NC 116

Exercise 2- EYES

Assessment

1. Label the following parts

3
4

1
6

9
7

Answers:

1. Pupil
2. Cornea
3. Ciliary Body
 4. Sclera
5. Retina
6. Optic Disc
7. Optic Nerve
8. Vitreous Humor/Body
9. Lens

Describe the uses and how the following procedures are done based on the video clip.

A. Snellen Chart test- The Snellen test uses a chart of letters or symbols. The letters are
different sizes and arranged in rows and columns. Viewed from 14 to 20 feet away, this
chart helps determine how well patient can see letters and shapes. During the test and as
showed in the video the patient sit or stand a specific distance away from the chart and
cover one eye. He will read out loud the letters he see with uncovered eye. The patient
will repeat this process with other eye. Typically, the doctor will ask patient to read
smaller and smaller letters until he can no longer accurately distinguish letters.

B. Assessment for visual neglect- Visual neglect refers to the failure of a patient to report,
respond, or orient to external visual stimulation or mental images of objects and scenes
that are positioned contralateral to the brain lesion, which caused neglect. Another widely
used test is the line cancellation test. Here, a patient is presented with a piece of paper
that has various lines scattered across it and is asked to mark each of the lines. Patients
who exhibit left-sided neglect will completely ignore all lines on the left side of the
paper.

C. Assessment for visual field- Visual field testing is one way your ophthalmologist
measures how much vision you have in either of the eye, or how much vision loss may
have occurred over time. A visual field test can determine if the patient have blind spots
in his vision and where they are located. Patient’s visual field is the full extent of what he
can see to the sides without moving their eyes. The visual field test determines whether
they have difficulty seeing in any areas of their overall field of vision.

D. Test for direct pupillary reflex- When light reaches a pupil there should be a normal
direct and consensual response. This decrease in constriction or widening of the pupil is
due to reduced stimulation of the visual pathway by the pupil on the affected side. This
has shown in the video wherein they tried to close the lights and check for the pupillary
reflex.

E. Accommodation reflex- Testing for the accommodation reflex follows nicely on from
eye movements. The physician will ask the patient to keep focusing on the tip of the
index finger and slowly move it towards them, aiming for the tip of their nose. The nurse
 on duty or the specialist need to be watching their pupils to make sure they see them
constrict as their finger gets closer.

F. Assessment for eye movement- This test is conducted by having the patient look in all
directions without moving their head and ask them if they experiences any double vision.
When testing motility, assess the eye alignment in primary gaze and then have the patient
move the eyes in an “H” pattern. Using physician’s finger, a light or a toy, trace an “H”
pattern in front of the patient while instructing them to hold their head still. Be sure to
alternate between observing the left and right eye in each gaze during the exam.

G. Fundoscopy examination- Fundoscopy is a common procedure used to visualize the

innermost structures of the eyeball, including the vitreous, retina, retinal blood vessels,
macula and optic disc. This procedure is done by placing physician’s left hand on the
patient's head and placing the thumb on their eyebrow. Ophthalmologist will hold the
ophthalmoscope about 6 inches from the eye and 15 degrees to the right of the patient.
Find the red reflex. Move in closer, staying nasally until optic nerve is visible.