Chapter 16

Assessing Eyes
Structure of the Eye
External Structure of the Eye
Eyelids

Lateral (outer) and medial (inner) canthus

Eyelashes, conjunctiva

Lacrimal apparatus

Extraocular muscles
Internal Structure of the Eye
Sclera, cornea, iris, ciliary body

Pupil, lens, choroid, retina, optic disc

Physiologic cup, retinal vessels

Anterior chamber, posterior chamber

Visual fields
Visual pathways
Visual reflexes
◦Pupillary light reflex
◦Accommodation
Collecting Subjective Data
History of present health concern
Past health history
Family history
Lifestyle and health practices
Collecting Objective Data
Preparing the client
Equipment
◦ Snellen or E chart
◦ Hand-held Snellen card or near-vision screener
◦ Jaeger test
◦ Penlight
◦ Opaque cards
◦ Ophthalmoscope
Distant Visual Acuity
Snellen chart
❖A Snellen chart is an eye chart that
can be used to measure visual acuity.
Snellen charts are named after the
Dutch ophthalmologist Herman
Snellen, who developed the chart in
1862.
❖Normal acuity is 20/20 with or
without corrective lenses
 Near Visual Acuity
❖Handheld vision chart
◦ Handheld versions of Snellen charts
are used for testing near vision as well. By
viewing or reading each line from top to
bottom (with one eye covered at a time),
your eye doctor can gain a general
approximation of the quality of your visual
acuity, or sharpness.

https://www.grahamfield.com/pdfs/Resources/Exam%20Room/Eye%20Health%204%20Eye%20Test%20Charts%20an
d%20How%20They%20Work.
Question
Is the following statement true or false?
When testing near visual acuity, the client should be
asked to remove his or her glasses.
Answer to Question
False.
When testing near visual acuity, the client should keep his or
her glasses on.
 Confrontation Test
❖Confrontation visual field testing
involves having the patient looking
directly at your eye or nose and
testing each quadrant in the
patient's visual field by having them
count the number of fingers that
you are showing.
Testing Extraocular Muscle Function
❖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.
Corneal light reflex test
The corneal light reflex test
involves shining a light onto the
child's eyes from a distance and
observing the reflection of the
light on the cornea with respect
to the pupil. The location of the
reflection from both eyes
should appear symmetric and
generally slightly nasal to the
center of the pupil.
Cover Test
The cover test is used to
determine both the type of
ocular deviation and
measure the amount of
deviation. The two primary
types of ocular deviations are
the tropia and the phoria.
External Eye Structures
Inspect the bulbar
Observe the position and conjunctiva,
Inspect the eyelids and
alignment of the eyeball in the
eyelashes. palpebral conjunctiva
eye socket.
and sclera.

Test pupillary
Inspect and Palpate
Inspect the cornea reaction to light and
the lacrimal
lens, iris and pupil. accommodation of
apparatus.
pupils.
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

Accommodation
Shifting gaze from far to near
Normally, pupils constrict
Internal Eye
Structures
Inspect the optic disc.
Inspect the retinal vessels.
Inspect the retinal
background.
Inspect the fovea and
macula.
Inspect the anterior
chamber.
Ophthalmoscope Do’s and Don’ts
Do
◦ Begin about 10 to 15 in from the client at a 15-degree angle to the client’s side.
◦ Pretend that the ophthalmoscope is an extension of your eye.
◦ Stay focused on the red reflex as you move in closer, then rotate the diopter setting to see the optic
disc.

Don’t
◦ 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).
◦ Do not move the ophthalmoscope around; ask the client to look into the light to view the fovea and
macula.
◦ Do not get frustrated—the ophthalmologic examination requires practice.
 Abnormalities of External Eye

Exophthalmos Entropion and Ectropion

Chalazion Conjunctivitis Blepharitis

Lens abnormalities
◦ Nucleus cataract
◦ Peripheral cataract Corneal scar Pterygium
Cataract
>A cataract is a dense, cloudy area that
forms in the lens of the eye. A cataract
begins when proteins in the eye form clumps
that prevent the lens from sending clear
images to the retina. The retina works by
converting the light that comes through the
lens into signals.
>Leading cause of blindness worldwide
Risk Factors for Cataracts

Increasing Diabetes Excessive alcohol use Exposure to sunlight

Exposure to ionizing
radiation, such as that Prolonged use of
High blood pressure Obesity
used in X-rays and steroids
cancer radiation therapy
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.
 Abnormalities of Iris and Pupil
Irregularly shaped iris
Miosis
Anisocoria
Mydriasis

Miosis

Anisocaria Mydriasis
Abnormalities of Retinal Vessels and
Background
Cotton wool patches

Hard exudate

Microaneurysm
 Abnormalities of the Optic Disc
Papilledema
Papilledema
Glaucoma
Optic atrophy

Optic atrophy
Glaucoma
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.
Arcus senilis, a normal condition in older clients, appears as a
white arc around the limbus.
Though usually abnormal, entropion and ectropion are common
in older clients.
Validating and Documenting Findings
Health
Actual
promotion Risk diagnoses
diagnoses
diagnoses

Collaborative Medical
problems problems