NURSING

ASSESSMENT
AND
ASSESMENT
OF EYE
By: Ida Rosdiana
 EXAMINATION OF EYE

An examination of the eye includes an

external examination:
• Examination by ophthalmoscope, and
• An assessment of the functions of eye.
A. EXTERNAL EXAMINATION

B. PUPILLARY RESPONSE

C. FUNCTIONAL EXAMINATION
 ASSESSING SYMPTOMS
 The patient should be assessed:
 Discomfort or pain in or around the eye
 Photophobia (abnormal sensitivity to
light)
 Nystagmus (involuntary and rapid
movement of eyeball.)
 Strabismus (deviation of eye from
the normal physiological axis:
‘crossed vision’)
 Blurred vision
 ‘Spot 'or ‘light 'in the visual field
 ASSESSMENT PATIENT HISTORY

Age-Related
Functional
 Family history and genetic risk Changes
 Current health problems • Yellowing of lens
 Nutrition history • Accommodation gradually
lost
• Presbyopia
• Far point decreases
• Color perception decreases
• IOP increases
 Age-Related
Functional Changes
 A. EXTERNAL EXAMINATION

• It consist of inspection of the eyelids, surrounding tissue and

palpebral fissure.
• Palpation of the orbital rim may also be desirable, depending on the
presenting signs and symptoms
• The conjunctiva and sclera can be inspected by having the
individual look up, and shining a light while retracting the upper or
lower eyelid
• The cornea and iris may be similarly inspected
• The anterior segment of the eye examined by visual
inspection

Note the general appearance of the eyelids,

eyelashes and lacrimal apparatus.
Observe for:-
 1. Redness around the eye
 2. Discharge or crusting
 3. Growths on eyes or eyelids
 4. Excessive tearing
 • Position and mobility can be observed by having the
patient rotate the eyes, looking up, down and each side.
 B. PUPILLARY RESPONSE

 Normal pupils are rounded,

centrally placed and
generally equal in size
(about 25 percent of normal
individuals have pupils
slightly unequal in size.) 
 REACTION TO LIGHT

 Seat the patient in an area with even lighting and instruct him to fix
his gaze on the distant object.
 Cover one eye and shine a flashlight in front of the exposed eye.
The pupil should (constrict) because of the light. This response is
called a direct reaction.
 The covered pupil should also contract. This response is called a
consensual reaction.
 NEAR POINT REACTION:

When the gaze is changed from the distant object to an

object close at hand, the pupils should contract.
 C. FUNCTIONAL EXAMINATION

 1. Focusing power is tested by placing a line of print close to the

eye, then slowly moving it back to the point at which the patient is
able to read it. The nearest point of accommodation.
Confrontation Test:
• Measures peripheral vision compared to
examiner
• Both examiner and pt cover one eye
with card, stand about 2 feet away, and
maintain eye contact
• Advance finger, starting from periphery,
and ask ps to say “now” when the finger
is first visible
• Inability to see when the examiner sees
suggest peripheral field lost
3. Color sense is tested by using
specially designed colour pates
to distinguish reds, greens and
blues.
 4. Visual acuity testing is done with Snellen chart or one of its
modifications. Each eye is tested separately, both with and without
glasses, if worn.
 VISUAL ACUITY TESTING PROCEDURE
 Have patient completely occlude one eye
- start with either right or left; document apprropriately
 Instruct to:
- keep eye under occlude open and relaxed
- do not apply excessive pressure with occluder
 Ask patient to read letters beginning at mid chart (line 4 or line 5)
- if gets all correct or misses one letter, read next line below
- if misses two letters, read next line above
 The test is performed at a distance of 6 meters (20 feet).
 Vision is expressed by a fraction, the numerator denoting the
distance at which the test was performed (normally, 6 metres or 20
feet), and the denominator denoting the smallest line of letters which
could be read at that distance.
 If a patient is seated 6 meters from the chart and the smallest lie of
letters he is able to read is the one that should be read at a distance of
30 meters, then his vision is expressed at 6/30 (20/100).
 If the largest letters on the chart cannot be read at a distance of
6 meters, the patient is moved toward the chart until he can
read the largest letters.
 Vision is then expressed as a fraction, with the numerator
denoting the distance at which the largest line could be read
and the denominator denoting the number of largest line.
 If the patient cannot read the largest line at a distance of one
meter, the examiner tests the patient’s ability to see hand
motion in front of his face
 If the patient cannot see the examiner’s hand at a distance of one or
two meters, he is tested for light perception.
 A light is flashed from different directions and the patient is asked
from which direction the light appears and when it goes on and it
goes off.
  If the patient can do this, the examination is recorded as ‘light
perception present’.
 If no light perception is present, a person is technically blind
 EYE TEST AND EXAM

 OPHTHALMOSCOPY:
 It is an examination of the back part of 1 • DIRECT
the eyeball (fundus), which includes the OPHTHALMOSCOPY
retina, optic disc, choroid and blood
vessels. Ophthalmoscope examination
takes about 5 and 10 minutes. There are 2 • INDIRECT
different types of ophthalmoscopy.  OPHTHALMOSCOPY 
APPLANATION METHOD
 This eye test helps doctors to
diagnose glaucoma by measuring
the amount of pressure needed to
flattern a portion of the cornea.
 This is done by taking a thin strip
of paper 
CORNEAL TOPOGRAPHY
 Corneal topography is a computer
assisted diagnostic tool that creates
a three-dimensional map of the
surface curvature of the cornea
 PUPILLARY DILATION
TEST
 During this eye test, the eye doctor
places special drops (Tropicamide) in
the eye that cause the pupil to dilate.
 By dilating the pupils, doctor can
examine retina for any signs of
disease.
REFRACTION TEST
 This is measures the ability to see
objects at special distances.
 Often doctors will ask the patient to
look at a chart usually 20 feet away
and try to read it while looking
through a special; instrument known
as a phoropter.
 FLUORESCEIN ANGOGRAPHY
 Fluorescein angiography, fluorescent
angiography, or fundus fluorescein
angiography is a technique for
examining the circulation of the retina
and choroid using a fluorescent dye
and a specialized camera.
COLOR FUNDUS PHOTOGRAPHY
 Fundus camera to record color images
of the condition of the interior surface
of the eye, in order to document the
presence of disorders and monitor their
change over time.
 including the retina, retinal vasculature,
optic disc, macula, and posterior pole.
 TONOMETERY OTHER TEST

 Tonometry is the procedure eye care  ELECTRORETINOGRAPHY

professionals perform to determine the  VISUAL ACUITY TEST (SNELLEN
intraocular pressure, the fluid pressure CHART) 
inside the eye. It is an important test in
the evaluation of patients at risk from
 SIT LAMP EXAMINATION
glaucoma. • (normal pressure range is
12 to 22 mm Hg)