HA EYES Flashcards
TEST FOR CENTRAL VISUAL ACUITY
Materials needed: Snellen Chart and Opaque Card
Place the Snellen Alphabet Chart in a well-lit spot at eye level. Position the patient on a mark exactly 20 feet away from the chart.
Note: Remove Reading glasses = Blur vision
Normally, Can see the letters with no complaint and unnecessary movements
Abnormal Finding: There is HESITANCY, SQUINTING, LEANING FORWARD AND MISLEADING LETTERS
Record the result using the numeric fraction at the end of the last successful line read.
Normal: 20/20 vision
Abnormal: Larger denominator which means poorer vision
MYOPIA (impaired far vision)
If the person is unable to see even the largest letters, SHORTEN the distance until it is seen and record the distance
Normally, Can see it exactly 20 feet away
Abnormal: Impaired vision due to RETRACTIVE ERROR, OPACITY IN THE MEDIA or DISORDER IN THE RETINA
NEAR VISION TEST (JAEGER TEST)
Preparation: Test near vision using a handheld vision screener. 14 inches from/away the eye. MAGAZINE OR NEWSPAPER.
Special Consideration: Over 40 years old, some of them has a problem with near vision
Normal: 14/14 grade, NO HESITANCY AND WITHOUT MOVING THE CARD, CLOSER OR FARTHER AWAY.
Abnormal: PRESBYOPIA (impaired near vision) – moves away from the chart
Probably due to decreased in accommodation
TEST VISIUAL FIELDS
(CONFRONTATION TEST)
Preparation: Position yourself at eye level with the person about 2 feet away.
Cover one eye and focus the other eye forward (straight)
Use pencil to move on several directions
Ask the person to say “NOW” as the target first seen.
Normal:
Upward: 50 degrees
Downward: 70 degrees
Temporal: 90 degrees
Nasal: 60 degrees
Abnormal:
MONOCULAR BLINDNESS (tension on the right eye)
BITEMPORAL HEMIANOPIA
(Tension on optical chiasm)
CORNEAL LIGHT REFLEX (HIRSCHBERG TEST)
Preparation: Assess the parallel alignment of the eye. Hold a penlight approximately 12 INCHES AWAY from the client’s face. Shine light toward the nose bridge while the client stares straight ahead. NOTE THE LIGHT REFLECTED ON THE CORNEAS.
Normal: Reflection of light on the corneas should be in exactly the same spot, INDICATES PARALLEL ALIGNMENT
Abnormal: ASYMMETRIC POSITION OF THE LIGHT which might be due to DEVIATED ALIGNMENT OF THE EYES
STRABISMUS / TROPIA
- Consistent malalignment
- Esotropia
- Exotropia
COVER TEST
Preparation: Cover the eyes with an opaque card, then OBSERVE THE UNCOVERED EYE. Repeat test on the opposite eye
Special Consideration: PSEUDOSTRABISMUS in young children or infant
Normal: The uncovered eye should REMAIN FIXED after being uncovered.
Abnormal:
STRABISMUS / TROPIA
- Consistent malalignment
- Esotropia
- Exotropia
PHORIA
- A mild weakness noted only when fusion is blocked
DIAGNOSTIC TEST
Preparation:
12 INCHES AWAY, Follow my finger in the 6 CARDINAL GAZE POSITIONS
NOTE: PROGRESSIVE CLOCKWISE
A. Note also for NYSTAGMUS
- A disease of the semicircular canals in the ears
- Unusual movement of the eye during the procedure proper
B. You should NOT SEE a WHITE RIM OF THE SCLERA between the lid and the iris. If noted, it is termed as LID LAG, which is seen in HYPERTHYROIDISM
Normal:
PARALLEL TRACKING of the object in any or all directions (can keep up)
CN III = OCULOMOTOR
CN VI = ABDUCENS
CN IV = TROCHLEAR
Abnormal:
FAILURE of the eyes to FOLLOW SYMMETRICALLY in any or all directions.
