BACHELOR OF SCIENCE IN NURSING:

NCM 104 - MEDICAL & SURGICAL NURSING 2

COURSE MODULE COURSE UNIT WEEK
3 13 15
Review of the Anatomy and Physiology of the Eyes & Assessment

 Read the course and unit objectives

 Read the study guide before class begins
 Read required reading materials and
understand terminologies
 Participate in classroom discussion
 Participate in discussion board (Canvas)
 Answer and submit course unit tasks

At the end of the course unit (CU), learners will be able to:

Cognitive:
1. Have a mastery of the anatomy & physiology of the eyes.
2. Evaluate alterations in the normal assessment of eye.

Affective
1. Listen attentively during discussion.
2. Perform eye assessment confidently.

Psychomotor
1. Participate in an interactive discussion.
2. Formulate nursing diagnosis and care plans in clients with visual impairment.
Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing (14th ed) Philadelphia: Wolters Kluwer
Norris T. (2018) Porth’s Pathophysiology: Concepts of Altered Health States, (10th ed) Wolters Kluwer
Read on the Anatomy and Physiology of the Eyes & its Assessment

Introduction
The eyes are highly specialized sense organ
for vision. Loss of this function causes too
much disability in a person. Before the
discussion of eye disorders, this module
reviews the structures and functions of the
eyes.

The external structures of the eyes are composed of the eyelids and eyebrows which function is to
protect the eyes from sweat or any foreign body. Externally, the sclera, the white of the eye is seen,
the pupils where light enters the eyes and the iris, the colored portion of the eye. The eyeball is
located in the orbital cavity which is part of the skull. In the medial portion of the eye is the lacrimal
caruncle and the tear duct.

There is a conjugate movement of the eyes. They follow the same direction. The eyes move by the
contraction of the extraocular muscles. Superior rectus moves the eyeball upward. Inferior rectus
moves the eyeball downward. Medial rectus moves the eyeball medially, lateral recuts moves the
eyeball laterally. Superior rectus moves the eyeball upward and inward. Inferior rectus muscle moves
the eyeball upward and outward. Extraocular muscles are innervated by cranial nerves III, IV and VI.
Most of the extraocular muscles are innervated by CN III except the lateral rectus which is innervated
by CN IV and superior oblique which is supplied by CN IV. The eyes move together as one and the
brain sees one image only, binocular vision.

The tears are produced by the lacrimal glands and it is helpful to maintain a healthy eyes as it washes
away dirt and prevent irritation.

The eyes are capable of refraction. Refractive indices include the cornea, the transparent membrane
covering the eyes. The aqueous humor, a fluid produced by the ciliary bodies that nourishes the
eyeball, from the ciliary body, it flows to the posterior chamber, then it goes out of the pupil into the
anterior chamber and drains into the canal of schlemm in the venous circulation. Another refractive
index is the lens, this is also responsible for accommodation. And the last is the vitreous humor, a
jelly like substance at the back of the lens that gives shape to the eyeball.
The eyes have three layers, the outer layer is the fibrous layer, the second layer is the vascular layer
and the third layer is the nervous layer. The fibrous layer is composed of the sclera, the white of the
eyes, this is covered by a membrane called conjunctiva that lines the eyeball as well as the lining of
the inner lids. The vascular layer is composed of the ciliary bodies, the iris and the suspensory
ligaments that support the lens. The innermost layer is the nervous layer which contains the retina
where the photoreceptors, rods responsible for dim vision and cones for light vision are located.
Cranial nerve II or the optic nerve innervates the eyes for vision.

Light rays enter the eyes through

the pupils, the size of the pupils
regulate the amount of light
entering the eyes. The light rays
bend as it passes the refractory
indices and the image forms in
the retina is inverted. When the
optic nerve carries this image to
the brain ( occipital lobe) it is the
brain that actually see an upright
image.
 ASSESSMENT OF THE EYES

Assessment of Patient
 Assess history of eyestrain, headache, and double vision.
 Assess family history of squint and amblyopia.
 Assess history oy eye and head injury.
 Notice abnormal head adaptation such as head tilt and face turn.

Required Instrument
 Occluder
 Pen light
 Fixation target

Patient Preparation
 Explain patient about the nature of the test to seek his or her confidence and
co-operation.
 Ensure that the patient is comfortably seating in a dimly illuminated room.

Assessment starts with thorough history and physical examination. Instrument like ophthalmoscope
an Snellen’s chart are important. Patient should be placed in a very well lit place.

Inspection is done by looking at both eyes and the movement. EOMs are checked as the person
looks straight without moving the head and will be asked to follow the fingers as they move upward,
downward, sideways, in and out. The color of the sclera should be noted as well as the conjunctiva.

Using the penlight, pupillary movements are checked. Any opacity of the lens may be detected by
the light also.

Visual acuity is checked by using the Snellen’s chart. The normal vision is 20/20. The numerator is
the patient’s vision and the denominator is the normal person’s vision. Example if the visual acuity
is 20/100. This means that the patient can see at 20 feet where a normal person can see at 100 feet.
Legal blindness is having a visual acuity of 20/400.

Accommodation – process by which the eye adjusts for near distance (eg, reading) by changing
the curvature of the lens to focus a clear image on the retina.
Anterior chamber – space in the eye bordered anteriorly by the cornea and posteriorly by the iris
and pupil.
Aqueous humor – watery fluid that fills the anterior and posterior chambers of the eye.
Binocular vision – normal ability of both eyes to focus on one object and fuse the two images into
one.
Emmetropia – absence of refractive error enucleation: complete removal of the eyeball and part of
the optic nerve.
Rods – retinal photoreceptor cells essential for bright and dim light.
Vitreous humor – gelatinous material (transparent and colorless) that fills the eyeball behind the
lens.

Rizzo, D. C. (2016) Fundamentals of Anatomy and Physiology (4th ed) Cengage

Kumar V., Abbas A., Aster J. (2020) Robbins & Cotran Pathologic Basis of Disease (10th ed)
Elsevier

Make a knowledge matrix on the structures of the eyes, their function and normal assessment finding
using the pattern below:
Eye structure Function Normal Assessment Abnormal findings

Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing (14th ed) Philadelphia: Wolters Kluwer
Norris T. (2018) Porth’s Pathophysiology: Concepts of Altered Health States, (10th ed) Wolters
Kluwer
Illustration / Images:
Choate, W. (2015, Oct 31) [Assessing the Eyes] Choate eye associates: Common Age – Related
Eye Problems. Retrieved from https://www.choateeye.com/blog/2015/10/31/common-age-
related-eye-problems-163971
Pawlowski, A. (2018 Aug 24) Today: Mind and Body – A Key to early Alzheimer’s detection may be
in your eyes [Eye] Retrieved from https://www.today.com/health/how-diagnose-alzheimer-s-
early-eye-changes-may-be-clue-t136244
Carlson, D. [Eye Anatomy 2 Illustration] Carlson Stock Art: Life Science Illustration and More
Retrieved from https://www.carlsonstockart.com/photo/human-eye-eyeball-anatomy-
illustration-2/
[Eye Anatomy] Human Diseases and Conditions: Glaucoma. Retrieved from
http://www.humanillnesses.com/original/Gas-Hep/Glaucoma.html