Professional Documents
Culture Documents
Eye
Eye
EYES
External anatomy
Palpebral fissure
Limbus
Canthus
Caruncle
Structure & Function
External Anatomy (cont.)
External anatomy
Tarsal plates
Meibomian glands
Conjunctiva
Lacrimal apparatus
Structure & Function
External Anatomy (cont.)
Extraocular muscles
Six muscles attach the eyeball to its orbit & direct the
eye
Give eye straight & rotary movement
Four straight (rectus) muscles
Two slanting (oblique) muscles
Structure & Function
External Anatomy (cont.)
Outer layer
Sclera- tough, protective, white covering
Continuous anteriorly with smooth, transparent cornea
covering the iris & pupil
Cornea- part of refracting media of eye, bending
incoming light rays so that they will be focused on
inner retina
Sensitive to touch
Corneal reflex- blink
CN- V (trigeminal) carries the afferent sensation into the
brain and CN- VII (Cranial) carries the efferent message
that stimulates the blink
Structure & Function
Internal Anatomy
Middle Layer
Choroid- heavily vascularized to supply blood to retina
& has dark pigmentation to prevent light from
reflecting internally
Continuous anteriorly with ciliary body & iris
Muscles of ciliary body control the thickness of lens
Iris- functions as a diaphragm, varying opening at the
pupil
Controls amount of light admitted into retina
Iris contracts the pupil in bright light & accommodate for
near vision; dilate the pupil in dim light & accommodate for
far vision
Structure & Function
Internal Anatomy
Inner Layer
Retina- visual receptive layer of eye where light
waves are changed into nerve impulses
Optic Disc- area in which fibers from retina converge
to form the optic nerve
Retinal vessels- paired artery and vein extending to
each quadrant
Macula- receives & transduces light from the center
of the visual field.
Slightly darker pigmented region surrounding the fovea
centralis- area of sharpest & keenest vision
Structure & Function
Visual Pathways & Visual Fields
Aging Adult
Pupil size decreases
Lens lose elasticity, becoming hard & glasslike-
decreasing ability to change shape to accommodate
for near vision; presbyopia
By age 70, normally transparent fibers of lens begin
to thicken & yellow, the beginning of cataracts
Visual acuity may diminish gradually after age 50, &
more so after age 70
Structure & Function
Developmental Competence
Vision
difficulty
(decreased acuity, blurring, blind spots)
Floaters, Halos, Scotomas, Night Blindness
Pain
Vision difficulty
Difficulty seeing or any blurring? Blind spots? Come
on suddenly or progress slowly? One eye or both?
Constant? Come and go?
Objects out of focus? Clouding of objects?
Do spots move in front of your eyes? One or many?
Both eyes or one?
Halos/rainbows around object?
Blind spots? Any loss of peripheral vision?
Night blindness?
Subjective Data
Pain
Any eye pain?
Come on suddenly?
Quality: burning or itching? Or sharp, stabbing pain;
pain with bright light? Photophobia
Foreign body sensation? Or deep aching? Or
headache in brow area?
Subjective Data
Watering, discharge:
Any watering or excessive tearing?
Any discharge? Any matter in the eyes? Hard to open
eyes in the morning? What color is the discharge?
How do you remove the matter from the eye?
Past history of ocular problems:
Any history of injury or surgery to eye? Allergies?
Subjective Data
Glaucoma
Have you ever been Txd for glaucoma? Results?
Family Hx?
Use of glasses or contact lenses
Wear glasses or contacts? How do they work for you?
Last time your Rx was checked? Was it changed?
If you wear contact lenses, are there any problems
such as pain, photophobia, watering or swelling?
Subjective Data
Self-care behaviors
How do you care for your contacts? How long do you
wear them? How do you clean them? Do you remove
them for certain activities?
Last vision exam? Ever tested for color?
Any environmental conditions at home or work that
may affect your eyes? If so, do you wear goggles to
protect your eyes?
What medications are you taking? Systemic or topical?
If you have experienced vision loss, how do you cope?