- Indicates weakness in one or more extraocular muscles
- Dysfunction of the cranial nerves on those particular muscles
GENERAL
Normal:
Vision FUNCTIONING WELL ENOUGH TO AVOID OBSTACLES
Abnormal:
1. GROPING WITH HANDS IN THE EYE
2. SQUINTING OR CRANING FORWARD
EYEBROWS
Normal:
EYEBROWS PRESENT BILATERALLY, MOVE SYMMETRICALLY. NO SCALING OR LESIONS
Abnormal:
1. Scaling due to SEBORRHEA
2. ASYMMETRICAL EYEBROWS due to bell’s palsy or stroke
EYELIDS AND LASHES
Special Consideration:
Palpebral Fissures are HORIZONTAL in NON-ASIANS, while ASIANS have upward slant
Normal:
Upper lids NORMALLY OVERLAP the superior part of the iris
Skin is INTACT, WITHOUT REDNESS, DISCHARGE OR SWELLING
EYELASHES: EVENLY DISTRIBUTED along the lid margins
Abnormal:
1. LID LAG in HYPERTHYROIDISM
2. PTOSIS – drooping of the upper lid
3. ECTROPION
4. ENTROPION
EYEBALLS
Special Consideration:
Blacks have normally slight protrusion
Normal:
Aligned normally on their sockets with NO SUNKEN OR PORTRUSION APPEARANCE
Abnormal:
1. EXOPTHALMOS in GRAVES DISEASE / HYPERTHYROIDISM
2. ENOPTHALMOS (sunken eyes) – SEVERE DEHYDRATION
CONJUNCTIVA AND SCLERA
Preparation: Pull down the lower lid and instruct the client to look up
Special Consideration:
Blacks have GRAY-BLUE or “muddy color” to the sclera. They have small brown macules like freckles on the sclera
Normal:
Blood vessels show through the transparent conjunctiva. IT’S CLEAR AND SHOW NORMAL COLOR
1. Pink over the lower lids
2. Sclera is china white
Abnormal:
1. CONJUNCTIVITIS – generalized redness on the conjunctiva
2. EPISCLERITIS – local, non-infectious inflammation of the sclera
3. JAUNDICE = HEPATITIS
EVERSION OF THE UPPER LID
Preparation: INSPECT FOR ANY COLOR, SWELLING, LESION OR FOREIGN BODY
Normal:
NO SWELLING, LESION OR FOREIGN BODY
Abnormal:
IRRITATION, BURNING PAIN, LESION OR FOREIGN BODY ON THE UPPER EYELID
LACRIMAL APPARATUS
Preparation:
Ask the person to look down with your thumbs slide the outer part of the upper lid along the bony orbit. INSPECT FOR ANY REDNESS OR SWELLING
CHECK THE PUNCTA
Explain the flow of tears – (Eyes – Puncta – Lacrimal Canals – Nasolacrimal Sac – Nasolacrimal duct – Nasal Meatus)
Normal:
NO redness or swelling (Lacrimal gland)
It has no lesions or not blocked (Puncta)
Abnormal:
Swelling of the lacrimal gland caused by blockage, infection or an inflammatory condition
- REDNESS OR SWELLING around the Puncta
- Excessive Tearing
- May indicate nasolacrimal sac obstruction
CORNEA AND LENS
Normal:
IRIS:
FLAT, ROUNDREGULAR SHAPE, EVEN COLORATION
PUPILS:
ROUND, REGULAR, EQUAL IN SIZE (3 to 5 mm)
5% of people have anisocoria
Abnormal:
IRREGULARLY SHAPED IRISES
MIOSIS (pinpoint pupil) AND MYDRIASIS (Full dilation) and ANISOCORIA
TEST THE PUPILLARY REFLEX
Preparation: Darken the room and asks the person to gaze into the distance (which dilates the pupil). ADVANCE A LIGHT from the side and note the response
Normal:
1. Constriction of the same-sided pupil (Direct light reflex)
2. Simultaneous constriction of the other pupil (Consensual light reflex)
Abnormal:
NO constriction at all
TEST FOR ACCOMMODATION OF PUPILS
Preparation: Hold your finger or a pencil 12 – 15 inches. Ask the client to focus on the finger or object and to remain o it as you have it closer towards the eyes.
Normal:
DIRECT PUPILLARY RESPONSE IS CONSTRICTION AND CONVERGENCE
Abnormal:
1. PUPILS DO NOT CONSTRICT. EYES DO NOT CONVERGE
2. ASYMMETRIC RESPONSE OF EACH OF THE PUPIL
