Assessment of the eyes and ears

• Eyes

  • Delicate sensory organs equipped with many extraocular and intraocular structures
  • Some structures are easily visible, whereas others can only be viewed with special instruments such as your opthalmoscope
• Choroid


  Maintains blood supply to the eye

  
• Vitreous humor


  Maintains the placement of the retina and the eyeballs spherical shape
• Cornea


  Retracts light rays entering the eye
• Pupil

  • Permits light to enter the eyes
  • Are the dark-colored openings at the center of your eyes that let light in
  • 2 to 4 mm in diameter in bright light
  • 4 to 8 mm in the dark

  
• Lens


  Refracts and focuses light into the retina
• Retina


  Receives visual stimuli and transmits images to the brain from processing
• Sclera


  Maintains the eye size and shape
• Eyelids


  • Shields and protects the eyeball from mechanical injury and helps to provide the moist chamber essential for the normal functioning of the conjunctiva and cornea
• Eyelashes


  Hairs that grow at the edge of the eyelids, in one layer on the upper and lower eyelids

  
• Conjunctiva


  • Thin, clear membrane that protects your eye
  • Creates the mucus layer that forms part of your tears
• Lacrimal apparatus


  • The medical name for your tear system
  • A group of glands, sacs and ducts that makes new tears and drains old ones away
• Extraocular muscles


  • Responsible for the eye movement
  • 6 Cardinal fields of Gaze Test
• Extraocular muscles and their cranial nerves

  • Superior Rectus - Oculomotor
  • Superior Oblique - Trochlear
  • Lateral Rectus - Abducens
  • Inferior Oblique - Oculomotor
  • Inferior Rectus - Oculomotor
  • Medial Rectus - Oculomotor
• Eyebrow assessment

  1. Inspection - Hair Distribution

  2. Normal - Skin intact, equal movements

  3. Deviation - loss of hair
• Eyelash assessment

  1. Inspection - Distribution

  2. Normal - curving out ward

  3. Deviation - absence of eyelashes

  
• Eyelid assessment

  1. Inspection

  2. Normal

  3. Deviation

  
• Vision testing

  1. Snellen chart

  2. Rosenbaum card

  3. Jaeger's card

  4. Ishihara test

  5. Allen card test
• Snellen chart

  • 20/20 normal vision in adults and children age 6 and older
  • 20/50 normal vision in children age 3 and younger
  • 20/40 normal vision in children age 4
  • 20/30 normal vision in children age 5

  
• Entropion


  Inverted eyelashes
• Ectropion


  Everted eyelashes

  
• Ptosis


  Drooping eyelid

  
• Myasthenia gravis

  Disease that weakens the voluntary muscles, causing muscle weakness during activity that improves with rest
• Rosenbaum chart

  Used to evaluate near-vision, with a series of numbers, E's, X's, and O's in graduated sizes, viewed at 14 inches
• Jaeger's card

  Eye chart used in testing near vision acuity, with paragraphs of text in increasing sizes
• Ishihara test

  Color perception test for red-green color deficiencies
• Allen card test


  Test done at 3 meters/15 feet, with a set of 7 cards each containing a single picture, usually used for children 2 years and older
• Eye inspection

  1. Bulbar conjunctiva

  2. Palpebral conjunctiva

  3. Lacrimal apparatus

  4. Eyeball

  
• Conjunctivitis

  Irritation or infection of the membrane (conjunctiva) that covers the white of the eye and the inside of the eyelid

  
• Conjunctival pallor

  Simple physical exam finding that can identify anemic patients
• Pterygium/pinguecula

  Triangular fold of growing membrane that may extend over the cornea
• Sclera inspection

  Color and texture
• Icteric sclera

  Yellowish sclera at the limbus, due to elevated bilirubin (jaundice)
• Diffuse episcleritis

  Inflammation of the episclera
• Bluish sclera


  Seen in osteogenesis imperfecta
• Anisocoria

  When the eye's pupils are not the same size

  
• Miosis

  Having small or constricted pupils
• Mydriasis

  When the black center of the eyes are larger than normal

  
• Extraocular muscle assessment

  1. Inspection

  2. Normal

  3. Deviation
• Strabismus

  Misalignment of the eyes