ASSESSING THE EYES

PRE-INTRODUCTORY PHASE
1. Reviewed client's previous medical records if available.
This is done in order for you to know the previous medical history of
the patient to provide focus to the assessment in the patient.
2. Determined the scope of assessment needed. prepared necessary
equipment.
This is done in order for you to be able you know the extent of your
physical assessment and also, preparing assessment you will be able
to save time and energy.
3. Performed handwashing. Donned gloves (if deemed necessary).
Washing your hands properly with soap and water can help prevent
the spread of the germs (like bacteria and viruses) that cause diseases.
We need to sanitize our hands before wearing gloves because the
gloves used for routine patient care are not put on in a sterile manner. If
your hands aren't clean, any organisms on them will be transferred to
the outside of the gloves.

INTRODUCTORY PHASE
4. Greeted the client politely (and client's companion if around).
Introduced self and verified the client's identity. Asked how the client
would like to be called during the assessment. Established rapport
with the client.
So, the first thing that we need to do is to greet the patient and
introduce ourselves to the client to create rapport with the patient before
starting the assessment and also, we have to identify our patient in order
to ensure that we have the correct patient. Lastly, ask how the patient
would like to be called during the assessment so that they are at ease
with us.
a) Good morning Maám, I am Shairra Jane Salimbot your nurse
for todays’ session.
b) So, what’s your name Maám? Age? Birthday?
c) What do you want me to call you Maám?
 d) Today we are going to assess your eyes, so how are you
feeling?

5. Explained the procedure to the client, and how he or she can

participate during the assessment. Provided the client the
opportunity to clarify, ask or raise any concern. Through explaining
the procedure, we can lessen the anxiety of the patient and gain
their cooperation.
a) So, today I am going to assess your eyes. I am going to
check how clear and how good your eyesight is and ofcourse
check if there are certain spots or angles that you have
troubled seeing. Okay? So, during the conduct of the
assessment I might need to ask you to stand up or to sit down
to read something or shine light in your eyes, okay? And
ofcourse all the results will be documented but it will keep
confidential, okay Maám?
b) Do you have any questions or clarifications before we begin
the procedure?

6. Ensured client's comfort, privacy and confidentiality. Assessment

setting was assured to be safe, secured and free from distractions.
Positioned client to be seated comfortably. This is done in order to
provide comfort to the patient while the assessment is going on, and
also to provide dignity and to have an entrusting relationship with the
client.
a) Ma’am, I am going to close the doors and curtains for your
privacy, okay?
b) Are you comfortable with your position Maám?

WORKING PHASE
Assessing the Visual Acuity
7. Checked for use of any visual aids prior to starting the test. This
includes your lenses, your glasses and make sure to check them
because if the client have lenses or glasses make sure that they are
going to wear them during the test. But if the client has a reading
 glass make sure to remove them during the test because it can
cause blurring of vision.
a) Maám do you use graded glasses? Or contact lenses?

8. Had the client stand 20 ft (6 m) from the Snellen or E chart, covered

the eye being tested, and asked him/her to read each line until
he/she cannot decipher the letters or their direction.
a) May ask you to stand up, okay so what I need you to do is to use
this card board to cover right eye first like this, and then try to
read the letters that are written in the Snellen’s chart just up until
the letter that you can see okay?
b) Then after doing it to the right eye, you have to do it in your left
eye also and then repeat the procedure.
c) Lastly, read the Snellen’s chart with both eyes uncovered okay?

9. Took three readings: right eye, left eye, both eyes.

a) Then, you can now start reading from the E which is the upper
then down to the last letter.
b) After that, do it again with the other eye
c) Lastly, do it with your both eyes uncovered.

10. Recorded the readings of each eye and both eyes (i.e., the
smallest line from which the person is able to read one-half or more
of the letters)
11. Performed selected vision tests: light perception, hand
movements, then counting fingers (if necessary) if the client is
unable to see even the top line (20/200) of the Snellen-type chart.
a) So, Maám I need you to tell me how many fingers I am raising
okay? So, what about this?
b) I also need you to tell me what direction I am pointing at,
okay?
c) I need you to tell me if you could see the light okay? (light at
the upper of head) can you see it?

