Protozoa (Kingdom Protista): Chordata (chordates): Animals possessing a notochord at

some stage of their development, including vertebrates

(subphylum Vertebrata) such as fish, amphibians, reptiles,
birds, and mammals.
Protozoa are unicellular eukaryotic organisms.

They are classified into various phyla based on their mode of

locomotion and other morphological features.

Branches of Helminths (Parasitic Worms):

Major phyla within Protozoa include:

Sarcomastigophora: Includes organisms that move using Trematodes (Flukes):

flagella or pseudopodia. Examples include amoebas and
flagellates. Trematodes are leaf-shaped parasitic flatworms.

Ciliophora: Includes organisms that move using cilia. They typically have complex life cycles involving intermediate
Paramecium is a well-known example. hosts, such as snails.

Apicomplexa: Obligate parasites possessing a unique Examples include Schistosoma species, which cause
organelle called the apical complex. Examples include schistosomiasis.
Plasmodium species (causing malaria) and Toxoplasma gondii.

Microspora: Unicellular parasites with unique spores lacking

Cestodes (Tapeworms):
conventional mitochondria.
Cestodes are long, ribbon-like parasitic flatworms.

They lack a digestive system and absorb nutrients through

Metazoa (Kingdom Animalia): their body surface.

Examples include Taenia solium and Taenia saginata, which

infect humans via the ingestion of contaminated food.
Metazoa comprises multicellular eukaryotic organisms.

These organisms exhibit specialized tissues, organs, and

organ systems. Nematodes (Roundworms):
Metazoa includes a wide range of animal phyla, which are Nematodes are cylindrical parasitic worms with a complete
further classified based on various characteristics. digestive system.

They include soil-transmitted helminths (e.g., Ascaris

lumbricoides, hookworms, whipworms) and filarial worms (e.g.,
Major branches within Metazoa include:
Wuchereria bancrofti, causing lymphatic filariasis).
Porifera (sponges): Simple multicellular animals lacking true
tissues.
Acanthocephalans (Thorny-headed Worms):
Cnidaria (jellyfish, corals, etc.): Radially symmetrical animals
possessing specialized cells called cnidocytes. Acanthocephalans are parasitic worms with retractable
proboscis armed with hooks for attachment to the host's
Platyhelminthes (flatworms): Bilaterally symmetrical animals
intestine.
with flat bodies, including tapeworms and flukes.
They have indirect life cycles typically involving arthropod
Nematoda (roundworms): Unsegmented worms with
intermediate hosts.
cylindrical bodies, such as Ascaris.
Each branch of helminths exhibits unique morphological and
Annelida (segmented worms): Worms with segmented
physiological adaptations to their parasitic lifestyle, including
bodies, including earthworms and leeches.
specialized structures for attachment, nutrient acquisition, and
Arthropoda (arthropods): Largest phylum, including insects, evasion of host immune responses. Understanding these
arachnids, crustaceans, and myriapods. characteristics is crucial for the diagnosis, treatment, and
prevention of parasitic infections.
Mollusca (mollusks): Soft-bodied animals with a muscular
foot, mantle, and often a protective shell, such as snails,
clams, and octopuses.

Echinodermata (echinoderms): Marine animals with a spiny

skin, radial symmetry, and a water vascular system, including
starfish and sea urchins.

