EYES AND EARS

ASSESSMENT
ACROSS THE LIFESPAN
Learning objectives
 Perform an eye and ear assessment,
including visual acuity, extraoccular
motion, and hearing acuity.
 Modify assessment techniques to
reflect variations across the lifespan
 Document actions and observations
Anatomy of the Eyes

 The eye is made up of three coats, which

enclose the optically clear aqueous
humour, lens and vitreous body. The outer
most coat consist of the cornea and the
sclera; the middle coat contains the main
blood supply to the eye and consists, from
the back forward, of the choroid , the
ciliary body and the iris.
Anatomy of the Eyes
Eyes and Vision

 Under age 40 should have their eyes tested 3 to

5 years or more frequently if there is family
history of DM, Hypertension, blood dyscracia,
or eye disease. Above 40,recommended eye
examination every 2 years old to role out
possibility of Glaucoma.
 Eye assessment is included in initial physical
examination. Examination includes external
structures, visual acuity, ocular movement,
visual fields.
 Common refractive errors of lens of the
eyes:

a) Myopia ( nearsightedness)
b) Hyperopia ( Farsightedness)
c) Presbyopia ( loss of elasticity of the lens and
thus loss of the ability to see close objects) –
begins at 45 years of age.
d) Astigmatism – uneven curvature of the cornea
that prevents horizontal and vertical rays from
focusing the retina. May be corrected with
glasses or surgery.
Charts used to test visual Acuity
 Common visual problems:
1. Conjunctivitis ( inflammation of the bulbar and
palpebral conjunctiva) – may result from foreign
bodies, chemical, allergenic agents, bacteria, or
viruses.
2. Dacryocystitis ( inflammation of the lacrimal sac) is
manifested by tearing and discharge from the
nasolacrimal duct.
3. Hordeolum (sty) – is a redness and swelling, and
tenderness of the hair follicle and glands that empty
at the edge of the eyelids.
4. Iritis ( inflammation of the iris)- may be caused by
systemic infection, and results in pain, tearing, and
photophobia.
Lifespan Considerations

 Infants
 4 weeks of age should gaze and follow objects.
 Ability to focus with both eyes should be present by 6
months of age.
 Infants do not have tears until about 3 months of age.
 A cover test and the corneal light reflex (Hirschberg)
test should be conducted on infants to detect
misalignment early and prevent amblyopia.
 Visual acuity is about 20/300 at 4 months and
progressively improves.
 Children
 Epichanthal folds, common in person of Asian
cultures, may cover the medial canthus and cause
eyes to appear misaligned. Epichanthal folds may
also be seen in young children of any race before
the bridge of nose begins to elevate.
 Preschool children’s acuity can be checked with
picture cards or the E chart. Acuity should
approach 20/20 by 6 years of age.
 A cover test and the corneal light reflex
(hirschberg) test should be conducted on young
children to detect misalignment early and
prevent amblyopia.
 Always perform the acuity test with glasses f
if a child has a prescription to wear lenses.
 Children should be tested for color vision
deficit. From 8% to 10% of Caucasian males
and from 0.5 % to 1% of Caucasian females
have this deficit, it is much more less
common in no-Caucasian children. The
Ishihara or Hardy-Rand-Rittler test can be
used.
 Elderly
Visual Acuity
 Visual acuity decreases as the lens of the eye ages and
becomes more opaque and loses elasticity.
 The ability of the iris to accommodate to darkness and dim
light diminishes.
 Peripheral vision diminishes.
 The adaptation to light (glare) and dark decreases.
 Accommodation to far objects often improves, but
accommodation to near objects decreases.
 Color vision declines; older people are less able to perceive
purple colors and to discriminate pastel colors.
 Many elders wear corrective lenses; they are mostly likely to
have hyperopia. Visual changes are due to loss of elasticity
( presbyopia) and transparency of the lens.
External Eye Structure

 The skin around the orbit of the eye may darken.

 The eyeball may appear sunken because of the decrease in orbital fat.
 Skin folds of the upper lids may seem more prominent, and the lower
lids may sag.
 The eyes may appear dry and lusterless because of the decrease in
tear production from the lacrimal glands.
 A thin, grayish white arc or ring (arcus senilis) appears around part or
all of the cornea. It results from the accumulation of a lipid substance
on the cornea. The cornea tends to cloud with age.
 The conjunctiva of the eye may appear paler than that of the younger
adults and may take a slight yellow appearance because of the
deposition of fat.
 Pupil reaction to light and accommodation is normally symmetrically
equal but may be less brisk.
 The pupils can appear smaller in size, unequal, and irregular in shape
because of sclerotic changes in the iris.
Home Considerations
 When making a home visit take your equipment and
charts with you. Also include tape measure to lay out the
20 feet for distance vision testing.
 Use the assessment as an opportunity to reinforce proper
eye care and need for regular vision testing.

Performing Functional Vision Test

 Light perception
Shine a penlight into a client’s eye from a lateral position
and then turn the light off. Ask the client to tell you when
the light is on of off. If the client knows when the light is on
or off, the client has light perception, an the vision is
recorded as “LP”.
Hand movement (H/M)
Hold the hand 30 cm (1ft) from the client’s face
and move it slowly back and forth; stopping it
periodically. Ask the client to tell you when your
hand stops moving. If the client knows when your
hand stops moving record the vision as “H/M 1 ft”.

Counting Finger (C/F)

Hold up some of your fingers 30 cm (1ft) from the
clients face, and ask the client to count your
fingers. If the client can do so, note on the vision
record “C/F 1ft”.
Ears and Hearing
 Assessment includes direct inspection and
palpation of the external ear, inspection of the
remaining parts of the ear with an otoscope.
 External ear includes the auricle of pinna,
external auditory canal, and the tympanic
membrane or eardrum.
 The inner ear contains the cochlea, a sea shell-
shaped structure essential for sound
transmission and hearing, and the vestibule semi
circular canals, which contains the organs of
equilibrium.
Lifespan Consideration
Infants
 To assess the gross hearing, ring a bell from
behind the infant or have the patient call the
child’s name to check for a response.
Newborns will quiet to the sound and may
open their eyes wider. By 3 to 4 months of
age, the child will turn head and eyes toward
the sound.
 All newborn should be assessed for hearing
using auditory brain response testing prior to
discharge from the hospital.
Children
 To inspect the external canal and tympanic membrane in children
less than 3 years old, pull the pinna down and back. Insert the
speculum only ¼ to ½ inch.
 Hearing loss is becoming more common in adolescents and
young adults, probably as a result of exposure to loud music and
prolonged use of headsets at loud volumes.

Elderly
 The skin of the ear may appear dry and be less resilient because of
the loss of connective tissue.
 Increase coarse and wire-like hair growth occurs along the helix,
antihelix, and tragus.
 The pinna increases in both width and length, and the earlobe
elongates.
 Earwax is drier.
 The tympanic membrane is more translucent
and less flexible. The intensity of the light reflex
may diminish slightly.
 The sensorineural hearing loss occurs.
 Generalized hearing loss (prebycusis) occurs in
all frequencies, although the first symptom is the
loss of high-frequency sound the f, s, sh, and ph
sounds. To such persons, conservation can be
distorted and result in what appears to be
inappropriate or confused behaviour.