Assessment of the

Eyes
Arlyn C. Mendenilla
Clinical Instructor
To maintain optimum vision, people
need to have their eyes examined
regularly throughout life.
Examination of the eyes includes
assessment of the;
External structures eyes
Visual acuity
Ocular movement
Visual field
The external structures and lacrimal
apparatus of the left eye.
Anatomic structures of the right eye,
lateral view.
Anatomic structures of the right eye,
lateral view.
 Common Refractive Errors
Myopia
Hyperopia
Presbyopia
Astigmatism
 Common Visual problems
Conjunctivitis Ectropion
Dacrocystitis Entropion
Hordeolum (sty) Mydriasis
Iritis Miosis
Photophobia chalazion
Contusions
Catracts
Glaucoma
Ptosis
 Assessing the Eye Structures
and Visual Acuity
Planning
Place the client in an appropriate room
for assessing the eyes and vision.
The nurse must be able to control natural
and overhead lighting during some
portions of the examination.
 Preparation

Assemble equipment and supplies:

Cotton-tipped applicator
Examination gloves
Millimeter ruler
Penlight
Snellen’s or E chart
Opaque card
 Implementation
1. Introduce yourself and verify the client’s identity. Explain to the
client what you are going to do, why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Inquire if the client has any history of the following:
Family history of diabetes, hypertension, or blood dyscrasia
Eye disease, injury, or surgery
Last visit to an ophthalmologist
Current use of eye medications
Use of contact lenses or eyeglasses
Hygienic practices for corrective lenses
Current symptoms of eye problems
Assessment
External eyes
5. Inspect the eyebrows for hair
distribution and alignment, and
for skin quality and movement.
6. Inspect the eyelashes for
evenness of distribution and
direction of curl.
7. Inspect the eyelids for surface
characteristics, position in
relation to the cornea, ability to
blink, and frequency of blinking.
Inspect the lower eyelids while
the client’s eyes are closed.
Normal findings
•Hair evenly distributed;
skin intact
•Eyebrows symmetrically
aligned; equal movement
Equally distributed; curled
slightly outward
•Skin intact; no discharge;
no discoloration
•Lids close symmetrically
•Approximately 15 – 20
involuntary
blinks/min;bilateral
blinking
•When lids open, no visible
sclera above corneas, &
upper & lower borders of
cornea are slightly covered
Deviation from normal
•Loss of hair; scaling and
flakeness of skin
•Unequal alignment and
movement of eyebrows
Turned inward
•Redness , swelling,
flaking, crusting, plaques,
discharge, nodules,
lesions
•Lids close assymetrically,
incompletely, or painfully
•Rapid, monoocular,
absent or incomplete
blinking
•Ptosis, ectropion,
entropion, rim of the
sclera visible bet lid & iris
8. Inspect the bulbar Transparent; Jaundice sclera;
conjunctiva for color, capillaries sometimes excessively pale
texture, and the presence evident; sclera appears sclera; reddened
of lesions. Retract the white
sclera; lesion or
eyelids with your finger, nodules
exerting pressure over
the over the upper and
lower bony orbits, & ask
the client to look up,
down, and from side to
side

9. Inspect the Shiny, smooth, and Extremely pale;

palpebral conjunctiva pink or red extremely red; nodules or
by everting the lids. other lesion
Evert both lids, & ask
the client to look up.
Then gently retract the
lower lids with the
index fingers
10. Evert the upper lids if a
problem is suspected.
Ask the client to look down while
keeping the eyelids slightly open.
Gently grasp the client’s eyelashes
with thumb and forefinger. Pull
lashes gently downwards.
Place a cotton-tipped applicator
stick about 1cm above the lid
margin, and push it gently
downward while holding the
eyelashes.

Hold the margin of the everted lid

or eyelashes against the ridge of the
upper bony orbit with the
applicator stick or your thumb.