Amoebas:
Biologic Characteristics: Amoebas are protozoa characterized
by their use of pseudopodia for movement and feeding. They
are typically free-living in soil and freshwater environments, but
some species can be parasitic.
Morphologic Characteristics: Amoebas have an irregular shape
and lack permanent structures such as flagella or cilia. They
move by extending and retracting pseudopodia, which are
temporary projections of the cell membrane.
Physiologic Characteristics: Amoebas feed by engulfing food
particles, such as bacteria or organic debris, through
phagocytosis. They play important roles in nutrient cycling and
decomposition in ecosystems.
Flagellates:
Biologic Characteristics: Flagellates are protozoa that move
using one or more whip-like flagella. They can be free-living or
parasitic, and they are found in various aquatic and terrestrial
environments.
Morphologic Characteristics: Flagellates have a characteristic
flagellum or flagella used for locomotion. Some species may
also possess other structures such as a cell membrane or a
protective cyst wall.
Physiologic Characteristics: Flagellates exhibit diverse feeding
strategies, including phagocytosis, absorption, and
photosynthesis in some species. Some flagellates are
important pathogens in humans and animals, causing diseases
such as giardiasis and trichomoniasis.
humans, and are often transmitted through vectors such as
mosquitoes or ticks.
Morphologic Characteristics: Sporozoans lack locomotor
structures such as flagella, cilia, or pseudopodia. They typically
have a specialized structure called an apical complex, which is
used for host cell invasion.
Physiologic Characteristics: Sporozoans are intracellular
parasites that infect and multiply within host cells. They often
cause serious diseases in their hosts, such as malaria (caused
by Plasmodium spp.) and toxoplasmosis (caused by
Toxoplasma gondii).
Take note of the definition of terms
Encystation – process by which trophozoites differentiate
into cyst form.
Excystation – process by which cysts differentiate into
trophozoite forms.
Infective stage – stage where parasites that enters the
host or the stage that is present in the parasites source
infection.
Pathogenic stage – refers to the stage where parasite is
responsible for producing organ damage to the host
leading to clinical manifestation.

Ciliates:

Biologic Characteristics: Ciliates are protozoa characterized by

the presence of numerous hair-like structures called cilia,
which they use for movement and feeding. They are typically
found in freshwater environments, although some species can
be found in marine or terrestrial habitats.

Morphologic Characteristics: Ciliates have a characteristic oval

or elongated shape and are covered in cilia arranged in rows
or bands. They often possess specialized structures such as
contractile vacuoles for osmoregulation and food vacuoles for
digestion.

Physiologic Characteristics: Ciliates use their cilia for

locomotion and to create water currents for feeding. They feed
on bacteria, algae, and other small organisms by sweeping
them into their oral groove and digesting them in food
vacuoles.

Sporozoans (Sporozoa):

