1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Health Assessment Across the Lifespan NRS 102

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-3 Structure and Function External anatomy  Palpebral fissure  Limbus © Pat Thomas, 2006.

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-4 Structure and Function (cont.) External anatomy  Tarsal plates  Meibomian glands  Conjunctiva  Lacrimal apparatus

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-5 Structure and Function (cont.) Extraocular muscles  Superior rectus  Inferior rectus  Lateral rectus  Medial rectus  Superior oblique  Inferior oblique © Pat Thomas, 2006.

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-6 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

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-7 Structure and Function (cont.) Visual pathways and visual fields  Refraction of light rays  Crossing of fibers at optic nerve

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-8 Structure and Function (cont.) Visual reflexes  Pupillary light reflexes  Fixation  Accommodation

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-9 Structure and Function (cont.) Developmental care  Infants and children  Aging adult  Cataracts  Glaucoma  Macular degeneration Cross-cultural care  Racial variations

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-10 Subjective Data— Health History Questions  Vision difficulty (decreased acuity, blurring, blind spots)  Pain  Strabismus, diplopia  Redness, swelling

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-11 Subjective Data— Health History Questions (cont.)  Watering, discharge  History of ocular problems  Glaucoma  Glasses or contact lenses  Self-care behaviors

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-12 Health History Questions (cont.) Additional history for infants and children  Vaginal infection during delivery  Developmental milestones  Routine vision testing  Safety measures

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-13 Health History Questions (cont.) Additional history for aging adult  Visual difficulty  Glaucoma test  Cataracts  Eye dryness  Decreased activities

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-14 Objective Data— Physical Exam  Preparation  Position  Equipment  Snellen eye chart  Handheld visual screener  Opaque card or occluder  Penlight  Applicator stick  Ophthalmoscope

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-15 Objective Data—Physical Exam (cont.)  Central visual acuity  Snellen eye chart  Near vision  Visual fields  Confrontation test

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-16 Objective Data—Physical Exam (cont.) Extraocular muscle function—Inspect  Corneal light reflex (Hirschberg test)  Cover test  Diagnostic positions test

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-17 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

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-18 Objective Data—Physical Exam (cont.) Anterior eyeball structures—Inspect  Cornea and lens  Iris and pupil  Size and shape  Pupillary light reflex  Accommodation

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-19 Objective Data—Physical Exam (cont.) Ocular fundus—Inspect  Use of the ophthalmoscope  Red reflex  Optic disc  Color  Shape  Retinal vessels  Color  A:V ratio  Caliber  General background of the fundus  Macula

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-20 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

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-21 Objective Data—Physical Exam (cont.) Developmental care (cont.)  Aging adults  Visual acuity  Ocular structures  Ocular fundus

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-22 Sample Charting

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-23 Sample Charting (cont.)

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-24 Sample Charting (cont.)

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-25 Abnormal Findings Extraocular Muscle Dysfunction  Strabismus  Esotropia  Exotropia  Paralysis

26. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-26 Abnormal Findings (cont.) Abnormalities in the Eyelids  Periorbital edema  Exophthalmos (protruding eyes)  Enophthalmos (sunken eyes)  Ptosis (drooping upper lid)  Upward palpebral slant  Ectropion  Entropion

27. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-27 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

28. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-28 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

29. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-29 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

30. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-30 Abnormal Findings (cont.) Vascular Disorders of the External Eye  Conjunctivitis  Subconjunctival hemorrhage  Iritis (circumcorneal redness)  Acute glaucoma

31. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-31 Abnormal Findings (cont.) Abnormalities on the Cornea and Iris  Pterygium  Corneal abrasion  Hyphema  Hypopyon

32. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-32 Abnormal Findings (cont.) Opacities in the Lens  Central gray opacity—nuclear cataract  Star-shaped opacity—cortical cataract

33. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-33 Abnormal Findings (cont.) Abnormalities in the Optic Disc  Optic atrophy (disc pallor)  Papilledema (choked disc)  Excessive cup:disc ratio

34. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Eyes Chapter 14: Eyes Slide 14-34 Abnormal Findings (cont.) Abnormalities in the Retinal Vessels and Background  Arteriovenous crossing (nicking)  Narrowed (attenuated) arteries  Vessel nicking  Diabetic retinopathy  Microaneurysms  Intraretinal hemorrhages  Exudates