HEALTH ASSESSMENT
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
Collecting Subjective Data
History of present health concern
(VISUAL PROBLEMS)
1. Describe any recent visual difficulties or
changes in your vision that you have
experienced. Were they sudden or
gradual?
o Sudden changes in vision – associated
with acute problems: head trauma,
increased intracranial pressure
o Increased intracranial pressure - a rise
in pressure around your brain. It may be
due to an increase in the amount of fluid
surrounding your brain
o Gradual changes in vision may be related
to aging, diabetes, hypertension
neurologic disorders
2. Do you see spots or floaters in front of your
eyes?
o Spots or floaters – common among clients
with myopia or clients over age 40
3. Do you experience blind spots? Are they
constant or intermittent?
o Scotoma – blind spot surrounded by either
normal or slightly diminished peripheral
vision, may be from glaucoma
o Glaucoma - a condition that damages
your eye's optic nerve
o Intermittent blind spots – may be
associated with vascular spasms
(ophthalmic migraines) or pressure on
optic nerve by a tumor or increased
intracranial pressure
o Consistent blind spots – may indicate
retinal detachment
4. Do you see halos or rings around lights?
o If yes, it is associated with narrow-angle
glaucoma
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5. Do you have trouble seeing at night?
o Night blindness – associated with optic
atrophy, glaucoma and Vit A deficiency
o Atrophy - a condition that affects the
optic nerve, which carries impulses from
the eye to the brain
6. Do you experience double vision
(diplopia)?
o Double vision may indicate increased
intracranial pressure due to injury or tumor
(OTHER SYMPTOMS)
1. Do you have any eye pain or itching? Do
you have pain with bright lights
(photophobia)? Describe.
o Burning or itching – associated with
allergies or superficial irritation
o Throbbing, stabbing or deep, aching pain
– suggests a foreign body in eye or
changes within eye
2. Do you have any redness or swelling in
your eyes?
o Redness or swelling – related to an
inflammatory response caused by allergy,
foreign body or bacterial or viral infection
3. Do you experience excessive watering or
tearing of the eye? If so, is it in one eye or
both?
o Excessive tearing (epiphora) – caused by
exposure to irritants or obstruction of
lacrimal apparatus
o Unilateral epiphora – associated with
foreign body or obstruction
o Bilateral epiphora – associated with
exposure to irritants such as makeup or
HEALTH ASSESSMENT
NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
facial cleansers or it may be a systemic
response
4. Have you had any eye discharge?
Describe.
o Discharge other than tears – suggests
bacterial or viral infection
Personal Health History
1. Have you ever had problems with your
eyes or vision?
o History of eye problems or changes
provides clues to current health of eye
2. Have you ever had eye surgery?
o Surgery may alter the appearance of eye
and results of future examinations
3. Describe any past treatments you have
received for eye problems (medications,
surgery, laser treatment, corrective
lenses). Were these successful? Were you
satisfied?
4. What types of medication do you take?
o Ocular side effects of drugs – often
unrecognised or overlooked
o Some medications reported to have
ocular side effect: alpha-1 blockers, some
antiarrhythmics, anticholinergics
(including antihistamines, antipsychotics,
antispasmodics, cyclic antidepressants,
and mydriatics), anticoagulants,
antimalarials, bisphosphonates,
corticosteroids, digoxin, erectile
dysfunction medications, fluoroquinolones
and some other antibiotics and many
other medications
5. When was your last eye examination?
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6. Do you perform the test for macular
degeneration using the Amsler chart?
How do you use this chart and how often?
What do you see when you use it?
o To perform the test, client should wear
their glasses if they normally do so
o They should use the bottom portion to
view the chart if they wear bifocals
o Client to stand 12-14ft away from it and
cover one eye
o With the other eye, they should look at the
centre dot
o Any areas of distortion, greying, blurring or
blank spot should be marked on the chart
o Notify their physician
7. Do you have a prescription of corrective
lenses (glasses or contacts)? Do you wear
them regularly? If you wear contacts, how
