HEALTH ASSESSMENT Choroid Layer

MIDTERM  Vascular; provide nourishment to the

inner aspect of the eye
ASSESSING THE EYES  Prevents light from reflecting internally
 RETINA - innermost layer; receives
EXTERNAL STRUCTURES OF THE stimuli
EYES  Like eyeglasses

Eyelids Optic Disc

 Two movable structures; striated and  Cream-colored, cricular area located in
smooth muscles retina
 Protects eye from foreign bodies; limit  Can be seen with the use of
amount of light opthamolscope
 Tarsal plates (meibomian glands)
 Lateral (outer) and medial (inner) Retinal Vessels
canthus  Can be viewed with the opthalmoscope

Eyelashes VISION
 Filters dust and dirt from air
Visual Field
Conjuctiva  Refers to what a person sees with one
 Thin, transparent, continuous eye
membrane  Has four quadrants:
 Palpebral and bulbar - UPPER TEMPORAL
- LOWER TEMPORAL
Lacrimal Apparatus - UPPER NASAL
 Ducts that lubricates the eyes - LOWER NASAL
 Lacrimal gland - produce tears
Visual Perception
Extraocular Muscles  Light rays strike the retina
 Six muscles (4 rectus, 2 oblique)  Nerve impulse optic nerve
Interpretation
INTERNAL STRUCTURES OF THE
EYE (USES OPTHALMOSCOPE) VISUAL REFLEX
 Pupillary light reflex - cause pupils to
Sclera constrict when exposed to bright light
 Dense, protective, white covering that A. DIRECT REFLEX -
supports internal structures of the eye constriction occurs in an eye that is
exposed to light
Cornea B. INDIRECT
 “window of the eye” REFLEX/CONSENSUAL -
 PERMITS entrance of light constriction of opposite eye after
 Responsive to pain and touch light exposure to opposite eye
 Accommodation - functional reflex
Iris allowing eyes to focus on near objects
 Contains pigments that determine eye
color COLLECTING SUBJECTIVE DATA:
 PUPIL - CONTROLS amount of light THE NURSING HEALTH HISTORY
entering the eye
1. History of Present Health Concern
Lens  Visual problems
 Biconvex, transparent, avascular, 1. Describe any visual difficulties or
encapsulated structure changes in the vision that you have
experienced. Where they sudden or
gradual?

2. Do you see spots or floaters in
front of your eyes?
- MYOPIA (nearsightedness)
3. Do you experience blind spots?
Constant or Intermittent?
- SCOTOMA (blind spots);
Glaucoma - white spots (common in
elderly, diabetes)
- INTERMITTENT BLIND
SPOTS (opthalmic migraines,
tumor, ICP - increase intracranial
pressure)
- RETINAL DETACHMENT
(constant blind spot)
4. Do you see any halos or rings
around lights?
- NARROW-ANGLE
GLAUCOMA
5. Do you have trouble seeing at
night?
- OPTIC ATROPHY,
GLAUCOMA, VITAMIN A  Normal: client sees the examiners
DEFICIENCY
6. Do you experience double vision?
- DIPLOPIA
A. One eye - dryness in
lacrimal apparatus
B. Both - misalignment
C. Persistent - stroke,
tumor, head injury, swelling,
aneurysm
2. Personal Health History
 Have you ever had problems in your
eyes?
 Have you ever had eye surgery?
 Have you ever tested for glaucoma?
 CATARACT - complete blindness
3. Family History
4. Lifestyle and Health Practices
A. EVALUATING VISION
1. Test DISTANT visual acuity.
 Snellen or E-chart (20 ft)
 Normal: 20/20 with or without
corrective lenses
 Abrnomal: MYOPIA - impaired far
vision (20/40)
 Note client behaviors:
A. Leaning forward
B. Head tilting
C. Squinting
2. Test NEAR visual acuity.
 Test for middle-aged clients who have
difficulty with near vision or reading
 Jaeger Reading Card, Snellen,
Comparable Chart (14 in from the eyes)
 Cover one eye with an opaque card
before reading the top to bottom
 Normal: 14/14 with or without
corrective lenses
 Abnormal: PRESBYOPIA - impaired
near vision; lens ages and stiffens,
bringing the focal point behind the
retina and causing blurry vision
(common among 45 years old and
above)
3. Test VISUAL FIELDS for gross
peripheral vission
 Confrontation Test (superior, temporal,
and nasal)
finger at the same time the examiner
sees it
- INFERIOR (70 degrees)
- SUPERIOR (50 degrees)
- TEMPORAL (90 degrees)
- NASAL (60 degrees)
 Abnormal: delayed or absent
perception of the examiner’s finger
B. TESTING EXTRAOCULAR
MUSCLE FUNCTION
1. Perform CORNEAL LIGHT REFLEX
test.
 Tests parallel alignment of eyes
 Use a penlight, shine the light toward
the bridge of the nose while the client
stares ahead (12 in from the client’s
face)
 Normal: parallel alignment (reflection
in the corneas should be in exact spot
on each eye)
 Abnorrmal:
A. PSEUDOSTRABISMUS -
pupils appear at inner canthus
B. STRABISMUS (Tropia) -
malalignment of eye axis

