ASSESSMENT

OF THE
EYES
 Learning Outcomes
1. Recall the anatomy and physiology of the eye.
2. Explain the following:
a. patient preparation for assessment of the eye;
b. techniques used for assessment of the eye;
c. use of the ophthalmoscope.
3. Differentiate normal from abnormal findings in PA
of the eye.
4. Demonstrate the correct technique in PA of the
eye.
 REVIEW:
Anatomy and Physiology of the Eye
Accessory Structures of the Eye
 Figure 9.8

Accessory Structures of the Eye

 Figure 9.9

Tunics and Chambers of the Eye

 Figure 9.11

Iris
 Figure 9.10

Lens
 Figure 9.14a

Retina
 Figure 9.15a

Vision: Distant and Near

Figure 9.17a
 EYE EXAMINATION
• Assessment of eye function through specific
vision tests: visual acuity, visual field, muscle
function
• Inspection of the external eye
• Inspection of the internal eye
 Preparing the Client

• Explain each vision test thoroughly to guarantee

accurate results.

• Position for the eye examination: sitting or standing

• Explain in detail what will be done and answer

questions of the client to relieve anxiety.
 Equipment Needed
• Visual acuity charts (Snellen or E
chart; Rosenbaum chart; Jaeger
chart; chart with pictures and
numbers)
• Penlight
• Opaque card/eye cover
• Cotton-tipped applicator
• Ophthalmoscope
• Disposable gloves
 VISUAL ACUITY
Distant Vision
- with and without glasses

Normal Findings:
– Visual acuity of 20/20

Abnormal Findings:
• Myopia
• Amblyopia
 VISUAL ACUITY
Near Vision

Normal Findings:
- near visual acuity:
14/14 (with or without
corrective lenses).
Abnormal Findings:
• presbyopia
• hyperopia
 VISUAL FIELDS: Peripheral Vision
Direct confrontation visual field test
Normal: - able to see the stimulus at about
90 degrees temporally, 60
degrees nasally, 50 degrees
superiorly and 70 degrees
inferiorly
- able to see object at the same
time that the
examiner does
 500
700
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500

700
 EXTRAOCULAR MUSCLE FUNCTION
• Cardinal Fields of Gaze (Extraocular Muscle
Movements)/Positions Test
Normal Findings:
• Both eyes should move smoothly and
symmetrically in each of the six fields of gaze and
convergence on the held object as it moves
toward the nose.
Abnormal Findings:
- Abnormal eye movements consist of
failure of an eye to move outward (CNVI),
inability of the eye to move downward
when deviated inward (CNIV) or other
defects in movement (CNIII)

Nystagmus
https://www.youtube.com/watch?v=selZ9WrD7
ac
 EXTRAOCULAR MUSCLE FUNCTION
• Corneal Light Reflex (Hirschberg Test)
Normal Findings:
• reflected light (light reflex) seen symmetrically in
the center of each cornea

Abnormal Findings:
– Light reflections noted on different areas on both eyes
Pseudostrabismus

Normal in young children, the pupils will appear at the inner canthus.
 EXTRAOCULAR MUSCLE FUNCTION
• Cover – Uncover Test (for abnormal eye movement)
Normal Findings:
• Uncovered eye does not move as opposite eye is
covered
• Covered eye does not move as cover is removed
• Abnormal Findings:
Phoria
Strabismus
- Esotropia
- Exotropia
 EXTERNAL EYE STRUCTURE
• Eyelids, Eyebrows and Eyelashes
– Normal Findings:
» Symmetrical with no drooping, infections or
tumors of the lids.
» When the eyes are focused in a normal frontal
gaze, the lids should cover the upper portion of the
iris.
» can raise both eyelids symmetrically (CNIII)
» When the eye is closed, no portion of the cornea
should be exposed.
» Normal lid margins are smooth with the lashes
evenly distributed and sweeping upward from the
upper lids and downward from the lower lids.
» Eyebrows are present bilaterally and are
symmetrical and without lesions or scaling.
 EXTERNAL EYE STRUCTURE
• Eyelids 1

Abnormal Findings:
4 1. Ptosis
2. Lagophthalmos
3. Exophthalmos 2
4. Entropion
5. Ectropion
6 6. Hordeolum 3
7. Chalazion