Inspect the conjunctiva for color,

texture lesions, and foreign bodies.
11. Inspect and palpate the No edema or Swelling or tenderness
lacrimal gland. tenderness over over lacrimal gland
lacrimal gland
Using the tip of your index
finger,
palpate the lacrimal gland.
Observe for edema between
the lower lid and the nose.
12. Inspect and palpate No edema or tearing Evidence of increase
the lacrimal sac and tearing; regurgitation of
fluid on palpation of
nasolacrimal duct. lacrimal sac
Observe for evidence of
increased tearing.
Using the tip of your index
finger, palpate inside the
lower orbital rim near the
inner canthus.
13. Inspect the cornea 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.
14. Perform the corneal
sensitivity (reflex) test to
determine the function of the
fifth (trigeminal) cranial nerve.
Ask the client to keep both eyes
open and look straight ahead.
Approach from behind and
beside the client, and lightly
touch the cornea with a corner
of the gauze.
•Transparent ,shiny, •Opaque; surface not
and smooth; details smooth ( maybe a result
of the iris is visible of trauma or abrasion
•In older people, a •Arcus senelis in clients
thin, grayish white under age 40
ring around the
margin, called arcus
senelis,, maybe
evident
Clients blinks when One or both eyelids fail to
the cornea is touched, respond
indicating that the
trigeminal nerve is
intact
15. Inspect the •Transparent •Cloudy
anterior chamber for •No shadows •Crescent-
of light on shaped shadoes
transparency and on far side of
depth. Use the same iris iris
oblique lighting used •Depth of •Shallow
about 3 mm chamber
when testing the (possible
cornea. glaucoma)
16. Inspect the pupils Black in color;equal
in size;normally 3 to
Cloudiness, mydriasis,
miosis, anisocoria;
for color, shape, and 7 mm in diameter; bulging of iris toward
cornea
symmetry of size. round, smooth
border, iris flat and
round
17. Assess each pupil’s Illuminated pupil Neither pupil
direct and consensual constrict (direct constricts
response)
reaction to light.
Partially darken a room. Nonilluminated pupils Unequal response
constrict (consensual Absent responses
response)
Ask the client to look
straight ahead.
Using a penlight and
approaching from the side,
shine a light on the pupil.
Observe the response. The
pupil should constrict
(direct response).
Shine the light on the pupil
again, and observe the
response of the other pupil.
It should also constrict
(consensual response).
18.Assess each pupil’s Pupils constrict when One or both pupils
reaction to looking at near object; fail to constrict,
pupils dilate when dilate or converge
accommodation. looking at far objects;
pupils converge when
near object is moved
toward nose
Hold an object about 10 cm from
the client’s nose.
Ask the client to look first at the top
of the object and then at a distant
object behind the penlight. Alternate
the gaze between the near and far
objects.
Observe the pupil response. Pupils
should constrict when looking at the
near object and dilate when looking
at the far object.
Next, move the penlight or pencil
toward the client’s nose. The pupils
should converge. To record normal
assessment of the pupils, use the
abbreviation PERRLA.
Visual Fields
19. Assess peripheral visual When looking straight Visual field smaller
fields. ahead, client can objects than normal;1/2 vision
in the periphery in 1 or both eyes
•Have the client sit directly
facing you at a distance of 60–90
cm.
•Ask the client to cover right eye
with the card and look directly
at your nose.
•Cover or close your eye directly
opposite the client’s covered eye,
and look directly at the client’s
nose.
•Hold an object in your
fingers, extend your arm,
and move the object into the
visual field from various
points in the periphery. The
object should be at an equal
distance from the client and
yourself. Ask the client to
tell you when the moving
object is first spotted.
1. To test the temporal field of the left eye, extend and move your right
arm in from the client’s right periphery. Temporally, peripheral objects
can be seen at right angles to the central point of vision.

2. To test the upward field of the left eye, extend and move the right arm down
from the upward periphery. The upward field of vision is normally 50 degrees
because the orbital edge is in the way.

3. To test the downward field of the left eye, extend and move the right arm up
from the lower periphery. The downward field of vision is normally 70 degrees
because the cheekbone is in the way.

4. To test the downward field of the left eye, extend and move the right arm up
from the lower periphery. The downward field of vision is normally 70 degrees
because the cheekbone is in the way.
5. To test the nasal field of the left eye, extend and move your left arm in from the
periphery. The nasal field of vision is normally 50 degrees away from the central
point because the nose is in the way.
Repeat the above steps for the right eye.
Extraocular Muscle Tests
Normal – both eyes coordinated, move in unison, with parallel
alignment
Deviation – eye movement not coordinate or parallel; one or both eyes
fail to follow a penlight in a specific direction ex. strabismus

20. Assess six ocular movements to determine eye

alignment and coordination.
•Stand directly in front of client and hold the penlight at a
comfortable distance, such as 30 cm in front of the client’s
eyes.
•Ask the client to hold head in a fixed position facing you
and follow the movements of the penlight with the eyes
only.
•Move the penlight in a slow, orderly manner through the
six cardinal fields of gaze.
•Stop the movement s of the penlight periodically so that
the nystagmus can be detected.
21. Assess for location of Lights falls Lights falls off
light reflex by shining a symmetrically center on one eye
penlight on the pupil in at both eyes (indicates
corneal surface misalignment)
(Hirschberg Test).

22. Have the client fixate Uncovered If misalignment is

on a near or far object. present, when
eye does not dominant eye is
Cover one eye and move covered, the
observe for movement in uncovered eye will
the uncovered eye (cover move to focus on
object
test).
Visual Acuity
23. Assess near vision by providing adequate lighting
and asking the client to read from a magazine or
newspaper held at a distance of 36 cm (14 in). If
the clients normally wears corrective glasses, it
should be worn during the test.
 Normal - Able to read
 Deviation – difficulty reading newsprint unless due
to aging process
 A Rosenbaum eye chart maybe used to test near
vision. It consist of paragraphs of text or
characters in different sizes on 3 ½ x 6 ½ inch
card. Be sure the client has a literacy level
Three types of eye charts
24. Assess distance 20/20 vision on snellen Denominator of 40 or
vision by asking the chart more Snellen type chart
with corrective lenses
client to wear
corrective lenses unless
they are used for
reading only.
Ask the client to sit or
stand 6 meters (20 ft)
from Snellen’s chart,
cover the eye not being
tested, and identify the
letters or characters.
Take three readings:
right eye, left eye, and
both eyes.
25. Perform functional
vision tests if the client
is unable to see the top
line (20/200) of
Snellen’s chart.
26. Document findings
in the client record.