Weber
Health Assessment in Nursing
Chapter 15: Eyes
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
External Structure of the Eye
Eyelids
Lateral and medial canthus
Eyelashes, conjunctiva
Lacrimal apparatus
Extraocular muscles
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure of Eye
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Internal Structure of the Eye
Sclera, cornea, iris, ciliary body,
Pupil, lens, choroid, retina, optic disc
Physiological cup, retinal vessels
Anterior chamber, posterior chamber
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is
True or False.
The lens flattens to focus on close
objects and bulges to focus on far
objects.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
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.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Vision
Visual fields
Visual pathways
Visual reflexes
Pupillary light reflex
Accommodation
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Collecting Subjective Data
History of present health concern
Past health history
Family history
Lifestyle and health practices
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cataract
Opacity or clouding of the eyes lens
Leading cause of blindness worldwide
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors
Increasing age
Exposure to ultraviolet B light
Diabetes mellitus
Cigarette smoking
Alcohol use
Diet low in antioxidant vitamins
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors (cont.)
High blood pressure
Eye injuries/surgery
Steroid use
Female gender
Persistent diarrhea
Gout
Abdominal obesity
Beta blocker use
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Reduction
Wear sunglasses
Quit smoking
Limit alcohol intake
Avoid eye injuries
Regular eye examination
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is
True or False.
Exposure to ultraviolet radiation
increases the risk for development of
cataracts.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Exposure to ultraviolet radiation
increases the risk for development of
cataracts.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Collecting Objective Data
Preparing the client
Equipment
Snellen or E chart
Hand-held Snellen card or near vision
screener
Penlight
Opaque cards
Ophthalmoscope
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Distant Visual Acuity
Snellen chart
Normal acuity is 20/20 with or without
corrective lenses
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Near Visual Acuity
Handheld vision chart
Normal acuity is 14/14 with or without
corrective lenses
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is
True or False.
When testing near visual acuity the
client should be asked to remove his or
her glasses.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
When testing near visual acuity the
client should keep his or her glasses on.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Confrontation Test
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Testing Extraocular Muscle Function
Corneal light reflex test: use penlight to
observe parallel alignment of light
refection on corneas
Cover test: use opaque card to cover an
eye to observe for eye movement
Positions test: observe for eye
movement
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Testing Extraocular Muscle Function
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Extraocular Muscle Dysfunction
Corneal light reflex test abnormalities
Pseudostrabismus, strabismus
Test abnormalities
Phobia
Positions test abnormalities
Paralytic strabismus, 6th, 4th, 3rd
nerve paralysis
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
External Eye Structures
Inspect the eyelids and eyelashes
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
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
External Eye Structures (Contd)
Palpate the lacrimal apparatus
Inspect the cornea and lens
Inspect the iris and pupil
Test pupillary reaction to light
Test accommodation of pupils
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of External Eye
Ptosis, exophthalmos
Entropion, chalazion
Blepharitis, ectropion
Conjunctivitis
Hordeolum, diffuse episcleritis
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pupillary Reaction to Light
Darkened room
Have client focus on a distant object
Shine light obliquely into the pupil and
observe the pupils reaction to light
Normally, pupils constrict
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Accommodation
Shifting gaze from far to near
Normally, pupils constrict
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ophthalmoscope
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Internal Eye Structures
Inspect the optic disc
Inspect the retinal vessels
Inspect retinal background
Inspect fovea and macula
Inspect anterior chamber
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Visual Field Defects
Unilateral blindness
Bitemporal hemianopia
Lesion in optic nerve
Lesion of optic chiasm
Left superior quadrant anopia
Right visual field loss
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of Cornea and Lens
Corneal abnormalities
Corneal scar, pterygium
Lens abnormalities
Nucleus cataract, peripheral cataract
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of Iris and Pupil
Irregularly shaped iris
Miosis
Anisocoria
Mydriasis
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of Retinal Vessels and
Background
Constricted arteriole
Copper wire arteriole
Silver wire arteriole
Arteriovenous nicking
Arteriovenous tapering
Arteriovenous banking
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of Retinal Vessels and
Background (Contd)
Cotton wool patches
Hard exudate
Superficial retinal hemorrhages
Deep retinal hemorrhages
Microaneurysms
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Abnormalities of Optic Disc
Papilledema
Glacoma
Optic atrophy
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is
True or False.
In 3rd nerve paralysis, the eyes cannot
look down when turned inward.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
In 3rd nerve paralysis, the eye looks
straight ahead. If the eyes cannot look
down when turned inward it indicates 4th
nerve paralysis.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins