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Health Assessment
Assessment of eye
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Eye
• Only a small portion of the eye is seen.
• Sclera
– Cornea
• Choroid
– Iris
– Pupil
 Dim light enlarges (mydriasis)
 Bright light decreases (miosis)
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Eye
• Retina
– Sensory portion
– Optic disc
 Center is the point at which the vascular
network enters the eye
– Macula
 Responsible for central vision
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.2
Interior of the eye.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Visual Pathways
• Light waves must bend to focus
correctly on the retina.
– Refractory structures bend light waves
onto retina.
• Optic fibers of the optic nerve cross
over at the chiasm and join temporal
fibers from the opposite eye.
– Impulse transmitted to occipital lobe of
brain for interpretation
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.3
Visual fields of the eye and the visual pathway to the brain.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Accessory Structures of the Eye
• Eyebrows
– Protect the eye
• Eyelids
-Movable folds of skin that cover and
protect the eyes
– Palpebral fissure is opening between
upper and lower eyelids.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Accessory Structures of the Eye
• Eyelids
– Meibomian glands
 glands that lubricate eyes and eyelids
• Eyelashes
– Project from eyelids and curl outward
• Conjunctivae
– Prevents foreign objects from entering
eye
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Accessory Structures of the Eye
• Lacrimal apparatus
– Secretes tears that spread over
conjunctivae when blinking
• Extrinsic muscles
–
–
–
–
–
–
Lateral rectus
Medial rectus
Superior rectus
Inferior rectus
Inferior oblique
Superior oblique
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.4
Lacrimal glands of the eye.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Special Considerations
•
•
•
•
•
•
•
Age
Developmental level
Race
Ethnicity
Occupation
Socioeconomics
Emotional well-being
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Lifespan Considerations
• Infants and children
– Visual acuity not as sharp as adults
 Children typically have 20/20 vision by
age 7.
– At birth, the iris has little color but
changes to permanent color by 3
months of age.
continued on next slide
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Lifespan Considerations
• The pregnant female
– Dryness of the eyes
– Vision changes
 Due to shifting fluid in cornea
 Blurriness
 Distorted vision
 Up to 6 weeks postpartum
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Lifespan Considerations
• The older adult
– Cataracts
– Macular degeneration
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Psychosocial Considerations
• Impact of decreased visual
acuity/visual impairment on
independence and quality of life
– Children may experience developmental
delays.
– Stress for families and individuals
• Eye contact within culture, age, gender
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Cultural and Environmental
Considerations
• Changes that occur normally in various
races and ethnic groups
• Excessive sun exposure
• Medications
• Hygiene practices
• Trauma or damage
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Focused Interview
• Function and structures of the eye
• Consider in relation to expectations
based on age, gender, race, culture,
environment, health practices, past and
current problems, and therapies
• Consider patient's ability to participate
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Focused Interview
• Focused interview questions
– General
– Illness or infection
– Symptoms, pain, and behaviors
continued on next slide
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Assessment of the Eye
• Techniques
– Inspection
– Palpation
– Ophthalmoscope
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.7
Testing distant vision.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.8
E chart for testing distant vision.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.9
Testing near vision.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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Assessment of the Eye
• Visual acuity of distant and near vision
using Jaeger or Rosenbaum charts
• Visual fields by confrontation
• Six cardinal fields of gaze
• Corneal light reflex
• Cover/uncover test
• Pupils and pupillary response
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Assessment of the Eye
•
•
•
•
Accommodation of pupil response
Corneal reflex
External eye
Sclera
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.12
Alternative method of testing cardinal field of gaze.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.13
Testing the corneal light reflex.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.14
Cover/Uncover test.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Figure 15.15
Inspecting the cornea.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
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by Pearson Education, Inc.
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Assessment of the Eye
• Ophthalmoscope
– Fundus
– Advanced skill
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.16
Approaching the patient for the ophthalmoscopic exam.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.17
Examining the eye using the ophthalmoscope.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.18 Use of diopter to adjust for problems of refraction. A. In the emmetropic (normal) eye, light is
focused properly on the retina, and the 0 diopter is used. B. In the myopic eye, light from a distant source
converges to a focal point before reaching the retina. Negative diopter numbers are used. C. In the hyperopic
eye, light from a near source converges to a focal point past the retina. Positive diopter numbers are used.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Abnormal Findings
• Vision
• Eye movement
• Internal and external structures
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Table 15.3
Abnormalities of the Eyelids
continued on next slide
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Table 15.5
Abnormalities of the Fundus
continued on next slide
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Figure 15.44
Cranial nerve III damage.
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Abnormal Findings
• Disorders of visual acuity
– Myopia
– Hyperopia
– Astigmatism
 Familial condition
 Refraction of light spread over a wide
area rather than a distinct point on the
retina
– Presbyopia
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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Abnormal Findings
• Visual fields
– Damage to the retina
– Lesions in the optic nerve or chiasm
– Increased intraocular pressure
– Retinal vascular damage
• Cardinal fields of gaze
– Strabismus
– Esophoria
– Exophoria
Health & Physical Assessment in Nursing, Third Edition
Donita D'Amico | Colleen Barbarito
Copyright © 2016, © 2012, © 2007
by Pearson Education, Inc.
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