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65 Cards in this Set
- Front
- Back
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What information is provided through assessment of eyes?
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nutritional
endocrine CV GI neurological |
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external structures of the eye
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eyelids
conjunctiva lacrimal glands extraocular muscles |
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Purpose of eyelids
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admit light to eye while protecting and maintaining lubrication of the eye
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Purpose of conjunctiva + types
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palpebral, bulbar
contain blood vessels and pain receptors that respond quickly to outside insult |
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Purpose of eyelashes
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protect eye by filtering out particles of dirt and dust
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What is the limbus?
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junction of sclera and cornea
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What is the lacrimal apparatus? Purpose?
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made up of lacrimal glands and ducts, located above and on temporal side of each eye
produces tears which lubricate the eye |
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What is the passage of tears?
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drain through inferior and superior puncta and through nasolacrimal duct and lacrimal sac to the inferior turbinate in the nose
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What is the caruncle?
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round, red structure in inner canthus that contains sebaceous glands
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What are the extraocular muscles? What do they do?
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superior, inferior, medial, lateral recti, superior and inferior obliques
work to move eyes with precision to provide single image to brain |
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Layers of the eye
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outer - fibrous tunic (sclera), vascular tunic, retina
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Components of outer tunic
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sclera, cornea
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purpose of sclera
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covers structures inside eye, attaches extraocular muscles, contains opening for optic nerve and blood vessels
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purpose of cornea
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covers iris
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components of middle layer
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choroid, ciliary body, iris, lens, pupil, vitreous humour, anterior chamber, posterior chamber
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function of choroid
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provides nutrition to the retinal pigment epithelium and helps absorb excess light
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function of ciliary body
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produces aqueous humour
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What are zonules? What do they do?
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small strands of tissue extending from ciliary body to lens which they hold in place and allow it to change shape to refract light
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function of vitreous humour
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helps maintain shape of eye and position of internal structures
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what is the retina?
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extension of the optic nerve which receives light impulses that are transmitted to the occipital lobe of the brain
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Visual pathway
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light received by sensory neurons in retina which are upside down and reversed --> nerve fibres --> optic disc --> optic nerve --> fibres from left half of each eye pass through optic chiasm to right side of brain, fibres from right sides of eyes pass to left side of visual cortex
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Health History: Age-Related
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cataracts (elderly)
presbyopia (middle adult) hypertensive retinopathy (middle adult to elderly) glaucoma (middle adult to elderly) MD (elderly) entropion, ectropion (elderly) dry eyes (elderly) |
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Health History: female related
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dry eyes, thyroid-related opthalmopathy
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Health History: Health issues/concerns
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changes in visual acuity
pain drainage itching dryness |
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Health History: eye specific medical history
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myopia, hyperopia, strabismus, astigmatism, glaucoma, cataracts, conjunctivitis, hordeolum, pterygium, blepharitis, chalazion, trachoma, MD
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Health History: non-eye specific medical history
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diabetes mellitus, renal disease, atherosclerotic disease, HTN, inflammatory processes, infections, immunosuppressive disease, nutritional disturbances
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Health History: surgical history
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cataract extraction, lens implant, LASIK, repair of detached retina, neurosurgery, enucleation of eye, optic nerve decompression
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Health History: medications
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antibiotics, antihistamines, decongestants, corticosteroids, artificial tears, mydriatics, myotics
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Health History: allergies
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pollen
insect stings animal dander |
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Health History: special needs
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legal blindness, low vision
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Health History: childhood illnesses
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rubella and visual sequelae, congenital syphilis
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Health History: family history
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myopia, hyperopia, strabismus, colour blindness, cataracts, glaucoma, retinitis pigmentosa, retinoblastoma, neonatal blindness secondary to cataracts from mother contracting rubella in pregnancy
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Order of Assessment of Eye
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Determination of visual acuity
Determination of visual fields Assessment of the external eye and lacrimal apparatus Evaluation of extraocular muscle function Assessment of the anterior segment structures Assessment of the posterior segment structures |
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Assessment of Distance Vision
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1) have pt sit or stand facing Snellen chart at 20 feet
2) if wears glasses, ask to remove 3) pt covers L eye with occluder and reads as many lines of chart as possible 4) note number at the end of the last line the patient was able to read 5) repeat occluding R eye 6) if pt wears glasses, repeat with glasses on and note difference NORMAL: 20/20 visual acuity |
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Assessment of Near Vision
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1) use pocket chart
2) have pt hold card 35cm from face without moving it, ask to read smallest line possible NORMAL: generally possible at this distance until late 30s- late 40s |
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Assessment of colour vision
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have patient identify primary colours in room
should identify all correctly |
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Low vision vs. legal blindness
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low vision - corrected less than 20/60 and better than 20/200
legal blindness - corrected vision is 20/200 or worse or peripheral vision less than 20 degrees |
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Eye Assessment: Visual Fields
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1) sit or stand 60-90cm from patient with eyes at same level
2) have patient cover right eye and cover your left eye 3) have patient look at your uncovered eye 4) hold free hand at arms length and move hand or object into patient's field of vision from nasal, temporal, superior, inferior, and oblique angles 5) ask patient to saw now when your hand is seen moving into field of vision - compare with your own 6) repeat on other eye NORMAL: stimulus seen at 90d temporally, 60d nasally, 50 superiorly, 70 inferiorly |
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Eye Assessment: Eyelids
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1) assess for droopiness, infection, tumours, other abnormalities
2) note distribution of eyelashes and eyebrows 3) instruct patient to focus on an object or finger 25-30cm away and slightly above eye level 4) move object or finger slowly downward and observe for a white space of the sclera between upper lid and limbus NORMAL: eyelids should be symmetrical with no drooping, infections, tumours. When eyes focused forward in normal frontal gaze, lids cover upper portion of the iris. Both eyelids can be risen symmetrically. Slight ptosis normal. When eye is closed, no portion of cornea should be exposed. Normal lid margins smooth with lashes evenly distributed and sweeping upward from upper lids and downward from lower eyes. Eyebrows bilateral and symmetrical without lesions or scaling |
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Eye Assessment: Lacrimal Apparatus Inspection
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examine lacrimal gland for swelling, enlargement, redness, increased tearing, exudate at inner canthus - compare bilaterally
NORMAL: no enlargement, swelling, redness, no large amount of exudate, minimal tearing |
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Eye Assessment: Lacrimal Apparatus Palpation
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use gloves
press index finger near inner canthus just inside rim of bony orbit of eye NORMAL: no excessive tearing or discharge from punctum |
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Which cranial nerves go with which extraocular muscles?
