Eyes Flashcards
The nurse is performing an external eye examination. Which statement regarding the outer layer of the eye is true?
A. The outer layer of the eye is very sensitive to touch.
B. The outer layer of the eye is darkly pigmented to prevent light from reflecting internally.
C. The trigeminal (CN V) and the trochlear (CN IV) nerves are stimulated when the outer surface of the eye is stimulated.
D. The visual receptive layer of the eye in which light waves are changed into nerve impulses is located in the outer layer of the eye.
A. The outer later of the eye is sensitive to touch
The nurse is reviewing causes of increased intraocular pressure. Which of these factors determines intraocular pressure?
A. Amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber
B. Posterior chamber as it accommodates an increase in fluid
C. Contraction of the ciliary body in response to the aqueous within the eye
D. Thickness or bulging of the lens
A. The amount of aqueous produced and resistance to outflow
Which of these assessment findings would the nurse expect to see when examining the eyes of a black patient? A. A dark retinal background B. Increased photosensitivity C. Increased night vision D. Narrowed palpebral fissures
A. A dark retinal background
When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 o’clock in each eye. The nurse should:
A. consider this a normal finding.
B. perform the confrontation test to validate the findings.
C. refer the individual for further evaluation.
D. document this as an asymmetric light reflex.
A. Consider this a normal finding
When assessing the pupillary light reflex, the nurse should use which technique?
A. Ask the patient to follow the penlight in eight directions and observe for bilateral pupil constriction.
B. Shine a penlight from directly in front of the patient and inspect for pupillary constriction.
C. Ask the patient to focus on a distant object. Then ask the patient to follow the penlight to about 7 cm from the nose.
D. Shine a light across the pupil from the side and observe for direct and consensual pupillary constriction.
D. Shine a light across the pupil from the side and observe for direct and consensual pupillary constriction
In a patient who has anisocoria, the nurse would expect to observe: A. excessive tearing. B. pupils of unequal size. C. dilated pupils. D. an uneven curvature of the lens.
B. Pupils of unequal size
When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 o’clock in each eye. The nurse should:
A. document this as an asymmetric light reflex.
B. refer the individual for further evaluation.
C. perform the confrontation test to validate the findings.
D. consider this a normal finding.
D. Consider this a normal finding
During an assessment of the sclera of an African-American patient, the nurse would consider which of these an expected finding?
A. The presence of small brown macules on the sclera
B. Yellow color of the sclera that extends up to the iris
C. Pallor near the outer canthus of the lower lid
D. Yellow fatty deposits over the cornea
A. The presence of small brown macules on the sclera
When assessing the pupillary light reflex, the nurse should use which technique?
A. Shine a penlight from directly in front of the patient and inspect for pupillary constriction.
B. Shine a light across the pupil from the side and observe for direct and consensual pupillary constriction.
C. Ask the patient to follow the penlight in eight directions and observe for bilateral pupil constriction.
D. Ask the patient to focus on a distant object. Then ask the patient to follow the penlight to about 7 cm from the nose
B. Shine a light across the pupil from the side and observe for direct and consensual pupillary constriction
The nurse is performing an eye assessment on an 80 year old patient. Which of these findings in considered abnormal?
A. Decrease in tear production
B. Unequal pupillary constriction in response to light
C. The presence of arcus senilis seen around the cornea
D. Loss of outer hair on the eyebrows due to decreased hair follicles
B. Unequal pupillary constriction in response to light
The nurse notices the presence of peri orbital edema when performing an eye assessment on a 70 yr old patient. The nurse should:
A. Check for the presence of exophthalmos
B. Suspect the patient has hyperthyroidism
C. Ask the patient if he or she has a history of heart failure
D. Assess for blepharitis bc this is often associated with peri orbital edema
C. Ask the patient if he or she has a history of heart failure
A pt comes to the ER after a boxing match, and his left eye is almost swollen shut. He has bruises on his face and neck. He says he is worried bc he can’t see well from his left eye. The physician suspects retinal damage. The nurse recognizes that signs of retinal detachment include:
A. Loss of central vision.
B. Shadow or dismissed vision in one quadrant or one half of the visual field.
C. Loss of peripheral vision
D. Sudden loss of pupillary constriction and accommodation
B. Shadow or dismissed vision in one quadrant or one half of the visual field.
In a patient who has anisocoria, the nurse would expect to observe: A. excessive tearing. B. pupils of unequal size. C. dilated pupils. D. an uneven curvature of the lens.
