 Identify pertinent eye history questions

 Obtain an eye history

 Perform an eye physical assessment
 Document eye assessment findings
 Identify actual / potential health problems stated as
nursing diagnoses
 Differentiate between normal and abnormal findings
What developmental variations of the eyes might
be seen with:
 Children
 Adolescents
 Pregnant clients
 Older adults
What cultural variations of the eyes might be
seen with:
 Dark-skinned African-Americans
 Asians
 Yearly eye exams for patients at risk
 African Americana
 Diabetes
 HTN
 Myopia
 Family history of glaucoma
 Biographical data
 Current health status
 Past health history
 Family history
 Review of systems
 Psychosocial history
 Secretary, 4 hours computer work/day
 Blurred vision: constant, worse with
fatigue
 Difficulty reading; reading glasses not helpful
 HTN, DM
 Lasix, captopril, and Glucotrol
 + Family history of CV disease, DM, MS
 Last eye exam 5 years ago
 Widow: son and friends as supports
 Vision loss  Eye pain
 Double vision  Blurred vision
 Eye tearing  Dry eyes
 Eye drainage
 Eye appearance changes
External
 Eyelids Extraocular muscles
 Eyelashes Cornea
 Lacrimal glands Lacrimal ducts
 Conjunctiva Anterior chamber
 Sclera Pupils
 Iris
Internal
 Optic disc
 Physiological cup
 Retinal arteries
 Retinal veins
 Retina
 Macula
Eyelids and lashes:
Protect the eyes
Lacrimal glands and ducts:
Produce tears
Conjunctiva:
Provide lubrication
Sclera:
Gives shape and structure to eye
Iris:
Controls amount of light entering eye; provides
eye color
Extraocular muscles:
Control eye movement
Cornea:
Transparent, avascular outer layer
of the eyeball
Anterior chamber:
Filled with aqueous humor
Pupil:
The aperture of the iris
Optic disc and physiological cup:
Area where the optic nerve and the blood vessels
enter the eye

Retinal blood vessels:

Blood supply to eye
Retina:
Inner layer; receives light waves that are
sent to brain and converted into
visible perceptions

