THE EYES

PALPEBRAL FISSURE
- the opening between the eyelids

CONJUCTIVA
- a clear mucous membrane with two easily visible components known as the;

BULBAR CONJUCTIVA
- also known as the sclera, covers most of the anterior eyeball, adhering loosely to the underlying
tissues.

PALPEBRAL CONJUCTIVA
- lines the eyelids

The two parts of the conjuctiva merge into a folded process that permits the movement of the
eyeball.

The Lacrimal Gland lies most likely within the bony orbit above and lateral to the eyeball.
The tears spreads across the eye and drains medially through the two tiny holes called Lacrimal
Puncta.
The tears then pass to the Lacrimal Sac and into the nose through the Nasolacrimal Duct

VITREOUS HUMOR
- a clear gel that fills the space between the lens and the retina.

AQUAEOUS HUMOR
- a clear liquid that fills the anterior and posterior chambers of the eye.
- produced by the Ciliary Body.
- circulates from the posterior chamber through the pupil into the anterior chamber, and drains
out to the Canal of Schlemm.

The Circulation maintains the intraoccular pressure of the eyes.

CHANGES IN VISION:
⚫ HYPEROPIA - farsightedness
⚫ PRESBYOPIA - impaired near vision/ loss of ability to focus on nearby objects
⚫ MYOPIA - impaired far vision/ nearsightedness
⚫ SCOTOMAS - blindspots
⚫ DIPLOPIA - double vision
⚫ STRABISMUS - cross-eyed
⚫ BLURRING
⚫ REDNESS
⚫ ITCHING
⚫ DISCHARGE
⚫ PAIN
⚫ TEARING
⚫ EDEMA - manifestations of endocrine disorders
⚫ LESIONS
⚫ VISUAL DISTURBANCES
⚫ PHOTOPHOBIA - fear of light/sunlight
⚫ AMBLYOPIA - lazy eye
AREAS OF HISTORY INTERVIEW
- eye history
- family history
- lifestyle

PHYSICAL EXAMINATION

VISION TEST:
- distal, near, and peripheral
- inspection of the eye, eyebrows, lids, conjunctiva, sclera, cornea, lens, iris, and pupils.
- inspection and palpation of the Lacrimal Apparatus

EXTRAOCCULAR MOVEMENTS
- assessment of the cardinal fields, convergence, corneal light test, and cover and uncover test.

EQUIPMENT FOR EXAMINATION

⚫ Snellen Chart/ E card

⚫ Rosenbaum - near vision card
⚫ Index Card
⚫ Penlight
⚫ Opthalmoscope

VISUAL ACUITY
- expressed as two numbers (e.g. 20/30); the numerator indicates the distance of the patient
from the chart and this number should always be 20 unless the patient moved closer to see, and
the denominator is the distance at which the normal eye can read the line of letters.

NEAR VISION
- the Rosenbaum Chart helps identify the need for reading glasses or bifocals in patients older
than 45 years. This card can be utilized to test visual acuity at the bedside. Held 14 inches from
the patient’s eyes, the card simulates a Snellen Chart, However, patients may choose their own
distance.

EXTERNAL EYE EXAMINATION

⚫ Position of the alignment of the eye - Stand in front of the patient and survey the eyes for
position and alignment. If one or both eyes seem to protrude, assess them from above.
⚫ Eyebrows - Inspect the eyebrows noting their quantity and distributionand any scaliness of
the underlying skin.
⚫ Eyelids - Note the position of the eyelids in relation to the eyeballs.

INSPECT FOR THE FF.

1. Width of the Palpebral Fissures
2. Edema of the lids
3. Color of the lids
4. Lesions
5. Condition and direction of eyelashes
6. Adequacy with which the eyes close.
- look for this especially when the eyes are unusually prominent, when there is a facial paralysis,
or when the patient is unconscious.

INTERNAL EYE EXAMINATION

⚫ CORNEA AND LENS
- with oblique lighting, inspect the cornea of each eye for opacities and note any opacities in the
lens that may be visible through the pupil.
⚫ IRIS
- inspect each iris at the same time. The markings should be clearly defined. With your light
shining directly from the temporal side, look for a crescentic shadow on the medial side of the iris.
Because the iris is normally fairly flat, and forms a relatively open angle with the cornea, this
lighting cast with no shadow.
⚫ PUPILS
- inspect the size, shape, and symmetry of the pupil.
- if the pupils are large (5mm), small (3mm), or unequal, measure them. A pupil guide with black
circles of varying sizes facilitates measurement.

⚫ Test the pupillary reaction to light, ask the patient to look into the distance and shine a
bright light obliquely into each pupil in turn.

PERRLA - Pupil is Equal, Round, and Reactive to Light Accommodation

OPTHALMOSCOPIC EXAMINATION
- the nurse would examine the patient’s eyes without dilating the pupil, the view is therefore
limited to the posterior structures of the retina, to see more peripheral structures, to evaluate the
macula well, or investigate unexplained visual loss, opthalmologists dilate the pupil with mydriatic
drops unless this is contraindicted.

MYDRIASIS - DILATION OF PUPILS

MIOSIS - CONSTRICTION OF PUPILS

EXTRAOCULAR MUSCLES
⚫ ASSESS THE EXTRAOCULAR MOVEMENTS, LOOKING FOR:
- the normal conjugate movements of the eyes in each direction, or any deviation from normal.
⚫ NYSTAGMUS - a fine rythmic oscillation of the eyes
- a few beats of nystagmus on extreme lateral gaze is normal. If you see it, bring your finger in
to within the field of binocular vision and look again.