long do you wear them? How do you
clean them?
o Improper cleaning or prolonged wearing
of contact lenses can lead to infection
and corneal damage
8. Have you ever been tested for
glaucoma? What were the results?
o Tonometry is used to measure pressure
within the eye
o Normal eye pressures range from 10-
21mm of mercury (mm Hg)
o Eye pressures greater than 22 mm Hg
increases one’s risk for developing
glaucoma
o But people with normal eye pressure can
still get glaucoma
Family History
1. Is there a history of eye problems or vision
loss in your family?
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
o Many eye disorders have familial
tendencies
o Examples include glaucoma, refraction
errors, allergies, and macular
degeneration
o Macular degeneration - caused by
deterioration of the retina and can
severely impair vision
Lifestyle and Health Practices
1. Are you exposed to conditions or
substances in the workplace or home that
may harm your eyes or vision (e.g.
chemicals, fumes, smoke, dust, or flying
sparks)? Do you wear safety glasses
during exposure to harmful substances?
o Injuries or diseases may be related to
exposure in workplace or home
o These problems can be minimized or
avoided altogether with hazard
identification and implementation of
safety measures
o Important to teach client to use
protective eyewear when engaging in
recreational activities and hazardous
situations.
2. Do you wear sunglasses during exposure
to the sun?
o Exposure to ultraviolet radiation puts client
at risk for the development of cataracts
o Consistent use of sunglasses during
exposure minimizes the client's risk
o Cataracts - clouding of the lens of the eye
which leads to a decrease in vision
3. Do you have any vision loss? Has your
vision loss affected your ability to care for
yourself? To work?
o Vision problems may interfere with client's
ability to perform usual ADL
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o Client may be unable to read medication
labels or fill insulin syringes
o Vision problems may affect client's ability
to work if the job is one that depends on
sight such as a pilot or commercial motor
vehicle operator.
4. What visual aids do you use to assist you
with your visual loss (magnifying glasses,
audiotapes, CDs, special glasses for
viewing television, large-numbered
phones, large-print checks, large-print
books)?
o Important to assist client to access and
use assistive and adaptive visual devices
to improve one's ADL
5. Describe your typical diet. What have you
eaten in the last 24 hours? Do you take
any vitamins or supplements?
o Lutein and zeaxanthin (in foods or by
supplements) found in green leafy
vegetables, eggs, and other foods
reduce risk of chronic eye diseases,
including age-related macular
degeneration and cataracts. (kale,
spinach, collards, turnip greens, corn,
green peas, broccoli, romaine lettuce,
green beans, eggs, and oranges)
o Vitamin C can decrease risk of cataracts
and reduce risk of age-related macular
degeneration when taken with other
essential nutrients.
o Vitamin E in its most biologically active
form is powerful antioxidant which, when
taken with antioxidants beta-carotene,
vitamin C and zinc has been found to
slow progression of AMD by 25% in high-
risk individuals.
o Zinc is an essential trace mineral or "helper
molecule". It plays a vital role in bringing
vitamin A from liver to retina in order to
produce melanin, a protective pigment in
the eyes.
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
o Two omega-3 fatty acids have been
shown to be important for proper visual
development and retinal function.
o Beta-carotene supplements have been
known to decrease one's risk of
developing cataracts and AMD.
However, research shows this may
increase the risk of lung cancer in people
who smokes, former smokers, have been
exposed to asbestos, or drink one or more
alcoholic beverages and also smoke.
6. Do you smoke? How many packs and for
how long?
o Tobacco smoking - associated with eye
diseases, doubling the chance of forming
cataracts and causing a three-fold risk of
developing AMD.
Collecting Objective Data
Physical Examination
Preparing the client:
o Explain each vision test thoroughly to
guarantee accurate eye results
o Position client to sit comfortably
o Examination of internal eye with
ophthalmoscope: move very close to
client’s face to view retina and internal
structures
o Explain to client that this may be slightly
uncomfortable