B. pupils of unequal size
When performing the corneal light reflex assessment, the nurse notes that the light is reflected at 2 o’clock in each eye. The nurse should:
A. consider this a normal finding.
B. perform the confrontation test to validate the findings.
C. refer the individual for further evaluation.
D. document this as an asymmetric light reflex.
A. Consider this a normal finding
the exposed part of the eye has a transparent protective covering which is the __.
conjunctiva
the _____ provides constant irrigation to keep the conjunctiva and cornea moist and lubricated..
lacrimal apparatus
movement of the extraocular muscles is stimulated by 3 cranial nerves which are?
3,4,6
cranial nerve___ is for vision
2
in older adults, the most common caus of decreased visual functioning are:
- cataract formation or lens opacity
- glaucoma or increased intraocular pressure
- macuar degeneration or the breakdown of cells in the macula of the retina
____ are common with myopia or after middle age due to condensed vitreous fibers. significant?
floaters
usually not significant but acute onset of floaters occurs with retinal detachment
halos around the eyes occurs with
acute narrow-angle glaucoma
a blind spot surrounded by an area of normal or decreased vision occurs with glaucoma, with optic nerve disorders
scotoma
night blindness occurs with
optic atrophy
glaucoma
vit a defincieny
deviation in the axis of the eye
strabismus
perception of two images off a single object
diplopia
the ____ is the most commonly used and accurate measure of visual acuity.
snellen eye chart.
if the patient wears glasses or contacts, what should you do when assessing snellen eye chart exam?
keep them on unless they are reading glasses. reading glasses will blur the distant vision
“OU”
both eyes
“OD”
right eye
“OS”
left eye
snellen eye chart results is NOT a percentage instead the top number means ____ and the bottom number means___.
the distance the person is standing from the chart
the distance at which a normal eye could have read that particular line.
the larger the denominator, the _____.
poorer the vision
the decrease in power of accomodation with aging, is suggested when the person moves the card farther.
presbyopia
for a person older than 40 yrs or for those who report increasing difficulty reading, ____
test near vision with a handheld vision screener with various sizes of print (Jaeger card). hold the card in good light about 14 in from the eye.
what does the confrontation test test? how do you do it?
peripheral vision
it compares the persons peripheral vision with your own.
position yourself at eye level with patient about 2 ft away, direct the person to cover one eye with an opaque card, and with the other eye to look straight at you.
in confrontation test is normal what should you report?
peripheral vision intact, bilateral
Confrontation test works with all but _____, and you will need ___.
temporal visual field
need a 6-foot arm to avoid being seen initially! with the temporal direction, start the object somewhat behind the person.
muscle movement ____ with vision
does NOT have anything to do with
what do you do to test visual fields?
confrontation test
what do you do to test extraocular muscle function?
corneal light reflex( the hirschberg test)
cover test
diagnostic positions test
Asians people
Asians often have narrowed palpable fissures and this is perfectly acceptable. In NON ASIAN people, narrowed palpable fissures indicate Down syndrome!
Presbyopia
Commonly affects older people
In older adults, most common causes of decreased visual functioning are:
- Cataract formation, or lens opacity
- )glaucoma, or increased ocular pressure (chronic open glaucoma is the most common type)
- Macular degeneration or the breakdown of cells in the macula of the retina
Cultural differences
Culturally based variability occurs in the color of the iris and In retinal pigmentation, with darker irides having darker retinas behind them. Individuals with light retinas generally have better night vision but can have pain in an environment that has too much light
Eye pain
SUDDEN onset of eye symptoms (pain, floaters, blind spot, loss of peripheral vision) is an EMERGENCY
Eye allergies
Allergens can cause irritation of conjunctiva or cornea
Macular degeneration
Causes a loss in central vision acuity
Eye brows
Look for symmetry, bilaterally, no scaling or lesions
Eye lids And lashes
Approximate completely with the lower lids when closed. Skin is intact without redness, swelling, discharge or lesions
Lid lag occurs with?
Occurs with hyperthyroidism
Eyelids
The palpebral fissures are horizontal in non-Asians, where as Asians normally have an upward slant
Eyeballs
The eyeballs are aligned normally in their sockets with no protrusion or sunken appearance. African Americans normally have a slight protrusion of the eyeball beyond the supra orbital ridge.