Biologic Characteristics: Sporozoans are protozoa that typically

have complex life cycles involving both sexual and asexual
reproduction. They are obligate parasites of animals, including
Cestodes
Extra-intestinal cestodes
the genus Echinococcus include Echinococcus granulosus
and Echinococcus multilocularis.
These tapeworms cause echinococcosis or hydatid
disease, characterized by the formation of fluid-filled cysts
(hydatid cysts) in various organs such as the liver, lungs,
and other tissues.
Humans become infected by ingesting parasite eggs shed in
the feces of definitive hosts, often dogs or other canids.
Echinococcosis can lead to serious complications, including
organ dysfunction, cyst rupture, anaphylaxis, and
secondary infections.
Taenia solium (Cysticercosis):
Taenia solium, the pork tapeworm, can cause cysticercosis,
an infection characterized by the development of cysts
(cysticerci) in various tissues, including the brain,
muscles, and eyes.
Humans acquire cysticercosis by ingesting eggs shed in the
feces of carriers or through autoinfection.
Neurocysticercosis, involving cysts in the brain and spinal
cord, is the most severe form of the disease and can lead to
neurological symptoms, seizures, and cognitive
impairment.
Intra-intestinal Cestodes
Taenia saginata (Beef Tapeworm):
Taenia saginata in an intra-intestinal cestode infecting
humans who consume raw or undercooked beef containing
larvae (cysticerci).
Infection with T. saginata, known as taeniasis, is usually
asymptomatic or causes mild gastrointestinal symptoms such
as abdominal discomfort, nausea, and diarrhea.
Adult tapeworms attach to the intestinal wall, where they can
grow to several meters in length and release proglottids
containing eggs.
Taenia solium (Pork Tapeworm):
In addition to causing cysticercosis, Taenia solium also infects
humans as the pork tapeworm, causing taeniasis.
Taeniasis due to T. solium is similar to that caused by T.
saginata, with adult tapeworms residing in the small intestine
and releasing eggs through proglottids
Clinical symptoms are usually mild and nonspecific, although
heavy infections may lead to weight loss, vitamin deficiencies,
and gastrointestinal disturbances.
Diphyllobothrium latum (Fish Tapeworm):
Diphyllobothrium latum is an intra-intestinal cestode acquired
by humans consuming raw or undercooked freshwater fish
harboring larvae (plerocercoids).
Infection with D. latum, known as diphyllobothriasis, can lead
to symptoms such as abdominal discomfort, diarrhea, vitamin
B12 deficiency, and megaloblastic anemia.
Adult tapeworms can grow to lengths exceeding 10 meters in
the small intestine and produce proglottids containing eggs.
Trematodes
Schistosoma spp.:
Schistosoma species are responsible for causing
schistosomiasis, also known as bilharzia.
They have a complex life cycle involving freshwater snails as
intermediate hosts and humans or other mammals as definitive
hosts.
Schistosomiasis is prevalent in tropical and subtropical
regions, particularly in areas with poor sanitation and water
contamination.
Common species include Schistosoma mansoni, Schistosoma
japonicum, and Schistosoma haematobium, each causing
distinct clinical manifestations.
Fasciola hepatica:
Fasciola hepatica, also known as the liver fluke, infects a wide
range of mammalian hosts, including humans, sheep, cattle,
and other herbivores.
The life cycle involves snails as intermediate hosts and
mammals as definitive hosts.
In humans, fascioliasis occurs through the ingestion of
contaminated water or plants containing encysted larvae
(metacercariae), leading to symptoms such as abdominal pain,
fever, and hepatomegaly.
Clonorchis sinensis:
Clonorchis sinensis, also known as the Chinese liver fluke,
infects humans and other mammals.
The life cycle involves freshwater snails as intermediate hosts
and freshwater fish as second intermediate hosts, which are
then ingested by definitive hosts.
Infection with Clonorchis sinensis occurs through the
consumption of raw or undercooked freshwater fish containing
encysted larvae (metacercariae).
It can cause clonorchiasis, characterized by symptoms such as
abdominal pain, diarrhea, jaundice, and hepatomegaly.
Paragonimus spp.:
Paragonimus species are lung flukes that infect humans,
mammals, and birds.
The life cycle involves freshwater snails as intermediate hosts
and crustaceans such as crabs and crayfish as second
intermediate hosts.
Humans can become infected by consuming raw or
undercooked crustaceans containing encysted larvae
(metacercariae).
Paragonimiasis manifests with symptoms such as chronic
cough, chest pain, hemoptysis, and fever.
Opisthorchis spp.:
Opisthorchis species, such as Opisthorchis viverrini and
Opisthorchis felineus, are liver flukes endemic in certain
regions of Asia and Europe, respectively.
The life cycle involves freshwater snails as intermediate hosts
and freshwater fish as second intermediate hosts.
Human infection occurs through the consumption of raw or
undercooked freshwater fish containing encysted larvae
(metacercariae).
Opisthorchiasis can lead to hepatobiliary disorders, including
cholangitis, cholecystitis, and cholangiocarcinoma.
These are some of the most notable types of trematodes that
can infect humans and animals, causing a range of diseases
collectively known as trematodiases or fluke infections.
The life cycle of a tapeworm
Taenia solium (pork tapeworm) or Taenia saginata (beef
tapeworm), typically involves multiple stages and hosts. Let's
take the example of Taenia solium:
Adult Tapeworm Stage:
The life cycle begins with the adult tapeworm residing in the
small intestine of the definitive host, typically a human.
The tapeworm attaches to the intestinal wall using its scolex
(head) equipped with hooks and suckers.
The body of the tapeworm consists of multiple segments called
proglottids, each containing reproductive organs.
Egg Production:
Mature proglottids, located at the posterior end of the
tapeworm, contain numerous fertilized eggs.
These eggs are released into the environment through the
feces of the definitive host.
Intermediate Host Infection:
Eggs ingested by an intermediate host, such as a pig in the
case of Taenia solium, hatch into larvae (oncospheres) in the
digestive tract.
The larvae penetrate the intestinal wall and migrate to various
tissues, where they develop into cysticerci (larval stage).
Cysticerci Formation:
In Taenia solium, cysticerci preferentially develop in the muscle
tissue (including heart and brain) of the intermediate host,
forming fluid-filled cysts containing an invaginated scolex.
Humans can become intermediate hosts by ingesting
undercooked pork containing cysticerci.
Human Infection:
Upon ingestion of contaminated pork, cysticerci from the meat
are released in the human digestive tract.
Once in the human intestine, the cysticerci evaginate, and the
scolex attaches to the intestinal wall, initiating the growth of a
new tapeworm.
Adult Tapeworm Growth:
The tapeworm matures in the human intestine, repeating the
cycle by producing eggs through the development of
proglottids.
Nematodes
Ascaris lumbricoides: This is one of the most common
nematodes:
Ascaris lumbricoides - Intestinal parasite transmitted through
contaminated food or water, causing abdominal discomfort.
Trichuris trichiura - Whipworm transmitted through ingestion of
soil, leading to abdominal pain and diarrhea.
Enterobius vermicularis: Pinworm spread via contaminated
hands or objects, causing anal itching.
Hookworms - Transmitted through skin contact with
contaminated soil, leading to anemia and gastrointestinal
issues.