o Explain in detail what will be done and
answer any questions client raises
Equipment:
o Snellen or E chart (check page 316)
o Hand-held Snellen card or near-vision
screener
o Penlight
o Opaque cards
o Ophthalmoscope
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o Disposable gloves (wear as needed to
prevent spreading infection or coming in
contact with exudate)
Physical Assessment:
Before performing eye examination, review
and recognise structures and functions of
eyes
o Administer vision tests competently and
record results
o Use the ophthalmoscope correctly and
confidently
o Recognise and distinguish normal
variations from abnormal findings
General Routine Screening
o Test distant visual acuity
o Test near visual acuity
o Test visual fields for gross peripheral vision
o Inspect eyelids and eyelashes
o Observe the position and alignment of
eyeball in the eye socket
o Inspect the bulbar conjunctiva and sclera
o Inspect the lacrimal apparatus
o Inspect the iris and pupil
o Assess pupillary reaction to light
Focused Specialty Assessment
o Perform corneal light reflex test
o Perform cover test
o Perform the cardinal fields of gaze test
o Inspect the palpebral conjunctiva
o Palpate the lacrimal apparatus
o Inspect the cornea and lens
o Assess accommodation of pupils
o Use ophthalmoscope to inspect the optic
disc, retinal vessels and background,
fovea and macula and anterior chamber
Evaluating Vision
1. Test distant visual acuity
o Position client 20ft from the Snellen or E
chart
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
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o Ask client to read each line until he
cannot decipher the letters or directions
o During vision test, note any client
behaviours that could be unconscious
attempts to see better
֍ Myopia (impaired far vision) is present
when the second number in the test
result is larger than the first (20/40)
֍ The higher the second number, the
poorer the vision. A client is considered
legally blind when vision in the better
eye with corrective lenses is 20/200 or
less.
2. Test near visual acuity
o Use this test for middle-aged clients and
others who have difficulty with near vision
or with reading
o Give the client a hand-held vision chart
(e.g. Jaeger reading card, Snellen card,
or comparable chart)
o Hold 14 inches from eyes
o Have client cover one eye with an
opaque card before reading from top to
bottom
o Repeat test for the other eye
o Client who wears glasses should keep
them on for this test
֍ Presbyopia (impaired near vision) is
indicated when client moves the chart
away from the eyes to focus on the
print, caused by decreased
accommodation
֍ (older adult considerations) common
condition in clients over 45 years of
age.
3. Test visual fields for gross peripheral vision
o Position yourself approximately 2 ft away
from client at eye level
o Have client cover left eye while you cover
your right eye
o Look directly at each other with your
uncovered eyes
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o Fully extend your left arm at midline and
slowly move one finger or pencil upward
from below until the client sees your finger
or pencil
o Test the remaining three visual fields of
client's right eye
o Repeat the test for the opposite eye
֍ A delayed or absent perception of the
examiner's finger indicates reduced
peripheral vision
֍ Refer the client for further evaluation
֍ Normal visual field degrees are
approximately as follows:
 Inferior: 70 degrees
 Superior: 50 degrees
 Temporal: 90 degrees
 Nasal: 60 degrees
Testing Extraocular Muscle Function
1. Perform corneal light reflex test
o Hold penlight approximately 12 inches
from client's face
o Shine light toward bridge of nose while
client stares straight ahead
o Note the light reflected on corneas
֍ Asymmetric position of light reflex
indicates deviated alignment of eyes -
may be due to muscle weakness or
paralysis
2. Perform cover test
o This test detects the deviation in
alignment or strength and slight deviation
in eye movement
o Ask client to stare straight ahead and
focus on a distant object
o Cover on of client's eyes with an opaque
card
o As you cover the eye, observe the
uncovered eye for movement
o Remove opaque card
o Observe the previously covered eye for
any movement
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o Repeat test on opposite eye
֍ The uncovered eye will move to
establish focus when the opposite eye
is covered.
֍ When covered eye is uncovered,
