3External Eye Exam Inspect for: Symmetry Discharge or lesions Eyelids: blink, position (ptosis), swellingSclera: should be white (not red or yellow)Cornea: assess for opacity or scratchConjunctiva: should be pink
4External Eye Exam continued Pupil -- Check for response to:LightAccomodationPERRLA
5External Eye Exam continued Extraocular Muscle FunctionCheck eye movement through the six cardinal directions of gaze.Watch for parallel movementNystagmus (involuntary rapid rhythmic movement)
6Normal Anatomy of the Eye Cornea:clear layer covering the front of the eye.works with the lens to focus images on the retina.
7Normal Anatomy of the Eye Retinainternal layerreceives and transmits focused images.normally red due to its rich blood supply.
8Retina Can be seen with an ophthalmoscope Allows the examiner to see through the pupil and lens to the retinaCalled a funduscopic exam
9RetinaExamination of fundus includesRetinaOptic discBlood vessels.
11Funduscopic Exam Ophalmoscope Seated in a darkened roomExaminer projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball
12Using the Ophalmoscope Turn on and adjust to round beam of white lightPlace scope light on dim settingSet lens disc to 0 diopters (neutral)Keep index finger on lens disc to adjust during examination
13Approaching the patient Right hand and right eye to pt. Right eyeLeft hand and left eye to pt. Left eyeHold opthalmoscope firmly against your bony orbitGlasses off (both examiner and patient)Contacts are OK
14The examinationHave patient look over your shoulder and across the room at a specific point on the wallFrom about 15 inches and 15 degrees lateral to the patient’s line of vision, shine the light beam on the pupil
15Getting a closer lookShould see an orange glow (the red reflex – reflection of light off retina)Move in on the 15 degree line toward the pupil , almost touching the patient’s lashes
16Finding the optic disk On NASAL side of each retina Yellowish orange to creamy pink oval or roundFollow a blood vessel centrally until you see it
17Inspecting the optic disk Clarity – should have sharp marginsSymmetry of both eyes
18Inspecting the retina Visualize arteries and veins Identify any lesions in retinaRed spots, streaks, light spots
21Normal Anatomy of the Ear external, middle, and inner structures.eardrum and the three tiny bones conduct sound from the eardrum to the cochlea: malleus, incus, stapes
22External Ear Exam Symmetry, size, shape Position: pinna level with corner of eyeLesionsDrainage
23Examine Auditory Acuity Whisper two syllable word (out of view)Weber Test: lateralization of sound..Rinne test: bone vs air conduction of soundWeber Test: Place vibrating tuning form on top of head or middle of forehead. Client should hear tone equally in both ears.Rinne test: compares air and bone conduction of sound. Place vibrating tuning fork on mastoid process (bone conduction) and ask client to indicate when he can no longer hear sound. Then quickly move tuning fork in front of auditory meatus (air conduction). Have client indicate when sound ends. Air conduction should be twice as long as bone conduction.
25Normal Anatomy of the Ear The tympanic membrane, or eardrumseparates the ear canal and the middle ear.ossicles : can see the short process of the malleous, handle of the malleous, and the incusThere is a cone of light that is a reflection of the otoscope light
26Otoscopic Examination An otoscopeis an instrument used to look into the ear canalear speculuma cone-shaped viewing piece of the otoscope)Use largest size possible
27Otoscopic Examination Dim lights in roomPatient in sitting positionPull ear up and back (down for kids)SLOWLY insert otoscope into ear canal while looking into viewer
28Otoscopic LandmarksTympanic membrane: should be intact, pearly gray, translucent, shinyCone of light: right side 4/5 o’clock; left side 7/8 o’clockMalleus short process -- knob
29Abnormal Findings: Perforations Bulging Retraction Blue ,red, or amber coloringdullnss
31Otoscopic Examination The speculum is angled slightly toward the person's nose to follow the canal.A light beam extends beyond the viewing tip of the speculum.The otoscope is gently moved to different angles to view the canal walls and eardrum.