Strongyloides stercoralis - Can cause strongyloidiasis,

transmitted through skin contact or ingestion, leading to
gastrointestinal discomfort and systemic infections.

Filariasis - Caused by various species of filarial nematodes

transmitted by mosquitoes, leading to conditions such as
lymphatic filariasis and onchocerciasis.
Palpation of the ears
Palpate for consistency and tenderness - Always
palpate tragus, helix, and mastoid process for
tenderness prior to otoscopic exam
- Soft and pliable, nontender Structures
- Nontender, with no nodules or swelling
Palpating the ear, palpating the tragus, palpating
the mastoid, and pulling the helix forward
Abnormal findings - Tenderness of mastoid, helix,
tragus or pinna. indicates ear infections
Hearing test
Whisper test NORMAL: Client repeats most words
whispered in each ear at a distance of 1-2ft
Watch tick test NORMAL: Client hears tick of a
watch in each ear at a distance of 5 inches
Webber test - Hold tuning fork by stem Tap tuning
fork prongs on palm of your hand Place vibrating
tuning fork in the middle of the patient’s forehead or
on the top of patient’s head Note patient’s ability to
hear - sound; note lateralization of sound
Abnormal findings - Lateralization of vibrations,
Conductive hearing loss, and Sensorineural
hearing loss
Conductive hearing loss
- The client “hears” the sound in the poor ear
- The good ear is distracted by background
noise and conducted air
- The poor ear has trouble hearing thus, the
poor ear receives most of the sound
conducted by bone vibration
Sensorineural hearing loss
- The client “hears” the sound in the good ear
- There is a limited perception of the sound
due to nerve damage in the poor ear
- This makes the sound seem louder in the
unaffected ear
Rinnie’s Test - Compares air and bone conduction
sounds
– tuning fork base is placed on the mastoid
process, after that, tuning fork is moved in front of
the external auditory canal, lastly, strike the tuning
fork and placed the tuning forks base on the client
mastoid process.
Ask the client when the sound is no longer heard
Normal findings - Air conduction (AC) sound is
normally twice as long for bone conduction (BC) or
normally heard longer (AC>BC)
The ratio of AC to BC is similar in both ears
Abnormal findings - SENSORINEURAL
HEARING LOSS
Finding will also be AC > BC
The most common type of permanent hearing loss
• ototoxic drugs
• genetic hearing loss
• aging
• head trauma
• malformation of the inner ear
• loud noise exposure
Abnormal findings – CONDUCTIVE HEARING
LOSS
BC sound is heard longer than or equally as long
as AC sound
- impacted cerumen
- otitis media
- serous otitis media
Robmberg’s test - test the client equilibrium / inner
ear vestibular function
- Ask the client to stand with feet, together,
arms at side, and eyes, open, then with the
eyes closed, stand close by in case patient
loses balance. Note patient’s ability to
maintain balance Patient stands with feet
together and eyes closed.
- When performing this test, put your arms
around the client without touching him or
her to prevent falls.
Normal findings
- client maintains position for 20
seconds without swaying or with
minimal swaying
- maintains balance
- negative Romberg

