Eent

• 70 % of all sensory information reaches the brain through the eyes
• Any disorder will interfere with your client's ability to function independently, perceive the world, and enjoy its beauty
• External Structures of the Eye

  • Extraocular Muscles
  • Lacrimal Apparatus

  
• Eyebrows

  • Inspect For Hair Distribution, Alignment, Skin And Quality And Movement
  • Normal: Hair evenly distributed; skin intact, Symmetrically aligned; equal movement
  • Deviations from normal: Loss of hair; Scaling and flakiness of skin; Unequal alignment and movement of eyebrow
• Air conduction


  The primary mechanism of hearing, involving carrying soundwaves through the external auditory canal to the tympanic membrane
• Eyelashes

  • Normal: Present and curving outward; No crusting or infestation
  • Deviations from normal: Absence of eyelashes; Lice or ticks at base of eyelashes; Inflammation; Inverted eyelashes; Everted eyelashes: Ectropion

  
• How we hear

  1. Sound waves through external auditory canal

  2. Tympanic membrane (TM) vibrates

  3. Sound vibrations cause the TM and the malleus (hammer), incus (anvil), and stapes (stirrup) bones to move

  4. Vibrations to inner ear structures
• Eyelids

  • Normal: Upper eyelid normally covers one-half of the upper iris; Palpebral fissures are symmetrical; Eyelids in contact with the eyeball; No lesions
  • Deviations from normal: Asymmetry of lids; Ptosis of both eyelids; Lesions on eyelids; Xanthelasma; Chalazion; Hordeolum / Stye

  
• Inspection of the ear

  • Angle of attachment
  • Normal shape and presence of landmarks (helix, antihelix, antitragus, tragus, lobule, Darwinian tubercle)
  • Position (helix level with imaginary line, rotated 0-15 degrees posteriorly)
  • Condition of skin (intact, no lesions)
  • Color (consistent with skin color)
  • Drainage (earwax, cerumen)
• Testing Visual Acuity


  1. Use Snellen Chart: Have client stand 20 ft. away, cover 1 eye, read top letter, test each eye separately, then together with and without corrective lenses

  2. Use Pocket Vision Screener: Have patient hold 14 inches from eye and proceed testing

  
• Abnormal findings

  • Microtia
  • Macrotia
  • Missing or malformed landmarks
  • Creased earlobes
  • Ear pits or sinuses
  • Low-set ears or lobes rotated >15 degrees
  • Drainage (bloody, pus, clear)
  • Impacted cerumen
  • Redness
  • Otitis externa
  • Acute otitis media
  • Meniere's disease
  • Lesions
  • Cysts
• Visual Acuity

  The ability to discern letters or numbers at a given distance
• Assessment


  • Otoscope
  • Palpation (tragus, helix, mastoid process)
• Snellen Chart


  Named after a Dutch ophthalmologist, used to test distance visual acuity
• Scoring Visual Acuity

  20/20 is normal, 20/15 is better vision, 20/200 is legally blind, smaller fraction indicates decreased vision
• Hearing tests

  • Whisper test
  • Watch-tick test
  • Weber test
  • Rinne test
  • Romberg's test
• Jaeger Test


  Tests near vision acuity, uses a card with paragraphs of text held at 14 inches
• Whisper test

  Tests for low-pitch deficits
• Watch-tick test

  Tests for high-pitch deficits
• Snellen E Chart


  Also known as "Tumbling E", useful to test distance visual acuity of children or adults who cannot communicate verbally
• Weber test

  Evaluates conduction of sound waves through bone to distinguish between conductive and sensorineural hearing loss
• Ishihara Test


  Color perception / vision test for red-green color deficiencies
• Weber test normal


  • Vibrations felt or heard equally in both ears, negative lateralization
• Allen Card Test


  Tests distance visual acuity, uses a set of 7 cards with pictures, usually for 2 year olds and older
• Weber test abnormal


  • Lateralization of vibrations to poor ear (conductive hearing loss) or good ear (sensorineural hearing loss)
• Palpation of Eyeball


  Gently palpate below eyebrow and note firmness of eyeball
• Rinne test


  Compares air and bone conduction sounds
• Conjunctiva


  • Normal: Bulbar conjunctiva clear, with few underlying blood vessels; Palpebral conjunctiva smooth, glistening, pinkish-peach color
  • Deviations from normal: Jaundiced sclera, excessively pale sclera, reddened sclera; lesions or nodules
• Rinne test normal


  • Air conduction sound is normally twice as long as bone conduction, ratio similar in both ears
• Common Conjunctiva Abnormalities


  • Conjunctivitis, Anemia, Pterygium or pinguecula, Subconjunctival hemorrhage, Nevus, Papilloma
• Inspection & Palpation of Lacrimal Apparatus

  Inspect for swelling, redness, tearing; Palpate nasolacrimal duct for blockage
• Rinne test abnormal


  • Conductive hearing loss: AC less than twice BC, BC ≥ AC

  Sensorineural hearing loss: AC > BC, decreases ability to hear faint or loud sounds
• Romberg's test


  Tests equilibrium/inner ear vestibular function
• Cornea


  • Normal: Transparent, shiny and smooth, details of iris visible
  • Deviations from normal: Opaque, surface not smooth, Arcus senilis under age 40
• Corneal Light Reflex Test

  Shine light directly in patient's eyes, note symmetry of light reflection
• Romberg's test normal


  • Client maintains position for 20 seconds without swaying, maintains balance
• Romberg's test abnormal


  • Client moves feet apart or loses balance, indicating vestibular disorder or inner ear/cerebellar damage
• Cornea and Lens Examination

  Shine light on cornea from oblique angle, note clarity and abrasions; Test corneal reflex and blink reflex
• Corneal Abnormalities


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


  • Cataracts