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LR - VI
SO - IV all others III |
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Eye Assessment: Corneal Light Reflex (Hirschberg Test)
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1) instruct patient to look straight ahead
2) focus penlight on corneas from 30-38cm from midline 3) observe location of reflected light on the cornea NORMAL: reflected light should be seen symmetrically in the centre of each cornea |
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Eye Assessment: Cover/Uncover Test
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1) ask pt to look straight ahead and focus on object in distance
2) place occluder over pt's left eye for several seconds and observe for movement in the uncovered right eye 3) as occluder is removed, observe covered eye for movement 4) repeat with same eye, focusing on object close to the eye 5) repeat with other eye NORMAL: no movement of either eye |
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Eye Assessment: Cardinal Fields of Gaze
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1) pt sitting in front of you
2) place non-dominant hand just under patient's chin or on top of patient's head 3) ask patient to follow an object with eyes 4) move object through the 6 fields of gaze in a smooth and steady manner, pausing at each extreme position and return to center after each field is tested 5) move object forward to about 12cm in front of nose at midline NORMAL: eyes move smoothly and symmetrically in each field and converge on the held object as it moves toward the nose |
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Six Cardinal Fields of Gaze
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left lateral gaze
left lateral inferior gaze right lateral inferior gaze right lateral gaze right lateral superior gaze left lateral superior gaze |
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Eye Assessment: bulbar conjunctiva
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1) separate patient's lid margins with your fingers
2) have patient look up, down, left, right 3) inspect surface for colour, redness, swelling, exudate, foreign bodies 4) with thumb gently pull lower lid toward cheek and inspect surface for colour, inflammation. edema, lesions, foreign bodies NORMAL: transparent with small blood vessels visible in it. Should appear white (except bvs). No swelling, injection, exdudate, foreign bodies, lesions |
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Eye Assessment: palpebral conjunctiva
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1) patient looks down to relax levator muscle
2) pull eyelashes down and place a sterile, cotton-tipped applicator 1cm above lid margin 3) gently exert downward pressure on applicator while pulling eyelashes upward 4) inspect palpebral conjunctiva for infection, swelling, chemosis, exudate, foreign bodies 5) return lid to its normal position by instructing patient to look up and then pulling the eyelid outward and removing the cotton tipped applicator, ask patient to blink NORMAL: pink and moist with no lesions, swelling, injection, exudate, foreign bodies |
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Eye Assessment: Sclera
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inspect while assessing conjunctiva
NORMAL: light skin - sclera white with some small superficial vessels, without exudate, lesions, foreign bodies dark skin - sclera may have tiny brown patches of melanin or greyish-blue "muddy" colour |
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Eye Assessment: Cornea
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shine penlight directly into cornea and move light laterally to view from that angle
NORMAL: surface should be moist and shiny, no discharge, cloudiness, opacities, or irregularities |
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Eye Assessment: Anterior Chamber
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face patient and shine a light obliquely thorough anterior chamber from lateral side toward nasal side, observe distribution of light in the anterior chamber, repeat on other eye
NORMAL: entire iris will be illuminated |
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Eye Assessment: Iris
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inspect for colour, nodules, vascularity
NORMAL: colour is evenly distributed over the iris (can be mosaic variance) and it is smooth and without apparent vascularity |
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Eye Assessment: Pupil
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note size and shape
move a penlight from the side to the front of one eye without allowing the light to shine on the other eye, observe pupillary reaction and note size and time taken to respond - repeat in other eye instruct patient to shift gaze to a distant object for 30s, instruct patient to then look at your finger or an object held in your hand 10cm in front of patient, note reaction and size of pupils NORMAL: pupils deep black, round, equal diameter, 2-6mm. Constrict briskly to direct and consensual light and to accommodation |
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Eye Assessment: Lens
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shine penlight directly on pupil, note colour
NORMAL: lens is transparent |
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Pupil acronym
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P - pupils
E - equal diameter R - round R - reactive to L - light and A - accomodation |
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Gerontological Variations
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-4 main causes of vision loss: ARMD, glaucoma, diabetic retinopathy, cataract
-presbyopia - farsightedness from lens hardening -lens yellows and becomes cloudy -pupils smaller, need more light to see -decrease in tear production |
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Components of inner layer of eye
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retina
optic disc macula Fovea centralis cones rods |
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General things in past health history to ask about
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past injury or surgery to eyes
change or loss of vision eye pain frequent headaches excessive tearing or dryness use glasses or contact lenses last vision exam use of eye drops |
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What cranial nerve is being tested when testing visual acuity?
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cranial nerve II
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Amblyopia
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loss of acuity, not correctable
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Hyperopia
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young person with difficulty seeing close
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Myopia
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correctable loss of acuity
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Visual Field Defects
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hemianopsia
circumferential blindness unilateral blindness |
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Abnormal eyelid findings
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ptosis
exophthalmos entropion, ectropion chalazion-inflammation of lid |