Abnormal findings
- client moves feet apart to prevent
falls or starts to fall from loss of
balance
- may indicate a vestibular disorder
loss of balance
- inner ear disorder
- cerebellar damage
- ingestion of intoxicants
Inspection of the eyes
Eyebrows - Inspect for hair distribution,
alignment, skin and quality and movement
Normal findings - hair evenly distributed;
skin intact, symmetrically aligned; equal
movement
Abnormal findings - loss of hair, scaling and
flakiness of skin, unequal alignment and
movement of eyebrow
Eyelashes - Note distribution, inversion or
eversion, Present and curving outward, and
No crusting or infestation
Abnormal findings - Absence of eyelashes
Lice or ticks at base of eyelashes
Inflammation
Inverted eyelashes
Eyelids - Note edema, lesions.
Upper eyelid normally covers one-half of
upper iris, Palpebral fissures symmetrical,
Eyelids in contact with eyeball, and No
lesions.
- Inspect for the surface
characteristics, position in relation to
the cornea, ability to blink, and
frequency of blinking
The Snellen chart
1. Have client stand 20 ft. away from the
Snellen Chart
2. Cover up 1 eye with pad
3. Uncovered eye will read the TOP letter
(which is the letter “E”) at 20 ft.
4. Glance on the chart and on the patient
making sure that he only reads with 1
eye and not with both eyes
It could be easy if you memorize the chart
5. Test each eye separately, then together
with and without corrective lenses (OD,
OS & OU)
6. Note smallest line of print patient is able
to read with no more than two mistakes
7. Alternate method using pocket vision
screener:
Have patient hold pocket vision
screener about 14 inches from eye and
proceed testing as the chart
- Also known as the “Tumbling E”
Eye Char
- 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
Normal Findings
20 / 20 is the Normal acuity
20 / 15 is a better vision
Abnormal findings
20 / 200 – legally blind
Smaller fraction eg. 20 / 40
Testing for visual acuity
Jaeger test
- An eye chart used in testing NEAR
VISION ACUITY
- A card which paragraphs of text are
printed
- Held by a client at a fixed distance
(14 inches)
- Normal is 14 / 14
Abnormal findings - A smaller
fraction (e.g., 14/18): Person must
hold print farther away to see clearly
because of decreased ability of lens
to accommodate to near objects.
ISHIHARA TEST
Color perception / vision test for
RED – GREEN color deficiencies
Named after the designer Dr.
Shinobu Ishihara
Normal findings - Correctly
identifies embedded figures in the
Ishihara cards or identifies colored
bars on the Snellen eye chart.
Abnormal findings -Inability to detect the
embedded number or letter in the Ishihara
chart: Defect in color perception (color
blindness).
Palpation
Palpation of the Eyeball - Gently palpate
below eyebrow and note firmness of eyeball
Normal - Globe is firm and nontender
Abnormal - Excessively firm or tender
globe Indicating glaucoma
Precaution - Do not palpate eyeball in
patients with eye trauma or known
glaucoma
Inspection for Palpebral Conjunctiva and
Bulbar Conjunctiva
- the mucous membrane that covers
the front of the eye and lines the
inside of the eyelids
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.
Normal findings - Bulbar
conjunctiva over globes are clear,
with few underlying blood vessels
and white sclera visible
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.
Normal findings - Palpebral
conjunctiva is smooth, glistening,
pinkish-peach color, with minimal
blood vessels visible
Inspect the palpebral conjunctiva
(lining the eyelids) by everting the
lids
Normal - Shiny, smooth, and pink or
red
Abnormal - Extremely pale,
extremely red, nodules or other
lesions
Inspect the bulbar conjunctiva

