Protected by:

-bony orbits & pads of fat surrounding each eye dorsally

-eyelids & eyelashes which close over the eyes
-lacrimal apparatus/ glands lubricating & washing off foreign particles
-conjunctiva which lines the eyelids & covers exposed scleral surface
1. cornea

2. iris

3. pupil

4. lens

5. conjunctiva / sclera

6. choroid / retina

7. optic nerve
1. The cornea is the clear surface of the outer eye which can be damaged by
infections.

2. The iris gives the eye color.

3. The pupil is the black hole within the iris that lets light into the eye.
It changes size in response to light levels, among other things.

4. The lens is the internal focusing element of the eye, it is curved on both sides. The
clear lens becomes cloudy when a cataract forms.

5. The conjunctiva is the thin lining of the inside of the eyelid. It extends over the front
of the white part of the eye.

6. The retina is the light sensitive part of the eye.

7. The optic nerve. In glaucoma, the rise in fluid pressure in the eye damages the nerve
fibers entering the optic nerve from the retina.
Wall of the eyeball is composed of 3
layers:

1. Outer fibrous protective layer

-posteriorly= sclera, the ‘white of the
eye’
with firm tough
connective tissue
-anteriorly= cornea, ‘window of the
eye’
a forward continuation of
the sclera, transparent &
avascular
Wall of the eyeball is composed of 3
layers:

2. Middle vascular layer –pigmented

-posterior =choroid
-anterior =ciliary body & iris
the iris being the extension of
the ciliary body +pupil which
regulates the amount of light
entering the interior of the eye

choroid
ciliary body uveal tract
iris
3. Inner neural layer –with layers of
nerve cells
including: photo receptors
a. rods
-concentrated along the outer
perimeter of the retina
-help us to see images that come into
our peripheral or side vision
-help us to see in dark and dimly lit
environments
b. cones
-concentrated in the macula, the
center of the retina
- allow us to perceive color

Together, rods and cones are the cells

responsible for converting light into
electrical impulses that are transmitted to
the brain where "seeing" actually occurs.
process of vision
Light waves from an object (such as a tree) enter the eye first through the
cornea [18], which is the clear dome at the front of the eye.
The light then progresses through the pupil, the circular opening in the
center of the colored iris. [19]
Next, the light passes through the crystalline lens, [20] which is located
immediately behind the iris and the pupil.

Initially, the light waves are bent or converged first by the cornea, and then
further by the crystalline lens, to a nodal point (N) located immediately
behind the back surface of the lens.
At that point, the image becomes reversed (turned backwards) and
inverted (turned upside-down).
The light continues through the vitreous humor,
the clear gel that makes up about 80% of the
eye’s volume, and then, ideally, back to a clear
focus on the retina behind the vitreous.

The small central area of the retina is the

macula, which provides the best vision of
any location in the retina.

If the eye is considered to be a type of camera, the retina is equivalent to the

film inside of the camera, registering the tiny photons of light which interact with
it.
Within the layers of the retina, light impulses are changed into electrical signals
and then sent through the optic nerve, along the visual pathway, to the
occipital cortex at the posterior or back of the brain.

Actually, then, we do not “see” with our eyes but, rather, with our brains. Our
eyes merely are the beginnings of the visual process.
1.Snellen Chart
2.Tonometry
3.Gonioscopy
4.Opthalmoscopy / Fundoscopy
5.Slit-lamp Biomicroscopy
6.Perimetry
Visual acuity (vision) is determined in each eye using the Snellen Chart.
This chart consists of random letters of different sizes.
The letters for normal vision (20/20) are 3/8-inch tall, viewed at 20 feet.
People with normal vision can read these letters.
A refraction test may also be performed (the doctor puts several lenses in
front of the eyes to determine if glasses are needed).
Tonometry is a procedure that measures the pressure inside the eyes.
The test is used to screen for glaucoma.

There are three types of tonometry:

1.Air Puff - This is the only type of tonometry that does not touch
the surface of the eye.
The patient sits upright at the instrument, and a warm puff of air is
directed at the eye.

