Retdem

• Eyebrow assessment


  • Inspect for hair distribution, alignment, skin and quality and movement
• Normal eyebrows


  • Hair evenly distributed; skin intact, Symmetrically aligned; equal movement
• Abnormal eyebrows


  • Loss of hair
  • Scaling and flakiness of skin
  • Unequal alignment and movement of eyebrow
• Eyelash inspection


  • Note distribution, inversion or eversion
  • Present and curving outward
  • No crusting or infestation
• Abnormal eyelash findings


  • Absence of eyelashes
  • Lice or ticks at base of eyelashes
  • Inflammation
  • Inverted eyelashes
• Abnormal eyelid findings


  • Ectropion
  • Exophthalmos
  • Everted eyelashes
  • Visible sclera between iris and upper lid
• Normal eyelids


  • Upper eyelid normally covers one-half of upper iris
  • Palpebral fissures symmetrical
  • Eyelids in contact with eyeball
  • No lesions
• Abnormal eyelid findings


  • Assymetry of lids
  • Ptosis of both eyelids
  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
• Snellen

  1. Have client stand 20 ft. away from the Snellen Chart

  2. Cover up 1 eye with pad

  3. Uncovered eye will read the TOP letter (which is the letter "E") at 20 ft.

  4. Glance on the chart and on the patient making sure that he only reads with 1 eye and not with both eyes

  5. Test each eye separately, then together with and without corrective lenses (OD, OS & OU)
• Snellen Chart

  • Measured in one eye at a time, and then in both eyes together with the client comfortably sitting or standing
  • The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered
  • Then both eyes are tested together
  • Visual acuity is measured with or without corrective lenses and the client stands at a distance of 20 feet from the chart
• The score on R eye might not be the score on L eye
• Alternative visual acuity testing


  Have patient hold pocket vision screener about 14 inches from eye and proceed testing as the chart

  
• Scoring visual acuity


  • If a client can only read the topmost letter (E), his or her score is 20/200
  • Meaning that the letter he / she recognized or identified IS READ BY A CLIENT WITH NORMAL VISION AT A DISTANCE OF 200 FT.
  • The client can read it only at a distance of 20 feet but they cannot read it at 200 feet
• Normal visual acuity


  • 20 / 20 is the Normal acuity
  • 20 / 15 is a better vision
• Abnormal visual acuity


  • 20 / 200 – legally blind
  • Smaller fraction eg. 20 / 40
• Jaeger test


  1. An eye chart used in testing NEAR VISION ACUITY

  2. A card which paragraphs of text are printed

  3. Held by a client at a fixed distance (14 inches)
• Normal Jaeger test


  14 / 14
• Abnormal Jaeger test


  A smaller fraction (e.g., 14/18): Person must hold print farther away to see clearly because of decreased ability of lens to accommodate to near objects
• Snellen E chart


  • Also known as the "Tumbling E" Eye Chart
  • Useful to test the distance visual acuity of CHILDREN or ADULTS who cannot communicate verbally due to physical / mental disability, language barrier or other reasons
• Ishihara test


  1. Color perception / vision test for RED – GREEN color deficiencies

  2. Named after the designer Dr. Shinobu Ishihara
• Normal Ishihara test


  • Correctly identifies embedded figures in the Ishihara cards or identifies colored bars on the Snellen eye chart
• Abnormal Ishihara test


  • Inability to detect the embedded number or letter in the Ishihara chart: Defect in color perception (color blindness)
• Palpation of eyeball


  Gently palpate below eyebrow and note firmness of eyeball
• Normal eyeball palpation


  • Globe is firm and nontender
• Abnormal eyeball palpation


  • Excessively firm or tender globe Indicating glaucoma
• Do not palpate eyeball in patients with eye trauma or known glaucoma
• Conjunctiva


  The mucous membrane that covers the front of the eye and lines the inside of the eyelids
• Inspecting the bulbar conjunctiva


  1. Have the client keep the head straight while looking from side to side then up toward the ceiling

  2. Observe clarity, color, and texture
• Normal bulbar conjunctiva


  • Clear, with few underlying blood vessels and white sclera visible
• Inspecting the palpebral conjunctiva


  Inspect the palpebral conjunctiva of the lower eyelid by placing your thumbs bilaterally at the level of the lower bony orbital rim and gently pulling down to expose the palpebral conjunctiva

  
• Normal palpebral conjunctiva


  • Smooth, glistening, pinkish-peach color,with minimal blood vessels visible
• Everting the upper eyelid

  1. Place a cotton-tipped applicator approximately 1 cm above the eyelid margin and push down with the applicator while still holding the eyelashes

  2. Hold the eyelashes against the upper ridge of the bony orbit just below the eyebrow, to maintain the everted position of the eyelid

  3. Examine the palpebral conjunctiva for swelling, foreign bodies, or trauma

  4. Return the eyelid to normal by moving the lashes forward and asking the client to look up and blink
• Normal bulbar conjunctiva


  • Transparent, capillaries sometimes evident; Sclera appears white
  • Darker or yellowish & with small brown macules in dark skinned clients are NORMAL
• Abnormal bulbar conjunctiva


  • Jaundiced sclera, excessively pale sclera, reddened sclera; lesions or nodules
• Normal palpebral conjunctiva


  • Shiny, smooth, and pink or red
• Abnormal palpebral conjunctiva


  • Extremely pale, extremely red, nodules or other lesions
• Conjunctival abnormalities


  • Conjunctivitis (red palpebral and bulbar conjunctiva)
  • Anemia (pale pink conjunctiva)
  • Pterygium / pinguecula (growth or thickening of conjunctiva from inner canthal area toward iris)
  • Subconjunctival hemorrhage (eye injury; bright red areas of the sclera)
  • Nevus (benign pigmented congenital discoloration)
  • Papilloma (benign growth)
• Inspection and palpation of the lacrimal apparatus


  Assess the areas over the lacrimal glands (lateral aspect of upper eyelid) and the puncta (medial aspect of lower eyelid)

  
• Normal lacrimal apparatus


  • No edema or tenderness or tearing
  • Puncta is visible without swelling or redness
• Abnormal lacrimal apparatus


  • Swelling of lacrimal gland visible in the lateral aspect of upper eyelid
  • Redness / swelling around the puncta
  • Excessive tearing