(lying over the sclera) Inspect for
color, texture, and presence of
lesions
Normal - Transparent, capillaries
sometimes evident; Sclera appears
white Darker or yellowish & with
small brown macules in dark
skinned clients are normal.
Abnormal - Jaundiced sclera,
excessively pale sclera, reddened
sclera; lesions or nodules.
Abnormalities
Pterygium / pinguecula
growth or thickening of conjunctiva
from inner canthal area toward iris
early pterygium
Subconjunctival hemorrhage
eye injury; bright red areas of the
sclera
Nevus - benign pigmented
congenital discoloration
Papilloma - benign growth
Inspection & Palpation of the
Lacrimal Apparatus
Inspect the lacrimal apparatus -
Assess the areas over the lacrimal
glands (lateral aspect of upper
eyelid) and the puncta (medial
aspect of lower eyelid
Inspect the lacrimal apparatus
Normal - No edema or tenderness or
tearing and Puncta is visible without
swelling or redness
Abnormal - Swelling of lacrimal
gland visible in the lateral aspect of
upper eyelid maybe due to blockage,
infection or inflammatory condition
Redness / swelling around the
puncta - indicate infectious or
inflammatory condition
Excessive tearing - may indicate a
nasolacrimal sac obstruction
Palpate the lacrimal apparatus
- Put on disposable gloves to
palpate for the nasolacrimal
duct to assess for blockage
- Use one finger and palpate
just inside the lower orbital
rim
Palpate the lacrimal apparatus
Normal - drainage should be noted
for the puncta when palpating the
nasolacrimal duct
Abnormal - Expressed drainage from
the puncta on palpation on occurs
with duct blockage
Inspection for 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
Inspect for clarity and texture
Arcus senilis under age 40
a normal condition in older clients,
appears as a white arc around the
limbus has no effect on vision
Corneal light reflex test
Shine light directly in patient’s eyes; - roughness and irregularities of
note position of the light reflection off cornea
the cornea in each eye.
Kayser - fleischer ring
Findings - Light should be seen
- yellow ring in outer margin;
symmetrically on each cornea. WILSON’s disease, increased
copper absorption
Note - Note for the SPARKLE, -
that is the light reflecting off the
cornea Corneal scar

- appears grayish white, usually

due to an old injury or
Abnormal - Asymmetrical corneal inflammation
light reflex: weak extraocular
Early Pterygium
muscles or strabismus, congenital
exotropia. - thickening of the bulbar
conjunctiva that extends across
the nasal side
Cornea and Lens Negative corneal reflex

- indicates neurological problem,

Shine a light on the cornea from an
CN V and VII
oblique angle
- may also be absent or
diminished in people who
Note - clarity and abrasions wear contact lenses

Corneal Reflex

- take a wisp of rolled cotton

and gently touch the cornea Lens abnormalities

- take a needleless syringe filled

with air and shoot a puff of air
Cataracts - lens opacities
over the cornea, note for
blinking and tearing

Blink Reflex Scelera

- Brush your index finger across - Note COLOR OF SCLERA

patient’s eyelashes and note - Should be smooth, white,
blinking glistening
- - Dark-skinned patients may have
a yellowish cast to the
peripheral sclera with whiter
Corneal abnormalities
sclera at the limbus or small
brown spots called muddy
cloudy cornea
sclera
- vit A deficiency; infection which
may be accompanied by
HYPOPION(pus in anterior
chamber)