2. Applanation - The patient’s eye is first treated with numbing

drops and a stain called fluorescein. The tonometer is then
placed gently on the cornea, and a very small amount of
pressure is applied to the cornea. A hand-held tonometer may
be used.

3.Schiotz - older version of applanation

This type of tonometer was formerly used in the operating room or
with people who are unable to sit upright (such as infants or small
children).
KEELER Pulsair Desktop Non Contact Tonometer Handheld

The Keeler Pulsair Desktop Tonometer uses advanced optical and sensor
technology for positional detection and puff control.
applanation schiotz
Before the test:

❖Remove contact lenses before the examination.

The dye can permanently stain contact lenses.

❖Inform the health care provider if you have:

corneal ulcers and infections, an eye infection,
taking any drugs, with history of glaucoma

After:

❖If the applanation method is used, there is a small

chance the cornea may be scratched (corneal
abrasion).
This will normally heal itself within a few days.
Gonioscopy is an eye examination to look at the front part of your eye
(anterior chamber) between the cornea and the iris.

Gonioscopy is done to:

▪Evaluate the anterior chamber of the

eye when glaucoma is suspected.

▪Determine whether the drainage angle

of the eye is closed or nearly closed.
- type of glaucoma-

▪Treat glaucoma.
-laser light can be directed through the
goniolens at the drainage angle.

▪Check for birth defects that may be

causing glaucoma.
Before the test:

❖Remove contact lenses

before this test
❖Do not put them back in until at
least an hour after the test , until
the anesthetic medication wears
off.

After:
❖If your eyes may be dilated during
your examination, you should
arrange for someone to drive you
home after the test.

❖You should not rub your eyes for at

least 20 minutes after the test,
or until the anesthetic wears off.
Ophthalmoscopy/ Fundoscopy is an examination of the back part of
the eyeball (fundus), which includes the retina, optic disc, choroid,
and blood vessels.

The direct ophthalmoscope is an The binocular indirect ophthalmoscope,

instrument about the size of a small
flashlight (torch) with several lenses
that can magnify up to about 15x.
or indirect ophthalmoscope, is an optical
instrument worn on the examiner's head, and
sometimes attached to spectacles, that is used
to inspect the fundus or back of the eye. It
produces an stereoscopic image with between
2x and 5x magnification.
Before the test:

❖Indirect ophthalmoscopy are performed after eye drops are placed

to dilate the pupils.
❖Direct ophthalmoscopy can be performed with or without dilation
of the pupil.
❖ Inform the health care provider if you have:
corneal ulcers and infections, an eye infection, taking any drugs, with history of
glaucoma

After:

❖The dilating drops may impair focusing of the eyes for several
hours.
>Arrangements should be made for someone else
to drive after the examination.
>Wearing sunglasses or tinted lenses will make the patient with
dilated pupils more comfortable.
The Slit-lamp Examination looks at structures that are at the front of
the eye.
The slit-lamp is a low-power microscope combined with a high-intensity
light source that can be focused to shine as a slit beam.

No special preparation is necessary for this test.

The slit lamp exam is usually done at an optometry or ophthalmology
office. The exam is also called biomicroscopy; Slit-Lamp Biomicroscopy.
It allows the doctor to microscopically examine your eyes for any
abnormalities or problems.

What does this exam help diagnose?

A slit lamp exam can help diagnose the following conditions:
• macular degeneration, a chronic condition affecting the part of the
eye that is responsible for central vision
• detached retina, a condition when the retina, which is an important
layer of tissue at the back of the eye, becomes detached from its
base
• cataracts, a clouding of the lens that negatively affects the ability to
see images clearly
• injury to the cornea, an injury to one of the tissues that covers the
surface of the eye
• blockages of the retinal vessel, obstructions in the eye’s blood
vessels that can cause a sudden or gradual loss of vision
 Automated perimetry
You sit in front of a concave dome
and stare at a central target within
the dome.
A computer-driven program
flashes small lights at different
locations within the dome's
surface, and you press a button
when you see the small lights in
your peripheral vision.
Your responses are compared to
age-matched controls to determine
the presence of defects within the
visual field.

