Assessment of the Eyes

• 70 % of all sensory information reaches the brain through the eyes
• External Structures of the Eye

  • Eyebrows
  • Eyelashes
  • Eyelids
  • Extraocular Muscles
  • Lacrimal Apparatus

  
• Anatomy of the Eye

  • Choroid
  • Vitreous Humor
  • Cornea
  • Pupil
  • Lens
  • Retina
  • Sclera

  
• Eyebrows


  • Inspect For Hair Distribution, Alignment, Skin And Quality And Movement
• Eyelashes


  • Note distribution, inversion or eversion
• Eyelids


  • Note edema, lesions

  
• Snellen Chart


  Tests the ability to discern letters or numbers at a given distance
• Testing Visual Acuity with Snellen Chart

  1. Have client stand 20 ft. away

  2. Cover up 1 eye with pad

  3. Uncovered eye will read the TOP letter

  4. Test each eye separately, then together with and without corrective lenses

  
• Scoring Visual Acuity


  • 20 / 20 is the Normal acuity
  • 20 / 15 is a better vision
  • 20 / 200 – legally blind
• Jaeger Test


  Tests NEAR VISION ACUITY
• 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
• Ishihara Test

  Color perception / vision test for RED – GREEN color deficiencies
• Allen Card Test


  Tests visual acuity in 2 years old child and older
• Palpation of Eyeball


  • Gently palpate below eyebrow and note firmness of eyeball
• Inspecting the Bulbar Conjunctiva


  • Observe clarity, color, and texture
• 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

  
• Everting the Upper Eye Lid

  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

  
• Conjunctiva


  • Inspect the bulbar conjunctiva (lying over the sclera) for color, texture and presence of lesions
  • Inspect the palpebral conjunctiva (lining the eyelids) by everting the lids
• Lacrimal Apparatus


  • Lacrimal Gland
  • Puncta
  • Nasolacrimal Duct
• Inspection & Palpation of the Lacrimal Apparatus

  • Assess the areas over the lacrimal glands and the puncta
  • Palpate the nasolacrimal duct to assess for blockage
• Cornea


  • Inspect for clarity and texture
• Corneal Light Reflex Test


  Shine light directly in patient's eyes; note position of the light reflection off the cornea in each eye

  
• Cornea and Lens


  • Shine a light on the cornea from an oblique angle
  • Note clarity and abrasions
  • Corneal Reflex
  • Blink Reflex
• Examining the cornea


  1. Touch the cornea

  2. Use a needleless syringe filled with air and shoot a puff of air over the cornea

  3. Note for blinking and tearing
• Blink Reflex


  Brush your index finger across patient's eyelashes and note blinking
• Normal corneal reflex


  • Corneal reflex positive
  • Cornea and lens clear, smooth, and glistening
  • White ring encircling outer rim (arcus senilis) is a normal variant in older adults
• Corneal Abnormalities


  • Cloudy cornea
  • Corneal abrasions and ulcers
  • Kayser - Fleischer ring
  • Corneal scar
  • Early Pterygium
  • Negative corneal reflex
• Cloudy cornea


  May be due to vit A deficiency or infection which may be accompanied by HYPOPION (pus in anterior chamber)
• Corneal abrasions and ulcers

  Roughness and irregularities of cornea
• Kayser - Fleischer ring


  Yellow ring in outer margin, associated with WILSON's disease and increased copper absorption
• Corneal scar


  Appears grayish white, usually due to an old injury or inflammation
• Early Pterygium


  Thickening of the bulbar conjunctiva that extends across the nasal side
• Negative corneal reflex


  Indicates neurological problem, CN V and VII, may also be absent or diminished in people who wear contact lenses
• Lens Abnormalities


  • Cataracts

  
• Cataracts


  Lens opacities

  
• Sclera


  • Should be smooth, white, glistening
  • Dark-skinned patients may have a yellowish cast to the peripheral sclera with whiter sclera at the limbus or small brown spots called muddy sclera
• Common Abnormal Sclera Findings

  • Diffuse Episcleritis
  • Bluish Sclera
  • Icteric sclera
• Diffuse Episcleritis


  Inflammation of the episclera
• Bluish Sclera


  Associated with osteogenesis imperfecta
• Icteric sclera


  Yellowish discoloration at the limbus, due to elevated bilirubin (jaundice)