EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
`
SCHOOL OF NURSING

ASSESSING THE EYE STRUCTURES AND VISUAL ACUITY

NAME: ______________________________________________ SCORE: _____________________
YR/SEC/GRP: _________________________________________ DATE: ______________________

PERFORMED
PLANNING MASTERED COMMENTS
YES NO
 Place the client in an appropriate room for
assessing the eyes and vision.
 Control the natural and overhead lighting
during some portions of the examination.
PREPARATION
1. Assemble equipment and supplies:
 Millimeter ruler
 Penlight
 Snellen’s or E chart
 Opaque card
PROCEDURE
1. Introduce yourself and verify the client’s
identity. Explain to the client what you
are going to do, why it is necessary, and
how the client can cooperate. Discuss
how the results will be used in planning
further care or treatments.
2. Perform hand hygiene, apply gloves, and
observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Inquire if the client has any history of the
following:
 Family history of diabetes,
hypertension, or blood dyscracia
 Eye disease, injury, or surgery
 Last visit to an ophthalmologist
 Current use of eye medications
 Use of contact lenses or eyeglasses.
 Hygienic practices for corrective
lenses.
 Current symptoms of eye problems
e.g., changes in visual acuity, blurring
of vision, tearing, spots, photophobia,
itching or pain.
ASSESSMENT
EXTERNAL EYE STRUCTURES
5. Inspect the eyebrows for hair distribution
and alignment, and for skin quality and
movement.
 Ask client to raise and lower eyebrows
6. Inspect the eyelashes for evenness of
distribution and direction of curl.
7. Inspect the eyelids for surface
characteristics (skin quality and texture),
position in relation to the cornea, ability
to blink, and frequency of blinking;
inspect the lower eyelids while the

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 client’s eyes are closed.
8. Remove and discard gloves.
 Perform hand hygiene.
EXTERNAL EYE STRUCTURES
9. Inspect the bulbar conjunctiva for color,
texture, and the presence of lesions.
10. Inspect the cornea for clarity and texture.
 Ask the client to look straight ahead.
 Hold a penlight at an oblique angle to the
eye and move the light slowly across the
corneal surface.
11. Inspect the pupils for color, shape, and
symmetry of size.
12. Assess each pupil direct and consensual
reaction to light to determine the
function of the third (oculomotor) and
fourth (trochlear) cranial nerves
 Partially darken a room
 Ask the client to look straight ahead.
 Using a penlight and approaching from the
side, shine a light on the pupil.
 Observe the response of the illuminated
pupil. It should constrict (direct response)
 Shine the light on the pupil again and
observe the response of the other pupil. It
should also constrict (consensual
response)
13. Assess each pupil’s reaction to
accommodation.
 Hold an object (penlight or pencil) about
10 cm from the bridge of the client’s nose.
 Ask the client to look first at the top of the
object and then at a distant object behind
the penlight. Alternate the gaze from the
near to the far object. Observe the pupil
response.
 Next, ask the client to look at the near
object and then move the penlight or
pencil towards the client`s nose.
VISUAL FIELDS
14. Assess peripheral visual fields to
determine function of the retina and
neuronal visual pathways to the brain
and second (optic) cranial nerve.
 Have the client sit directly, facing you at a
distance of 60-90 cm. (2 to 3 ft.)
 Ask the client to cover right eye with a
card and look directly at your nose.
 Cover or close you eye directly opposite
the client’s covered eye (i.e., your left eye)
and look directly at the client`s nose.
 Hold an object (penlight or pencil) in your
fingers, extend your arm, and move the
object into the visual field from various
points in the periphery. The object should
be at an equal distance from the client and
yourself. Ask client to tell you when the
moving object is first spotted.
A. To test the temporal field of the left eye,

• VIRTUE • EXCELLENCE • SERVICE

 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
`
SCHOOL OF NURSING
extend and move your right arm in from
the client`s right periphery.
B. To test the upward field of the left eye,
extend and move the right arm down from
the upward periphery.
C. To test the downward field of the left eye,
extend and move the right arm up from
the lower periphery.
D. To test the nasal field of the left eye,
extend and move your left arm in from the
periphery.
 Repeat the above steps for the right eye,
reversing the process.
EXTRAOCULAR MUSCLE TEST
15. Assess six ocular movements to
determine eye alignment and
coordination.
 Stand directly in front of client and hold
the penlight at a comfortable distance
such as 30cm (1 ft.) in front of client’s
eyes.
 Ask the client to hold the head in a fixed
position facing you and to follow
movements of the penlight with the eyes
only.
 Move the penlight in a slow, orderly
manner through the six cardinal fields of
gaze, that is from the center of the eye
along the lines of the arrows in and back
to the center.
 Stop the movement of the penlight
periodically so that nystagmus can be
detected.
16. Assess for location of light reflex by
shining a penlight on the corneal surface
(Hirschberg Test)
17. Have the client fixate on a near or far
object. Cover one eye and observe for
movement in the uncovered eye (cover
test).
VISUAL ACUITY
18. If the client can read, assess near vision
by providing adequate lighting and asking
the client to read from a magazine or
newspaper held at a distance of 36 cm.
(14 in.). If the client normally wears
corrective lenses, the glasses or lenses
should be worn during the test. The
document must be in language the client
can read.
19. Assess distance vision by asking the client
to wear corrective lenses unless they are
used for reading only.
 Ask the client to stand or sit 6 meters (20
ft) from Snellen’s chart, cover the eye not
being tested, and identify the letters or
characters on the chart.
 Take three readings, right eye, left eye and
both eyes.

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  Record the readings of each eye and both
eyes (i.e., the smallest line from which the
person is able to read one-half or more of
the letters).
At the end of each line of the chart are
standardized numbers (fractions). The top
line is 20/100. The numerator (top
number) is always 20, the distance the
person stands from the chart.
The denominator (bottom number) is the
distance from which the normal eye can
read the chart.
20. If the client is unable to see even the top
line (20/200) of the Snellen-type chart,
perform selected vision tests
21. Document findings in the client record
supported by narrative notes when
appropriate.
TOTAL SCORE

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student

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