Subjective Data
Preparation
Position person standing for vision screening; then
sitting up with head at your eye level
Equipment needed
Snellen eye chart
Handheld visual screener
Opaque card or occluder
Penlight
Objective Data
Macula
Objective Data
Developmental competence
Aging adult
Visual acuity
Perform same exams
Central acuity may decrease >70 yo, peripheral vision may diminish
Ocular structures
Eyebrows may show loss of outer 1/3 to hair; remaining hair may
be coarse
Skin around eyes may show wrinkles or crows feet
Eyes may appear sunken from atrophy of orbital fat; orbital fat may
herniate, causing bulging at lower lids and inner third of upper lids
Lacrimal apparatus may decrease tear production, causing eye
dryness and burning sensation
Objective Data
Developmental competence
Aging Adult
Ocular structures (cont)
Pingueculae- yellowish, elevated nodules are d/t thickening of
the bulbar conjuctiva from prolonged exposure to sun, wind,
& dust. Appear at 3 & 9 oclock positions
Cornea may look cloudy with age
Arcus senilis commonly seen around cornea
Gray-white arc or circle around limbus d/t deposition of lipid material
Aging Adult
Ocular structures (cont)
Pupils small in old age, pupillary light reflex may be
slowed
Lens loses transparency and looks opaque
Ocular fundus
Retinal structures generally have less shine, blood
vessels look paler, narrower and attenuated; artieroles
appear paler and straighter with a narrower light reflex
Drusen, benign degenerative hyaline deposits are normal
development on retinal surface
Often symmetrically placed in eyes with no effect on vision
Abnormal Findings
Extraocular Muscle Dysfunction
Strabismus
Esotropia
Exotropia
Paralysis
Abnormal Findings-Abnormalities in the Eyelids
Periorbital edema
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes)
Ptosis (drooping upper lid)
Upward palpebral slant
Ectropion
Entropion
Abnormal Findings - Lesions on the Eyelids
Conjunctivitis
Subconjunctival hemorrhage
Iritis (circumcorneal redness)
Acute glaucoma
Abnormal Findings- Abnormalities in the
Retinal Vessels and Background
Findings:
Full and tortuous.
Develop an increased light reflex with a
bright coppery luster.
Arteriolar Changes: Silver
Wiring
Findings:
Portion of a narrowed artery
develops such an opaque wall
that no blood is visible within
it.
Arteriovenous Crossing/A-V
Nicking
Findings:
Vein appears to stop abruptly on
either side of the artery.
Findings:
Vein appears to taper
down on the side of the
artery.
Banking
Findings:
Vein is twisted on the
distal side of the artery
and forms a dark, wide
knuckle.
Hypertensive Retinopathy
Classification
Group 1:
Slight narrowing, sclerosis, and tortuosity of the retinal arterioles.
Mild, asymptomatic hypertension.
Group 2:
Definite narrowing, focal constriction, sclerosis, and AV nicking.
Blood pressure is higher and sustained.
Few, if any, symptoms referable to blood pressure.
Hypertensive Retinopathy
Classification
Group 3:
Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages).
Blood pressure is higher and more sustained.
Clinical manifestations of headaches, vertigo, and nervousness.
Mild impairment of cardiac, cerebral, and renal function.
Group 4:
Neuroretinal edema, including papilledema.
Siegrist streaks, Elschnig spots.
Blood pressure persistently elevated.
Clinical manifestations: headaches, asthenia, loss of weight, dyspnea, and visual disturbances.
Impairment of cardiac, cerebral, and renal function.
Differential Diagnosis
Findings:
Marked A-V crossing
changes along inferior
vessels.
Copper wiring of arterioles.
Cotton-wool spot superior
to disc.
Examples: Hypertensive
Retinopathy
Findings:
Punctuate exudates ->
scattered and radiating
from fovea forming a
macular star.
Two soft exudates about 1
disc diameter from disc.
Flame-shaped hemorrhages
sweeping toward 7 oclock
and 8 oclock.
Diabetic
Retinopathy
Diabetic Retinopathy
Moderate Nonproliferative
Retinopathy:
As the disease progresses, some
blood vessels that nourish the retina
are blocked.
Presence of hemorrhages,
microaneurysms, and hard
exudates.
Intraretinal microaneurysms and dot
and blot haemorrhages of greater
severity, in one to three quadrants.
Cotton wool spots, venous calibre
changes including venous beading,
and intraretinal microvascular
abnormalities are present but mild.
Diabetic Retinopathy
Proliferative Retinopathy:
Neovascularization is the hallmark.
Micro-vascular pathology with
capillary closure in the retina leads to
hypoxia of tissue -> hypoxia leads to
release of vaso-proliferative factors
which stimulate new blood vessel
formation to provide better
oxygenation of retinal tissue.
new vessels growing on the retina =
neovascularisation elsewhere (NVE)
and those on the optic disc are called
neovascularisation of the disc (NVD).
These new vessels can bleed and
produce haemorrhage into the
vitreous.
Differential Diagnosis
Types:
Dry Atrophic (more common, but less severe)
Wet Exudative/Neovascular
Macular Degeneration
Drusen = undigested
cellular debris
Hard and sharply defined
Soft and confluent with
altered pigmentation
Differential Diagnosis
Angioid Streaks
ARMD, Nonexudative
Chorioretinopathy, Central Serous
Choroidal Rupture
Melanoma, Choroidal
Multifocal Choroidopathy Syndromes
Neovascular Membranes, Subretinal
Neovascularization, Choroidal
Presumed Ocular Histoplasmosis Syndrome
Retinal Detachment, Exudative