Testing for Visual Fields

12. Faced the patient directly at a distance of 60 to 90 cm (2 to 3 ft)
13. Instructed the client to look directly onto the examiner's eyes with
both eyes
14. Placed hands about two feet apart, lateral to the patient's ears.
15. Slowly moved wiggling fingers of both hands along the imaginary
bowl (over the patient's head) until the patient identifies them. Ask
the client to tell you when the moving object is first spotted.
16. Repeated the action in the upper and lower temporal quadrants.
a.) So now Maám I need you to do is just to look straight into my
eyes, okay?
b.) And tell me the word okay if you first spot my fingers that entering
your visual field, okay? Tell me the word okay Maám? Okay?

17. If a defect is detected: Slowly moved wiggling fingers from the

defective area of the field toward the better vision. Repeated this at
several levels until the border of the defect has been defined.
18. Tested another eye for an accompanying defect
a.) Maám you have trouble seeing your right eye, so let’s do the
wiggling again. Tell me or say the word okay when you first spot
my fingers entering your visual field. Okay? Then let’s try the other
eye.

Visual Inspection of the Eyes

19. Visually inspected the eyes for alignment and symmetry
20. Inspected the eyebrows for hair distribution and alignment and skin
quality and movement (asked client to raise and lower the eyebrows)
a) So, now I’ll be checking your eyes. So, for starters I see that your
eyes are aligned and symmetrical. Your eyebrows are evenly
distributed and slightly arched.
b) Can you raise your eyebrows for me? Up? and down? Okay.

21. Inspected the eyelashes for evenness of distribution and direction

of curl
22. Inspected the eyelids for surface characteristics (e.g., skin quality
and texture), position in relation to the cornea, ability to blink, and
frequency of blinking. Inspected the lower eyelids while the client’s
eyes are closed
23. Inspected the area over the lacrimal gland and lacrimal sac for
swelling.
24. Asked the patient to look up; depressed the lower lid of the patient
with one's thumbs afterwards to assess sclera and bulbar
conjunctivae
25. Everted the eyelid to assess the palpebral conjunctiva
26. Inspected carefully each iris and pupil
27. Inspected each cornea and lens for opacities / clarity and texture:
Shone a penlight from the side toward the eye or shone a penlight at
an oblique angle to the eye, and moved the light slowly across the
corneal surface. Asked the client to look straight ahead while doing
so.
a.) Your eyelashes they are both evenly distributed and pearls are
curls, slightly upward.
b.) Okay, can you close your eyes? Okay. Its close symmetrically and
no discolorations, no lesions. You can open your eyes now.
c.) So, I am going to palpate for your nasal lacrimal sac and nasal
lacrimal gland. Okay. There are no edema, no swelling, and no
tearing of lacrimal ducts
d.) Can you look up for me, okay. (butangan katong murag stick sa
mata)
e.) I am going to be inspecting for your iris and pupil, so just look
straight into my eyes, okay? I’m going to use my pen light to check
for your cornea and lenses for any opacities. Okay?

Assessing Direct and Consensual Pupillary Reaction to Light

28. (a) Darkened the room partially. Asked the client to look into the
distance
29. (b) Shone a light obliquely into each pupil in turn (using a penlight,
approaching from the side).
30. (c) Looked for direct and consensual reaction.
a.) So now I need to close the light, okay?
b.) So, I’m gonna need to shine again the light in your eyes to check
for your direct and consensual reaction. Okay
c.) So, what I did is I shown light in your right eye and then it
constricted and that’s the direct reaction and for the consensual it
means that when I shown light in your right eye the left eye also
constricted which is pretty normal.
 Assessing the Accommodation
31. (a) Held an object (a penlight or pencil) about 10 cm (4 in.) from
the bridge of the client’s nose
32. (b) Asked the client to look first at the top of the object and then at
a distant object (e.g., the far wall) behind the penlight. Instructed
patient to alternate the gaze from the near to the far object.
Observed the pupil response.
33. (c) Asked the client to look at the near object and then moved the
penlight or pencil toward the client’s nose.
a.) Proceeding now to the assessment of your pupil’s reaction to
accommodation. So, what I need you to do is to look or focus
your eyes at the tip of my pen light and look at the wall at my
back. Okay? So, look at the tip of my pen light then at my
back, to my pen then at my back, again to my pen and my
back. Okay good.