Macula:
Avascular, darker area of central vision
Anatomical Landmarks: visual fields (superior,
inferior, nasal, temporal)
Approach: inspection, palpation, ophthalmoscopy
Position: sitting
Tools: visual acuity charts (Snellen), penlight,
ophthalmoscope, cotton ball, cotton swab
General survey and head-to-toe scan
 This includes:
 Determination of visual acuity
 Determination of visual fields
 Assessment of the external eye and lacrimal
apparatus
 Evaluation of the extra ocular muscle
function
 Assessment of the anterior segment
structures
 Assessment of the posterior segment
structures
 Assesses the distance vision, near vision and
color vision using the Snellen chart. This chart;
• Contains letters of various sizes with standardized
visual acuity numbers at the end of each line of
letters
• The numbers indicate the degree of visual acuity
when the patient is able to read that line of
letters at a distance of 20 feet.
• For example: a patient who has a visual acuity of
20/70 can read at 20 feet what a patient of 20/20
vision can read.
• Examination:
• Position patient on a mark exactly 20 feet
from the chart. If the client is wearing
glasses or contact lenses, leave them on.
• Shield one eye at a time during the test.
• Ask client to read through the chart to the
smallest line of letters possible.
• Record results using numeric fractions at the
end of the last successful line read.
• Indicate any letters missed or mispelt and
whether corrective lenses were worn e.g,
20/30-1, with glasses.
 Normal visual acuity is 20/20.
 The top number (numerator) indicates the
distance the person is standing at, from the
chart.
 The denominator gives the distance at which
a normal eye can read a particular line.
 The larger the denominator, the poorer the
vision
 A: vision is poorer than 20/30, vision in both
eyes different by two lines or more, or acuity
is absent.
 P: patient may have refractive error related
to a difference in the refractive power of the
cornea like myopia (short sightedness).
 P: corneal opacities that are congenital or
lesions that have scarred on the cornea.
 P: opacities of the lenses caused by senile or
traumatic cataracts
 Examination:
 Use a pocket vision card, Rosenbaum card.
 Instruct patient to sit comfortably and hold
the card 14 inches from the face without
moving it.
 Ask the patient to read the smallest line
possible.
 Normal finding:
 Until the patient is in the late 30s to late
40s, reading is generally possible at a
distance of 14 inches.
 A : A patient in this age range who can not
read at 14 inches is considered presbyopic
(decrease in power of accomodation with
age). Younger persons may have difficulty
seeing up close because they have hyperopia
(farsightedness)
 P: normal aging process causes the lens to
harden (nuclear sclerosis), decreasing its
ability to change shape and therefore focus
on near objects.
 E: For routine testing of color, test the
clients ability to identify primary colors on
the Snellen chart or the examination room.
 N: patient should be able to identify all the
six primary colors.
 A: color vision defect designated as
red/green, blue/yellow, or complete when
the patient only sees gray shades.
 P: can result from diseases of the optic
nerve, macular degeneration, nutritional
deficiency, etc.
 The confrontation technique is used to test
visual fields of each eye (CN II).
 The visual field of each eye is divided into
quadrants, and a stimulus is presented in each
quadrants.
 Examination:
 Sit or stand approximately 2-3 feet opposite the
patient, with your eyes at same level as the
patient’s.
 Have the patients cover the right eye with the
right hands or an occluder.
 Cover your left eye in the same manner.
 Have the patient look at your uncovered eye
with his/her uncovered eye.
 Hold your free hand at arm’s length
equidistant from you and the patient and
move it or a held object such as a pen into
your and the patient’s field vision from
nasal, temporal superior, inferior and
oblique angles.
 Ask the patient to say “now” when your hand
is seen moving into the field of vision. Use
your own visual fields as the control for
comparison to the patient’s.
 Repeat the procedure for the others
 N: the patient is unable to see the stimulus
at about 90 degree temporarily, 60 degree
nasally, 50 degree superiorly, and 70 degree
inferiorly.
 A: if patient is unable to identify movement
that you perceive, a defect in the visual field
is presumed and the visual portion noted.
 P: Defect may be associated with a tumors or
strokes or neurological diseases such as
gluacoma or retinal detachment.
 A: Circumferential blindness
 P: may occur due to hysteria, optic or
retrobulbar neuritis.
 Parallel alignment
 Test corneal light reflex
 Test six cardinal fields of gaze
 CN III, IV, VI
 Perform cover-uncover test for drifting
 Lids and lashes: color, lesions, edema,
symmetry, position and distribution of
lashes
Lacrimal glands and ducts: color, edema,
excessive tearing or drainage
Conjunctiva: color, moisture, lesions, and
foreign bodies
Sclera: color, moisture, lesions, or tears
Cornea: clarity and abrasions, corneal reflex
Anterior chamber: clarity, bulging iris, and blood
Iris: color, size, shape, and symmetry
Pupils: size, shape, reaction to light–direct and
consensual, test accommodation
Red reflex: presence, opacities
Optic disc and physiologic cup: color, size, shape,
borders, cup-disc ratio
Retinal vessels: size ratio of arteries and veins,
color, arteriole light reflex, crossings
Retina: color, texture, exudates, lesions,
hemorrhages, and aneurysms
Macula and fovea: color, size, location, lesions
Eye ball: consistency and tenderness
Lacrimal glands and ducts: tenderness
and excessive tearing
General and head-to-toe scan: obese
female, + S4
Visual acuity: near vision blurred
Peripheral vision: temporal field 70
degrees
External eye structures: cornea hazy,
arcus senilis
Fundoscopic exam: disc margins blurred, +
nicking, and scattered hemorrhages