movement to re-establish focus occurs
֍ Either of these findings – indicates
deviation in alignment of eyes and
muscle weakness
֍ Phoria is a term used to describe
misalignment that occurs only when
fusion reflex is blocked
֍ Strabismus is constant malalignment of
eyes
֍ Tropia is a specific type of
misalignment
֍ esotropia is an inward turn if eye
֍ exotropia is an outward turn of eye
3. Perform the cardinal fields of gaze test
o Which assess eye muscle strength and
cranial nerve function
o Instruct client to focus on an object you
are holding (approximately 12 inches from
client’s face)
o Move object through the size cardinal
positions of gaze in a clockwise direction
o Observe client’s eye movements
֍ Failure of eyes to follow movements
symmetrically in any or all directions –
indicates a weakness in one or more
extraocular muscles or dysfunction of
cranial nerve that innervates particular
muscle
֍ Nystagmus – an oscillating (shaking)
movement of the eye – may be
associated with an inner ear disorder,
multiple sclerosis, brain lesions or
narcotics use
Inspection and Palpation External eye
structures
1. Inspect the eyelids and eyelashes
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o Note width and position of palpebral
fissures
֍ Drooping of the upper lid is called
ptosis (formal term blepharoptosis)
֍ Retracted lid margins which allow for
viewing of sclera when the eyes are
open - suggest hyperthyroidism
o Assess ability of eyelids to close
֍ Failure of lids to close completely puts
client at risk for corneal damage
o Note the position of the eyelids in
comparison with the eyeballs
o Also note any unusual turnings, colour
swelling, lesions, and discharge
֍ Entropion - inverted lower lid, which
may cause pain and injure cornea as
the eyelash brushes against the
conjunctive and cornea
֍ Ectropion - everted lower eyelid, results
in exposure and drying of conjunctiva
֍ (older adult considerations) though
usually abnormal, entropion and
ectropion are common
o Observe for redness, swelling, discharge or
lesions
֍ Redness and crusting along the lid
margins suggest seborrhoea or
blepharitis - an infection caused by
Staphylococcus Aureus.
֍ Hordeolum (stye) - a hair follicle
infection causes local redness,
swelling, and pain.
֍ A chalazion - an infection of
Meibomian gland (located in the
eyelid) may produce extreme swelling
of the lid, moderate redness, but
minimal pain
2. Observe the position and alignment of the
eyeball in the eye socket
֍ Protrusion of the eyeballs
accompanied by retracted eyelid
margins - exophthalmos and
characteristic of Graves disease
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
֍ A sunken appearance of the eyes
may be seen with severe dehydration
or chronic wasting illnesses
3. Inspect the bulbar conjunctiva and sclera
o Have the client keep head straight while
looking from side to side then up toward
the ceiling
o Observe clarity, colour, and texture
֍ Generalized redness of the
conjunctiva - conjunctivitis (pink eye)
֍ Areas of dryness - associated with
allergies or trauma
֍ Episcleritis - local, non-infectious
inflammation of sclera, usually
characterized by either a nodular
appearance or by redness with
dilated vessels
֍ Yellow sclera occurs when client has
jaundice or icterus
֍ Bright red areas on the sclera indicate
a subconjunctival haemorrhage -
often caused by sneezing, coughing,
or vomiting
֍ (older adult considerations) yellowish
nodules on bulbar conjunctiva are
called pinguecula, which are harmless
֍ (cultural considerations) dark-skinned
clients may have sclera with yellow or
pigmented freckles
4. Inspect palpebral conjunctiva
o Put gloves on
o Inspect the palpebral conjunctiva of
lower eyelid by placing thumbs bilaterally
at the level of the lower bony orbital rim
o Gently pull down to expose the palpebral
conjunctiva
o Avoid putting pressure on the eye
o Ask client to look up to observe the
exposed areas
֍ Cyanosis of lower lid suggests – heart
or lung disorder
o Evert upper eyelid
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o Ask client to look down with eyes slightly
open
o Gently grasp client’s upper eyelashes and
pull lid downward
o Place a cotton-tipped applicator
approximately 1cm above eyelid margin
o Push down with the applicator while still
holding eyelashes
o Hold eyelashes against upper ridge of
bony orbit below eyebrow, to maintain
everted position of eyelid
o Examine palpebral conjunctiva for