Performing Hirschberg Test

34. (a) From about two feet directly in front of the patient, shone a light
onto the patient's eyes and ask the patient to look at it
35. (b) Inspected the reflections in the corneas.
36. (c) Looked for direct and consensual reaction
a.) So now I will be performing Hirschberg test. So, basically I’m just
gonna shine my pen light in your eyes and then look for the
reflection of it in your corneas, okay?
b.) So just look straight (put light in the eyes left and right)

Performing the Cardinal Fields of Gaze Test

37. (a) Stood two to three feet in front of the patient.
38. (b) Asked the patient to follow the examiner's (you) finger or a
pencil while making a wide H in the air.
39. (c) Looked for jerky movements of nystagmus on lateral gaze and
on upward gaze
40. Watched for a rim of sclera between the upper lid and iris as the
eyes move up and down.
a.) So now I will be performing cardinal fields of gaze test okay. So, I
need you to follow the tip of my pen light, with your eyes only. Do
not move your neck with it okay? Just the eyes.
 b.) I lihok lihok ang pen light in different place, angles or direction.

Testing for Convergence

41. Asked the patient to look at examiner's (you) finger as the
examiner moves it towards the bridge of the nose. Check eye
convergence
a.) So now I’ll be testing for your convergence. Simply just follow
the pen light okay? (e move ang pen light towards the patient)

SUMMARY AND CLOSING PHASE

42. Summarized the information obtained during the working phase
and discussed findings to the client. Discussed to the client possible
plans to resolve health concern, if present
a.) Now Maám I’ll be summing up everything that we do earlier.
b.) So for your visual acquity when you were reading the Snellen’s
chart, the resultwas your right eye vision is ______, then your left
eyes is at _____, and both of your eyes is at ______.
c.) For your visual fields the one which was I did when I was wiggling
my fingers and then you said okay, if you spot my fingers in your
visual fields, so your upward field is ______, your downward field
at _______ and then your nasal field at ______ which is normal.
d.) So, for the inspection of the eyes, the eyes are aligned and
symmetrical, the eyebrows are evenly distributed and arched
eyelashes are evenly curled upward. For the eyelid skin is intact,
lids flow symmetrically, no discharges, no discoloration, and we
have normal blinking which is at 15 to 20 blinks per minute.
e.) As I was palpating for your lacrimal gland and nasal lacrimal sac,
there was no edema, no tenderness, no swelling. Sclera is white
which is normal and your bulbar conjunctiva is good. Iris and pupil
are both normal, no opacities, and the pupil is at three millimeters
which is normal too.
f.) Your pupils reaction to accommodation is normal too. The one
that we did when you were looking at the tip of my pen light and
when you look at the wall that’s accommodation.
g.) The cardinal fields gaze tests, both are coordinated, no jerky
movements.
43. Assessed for client's understanding of the plan and the need for
further teaching. Provided the client the opportunity to clarify, ask or
raise any concern.
a.) So, everything is pretty normal, there’s no problem with your
eyes and I just want to advise you to minimize your exposure
to your cellphone screen, continue to consume vitamin a rich
food, which is a vitamin good for your eyes okay? Then have a
rest after hours of spending time with your cellphone. Okay?
b.) So, do you have questions? Clarifications?
44. Thanked the client and ended the interview politely. Performed
handwashing. This is done to prevent the spread out of
microorganism
45. Documented findings in the client record using printed or electronic
forms or checklists supplemented by narrative notes when
appropriate