The test will detect any loss of peripheral vision and provide a map
of that loss which will be helpful in diagnosing the cause.

No special preparation is necessary for these tests.

 USES DRUG ACTION
-eye examinations; 1.Local Anesthetics =decrease pain
-surgery; a. Topical perception in the eyes
-treatment Tetracaine HCl(Pontocaine)
b. Injectable
Lidocaine HCl (Xylocaine)
-examination of the 2. Mydriatics =dilate pupils by causing
interior of the eye; Phenylepherine HCl contraction of dilator
-prevent adhesions of (Neo-Synephrine) muscle of the iris with
minimal effect on ciliary
iris with cornea in muscle which lessen
inflammations effect on accommodation
-eye examination; 3. Cycloplegics =dilate pupil
-decrease pain & Atropine Sulfate =paralyze ciliary muscle
photophobia & provide (Isoptoatropine) & iris
rest for inflammation of Scopolamine hydrobromide
the iris & ciliary body &
for diseases of cornea
 Physical Assessment of the Eye
I. Inspection

a. compensatory stances: head tilting, squinting

b. assess for symmetry in the appearance of the eyes

-equal distance from the nose
-same size
-same degree of prominence

c. assess for placement in the orbits & for symmetry & movement
exophthalmos(proptosis)-protrusion of the eyes
enophthalmos-sunken appearance of the eyes

d. hair distribution & direction of eyebrows & eyelashes

-normally point outward & away from the eyelid

e. eyelid: ptosis (drooping), redness, lesions or swelling

II. Scleral & Corneal Assessment

a. color: white
yellow - jaundice or systemic problems
for dark-skinned, normally yellow & with small pigmented dots

b. cornea: transparent, smooth, shiny, & bright

cloudy areas my be a result of accidents or injuries

c. blink reflex:
-bringing a fist quickly toward the client’s face
-expelling a syringe full of air toward the eyes
III. Pupillary Assessment PERRLA

a. round & equal in size

b. smaller in older adults

c. normal pupil diameter 3 - 5 mm

d. observe for response to light

-assess for the normal response to light:
direct response-constriction of the right pupil while shining a
penlight into the right eye
consensual response-constriction of the left pupil when light is
shined at the right pupil
-assess for speed of reaction:
brisk-rapid response ; sluggish-takes more than 1 sec to constrict;
nonreactive or fixed-fail to react

e. assess for accommodation:

hold the index finger abt 18 cm from the client’s nose & move it toward
the nose; client’s eye should converge & pupils constrict equally
IV. Measurement of Vision
a. Visual Acuity-measures both distance & near vision…
Snellen chart (dxtic test)

▪near-vision testing-for clients with

difficulty reading & over 40 yrs old

▪handheld snellen chart (Rosenbaum

Pocket Vision Screener or
Jaeger card); held 14 inches away
from his eyes & read

▪record the value of the lowest line

which the client can identify more
than half the characters
b. Visual Field or peripheral vision

-crude estimation

-automated perimetry

hemianopia-blindness in one half the field of vision

quadrantanopia-blindness in one fourth of the field of vision
large scotomas-blind spots in the visual field
V. Assessment of Extraocular Muscle Function

tests:

Six cardinal position of gaze-eye will not turn to a particular position

if the muscle is weak or if the controlling nerve is affected.

nystagmus-involuntary & rapid twitching of the eyeball is a

normal finding for the far lateral gaze or it may also be
caused by abnormal nerve function
 Six Positions of Cardinal Gaze:

DextroElevation- Rt & Up gaze LevoElevation- Lt & Up gaze

Dextroversion- Rt gaze LevoVersion - Lt gaze

PRIMARY GAZE

DextroDepression- Rt & down gaze LevoDepression-Lt & Down gaze

V. Assessment of Color Vision
Ishihara chart-shows numbers composed of dots of one color within
a circle of dots of different color
-test each eye separately by asking the client what numbers he sees
on the chart; reading the numbers correctly indicates normal vision