HA MIDTERM

• 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
• Testing Visual Acuity


  1. The Snellen Chart

  2. The Jaeger Test

  3. The Snellen E Chart

  4. The Ishihara Test

  5. The Allen Card Test
• Visual Acuity


  The ability to discern letters or numbers at a given distance
• Normal Visual Acuity


  20 / 20
• Deviations from Normal Visual Acuity

  • 20 / 200 - legally blind
  • Smaller fraction eg. 20 / 40
• Normal Near Vision Acuity

  14 / 14

  
• Deviations from Normal Near Vision Acuity


  • Smaller fraction (e.g., 14/18)
  • Myopia - Nearsigthedness
  • Hyperopia - Farsightedness
  • Presbyopia - Farsightedness due to aging
• Snellen E 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


  Color perception / vision test for RED – GREEN color deficiencies

  
• Allen Card Test


  • Done at a distance of 3 meter
  • Consist of a set of seven card with each card containing a single picture
  • Usually used for 2 years old child and older
• Palpation of Eyeball


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


  • Have the client keep the head straight while looking from side to side then up toward the ceiling
  • 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
• Common Abnormalities of the Conjunctiva

  • Conjunctivitis
  • Anemia
  • Pterygium or pinguecula
  • Subconjunctival hemorrhage
  • Nevus
  • Papilloma
• Lacrimal Apparatus


  • Lacrimal Gland
  • Puncta
  • Nasolacrimal Duct
• Inspection & 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)
  • Put on disposable gloves to palpate for the nasolacrimal duct to assess for blockage
• Cornea


  • Inspect for clarity and texture
  • Ask the client to look straight ahead
  • Hold a penlight at an oblique angle to the eye, and move the light slowly across the corneal surface
• 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 caused by 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