Exophthalmos
Protruding eyes
Conjunctiva and sclera
The eyeball looks moist and glossy. Numerous small blood vessels normally show through the transparent conjunctiva. Otherwise, the conjunctiva are clear and show normal color of the structure below. Pink over the lower lids and white over the sclera
Sclera appears what color?
Sclera is china white
In African Americans, the sclera is
- Sclera may be gray-blue or muddy color to the sclera
- You may see small brown macula (like freckles) on the sclera and that is normal
- they may also have yellowish fatty deposits beneath the lids away from the cornea
DO NOT confuse these yellow spots with the overall scleral yellowing that accompanies jaundice
Eversion of the eyelid
This is not a normal part of an examination but is useful when you must inspect the conjunctiva of the upper lid, as with eye pain or suspicion of a foreign body
Lacrimal apparatus
Ask the person to look down and use your thumbs to press on the outer part of the eye lid.
Inspect for any redness or swelling
Presence of excessive tearing may indicate blockage of the nasolacrimal duct.
Cornea and lens
Shine a light from the side across the cornea and check for smoothness and clarity
Their should be no opacities (cloudiness) in the cornea, the anterior chamber , or lens behind the pupil.
Do not confuse this with arcus senilis
Arcus senilis
This is commonly seen in older people
This is a gray-white arc or circle around the limbus;it is due to deposition of lipid material. The cornea may look thickened and raised but the arcus has no effect on vision.
Picture on page 307
Iris and pupil
The iris is normally flat, with a round regular shape and even colorations.
Anisocoria
A small number of people normally have pupils of two different sizes.
Pupillary light reflex
To test for this, darken the room and ask the person to gaze into the distance (this dilates the pupils). Advance a light in from the side and note the response
Pupillary light reflex normal response
Constriction of the same-sided pupil (a direct light reflex) and simultaneous construction of the other pupil (consensual light reflex)
Accommodation
Ask the person to focus on a distant object then have the person shift the gaze to a near object such as your finger.
A normal response includes pupillary constriction and convergence of the axes of the eyes
Accommodation results
PERRLA: Pupils Equal, Round, React to Light, AND Accommodation
Cataracts
Cataracts appear as opaque black areas against the red reflex.
Red reflex
The red glow filling the person’s pupil. This reflection is caused by the ophthalmoscope light off the inner retina
Aging adult
Central vision may decrease, particularly after 70 yrs old.
Peripheral vision may be diminished as well.
corneal light reflex (the hirschberg test)
what is it? how is it performed? normal response?
- assess the parallel alignment of the eye axes by shining a light toward the persons eyes
- direct the person to stare straight ahead as you hold the light about 30 cm away. not the reflection of the light on the corneas.
- it should be in exactly same spot on each eye.
cover test
what is it? how is it performed? normal response?
- detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel.
- ask the person to stare straight ahead at your nose even thought he faze may be interrupted. with an opaque card,cover one eye. as it is covered, note the uncovered eye.
- normal response is a fixed stead gaze
more severe- a constant mal alignment of the eyes.
tropia
fine, oscillating movement best seen around the iris
nystagmus; occurs with disease of the semicircular canals in the ears. a paretic eye muscle, multiple sclerosis or brain lesions
mild weakness noted only when fusion is blocked
phoria
mild nystagmus at a extreme lateral gaze is ____;
normal but nystagmus at any other position is NOT
in aging adults, when testing visual acuity, what might you expect?
central acuity may decrease, particularly after 70 yr. peripheral vision may be diminished.
soft, raised yellow plaques occuring on the lids at the inner canthus. they commonly occur around the fifth decade of life and more frequently in women.
xanthelasma
yellowish , elevated nodules are due to the thickening of the bulbar conjuctiva from prolonged exposure to sun, win and dust.
pinguecula
inward turning of the eyes
esotropia
outward turning of the eyes
exotropia
Aging adult
Central vision may decrease, particularly after 70 yrs old.
Peripheral vision may be diminished as well.
Drusen
Benign degenerative hyaline deposits. They are small, round, yellow dots that are scattered on the retina. They have no effect on the vision
Peri orbital edema
Lids are puffy and swollen. The fluid is apparent. This occurs with local infections, crying, and systemic conditions such as congestive heart failure, renal failure, allergy, and hypothyroidism (myxedema)
Exophthalmos
Forward Displacement of the eyeballs and widened palpebral fissures
Ptosis (drooping upper lid)
Occurs with neuromuscular weakness. For ex, myasthenia gravis with bilateral fatigue as the day progresses. This gives the person a sleepy appearance and impairs vision