Corneal abrasions and ulcers

Abnormal findings
 - Diffuse Episcleritis inflammation of the episclera
- Bluish Sclera - osteogenesis imperfecta
- Icteric sclera - due to elevated bilirubin -jaundice
Inspection for Pupils
- inspect pupil size and equality
- should be round and equal bilaterally
- size is larger in children, smaller in adults
- normal range is 3 – 5 mm in adults (usually
3mm)
- Inspect PUPIL SIZE and EQUALITY
- In about 20 percent of the population, unequal
pupils (ANISOCORIA) can be a normal variation
- If normal, the pupils react appropriately and the
difference is slight, 0.5 mm
Note REACTION and SPEED in both eyes
- Test pupillary reaction to light:
- Have patient look straight ahead while you bring
light in from the side over the eyes
Pupil Abnormalities
- unilateral large pupil (tonic pupil) that reacts to
light slowly (benign)
- HORNER’S SYNDROME - Enequal pupils;
affected pupil small but reacts to light and has
ptosis on affected eye related to sympathetic
nerve lesion
- ARGYLL ROBERTSON PUPILS - small and
irregular with no reaction to light or
accommodation, associated with neurosyphilis
- OVAL PUPILS - irregularly shaped pupils may
be caused by certain eye surgeries
- Sluggish or fixed pupil reaction to light: Lack
of oxygen to optic nerve or brain or topical or
systemic drug effects
- Absence of consensual response: Seen in
conditions that compress or deprive those areas
of oxygen
- Absent light reflex but no change in power of
contraction during accommodation (Argyll
Robertson pupil): Paralysis and locomotor ataxia
caused by syphilis
- MYDRIASIS - Dilated and fixed pupils, typically
resulting from central nervous system injury,
circulatory collapse, or deep anesthesia.
- MIOSIS - Also known as pinpoint pupils,
characterized by constricted and fixed pupils —
possibly a result of narcotic drugs or brain
damage.
Testing Accommodation of Pupils
- Accommodation (Adjustment of Eye for Various
Distances)
- Convergence of eyes and constriction of pupil to
focus on a near object and dilation of pupil when
looking at a far object
- Accommodation may be sluggish in advanced
age.
 Hold your finger or a pencil about 12 to 15
inches from the client.
 Ask the client to focus on your finger or pencil
and to remain focused on it as you move it
closer in toward the eyes.
ACCOMMODATION - occurs when the client
moves his or her focus of vision from a distant
point to a near object, causing the pupils to
constrict.
Convergence - assessed by moving the
finger toward the patient's nose
- hold a small target, such as a penlight, in front of
the client and slowly moves it closer until the
client have a double vision
 P – upils
 E – qual
 R – ound
 R – eactive
 L – ight reacting
 A – ccomodation
Extraocular Muscles
Assess 6 OCULAR MOVEMENTS to determine
ALIGNMENT AND COORDINATION
Normal - Both eyes coordinated, move in unison, with
parallel alignment
Abnormal - Eye movements not coordinated or parallel;
one or both eyes fail to follow a penlight in specific
directions
STRABISMUS
squint; deviation of the eye which the patient cannot - Assess EYE MUSCLE STRENGTH and
overcome CRANIAL NERVE FUNCTION

NYSTAGMUS

involuntary rapid movement (horizontal, vertical, rotatory,

or mixed) of the eyeball

COVER / UNCOVER TEST

- Cover patient’s one eye and have patient focus

on object afar
- Uncover eye and note any drifting
- Gaze should be steady when eye is covered and
uncovered. No drifting.

ABNORMALITIES

- Shift in gaze
- Movement of eyes to refocus gaze Assessing the 6 extraocular eye muscles by
- Weak eye muscles
the 6 cardinal fields of gaze
o If uncovered eye shifts in response to
covering opposite eye, covered
eye is dominant
o If covered eye shifts after being
uncovered, that eye is weak
- Weakness of extraocular muscles or CN III, IV,
and VI, which innervate extraocular muscles

VISUAL FIELDS
R/L SUPERIOR

R/L LATERAL

R/L INFERIOR NORMAL FINDINGS

- Assess EYE MUSCLE STRENGTH and
CRANIAL NERVE FUNCTION
- Instruct the client to focus on an object you are
holding (approx. 12in from the client’s face)
- Move the object through the 6 cardinal positions
of gaze in a clockwise direction
- Observe the client’s eye movement
- Assess EYE MUSCLE STRENGTH and
CRANIAL NERVE FUNCTION
- NOTE FOR NYSTAGMUS
- Eye movement should be conjugate (parallel),
smooth and symmetric throughout all 6
directions
- Equal palpebral fissures
- Intact extraocular muscles
ABNORMAL FINDINGS
- Nystagmus
- Limited or disconjugate movement in one or
more fields of gaze
- Ptosis (drooping of upper eyelid)
- Eyelid lag
Damage, irritation, or pressure on corresponding
extraocular muscle or cranial nerve that innervates the
muscle

CARDINAL FIELDS OF GAZE TEST