5
7
 EXTERNAL EYE STRUCTURE
• Eyelids
Abnormal Findings:
– Color changes :
• Redness –may indicate frontal sinusitis
• Bluish – cyanosis; orbital vein thrombosis, tumor or
aneurysm
• Black and Blue – ecchymosis; caused by bleeding into
the surrounding tissue following trauma (black eye)
- Edema – allergies, heart/kidney disease
 EXTERNAL EYE STRUCTURE
• Eyebrows
Abnormal Finding:
– Absence of lateral third of eyebrows –
hypothyroidism

• Eyelashes
- Absence – pulling or plucking associated with OC
behavior
 EXTERNAL EYE STRUCTURE
• Conjunctiva (bulbar and
palpebral)
Normal Findings:
• bulbar conjunctiva:
transparent with small
blood vessels visible in it;
no swelling, injection,
exudates, foreign bodies or
lesions
Abnormal Findings:
- Episcleritis
• The palpebral conjunctiva should appear pink
and moist. It is without swelling , lesions,
injection, exudates or foreign bodies.
 EXTERNAL EYE STRUCTURE
• Sclera
Normal Findings:
– In light skinned individuals: white with some
small, superficial vessels and without exudates,
lesions or foreign bodies.
– In dark-skinned individuals: may have tiny
brown patches of melanin or grayish blue or
“muddy” color
Abnormal Findings:
– Uniformly yellow- jaundice.
 EXTERNAL EYE STRUCTURE
• Lacrimal Apparatus
Normal Findings:
– no enlargement, swelling or redness, no large
amount of exudates and minimal tearing
(inspection)

– no excessive tearing or discharge from the

punctum. (palpation)
 EXTERNAL EYE STRUCTURE
• Cornea and Lens
Normal Findings:
- Cornea and lens are transparent with no
opacities. The oblique view shows a smooth
and overall moist surface; lens is free of
opacities
- Arcus senilis among elderly clients
Abnormal Findings:
– Areas of roughness or dryness on the cornea: associated
with injury or allergic responses
– Opacities of the lens: cataracts
 EXTERNAL EYE STRUCTURE
• Iris
Normal Findings:
– color evenly distributed over the iris,
although there can be a mosaic variant
– smooth and without apparent vascularity
Abnormal Findings:
– heavily pigmented,
slightly elevated area visible
in the iris
ANTERIOR SEGMENT STRUCTURES
• Pupil
• Inspection; pupillary reaction to light;
accommodation
Normal Findings:
• Pupils round with a regular border, centered
in the iris, equal in size (3 to 5 mm)
• PERRLA anisocoria
Abnormal Findings:

Miosis

Mydriasis
 INTERNAL EYE STRUCTURE
• Retinal Structures
• Red reflex; optic disc
Normal Findings:
– Red reflex is present
– The optic disc is pinkish in color.
Abnormal Findings:
– The optic disc is pale, due to optic atrophy
caused by increased ICP
 INTERNAL EYE STRUCTURE
• Macula
Normal Findings:
- The macula is a darker, avascular area with a pinpoint
reflective center (fovea centralis)
Abnormal Findings:
– retina pale with the macular region appearing
as a cherry-red spot (Tay-Sach’s disease)
 PALPATION OF THE EYE
• Lacrimal sacs, eyelids and erythematous
areas
Normal Findings:
- no swelling or tenderness
- eyeballs firm
Abnormal Finding:
- erythema – injury, infection, CV/renal
problem
- eyeballs hard - glaucoma
 Sample Objective Data
• Acuity tested by snellen chart: O.D. 20/20, O.S. 20/20.
• Visual fields full by confrontation.
• Corneal light reflex shows equal position of reflection.
• Eyes remain fixed throughout the cover test.
• Extraocular movements smooth and symmetric with no
nystagmus.
• Eyelids in normal position with no abnormal widening or
ptosis.
• No redness, discharge, or crusting noted on lid margins.
• Conjunctiva and sclera appear moist and smooth.
• Sclera white with no lesions and redness.
• No swelling and redness over lacrimal gland.
• Puncta is visible without swelling or redness.
 Appropriate Nursing Diagnoses
Wellness Diagnoses:
• Readiness for enhanced visual integrity

Risk Diagnoses
• Risk for Eye injury related to hazardous work area or
participation in high-level contact sports.
• Risk for Eye Injury related to decreased tear
production secondary to the aging process.
Actual Diagnoses
• Ineffective Health Maintenance related to lack
of knowledge of necessity for eye
examinations.
• Acute Pain related to injury from eye trauma,
abrasion, or exposure to chemical irritant.
THANK YOU!