Chapter 16

Assessing Eyes
External Structure of the Eye
 Eyelids
 Lateral (outer) and medial (inner) canthus
 Eyelashes, conjunctiva
 Lacrimal apparatus
 Extraocular muscles

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Structure of the Eye

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Internal Structure of the Eye
 Sclera, cornea, iris, ciliary body
 Pupil, lens, choroid, retina, optic disc
 Physiologic cup, retinal vessels
 Anterior chamber, posterior chamber

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Question #1
Is the following statement true or false?
The lens flattens to focus on close objects and bulges to
focus on far objects.

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Answer to Question #1
False.
The lens bulges to focus on close objects and flattens to
focus on far objects. This is possible due to the refractive
ability of the lens.

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Vision
 Visual fields
 Visual pathways
 Visual reflexes
o Pupillary light reflex
o Accommodation

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Cataract
 Opacity or clouding of the eye’s lens-With age, the lens
becomes less flexible, thicker, and less transparent as
tissues breakdown or clump together, turning the lens
yellow or brown.
 Leading cause of blindness worldwide

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Question #2
Is the following statement true or false?
Exposure to ultraviolet radiation increases the risk for
development of cataracts.

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Answer to Question #2
True.
Exposure to ultraviolet radiation increases the risk for
development of cataracts.

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Risk Factors for Cataracts #1
 Increasing age

 Diabetes mellitus

 Excessive alcohol use

 Exposure to sunlight (ultraviolet B light)

 Exposure to ionizing radiation, such as that used in X-

rays and cancer radiation therapy

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Risk Factors for Cataracts #2

 High blood pressure

 Obesity
 Previous eye injury, inflammation, surgery
 Prolonged steroid use
 Cigarette smoking

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Risk Reduction
 Wear sunglasses that block UVB rays.
 Avoid smoking or quit smoking.
 Avoid excessive alcohol intake.
 Avoid eye injuries.
 Maintain healthy weight.
 Use eye protectant equipment if necessary.
 Seek medication treatment for prolonged or unusual eye
inflammation or any eye injury.
 Regular eye examination.

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Collecting Subjective Data
 History of present health concern
 Past health history
 Family history
 Lifestyle and health practices

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Collecting Objective Data
 Preparing the client
 Equipment
o Snellen or E chart
o Hand-held Snellen card or near-vision screener
o Jaeger test
o Penlight
o Opaque cards
o Ophthalmoscope

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Distant Visual Acuity
 Snellen chart
 Normal acuity is 20/20 with or without corrective lenses

 Snellen Chart-measures how well you see at a distance.

 Numbers like 20/40 mean: You can see at 20 feet what
someone with perfect vision sees at 40 feet.
 A bigger bottom (20/40)number means worse vision.
 Myopia (Nearsightedness), hyperopia(farsightedness):

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Near Visual Acuity
 Handheld vision chart
 Jaeger test (pocket screener)
 Normal acuity is 14/14 with or without corrective lenses

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Question #3
Is the following statement true or false?
When testing near visual acuity, the client should be asked
to remove his or her glasses.

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Answer to Question #3
False.
When testing near visual acuity, the client should keep his
or her glasses on.

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Confrontation Test

- eyes’ visual field when focused on a central point

Here are the normal ranges for side vision:
Downward (inferior): 70 degrees (almost straight down)
Upward (superior): 50 degrees (not quite straight up)
Outward (temporal): 90 degrees (almost straight to the side)
Inward (nasal): 60 degrees (towards the nose)
During the test, the examiner holds up a finger just outside their
own side vision and asks the client if they can see it at the
same time. This helps check if the client's side vision is working
normally in different directions.

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Testing Extraocular Muscle Function #1
 Corneal light reflex test: Use penlight to observe parallel
alignment of light reflection on corneas.
 Cover test: Use opaque card to cover an eye to observe
for eye movement.
 Positions test: Observe for eye movement.
Neurologic test:
 Doll’s test- Hold her eyelids open with the thumb and
index finger of one hand so you can watch her eyes.
Briskly but gently rotate her head from side to side and
assess her eye movements. A normal response is for the
eyes to move in the direction opposite the head
movement, such as looking left as you turn her head to
the right.
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External Eye Structures #1
 Inspect the eyelids and eyelashes. (ptosis-drooping of
eyelids)
 Observe the position and alignment of the eyeball in the
eye socket.
 Inspect the bulbar conjunctiva and sclera.
 Inspect the palpebral conjunctiva.
 Inspect the lacrimal apparatus.

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External Eye Structures #2
 Palpate the lacrimal apparatus.
 Inspect the cornea and lens. - contact with a wisp of
cotton stimulates a normal reaction to blink in both
eyes known as the corneal reflex. Inspect the iris and pupil.
 Test pupillary reaction to light.
 Test accommodation of pupils.

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Pupillary Reaction to Light
 Darkened room
 Have client focus on a distant object
 Shine light obliquely into the pupil and observe the
pupil’s reaction to light
 Normally, pupils constrict

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Ophthalmoscope Do’s and Don’ts #1
 Do
o Begin about 10 to 15 in from the client at a 15-
degree angle to the client’s side.
o Pretend that the ophthalmoscope is an extension of
your eye.
o Stay focused on the red reflex as you move in closer,
then rotate the diopter setting to see the optic disc.

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Ophthalmoscope Do’s and Don’ts #2
 Don’t
o Do not use your right eye to examine the client’s left
eye or your left eye to examine the client’s right eye
(your noses will bump).
o Do not move the ophthalmoscope around; ask the
client to look into the light to view the fovea and
macula.
o Do not get frustrated—the ophthalmologic
examination requires practice.

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Internal Eye Structures
 Inspect the optic disc.
 Inspect the retinal vessels.
 Inspect the retinal background.
 Inspect the fovea and macula.

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Abnormalities of External Eye

 Exophthalmos
 Entropion
 Ectropion
 Conjunctivitis

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Visual Field Defects

 Unilateral blindness-During the swinging flashlight test, when light is directed in the
unaffected eye, both pupils react normally.
 Bitemporal hemianopia- describes the ocular defect that leads to impaired peripheral vision
in the outer temporal halves of the visual field of each eye.
 Left superior quadrant anopia

 Right visual field loss

 Lesion in optic nerve and optic

chiasm- Lesions involving the

whole optic nerve cause

complete blindness on the affected side

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Abnormalities of Cornea and Lens
 Corneal abnormalities
o Corneal scar-hallmark symptom of corneal scarring is blurry
vision.
o Pterygium-excessive UV rays
and require surgery
 Lens abnormalities
o Nucleus cataract(central)
o Peripheral cataract(side)

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Abnormalities of Iris and Pupil
 Irregularly shaped iris
 Miosis-excessive constriction of
the pupil of the eye.
 Anisocoria-drug use or trauma
 Mydriasis

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Abnormalities of the Optic Disc
 Papilledema-swelling of the optic disc due to
elevated intracranial pressure (ICP).

 Glaucoma- increase Icp-damage of

optic nerve causes tunnel
vision(Peripheral vision loss)
 Optic atrophy-end stage

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Older Adult Considerations

 Presbyopia is a common condition in clients over 45

years of age.
 Yellowish nodules on the bulbar conjunctiva are called
pinguecula. These harmless nodules are common in older
clients, appearing first on the medial side of the iris and
then on the lateral side.
 Though usually abnormal, entropion and ectropion are
common in older clients.

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