Abnormalities of the external eye

1. Ptosis - is a drooping or falling of the upper eyelid

2. Ectropion - condition in which your eyelid turns outward
3. Conjunctivitis - the inflammation or infection of the transparent membrane that
lines your eyelid and eyeball (sour eyes)
4. Exophthalmos - knows as proptosis, the medical term for bulging or protruding
eyeballs
5. Stye (hordeolum) - tender red bump on the edge of eyelid, it is an infection of
a gland of the eyelid.
6. Entropion - condition in which your eyelid turns inward so the eyelashes and
skin rub agains the eye surface.
7.

* INTERNAL STRUCTURE OF THE EYE:

The eyeball - is composed of three separate layers:
external, middle, innermost layer.

External :
Sclera - a daense protective white covering
Cornea - permits the entrance of light, which passes through the lens to the
retina.

ABNORMALITIES OF THE CORNEA AND LENS:

Pterygium or surfers eye is a growth of pink, fleshy tissue on the conjuctiva, the
clear tissue that lines your eyelids and covers the eyeball.
Cataracts - are the cloading of the lense of your eye, which is normally clear.

INTERNAL STRUCTURES OF THE EYE: MIDDLE LAYER

The Iris - Circular disc of muscle containing pigments that determine eye color
- The central aperture of the iris is called the pupil.

The lens is a biconvex, transparent, avascular, encapsulated structure located

immediately posterior to the iris.
- the lens functions to refrect or bend light rays onto the retina.

The choroid layer - contains the vascularity necessary to provide nourishment to

the innre aspect of the eye

Abnormalities of the iris and pupils

1. Miosis - known as pinpoint pupils, characterized by constricted and fixed
pupils.
2. Mydriasis - dilated and fixed pupils
3
.

INNER MOST LAYER

Retina - receives visual stimuli and sends it to the brain
Optic disc - a cream colored circular area located on the retina toward the medial
or nasal side of the eye.
Retinal vessels can be readily viewed-..

ASSESSMENT:
Purpose - to identify any changes in vision or signs of eye disorders in an effort
to initiate early treatment or corrective procedures
Preparing the client - Explain each vision test thoroughly to guarantee accurate
results.
- Explain to the client that this may be slightly uncomfortable.

EQUIPMENT:
Snellen Chart or E chart.
Penlight
Opaque Cards
Ophthalmoscope

ASSESSMENT OF THE EYE CHECKLIST

Test distant visual acuity - POsition the client 20 feet from the snellen or E
chart and ask her to read each line until she cannot decipher the letters or their
direction
Confrontation test: test visual fileds for gross peripheral vision - To perform,
position yourself approximately 2 feet away from the client at eye level. Have the
client cover the left eye while you cover your right eye.
Corneal Light reflex test - This test assesses parallel alignment of the eyes. Hold
a penlight approx. 12 inches from the client's face. Shine the light toward the
bridge of the nose while the client stares straight ahead. Note the light reflected
on the corneas.
Positions test: Perform the positions test which assesses the eye muscle strength
and cranial nerve function. Instruct the client to focus on an object you are
holding (approx. 12 inches from face). Move the object through the six cardinal
positions of gaze in a clock-wise direction, and observe the client's eye
movements.
Inspect eyelids and lashes - Inspect the eyelids and lashes (width, and position of
palpebral fissures, ability to close eyelids, direction of eyelid in comparison
with eyeballs color, swelling ,lessions, or discharge.)
Positioning of Eyeballs - Inspect positioning of eyeballs (alignment in sockets,
protrouded, sunken.)
Bulbar conjuctiva and sclera - Inspect bulbar conjunctiva and sclera for clarity,
color, and texture. Have the client keep the head straight while looking from side
to side then up toward the ceiling. Observe claritiy, color, and texture.

Observe the lacrimal apparatus - over the lacrimal glands (Lateral aspect of upper
eyelid) and puncta (medial aspect of lower eyelid). OBserve for swelling, redness,
or drainage.
Accomodation of pupils

EAR ASSESSMENT:
The Ear - The ear is the sense organ of hearing and quilibrium
- It consists of three distinct parts: External, middle, and inner ear.
EXTERNAL:
- Auricle is also known as the pinna, and it is most commonly referred to as the
ear. It is the most obiously visible part of the auditory system (Helix, Tragus,
lobule)
THe external auditory canal is S-shaped in the adult. Also called external auditory
meatus, or external acoustic meatus, passageway that leads from the outside of the
head to the tympanic membrane or eardrum membrane.
- Modified sweat glands in the external ear canal secrete cerumen, a wax-like
substance that keeps the tympanic membrane soft.
- Cerumen also called ear wax, has abacteriostatic properties and its sticky
consistency serves as a defense for foreign-..
- The tympanic membrane, or eardrum has a transclucent, pearly gray appearance and
serves as a partition stretched across the inner end of the auditory canal,
separating it from the middle ear.
The distinct landmarks include:
Handle and short process of the malleus - the nearest auditory ossicle
Umbo - the base of the malleus -..
MIDDLE:
Tympanic cavity - is a small, air filled chamber in the temporal bone.
Has three auditory ossicles: The malleus, incus, and stapes.
INNER:
Labyrinth - fluid filled and made up of the bony labyrinth and an inner membranous
labyrinth.
The bony "" has three parts: The cochlea, vestibule, and semicircular canals.

HEARING:
- The transmission of soundwaves throug hthe external and middle ear is referred to
as "conductive hearing"
- The transmission of sound waves in the inner ear is referred to as "perceptive"
or "sensorineural hearing".

Sensorineural hearing loss

- The sensorineural hearing loss would be related to dysfunction of the inner ear.
The causes of this type of hearing loss are generally sorted into two categories:
Acquired or Congenital.

ASSESSMENT OF THE EARS:

Purpose - to evaluate the condition of the external ear, the condition and patency
of the ear canal, the status of tympanic membrane, bone and air conduction of sound
vibrations, hearing acuity, and equilibrium.
Preparing the client - Make sure that the client is seated comfortably during the
examination
- The test should be explained thoroughly to guarantee accurate results
- Answer any questions the client may have
- Carefully note how the client responds to your explanations

EQUIPMENTS:
- Watch with a second hand for romberg test
- Tuning for (512 or 1024 Hz)
- Otoscope

Inspect the auricle, tragus, and lobule. Note size, shape, and position.
Palpate the auricle and mastoid process.
Inspect the external auditory canal. Use the otoscope. Not any discharge along with
the color and consistency of cerumen.
Observe the color and consistency of the ear canal walls and inspect the character
of any nodules
Inspect the tympanic membrane. Note color, shape, consistency, and landmarks.
Perform whisper test - Perform by asking the client to gently occlude the ear not
being tested and rub the tragus with a finger in a circular motion. Start with
testing the better hearing ear and then the poorer one. WIth your head 2 feet
behind the client, whisper a two-syllable word. Ask the client to repeat it back to
you. If the response is incorrec the first time, whisper the word one more time.
IDentifying three out of six whispered words is considered passing the test.