Download Inspect

Eyes
Health Assessment Across the
Lifespan
NRS 102
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 14: Eyes

Structure and Function

Subjective Data—Health History Questions

Objective Data—Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-2
Chapter 14: Eyes
Structure and Function
External anatomy

Palpebral fissure

Limbus
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-3
Chapter 14: Eyes
Structure and Function
(cont.)
External anatomy

Tarsal plates

Meibomian glands

Conjunctiva

Lacrimal apparatus
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-4
Chapter 14: Eyes
Structure and Function
(cont.)
Extraocular muscles

Superior rectus

Inferior rectus

Lateral rectus

Medial rectus

Superior oblique

Inferior oblique
© Pat Thomas, 2006.
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-5
Chapter 14: Eyes
Structure and Function
(cont.)
Internal anatomy

Outer layer—sclera

Middle layer—choroid


Ciliary body and iris

Pupil

Lens

Anterior chamber
Inner layer—retina

Optic disc

Retinal vessels

Macula
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-6
Chapter 14: Eyes
Structure and Function
(cont.)
Visual pathways and
visual fields

Refraction of light rays

Crossing of fibers at
optic nerve
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-7
Chapter 14: Eyes
Structure and Function
(cont.)
Visual reflexes

Pupillary light reflexes

Fixation

Accommodation
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-8
Chapter 14: Eyes
Structure and Function
(cont.)
Developmental care

Infants and children

Aging adult

Cataracts

Glaucoma

Macular degeneration
Cross-cultural care

Racial variations
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-9
Chapter 14: Eyes
Subjective Data—
Health History Questions

Vision difficulty
(decreased acuity, blurring, blind spots)

Pain

Strabismus, diplopia

Redness, swelling
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-10
Chapter 14: Eyes
Subjective Data—
Health History Questions
(cont.)

Watering, discharge

History of ocular problems

Glaucoma

Glasses or contact lenses

Self-care behaviors
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-11
Chapter 14: Eyes
Health History Questions
(cont.)
Additional history for infants and children

Vaginal infection during delivery

Developmental milestones

Routine vision testing

Safety measures
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-12
Chapter 14: Eyes
Health History Questions
(cont.)
Additional history for aging adult

Visual difficulty

Glaucoma test

Cataracts

Eye dryness

Decreased activities
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-13
Chapter 14: Eyes
Objective Data—
Physical Exam

Preparation


Position
Equipment

Snellen eye chart

Handheld visual screener

Opaque card or occluder

Penlight

Applicator stick

Ophthalmoscope
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-14
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)


Central visual acuity

Snellen eye chart

Near vision
Visual fields

Confrontation test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-15
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
Extraocular muscle function—Inspect

Corneal light reflex
(Hirschberg test)

Cover test

Diagnostic positions
test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-16
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
External ocular structures—Inspect

General

Eyebrows

Eyelids and lashes

Eyeballs

Conjunctiva and sclera

Eversion of the upper lid

Lacrimal apparatus
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-17
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
Anterior eyeball structures—Inspect

Cornea and lens

Iris and pupil

Size and shape

Pupillary light reflex

Accommodation
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-18
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
Ocular fundus—Inspect



Use of the ophthalmoscope
Red reflex
Optic disc



Retinal vessels





Color
Shape
Color
A:V ratio
Caliber
General background of the fundus
Macula
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-19
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
Developmental care
 Infants and children









Visual acuity
Visual fields
Color vision
Extraocular muscle function
External eye structures
Eyelids and lashes
Conjunctiva and sclera
Iris and pupils
Ocular fundus
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-20
Chapter 14: Eyes
Objective Data—Physical Exam
(cont.)
Developmental care (cont.)

Aging adults

Visual acuity

Ocular structures
Ocular fundus

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-21
Chapter 14: Eyes
Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-22
Chapter 14: Eyes
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-23
Chapter 14: Eyes
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-24
Chapter 14: Eyes
Abnormal Findings
Extraocular Muscle Dysfunction

Strabismus

Esotropia

Exotropia

Paralysis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-25
Chapter 14: Eyes
Abnormal Findings
(cont.)
Abnormalities in the Eyelids

Periorbital edema

Exophthalmos (protruding eyes)

Enophthalmos (sunken eyes)

Ptosis (drooping upper lid)

Upward palpebral slant

Ectropion

Entropion
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-26
Chapter 14: Eyes
Abnormal Findings
(cont.)
Lesions on the Eyelids

Blepharitis (inflammation of the eyelids)

Chalazion

Hordeolum (stye)

Dacryocystitis (inflammation of the lacrimal sac)

Dacryoadenitis (inflammation of the lacrimal
gland)

Basal cell carcinoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-27
Chapter 14: Eyes
Abnormal Findings
(cont.)
Abnormalities in the Pupil

Unequal pupil size—anisocoria

Monocular blindness

Constricted and fixed pupils—miosis

Dilated and fixed pupils—mydriasis

Argyll Robertson pupil

Tonic pupil (Adie’s pupil)

Cranial nerve III damage

Horner’s syndrome
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-28
Chapter 14: Eyes
Abnormal Findings For Advanced
Practice Visual Field Loss

Retinal damage

Lesion in globe or optic nerve

Lesion at optic chiasm

Lesion of outer uncrossed fibers at optic chiasm

Lesion R optic tract or R optic radiation
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-29
Chapter 14: Eyes
Abnormal Findings
(cont.)
Vascular Disorders of the External Eye

Conjunctivitis

Subconjunctival hemorrhage

Iritis (circumcorneal redness)

Acute glaucoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-30
Chapter 14: Eyes
Abnormal Findings
(cont.)
Abnormalities on the Cornea and Iris

Pterygium

Corneal abrasion

Hyphema

Hypopyon
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-31
Chapter 14: Eyes
Abnormal Findings
(cont.)
Opacities in the Lens

Central gray opacity—nuclear cataract

Star-shaped opacity—cortical cataract
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-32
Chapter 14: Eyes
Abnormal Findings
(cont.)
Abnormalities in the Optic Disc

Optic atrophy (disc pallor)

Papilledema (choked disc)

Excessive cup:disc ratio
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-33
Chapter 14: Eyes
Abnormal Findings
(cont.)
Abnormalities in the
Retinal Vessels and Background







Arteriovenous crossing (nicking)
Narrowed (attenuated) arteries
Vessel nicking
Diabetic retinopathy
Microaneurysms
Intraretinal hemorrhages
Exudates
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 14-34