Chapter 14Review Anatomy: StructureAnother ViewSlide 4Interior and Exterior StructuresPosterior StructuresVisual Reflexes: AccommodationDevelopmental ConsiderationsDevelopmental Considerations: Aging AdultsTranscultural ConsiderationsSubjective Data: Health HistoryCommon Eye ComplaintsThe Physical ExamThe OpthalmaloscopeEquipment cont’d.Order of the Eye ExaminationAssess Vision AcuityThe Snellen and Tumbling E ChartsNormal vs. Nearsighted vs. FarsightedVisual Screening in ChildrenTesting Visual FieldsObjective Data: Physical ExamInspection of Anterior StructuresInspect External Eye StructuresInspect and Palpate Lacrimal SacsInspect the Ocular Fundus (Posterior Internal Eye)Abnormal “Red Reflex”View of Normal Left Eye RetinaAbnormalities of the RetinaAbnormal Findings: EyelidsAbnormal Findings: Lesions & EyelidsHordeolum or StyeOther Abnormal FindingsAbnormal Findings of the PupilMacular Degeneration: Wet vs. DryCover Test AbnormalitiesMost Common Causes of Vision Problems in the Older AdultNursing Diagnoses Associated with the EyeNormal vs. Abnormal: External EyeNormal vs. Abnormal: VisionNsg 326 Clinical Eye AssessmentDocumentationChapter 14Chapter 14EYESEYESReview Anatomy: StructureReview Anatomy: StructureExternal Eye StructuresExternal Eye StructuresInternal AnatomyInternal AnatomyExtraocular Muscles Extraocular MusclesAnother ViewAnother ViewInterior and Exterior Interior and Exterior StructuresStructuresPosterior StructuresPosterior StructuresVisual Reflexes: Visual Reflexes: AccommodationAccommodationDevelopmental Developmental ConsiderationsConsiderationsNewbornsNewborns–Eye function is limitedEye function is limited–Absent macula Absent macula –Eye movement is poorly coordinatedEye movement is poorly coordinatedPregnant WomenPregnant Women–Mild corneal edema (3Mild corneal edema (3rdrd trimester) trimester)–Corneal thickeningCorneal thickeningHypersensitivity and change in refractory powerHypersensitivity and change in refractory power–Increased level of lysozyme in tears: “greasy” Increased level of lysozyme in tears: “greasy” sensationsensation–Intraocular pressure falls in latter half of Intraocular pressure falls in latter half of pregnancypregnancyDevelopmental Considerations: Developmental Considerations: Aging Adults Aging AdultsAging AdultAging Adult–Skin loses elasticity (wrinkling and Skin loses elasticity (wrinkling and drooping)drooping)–↓ ↓ in tear production (dryness and burning)in tear production (dryness and burning)–↓ ↓ in pupil sizein pupil size–Arcus senilusArcus senilus–Loss of elasticity in lens (presbyopia)Loss of elasticity in lens (presbyopia)–Senile cataract Senile cataract Lens fibers thicken and yellowLens fibers thicken and yellow–Visual acuity may diminish gradually after 50Visual acuity may diminish gradually after 50Transcultural ConsiderationsTranscultural ConsiderationsPalpebral fissuresPalpebral fissures–AsiansAsians–May be sign of serious congenital anomalyMay be sign of serious congenital anomalyOpen-angle glaucomaOpen-angle glaucoma–Blacks: 3 – 6 times the incidence of whitesBlacks: 3 – 6 times the incidence of whites–Different treatments based on responseDifferent treatments based on responseCataracts: > frequency among those in Cataracts: > frequency among those in sunny climatessunny climatesSubjective Data: Health Subjective Data: Health HistoryHistoryVision difficulty Vision difficulty –↓ ↓ acuity, any blurring or blind spotsacuity, any blurring or blind spotsPainPainStrabismus, diplopiaStrabismus, diplopiaRedness, swellingRedness, swellingWatering, dischargeWatering, dischargePast Hx of ocular problems or surgeriesPast Hx of ocular problems or surgeriesGlaucomaGlaucomaUse of glasses or contact lensesUse of glasses or contact lensesSelf-care behaviorsSelf-care behaviorsCommon Eye ComplaintsCommon Eye ComplaintsDecreased visual acuityDecreased visual acuityDiplopiaDiplopiaEye painEye painVisual halos or bright light ringsVisual halos or bright light ringsNight blindnessNight blindnessVision lossVision lossVisual floatersVisual floatersThe Physical ExamThe Physical ExamPreparationPreparation–Position patient sitting up with the head Position patient sitting up with the head at eye levelat eye levelEquipment Equipment –Snellen eye chartSnellen eye chart–Visual screener (Jaeger card)Visual screener (Jaeger card)–Opaque card or occluderOpaque card or occluder–PenlightPenlight–OphthalmoscopeOphthalmoscopeThe OpthalmaloscopeThe OpthalmaloscopeSide facing examiner Side facing Side facing examiner Side facing patientpatientEquipment cont’d.Equipment cont’d.OpthalmoscopeOpthalmoscopeOrder of the Eye Order of the Eye ExaminationExaminationTest visual acuityTest visual acuity–distance visiondistance vision–near visionnear visionTest visual fieldsTest visual fields–confrontation testconfrontation testVisual assessment of Visual assessment of the external eyethe external eye–lacrimal apparatuslacrimal apparatus–eyebrowseyebrows–eyelidseyelidsEvaluation of extraocular Evaluation of extraocular muscle functionmuscle function–accommodationaccommodation–six cardinal fields of six cardinal fields of gazegaze–check for nystagmuscheck for nystagmusAssessment of the Assessment of the anterior structures anterior structures (penlight)(penlight)–corneacornea–pupil responsepupil responseVisual assessment of Visual assessment of posterior eye structures posterior eye structures (using opthalmascope)(using opthalmascope)Assess Vision AcuityAssess Vision AcuityTest central visual acuityTest central visual acuity–Snellen eye chartSnellen eye chartFar visionFar vision–Jaeger CardJaeger CardNear visionNear visionThe Snellen and Tumbling E The Snellen and Tumbling E ChartsChartsNormal vs. Nearsighted vs. Normal vs. Nearsighted vs. FarsightedFarsightedVisual Screening in ChildrenVisual Screening in ChildrenNewbornNewbornTest light perception using the blink reflexTest light perception using the blink reflexYoung children (2 - 3 years)Young children (2 - 3 years)Allen test (picture cards)Allen test (picture cards)Young children (3 – 6 years)Young children (3 – 6 years)Picture chart or the Snellen E chartPicture chart or the Snellen E chartChildren (7 or 8 years and beyond)Children (7 or 8