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Eye Assessment

Eye Assessment

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Published by: Mabes on Oct 16, 2012
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03/05/2014

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Eye Assessment
Terms
1.
 
O.D. (Oculus Dexter)
 
 –
right eye2.
 
O.S. (Oculus Sinister)
 
 –
left eye3.
 
O.U. (Oculus Uterque)
 
 –
both eyes; left and right
Assessment
1.
 
Assess EYELIDS
a.
 
Check if puffy, protruded, and has dark under eye circles
(maybe anemic)
 
b.
 
Check no. of blinks
 
 
Main Ave:
8
 –
12 involuntary blinks per min
 
 
Average:
15
 –
20 involuntary blinks per min
 
c.
 
Procedure:
Ask PT to open and close the eyes if they close completely (Normal: no pain and closes completely)
 
Ptosis or Lid Lag
 
 –
 
“drooping of eyelid”;
delayed downward movement of upper eyelid
“Expothalmos or Proptosis”
 –
 
protrusion of the eyeball; occurs in Hyperthyroidism & Grave’s Disease.
d.
 
Check if there’s Dirty Sclera
 
(Retract lower eyelid and see if there’s brown in color)
 
Ophthalmic Installations
 
Retract lower eyelid with tissue
 
IF eyedrops
 –
middle to outer
 
If ointment
 –
inner to outer canthus
 
Close the eyes and don’t blink to allow meds to penetrate and don’t rub
 
Abnormal Findings
1.
 
Anopthalmia
 –
absence of the eye2.
 
Ablepharon
 –
absence of eyelid3.
 
Lagopthalmia
 
 –
eyes entirely covered with eyelid4.
 
Achromatopia
 –
color blindness5.
 
Distichiasis
 –
extra eyelashes6.
 
Ephiphora
 
Excessive tearing; problem with Nasolacrimal duct and lacrimal sac
 
Procedure: Apply pressure along inner eye canthus to check tearing and discharge.
 
2.
 
Assessment of Pupil
 
Normal:
Equal in size (3
 –
7 mm in diameter)
 
PERLAC
- Pupil Equally Round Reactive to Light and Accommodation and Convergencea.
 
Pupil’s direct and consensual reaction to light
 
 
Illuminated pupil should constrict (1
st
shine
 –
direct response)
 
Non
 –
illuminated pupil constricts
 
Equal responses on both pupil
 
Procedure:
Ask PT to look straight, penlight at the side and shine pupil directly. Opposite eye should alsoconstrict (consensual reflect)b.
 
Pupil’s reaction to
Accommodation
 
Procedure:
Ask PT to look at the object 4
 –
6 inches away and then in line with the bridge of the nose (papalapit)
 
 
Normal:
a.
 
Pupil dilates when looking at far objectsb.
 
Pupil constricts when looking at near objectsc.
 
Pupil converge when near
objects are moved towards the nose (become’s cross
eyed)3.
 
Assessment of Visual Acuity (Near and Distance Vision)2 Visual Acuity Charts
1.
 
Snellen Alphabet Chart
 
Most common to test vision
 
 
Assessing visual acuity in distance vision
 
Procedure:
a.
 
Ask PT to stand at 20ft away from the chart and cover his Left Eye with an opaque object.
 
b.
 
Ask to read the letters on one line from top (E) to bottom until patient can no longer read the letters.
 
c.
 
Repeat procedure to right eye.
Note:
1.
 
Normal Vision of 0 / 20 on Snellen Chart2.
 
Visual Acuity is recorded as fraction:20
 –
Distance between patient & snellen chart20
 –
Distance from which the patient with normal vision could read the lines at 20 feet away from chart.3.
 
The higher the denominator, the poorer vision4.
 
Not usually demonstrated until 5
 –
6 y/o.
Other: Assessing Visual Acuity (Near Vision)
 
 –
 
if there’s no snellen provide reading material
 
 
Procedure:
Ask PT to read newsprint from large to small letters (with corrective lenses if client has one)
 
Normal:
PT can read newsprint from large to small letters2.
 
Snellen E
 –
Chart
 
For children and adults who can’t read
 
Procedure:
a.
 
Cover left eye of PT then point to “E”.
b.
 
Ask where the letter facesc.
 
Repeat to right eye.
 
Snellen E Chart
Snellen Alphabet Chart
 
Assess Peripheral Vision
 
Normal:
 When looking straight ahead, client can see objects at periphery (sides) 
 
Procedure:
 a.
 
Stand or sit directly across patient to have his eyes focus her gaze on your eyes. b.
 
Ask not to move head only her eyes c.
 
Nurse will move hands at SUPERIOR & INFERIOR positions
(Hand Movement)
 
Assess Extraocular Muscles
1.
 
6 Cardinal Rule of Gaze or 6 Ocular Movements
 
Goal:
determine eye alignment and coordination
 
 
Evaluates the ff:
a.
 
CN 3 Oculomotor
 
 –
most eye movementb.
 
CN 5 Trigeminal
 
 –
corneal reflex and protective blinkc.
 
CN 6 Abducens
 
 –
lateral eye movementd.
 
Extraocular Muscles
 
Procedure:
a.
 
Stand directly in front of PT and Hold penlight at 1 Feet Distanceb.
 
Ask to follow the penlight movement and not to move his headc.
 
Move penlight in a slow, orderly manner thru 6 Cardinal Positions of Gaze from center of eye along the lines of arrows (periphery)

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