swelling, foreign bodies or trauma
֍ Foreign body or lesions may cause
irritation, burning, pain and/or swelling
of upper eyelid
o Return eyelid to normal by moving the
lashes forward and asking client to look
up and blink
o Eyelid should return to normal
5. Inspect the lacrimal apparatus
o Asses area over lacrimal glands and
puncta
֍ Swelling of lacrimal gland may be
visible in lateral aspect of upper eyelid,
may be caused by blockage,
infection or inflammatory condition
֍ Redness or swelling around puncta –
may indicate infectious or
inflammatory condition
֍ Excessive tearing may indicate a
nasolacrimal sac obstruction
֍ Nasolacrimal sac obstruction -
the obstruction of the nasolacrimal
duct and may be either congenital or
acquired
6. Palpate the lacrimal apparatus
o Put on disposable gloves
o Palpate nasolacrimal duct to assess for
blockage
o Use on finger and palpate just inside the
lower orbital rim
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
ASSESSING EYE
֍ Areas of roughness or dryness on
cornea – associated with injury or
allergic responses
֍ Opacities if lens are seen with
cataracts
֍ (older adult considerations) Arcus
senilis, a normal condition in older
clients, appears as a white arc around
limbus, the condition has no effect on
vision
7. Inspect the iris and pupil
o Inspect shape and colour of iris and size,
shape of pupil
o Measure pupils against gauge
o Check they appear larger or smaller than
normal or appear to be two different sizes
֍ Miosis - excessive constriction of the
pupil
֍ Mydriasis – dilation of the pupil, usually
having a non-physiological cause, or
sometimes a physiological pupillary
response
֍ Anisocoria - defined by a difference of
0.4 mm or more between the sizes of
the pupils of the eyes
8. Test pupillary reaction to light
o Test for direct response by darkening the
room
o Ask client to focus on a distant object
o To test direct pupil reaction: shine a light
obliquely into one eye and observe
pupillary reaction
o Shining the light obliquely into the pupil
and asking the client to focus on an
object in the distance ensures that
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pupillary constriction is a reaction to light
and not a near reaction
֍ Monocular blindness can be detected
when light directed to the blind eye
results in no response in either pupil
֍ When light is directed into the
unaffected eye, both pupils constrict
o Assess consensual response at the same
time as direct response by shining a light
obliquely into one eye
o Observe the pupillary reaction in the
opposite eye
֍ Pupils do not react at all to direct and
consensual pupillary testing
9. Test accommodation of pupils
o Accommodation occurs when the client
moves his or her focus of vision from a
distant point to a near object, causing
pupils to constrict.
o Hold your finger or a pencil about 12-15
inches from client
o Ask client to focus on your finger of pencil
and to remain focused on it as you move
it closer in toward eyes
֍ Pupils do not constrict; eyes do not
converge
Internal Eye Structures
1. Using an ophthalmoscope, inspect the
internal eye
o To observe the red reflex, set the diopter
at 0 and stand 10-15 inches from client's
right side at a 15-degree angle
o Place free hand on client's head which
helps limit head movement
o Shine the light beam toward the client’s
pupil
֍ Abnormalities of the red reflex most
often result from cataracts
֍ These usually appear as black spots
against the background of the red-
light reflex
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
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֍ Two types of age-related cataracts
are nuclear cataracts and peripheral
cataracts
2. Inspect the optic disc
o Keep the light beam focused on the pupil
o Move closer to client from a 15-degree
angle
o You should be very close to client's eye
(about 3-5 cm), almost touching
eyelashes
o Rotate diopter setting to bring the retinal
structures into sharp focus
o The diopter should be 0 if neither the
examiner nor the client has refractive
errors
o Note shape, colour, size, and physiologic
cup
֍ Papilledema or swelling of the optic
disc - a hyperemic (blood-filled)
appearance more visible and more
numerous disc vessels and lack of
visible physiologic cup, may result from
hypertension or increased intracranial
pressure
֍ The intraocular pressure associated
with glaucoma interferes with the
blood supply to optic structures and
results in the following characteristics:
> enlarged physiologic cup that
occupies more than half of disc's
diameter
> pale base of the enlarged
physiologic cup
> obscured or displaced retinal
vessels
֍ Optic atrophy is evidenced by the disc
being white in colour and a lack of
disc vessels, caused by the death of
optic nerve fibres
3. Inspect the retinal vessels
o Remain in same position as described
previously
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o Inspect sets of retinal vessels by following
them out to the periphery of each section
of the eye
o Note the number of sets of arterioles and
venules
֍ Changes in blood supply to the retina
may be observe in constricted
arterioles, dilated veins, or absence of
major vessels
֍ Initially hypertension may cause a
widening of the arterioles' light reflex
and arterioles take on a copper colour
o Note colour and diameter of arterioles
o Observe the arteriovenous (AV) ratio
o Look at AV crossings
֍ Arterial nicking, tapering, and banking
are abnormal AV crossings caused by
hypertension or arteriosclerosis
4. Inspect retinal background
o Remain in same position described
previously
o Search retinal background from the disc
to the macula
o Note the colour and presence of any
lesions
֍ Cotton-wool patches, hard exudates
from diabetes and hypertension
appear as light-coloured spots on
retinal background
֍ Hemorrhages & microaneurysms
appear as red spots and streaks on the
retinal background
5. Inspect fovea (sharpest area of vision)
and macula
o Remain in same position described
previously
o Shine light beam toward side of eye or ask
client to look directly into the light
o Observe the fovea and macula that
surrounds it
֍ Excessive clumped pigment appears
with detach retinas or retinal injuries.
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NURSING ASSESSMENT OF PHYSICAL SYSTEMS:
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֍ Macular degeneration – may be due
to hemorrhages, exudates, or cysts
6. Inspect anterior chamber
o Remain in same position and rotate lens
wheel slowly to +10, +12, or higher to
inspect anterior chamber of the eye
֍ Hyphemia - when injury causes red
blood cells to collect in lower half of
anterior chamber
֍ Hypopyon - results from inflammatory
response in which white blood cells
accumulate in anterior chamber and
produce cloudiness in front of the iris
Assessing Eye Trauma
o In the event of an eye trauma in which
client is experience eye pain, discomfort,
or feels something is in eye, observe for:
foreign body that remains after gentle
washing, perforated globe, blood in eye
o In the case of blunt eye trauma, observe
for: lid swollen shut, blood in anterior
chamber, white/hazy shaped. fixed.
dilated, or constricted pupil
֍ Refer client to an eye doctor
immediately if a foreign body cannot
be removed with gentle washing,
there is perforation of globe, blood in
eye, and/or client has impaired vision
֍ Refer client to eye doctor immediately
if eye is swollen, blood is observed in
anterior chamber, cornea is hazy, or
pupils are irregularly shaped, fixed,
dilated, or constricted.
֍ See a list of common eye injuries and
need for referral, especially if injury
needs immediate emergency referral
Nursing Diagnoses
Health Promotion Diagnoses
o Readiness for enhanced knowledge:
improved visual integrity
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Risk Diagnoses
o Risk for Eye Injury related to hazardous
work area or participation in high-level
contact sports
o Risk for Injury related to impaired vision
secondary to the aging process
o Risk for Eye Injury related to decreased
tear production secondary to the aging
process
o Risk for Self-Care Deficit (specify) related
to vision loss
Actual Diagnoses
o Dry eye related to decreased tear
production, inadequate intake of
nutrients and advancing age
o Ineffective Health Maintenance related to
lack of knowledge of necessity for eye
examinations
o Self-care Deficit (specify) related to poor
vision
o Acute Pain related to injury from eye
trauma, abrasion or exposure to chemical
irritant
o Social Isolation related to inability to
interact effectively with others secondary
to vision loss
Abnormalities of the External Eye
Ptosis (drooping eye)
Ectropion (outwardly turned lower lid)
Conjunctivitis (generalised inflammation of
the conjunctiva)
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Scleral jaundice
Exophthalmos (protruding eyeballs and
retracted eyelids) Abnormalities of the Cornea and Lens

