- Consists of the retina, a thin, delicate structure in

which the fibers of the optic nerve are distributed.

Anatomy and Physiology of the Eye
- The retina is bordered externally by the choroid and
The eye
sclera and internally by the vitreous.
o The eye is 1 inch in diameter and is located in the
- The retina is the visual receptive layer of the eye in
anterior portion of the orbit.
which light waves are changed into nerve impulses;
o The orbit is the bony structure of the skull that
it contains blood vessels and photoreceptors called
surrounds the eye and offers protection to the eye.
rods and cones.
Layers of the eye
Vitreous body
o External layer
- Contains a gelatinous substance that occupies the vitreous
- The fibrous coat that supports the eye
chamber, the space between the lens and the retina
- Contains the cornea, the dense transparent outer layer
- The vitreous body transmits light and gives shape to the
- Contains the sclera, the fibrous “white of the eye”
posterior eye.
o Middle layer
Vitreous
- Called the uveal tract
- Gell-like substance that maintains the shape of the eye
- Consists of the choroid, ciliary body, and iris
- Provides additional physical support to the retina
- The choroid is the dark brown membrane located
Rods and cones
between the sclera and the retina that has dark
- Rods are responsible for peripheral vision and
pigmentation to prevent light from reflecting
function at reduced levels of illumination.
internally.
- Cones function at bright levels of illumination and are
- The choroid lines most of the sclera and is attached
responsible for color vision and central vision.
to the retina but can detach easily from the sclera.
Optic disc
- The choroid contains many blood vessels and
- The optic disc is a creamy pink to white depressed area in
supplies nutrients to the retina.
the retina.
- The ciliary body connects the choroid with the iris
- The optic nerve enters and exits the eyeball at this area.
and secretes aqueous humor that helps give the eye
- This area is called the blind spot because it contains only
its shape; the muscles of the ciliary body control the
nerve fibers, lacks photoreceptor cells, and is insensitive to
thickness of the lens.
light.
- The iris is the colored portion of the eye, located in
Macula lutea
front of the lens, and it has a central circular
- Small, oval, yellowish-pink area located laterally and
opening called the pupil. The pupil controls the
temporally to the optic disc
amount of light admitted into the retina (darkness
- The central depressed part of the macula is the fovea
produces dilation and light produces constriction).
centralis, the area of sharpest and keenest vision, where
o Internal layer
most acute vision occurs.
Aqueous humor
- The aqueous humor is a clear watery fluid that fills the
anterior and posterior chambers of the eye.
- The aqueous humor is produced by the ciliary processes,
and the fluid drains into the canal of Schlemm.
- The anterior chamber lies between the cornea and the iris.
- The posterior chamber lies between the iris and the lens.
Canal of Schlemm: Passageway that extends completely around the
eye; it permits fluid to drain out of the eye into the systemic
circulation so that a constant intraocular pressure is
maintained.
Lens
- Transparent convex structure behind the iris and in front of
the vitreous body
- The lens bends rays of light so that the light falls on the
retina.
- The curve of the lens changes to focus on near or distant
objects.
Conjunctivae: Thin transparent mucous membranes of the eye that
line the posterior surface of each eyelid, located over the
sclera
Lacrimal gland
- The lacrimal gland produces tears.
- Tears are drained through the punctum into the lacrimal
duct and sac.
Eye muscles
- Muscles do not work independently; each muscle works
with the muscle that produces the opposite movement.
- Rectus muscles exert their pull when the eye turns
temporally.
- Oblique muscles exert their pull when the eye turns nasally.
Nerves
- Cranial nerve II: Optic nerve (nerve of sight)
- Cranial nerve III: Oculomotor
- Cranial nerve IV: Trochlear
- Cranial nerve VI: Abducens
Blood vessels
- The ophthalmic artery is the major artery supplying the
structures in the eye.
- The ophthalmic veins drain the blood from the eye.
Diagnostic Tests for the Eye
Fluorescein angiography
o Description
- A detailed imaging and recording of ocular circulation
by a series of photographs taken after the
administration of a dye
- This test is useful for assessing problems with retinal
circulation, such as those that occur in diabetic
retinopathy, retinal bleeding, and macular
degeneration, or to rule out intraocular tumors.
o Preprocedure interventions
- Assess the client for allergies and previous reactions to
dyes.
- Obtain informed consent.
- A mydriatic medication, which causes pupil dilation, is
instilled into the eye 1 hour before the test.
- The dye is injected into a vein of the client’s arm.
- Inform the client that the dye may cause the skin to
appear yellow for several hours after the test and is
eliminated gradually through the urine. Urine may be
bright green or orange for up to 2 days following the
procedure.
- The client may experience nausea, vomiting, sneezing,
paresthesia of the tongue, or pain at the injection site.
- If hives appear, antihistamines such as
diphenhydramine (Benadryl) are administered as
prescribed.
o Postprocedure interventions
 - Encourage rest.
- Encourage fluid intake to assist in eliminating the dye
from the client’s system.
- Remind the client that the yellow skin appearance will
disappear.
- Inform the client that the urine will appear bright green
or orange until the dye is excreted.
- Advise the client to avoid direct sunlight for a few hours
after the test and to wear sunglasses if staying inside is
not possible.
- Inform the client that the photophobia will continue
until pupil size returns to normal.
Computed tomography (CT)
o Description
- The test is performed to examine the eye, bony
structures around the eye, and extraocular muscles.
- A beam of x-rays scans the skull and orbits of the eye.
- A cross-sectional image is formed by the use of a
computer.
- Contrast material may be used unless eye trauma is
suspected.
o Interventions
- No special client preparation or follow-up care is
required.
- Instruct the client that he or she will be positioned in a
confined space and will need to keep the head still
during the procedure.
Slit lamp
o Description
- A slit lamp allows examination of the anterior ocular
structures under microscopic magnification.
- The client leans on a chin rest to stabilize the head while
a narrowed beam of light is aimed so that it illuminates
only a narrow segment of the eye.
o Interventions
- Explain the procedure to the client.
- Advise the client about the brightness of the light and
the need to look forward at a point over the examiner’s
ear.
Corneal staining
o Description
- A topical dye is instilled into the conjunctival sac to
outline irregularities of the corneal surface that are not
easily visible.
- The eye is viewed through a blue filter, and a bright
green color indicates areas of a nonintact corneal
epithelium.
o Interventions
- If the client wears contact lenses, the lenses must be
removed.
- The client is instructed to blink after the dye has been
applied to distribute the dye evenly across the cornea.
Tonometry
o Description: The test is used primarily to assess for an
increase in intraocular pressure and potential glaucoma.
o Noncontact tonometry
- No direct contact with the client’s cornea is needed and
no topical eye anesthetic is needed.
- A puff of air is directed at the cornea to indent the
cornea, which can be unpleasant and may startle the
client.
- It is a less accurate method of measurement as
compared with contact tonometry.
o Contact tonometry
- Requires a topical anesthetic
- A flattened cone is brought into contact with the cornea
and the amount of pressure needed to flatten the
cornea is measured.
 - The client must be instructed to avoid rubbing the eye
following the examination if the eye has been
anesthetized because of the potential for scratching the
cornea.
- Normal intraocular pressure is 10 to 21 mm Hg;
intraocular pressure varies throughout the day and is
normally higher in the morning (always document the
time of intraocular pressure measurement).
Ultrasound: Procedure is similar to an ultrasound procedure done in
other parts of the body and is done to detect lesions or tumors
in the eye.
Magnetic resonance imaging (MRI): Similar to an MRI done in other
parts of the body