimal sac obstruction.
Abnormal findings in Lacrimal puncta
Redness or swelling around the puncta may indicate an infectious or inflammatory condition.
- A disturbance in the circulation of aqueous liquid, which causes an increase intraocular pressure.
- Most frequent cause of blindness in people over age 40
Glaucoma
Danger signs of glaucoma
blurred or foggy vision, loss of peripheral vision, difficulty of focusing in close objects, difficulty
adjusting to dark rooms and seeing rainbow-colored rings around lights.
LACRIMAL MEATUS INSPECTION
a. Have the patient sit facing you.
b. Identify the area of the lacrimal gland. Note any swelling or enlargement of the gland or elevation
of the eyelid.
c. Compare to the other eye in order to determine whether there is unilateral of bilateral
involvement.
Lacrimal meatus normal findings
There should be no enlargement, swelling or redness
No large amount of exudate
Minimal tearing
Abnormal findings in lacrimal meatus inspection
DACRYOADENITIS
DACRYOCYSTITIS
- Inflammation of the lacrimal sac
- Manifested by tearing and a discharge from the nasolacrimal duct.
DACRYOCYSTITIS
LACRIMAL MEATUS PALPATION
a. Don gloves
b. Gently press the index finger near the inner canthus, just inside the rim of the bony orbit of the
eye.
c. Note any discharge from the punctum
Normal findings in lacrimal meatus palpation
No excessive tearing or discharge from the punctum.
Abnormal findings in lacrimal meatus palpation
PURULENT DISCHARGE
EPIPHORA