Corneal Abnormalities
A corneal scar, which appears greyish white,
usually is due to an old injury or inflammation.
Chalazion (infected meibomian gland)

Lens Abnormalities
Hordeolum (stye) Nuclear cataracts appear grey when seen
with a flashlight; they appear as a black spot
against the red reflex when seen though an
ophthalmoscope.

Entropion (inwardly turned lower eyelid)

Abnormalities of the Iris and Pupils

Blepharitis (staphylococcal infection of Irregularly shaped Iris

eyelid) An irregularly shaped iris causes a shallow
anterior chamber, which may increase the
risk for narrow-angle (close-angle) glaucoma.

Abnormalities of the Pupils

Miosis
Diffuse episcleritis (inflammation of the sclera)
Also known as pinpoint pupils, miosis is
characterised by constricted pupils – possibly
a result of narcotic drugs or brain damage.

Anisocoria
Anisocoria is pupils of unequal size. I some
Subconjunctival hemorrhage (bright red
cases, the condition is normal; in other cases,
areas of the sclera)
it is abnormal. For example, if anisocoria is
greater in bright light compared with dim
light, the cause may be trauma, tonic pupil
(caused by impaired parasympathetic nerve
supply to iris) and oculomotor nerve paralysis.
If it is greater in dim light compared with
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bright light, the cause may be Horner
syndrome (caused by paralysis of the
cervical sympathetic nerves and
characterised by ptosis, sunken eyeball,
flushing of the affected side of the face and
narrowing of the palpebral fissure.
Mydriasis
Dilated and fixed pupils, typically resulting
from central nervous system injury, circulatory
collapse or deep anesthesia.
Abnormalities od the Optic Disc
Papilledema
o Swollen optic disc
o Blurred margins
o Hyperemic appearance from
accumulation of excess blood
o Visible and numerous disc vessels
o Lack of visible physiologic cup
Glaucoma
o Enlarged physiologic cup occupying
more than half of the disc’s diameter
o Pale base of enlarged physiologic cup
o Obscured and/or displaced retinal vessels
Optic Atrophy
o White optic disc
o Lack of disc vessels
Abnormalities of the Retinal Vessels and
Background
Constricted Arteriole
o Narrowing of the arteriole
o Occurs with hypertension
Copper Wire Arteriole
o Widening of the light reflex and a coppery
colour
o Occurs with hypertension
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Silver Wire Arteriole
o Opaque or silver appearance caused by
thickening of arteriole wall
o Occurs with long-standing hypertension
Arteriovenous Nicking
o Characterised by vein appearing to stop
short on either side of arteriole
o Caused by loss of arteriole wall
transparency from hypertension
Arteriovenous Tapering
o Characterised by vein appearing to taper
to a point on either side of the arteriole
o Caused by loss of arteriole wall
transparency from hypertension
Arteriovenous Banking
o Characterised by twisting of the vein on
the arteriole’s distal side and formation of
a dark, knuckle-like structure
o Caused by loss of arteriole wall
transparency from hypertension
Cotton Wool Patches
o Also known as soft exudates, cotton wool
patches have a fluffy cotton ball
appearance, with irregular edges
o Appear as white or grey moderately sized
spots on retinal background
o Caused by arteriole microinfarction
o Associated with diabetes mellitus and
hypertension
Hard Exudate
o Solid smooth surface and well-defined
edges
o Creamy yellow-white, small, round spots
typically clustered in circular linear or star
pattern
o Associated with diabetes mellitus and
hypertension
Superficial (flame-shaped) Retinal
Hemorrhages
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o Appear as small, flame-shaped linear red

streaks on retinal background
o Hypertension and papilledema are
common causes

Deep (dot-shaped) Retinal Hemorrhages

o Appear as small, irregular red spots with
blurred edges on retinal background
o Lie deeper in retina than superficial retinal
haemorrhages
o Associated with diabetes mellitus

Microaneurysms
o Round, tiny red dots with smooth edges
on retinal background
o Localised dilations of small vessels in
retina, but vessels are too small to see
o Associated with diabetic retinopathy