2. Perform COVER TEST.
 Detects deviation in alignment or
strength and slight deviations in eye
movement by interrupting fusion reflex
 Normal: uncovered eye remain fixed
straight ahead; covered eye remain
fixed straight ahead after being
uncovered
 Abnormal:
A. PHORIA - misalignment occurs
only when fusion reflex is blocked
B. STRABISMUS - constant
misalignment of the eye
C. TROPIA - eye misalignment
3. Perform CARDINAL FIELDS GAZE
TEST.
 Assess eye muscle strength and cranial
nerve function
 Normal: smooth eye movement;
symmetric in all six directions
 Abnormal:
A. NYSTAGMUS - oscillating
movement of the eye (inner ear
disorder, multiple sclerosis, brain
lesions or narcotics use)
C.EXTERNAL EYE STRUCTURES
1. Inspect eyelids and eyelashes.
 Palpebral fissures
 Abnormal:
1. PTOSIS (BLEPHAROPTOSIS)
- oculomotor nerve damage
2. ENTROPION - inverted lower
lid
3. ECTROPTION - everted lower
lid
4. CHALAZION - infection of
meibomian gland
5. SEBORRHEA/BLEPHARITIS
- redness
2. Observe the POSITION AND
ALIGNMENT OF THE EYEBALL in the
eye socket.
 Normal: eyeballs are symmetrical
without protrusion or sinking
 Abnormal:
1. EXOPTHALMUS - Graves
Disease (Hyperthyroidism)
2. SUNKEN EYES - DHN
(dehydration); Chronic Wasting
Illness
3.Inspect bulbar conjuctiva and sclera
 Normal: Bulbar conjuctiva is clear,
moist, smooth and transparent with
visible tiny blood vessels; sclera is
smooth and white, no lesions, exudates
 PINGUECULA - yellowish nodules
on bulbar conjuctiva (harmless; older
adults)
 Abnormal:
1. CONJUNCTIVITIS -
inflammation
2. EPISCLARITIS - local,
noninfectious, inflammation of
sclera
3. JAUNDICE/ICTERUS - yellow
sclera
4. SUBCONJUCTIVAL
HEMORRHAGE - bright red eyes
(harmless, disappears in 1-2 weeks)
4.Inspect palpebral conjuctiva
 Stressful and uncomfortable to clients.
Usually done if clients complain
“something in the eye”
 Normal: clear and no swelling or
lesions’ no foreign bodies or trauma
 Abnormal:
1. CYANOSIS (lower lid) - heart
or lung disorder
2. IRRITATION, BURNING,
PAIN AND/OR SWELLING OF
UPPER EYELID - foreign body
5.Inspect lacrimal apparatus
 Normal: no swelling/redness; visible
puncta - no swelling/redness
 Abnormal:
1. SWELLING - blockage,
infection, inflammation
2. REDNESS OR SWELLING
AROUND PUNCTA - infection or
inflammation
 3. EXCESSIVE TEARING
nasolacrimal sac obstruction
6.Palpate lacrimal apparatus
 Normal: no drainage
 Abnromal: presence of drainage
7.Inspect the cornea and lens
 Normal: CORNEA - transparent, no
opacities; moist; LENS - no opacities
 Abnormal:
1. ROUGH OR DRY CORNEA -
injury or allergic reaction
2. CATARACTS - opacities of the
lens
8.Inspect iris and pupil
 Normal: IRIS - round, flat and evenly
colored
 PUPIL - round, regular boarder;
centered in iris (3-5mm);
ANISOCORIA - inequality less than
0.5mm
 Abnormal: irregular shaped irises,
miosis, mydriasis, anisocoria
 Begin palpation with the eye that is not
red or infected to avoid transmission
 ARCUS SENILIS (common in older
adults) - has no effect on vision; white
arc around limbus
ABNORMALITIES OF THE PUPILS
1. IRREGULAR SHAPED IRIS (closed
angle glaucoma)
2. MIOSIS - pinpoint pupils, characterized
by constricted and fixed pupils (narcotic
drugs or brain damage)
3. ANISOCORIA
A. Greater that bright light
compared with dim light - trauma,
tonic pupil (impaired
parasymphathetic nerve supply) and
oculomotor nerve paralysis
B. Greater than dim light compared
to bright light - Horner Syndrome
(paralysis of cervical sympathetic
nerves; ptosis, sunken eyeball,
flushing on affected side of dace,
narrowing of palpebral fissure)
4. MYDRIASIS - dilated and fixed pupil
resulting from CNS injury, circulatory
collapse or deep anesthesia
- 9. Test pupillary reaction to light
 Normal: bilateral constriction of pupils
to light
 Abnormal:
A. MONOCULAR BLINDNESS -
light directed to blind eye results in
no response in either pupil but when
light is directed to the unaffected
eye, both pupils constrict
10. Test accommodation of pupils
 Normal: constriction and convergence
 Abnormal: no constriction (pupils) and
convergence (eyes)
PERRLA
 Pupils are equal, round and reactive to
light accommodation
 The PERRLA eye test is used to check
if your pupils look and function
normally
D.INTERNAL EYE STRUCTURES
1. Inspect red reflex
2. Inspect optic disc
3. Inspect retinal vessels
4. Inspect retinal background
5. Inspect fovea (sharpest area of vision)
and macula
6. Inspect anterior chamber
ABNORMALITIES OF THE OPTIC
DISC
1. PAPILLEDEMA - swollen optic disc
2. GLAUCOMA - enlarged physiologic
cup occupying more than half’s the diameter
(less than 0.5 mm)
3. OPTIC ATROPHY - white optic disc