ASSESSMENT OF EYES - LEC

• Eye Examination


  -Assessment of eye function through specific vision test

  -Inspection of the external and internal eye
• Preparing the client

  -Explain each vision test thoroughly to guarantee accurate results

  -For the eye examination, position the client so she is seated comfortably

  -During examination of the internal eye with the opthalmoscope, you will move very close to the client's face to view the retina and internal structures

  -Explain in detail what will be done and answer questions of the client to relieve anxiety
• Equipment neede for eyes assessment

  -Snellen Chart

  -Hand held card or near vision screener

  -Penlight

  -Opaque cards

  -Ophtalmoscope

  -Disposable gloves
• Distance Vision (Visual Acuity)

  Normal Finding: 20/20 Visual Acuity

  Abnormal Finding: Myopia and Amblyopia
• Near Vison (Visual Acuity)

  Normal Finding: 14/14 with or without corrective lenses

  Abnormal Finding: Presbyopia and Hyperopia
• Color Vision (Visual Acuity)

  Normal Finding: Identify all six screening color correctly

  Abnormal Finding: The color vision defect is designated as red/green/blue/yellow or complete when the patient sees only shades of gray
• Myopia

  Near sightedness
• Amblyopia


  Permanent loss of visual acuity resulting from strabismus
• Presbyopia


  Impaired near vision is indicated when the client moves the chart away
• Hyperopia


  Difficulty seeing up close
• Cranial Nerve II Optic Nerve (Visual Field)

  Normal Finding: The patient who is able to see the stimulus at about 90 degrees temporally, 60 degrees nasally, 50 degrees superiorly and 70 degrees inferiorly
• Hirschberg Test


  Is the the test for corneal light reflex
• Corneal light reflex (Hirschberg Test)

  Normal Finding: The reflected light (light reflex) should be seen symmetrically in the center of each cornea

  Abnormal Finding: Light refelections noted on different areas of both eyes
• Pseudo Strabismus


  Normal in young children, the pupils will appear at the inner canthus.
• Cover and Uncover Test


  Test that is being for extraocular muscle function to identify abnormal eye movement
• Extraocular Muscle Function

  Normal Findings: Uncovered eye does not move as opposite eye is covered. Covered eye does not move as cover is removed.

  Abnormal Finding: Phoria, Strabismus, Esotropia/Exotropia
• Phoria


  Misalignment that occurs only when fusion reflex is blocked
• Strabismus


  Constant misalignment of the eyes
• Esotropia


  A form of strabismus (eye movement problem) where one or both of the eyes turn inwards toward the nose
• Exotropia


  A type of strabismus (misaligned eyes) where one or both eyes turn outward, away from the nose, and can be intermittent or constant
• Cardinal Fields of Gaze


  Are used to assess eye movement and the function of the extraocular muscles and cranial nerves III, IV, and VI by having a patient follow an object in six specific directions: up/right, right, down/right, down/left, left, and up/left
• Cardinal Fields of Gaze (Extraocular Muscle Movement)

  Normal Finding: Both eyes should move smoothly an symmetrically in each of the six fields of gaze and convergence on the held object as it moves toward the nose.

  Abnormal Findings: Abnormal eyes movements consist of failure of an eye to move outward, inability of the eye to move downward when deviated inward or other defects in movement.
• Nystagmus


  Involuntary movement and returning to the center after each field is tested
• Eyelids and Eyelashes (External eye structure)

  Normal finding: Symmetrical with no drooping infections or tumors of the lids. When the eyes are focused in a normal frontal gaze, the lids should cover the upper portion of the iris. Can raise boyh eyelids symmetrically. When the eye is closed, no portion of the cornea should be exposed. Normal lid margins are smooth with the lashes evenly distributed and sweeping upward from the upper lids and downward from the lowerlids. Eyebrows are present bilaterally and are symmetrical and without lesions or scaling
• Ptosis


  Drooping of the upper lid
• Lagophthalmos


  Inability to close the eyelids completely
• Exophthalmos


  Protrusion of the eyeballs accompanied by retracted eyelid margins
• Entropion


  Inverted lower lid
• Ectropion


  Everted lower eyelid
• Hordeolum


  A hair follicle infection
• Chalazion


  An infection of the meibomian gland
• Eyelids (External eye structure)

  Abnormal findings (Color changes): Redness, bluish black and blue
• Eyelid Abnormalities Color Changes:

  Redness - abnormality in the nasal half may indicate frontal sinusitis

  Bluish- cyanosis can result from the orbital vein thrombosis, tumor or aneurysm

  Black and blue - ecchymosis is caused by bleeding into the surrounding tissue following trauma (black eye)
• Conjunctiva ( External eye structure)

  Normal finding: The bulbar conjunctiva is transparent with small blood vessel visible in it. No swelling, injection, exudates, foreign bodies or lesions are noted.

  Abnormal finding: Episcleritis
• Episcleritis


  Local non infectious inflammation of the sclera
• The palpebral conjunctiva should appear pink and moist. It is without swelling, lesions, injection, exudates or foreign bodies.
• Sclera (External Eye structure)

  Normal finding: In light skinned individuals, the sclera should be white with some small, superficial vessels and without exudates, lesions or foreign bodies. In dark skinned individuals, the sclera may have tiny brown patches of melanin or grayish blue or ”muddy” color

  Abnormal Finding: Jaundice
• Lacrimal Apparatus (External eye structure)

  Normal finding: There should be no enlargement, swelling, or redness, no large amount of exudates and minimal tearing. There should be no excessive tearing or discharge from the punctum
• Cornea and Lens (External eye structure)

  Normal findings: Cornea and lens are transparent with no opacities. The oblique view shows a smooth and overall moist surface; lens is free of opacities. Arcus senilis among elderly clients white arc around the limbus.

  Abnormal Finding: Areas of roughness or dryness on the cornea. Opacities of the lens are seen with cataracts
• Iris (External eye structure)

  Normal finding: The color is evenly distributed over the iris, although there can be mosaic variant. It is normally smooth and without apparaent vascularity

  Abnormal finding: There is a heavily pigmented, slightly elevated area visible in the iris