HA

• External Structures of the Eyes


  • Eyelids
  • Eyelashes
  • Conjunctiva
  • Lacrimal apparatus
  • Extraocular muscles

  
• Eyelids


  • Two movable structures; striated and smooth muscles
  • Protects eye from foreign bodies; limit amount of light
  • Tarsal plates (meibomian glands)
  • Lateral and medial canthus

  
• Eyelashes


  • Filters dust and dirt from air
• Conjunctiva


  • Thin, transparent, continuous membrane
  • Palpebral and bulbar
• Lacrimal apparatus


  • Ducts that lubricates the eyes
  • Lacrimal gland - produce tears
• Extraocular muscles


  • Six muscles (4 rectus, 2 oblique)
• Internal Structures of the Eye

  • Sclera
  • Cornea
  • Iris
  • Lens
  • Choroid layer
  • Retina
  • Optic disc
  • Retinal vessels

  
• Sclera


  • Dense, protective, white covering that supports internal structures of the eye

  
• Cornea


  • Permits entrance of light
  • Responsive to pain and touch
• Iris


  • Contains pigments that determine eye color
  • Pupil - controls amount of light entering the eye

  
• Lens


  • Biconvex, transparent, avascular, encapsulated structure
• Choroid layer


  • Vascular; provide nourishment to the inner aspect of the eye
  • Prevents light from reflecting internally

  
• Retina


  • Innermost layer; receives stimuli
• Optic disc


  • Cream-colored, circular area located in retina
  • Can be seen with the use of ophthalmoscope

  
• Retinal vessels


  • Can be viewed with ophthalmoscope
• Visual field


  • Upper temporal
  • Lower temporal
  • Upper nasal
  • Lower nasal
• Visual perception


  1. Light rays strike the retina

  2. Nerve impulse

  3. Optic nerve (interpretation)

  
• Visual reflex


  • Pupillary light reflex - cause pupils to constrict when exposed to bright light
  • Direct reflex - constriction occurs in an eye that is exposed to light
  • Indirect reflex/consensual - constriction of opposite eye after light exposure to opposite eye

  
• Accommodation


  • Functional reflex allowing eyes to focus on near objects
• Collecting Subjective Data: The Nursing Health History


  • History of Present Health Concern
  • Personal Health History
  • Family History
  • Lifestyle and Health Practices
• Visual Problems


  • Describe any visual difficulties or changes in the vision that you have experienced. Where they sudden or gradual?
  • Do you see spots or floaters in front of your eyes?
  • Do you experience blind spots? Constant or Intermittent?
  • Do you see any halos around lights? or rings
  • Do you have trouble seeing at night?
  • Do you experience double vision?

  
• Evaluating Vision


  • Test distant visual acuity
  • Test near visual acuity
  • Test visual fields for gross peripheral vision

  
• Testing Extraocular Muscle Function

  1. Perform corneal light reflex test

  2. Perform cover test

  3. Perform cardinal fields gaze test
• External Eye Structure


  • Inspect eyelids and eyelashes
  • Observe the position and alignment of the eyeball in the eye socket
  • Inspect bulbar conjuctiva and sclera
  • Inspect palpebral conjuctiva
  • Inspect lacrimal apparatus
  • Palpate lacrimal apparatus
  • Inspect the cornea and lens
  • Inspect iris and pupil
  • Test pupillary reaction to light
  • Test accommodation of pupils

  
• Internal Eye Structures


  • Inspect red reflex
  • Inspect optic disc
  • Inspect retinal vessels
  • Inspect retinal background
  • Inspect fovea (sharpest area of vision) and macula
  • Inspect anterior chamber

  
• Abnormalities of the Optic Disc

  • Papilledema
  • Glaucoma
  • Optic atrophy

  
• Structures of the External Ear

  • Auricle or Pinna
  • External Auditory Canal

  
• Structures of the Middle Ear (Tympanic Cavity)

  • Tympanic cavity
  • Tympanic membrane
  • 3 auditory ossicles
  • Eustachian tube

  
• Structures of the Inner Ear or Labyrinth

  • Inner Ear or Labyrinth
  • Bony labyrinth - cochlea, vestibule, semi-circular canals
  • Inner cochlear duct - contains Spiral Organ of Corti
  • Sensory receptors - maintain static and dynamic equilibrium
  • Nerve fibers form Vestibular Nerve connected to Cochlear nerve (CN VIII - acoustic)

  
• Conductive hearing


  Transmission of sound waves through external and middle ear

  
• Perceptive or Sensorineural hearing

  • Transmission of sound waves in the inner ear
  • Focus on inner hearing

  
• Every 3 days to 1 week clean the ear to avoid damaging it

  
• Collecting Objective Data


  • Inspect auricle, tragus, and lobule
  • Inspect size, shape, and position of ears, auricle, and earlobes
• Vestibular Nerve


  Nerve fibers connected to Cochlear nerve (CN VIII - acoustic)
• Perceptive or Sensorineural hearing

  Transmission of sound waves in the inner ear, focus on inner hearing

  
• Health Assessment


  • Collecting Subjective Data: Nursing Health History
  • Collecting Objective Data
• History of Present Health Concern

  • Changes in Hearing
  • Other Symptoms
• Normal ear inspection findings

  • Ears equal in size bilaterally (4-10 cm)
  • Auricle aligns with corner of each eye, at midline of lateral canthus, in line
  • Earlobes free, attached, soldered
  • No lesions, lumps and deformities

  
• Abnormal ear inspection findings

  • Ears smaller (4cm); larger (10 cm)
  • Malaligned or low set ears
  • Microtia (congenital deformity; external canal not fully developed)

  
• Normal palpation findings


  • Auricle, tragus and mastoid process firm and non-tender