Health Assessment Assessment of eye

Eye Only a small portion of the eye is seen. Sclera Choroid Cornea Iris Pupil Dim light enlarges (mydriasis) Bright light decreases (miosis)

Eye Retina Sensory portion Optic disc Macula Center is the point at which the vascular network enters the eye Macula Responsible for central vision

Figure 15.2 Interior of the eye. 4

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

Figure 15.3 Visual fields of the eye and the visual pathway to the brain. 6

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.

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

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

Figure 15.4 Lacrimal glands of the eye. 10

Special Considerations Age Developmental level Race Ethnicity Occupation Socioeconomics Emotional well-being

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

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

Lifespan Considerations The older adult Cataracts Macular degeneration

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

Cultural and Environmental Considerations Changes that occur normally in various races and ethnic groups Excessive sun exposure Medications Hygiene practices Trauma or damage

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

Focused Interview Focused interview questions General Illness or infection Symptoms, pain, and behaviors continued on next slide

Assessment of the Eye Techniques Inspection Palpation Ophthalmoscope

Figure 15.7 Testing distant vision. 20

Figure 15.8 E chart for testing distant vision. 21

Figure 15.9 Testing near vision. 22

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

Assessment of the Eye Accommodation of pupil response Corneal reflex External eye Sclera

Figure 15.12 Alternative method of testing cardinal field of gaze. 25

Figure 15.13 Testing the corneal light reflex. 26

Figure 15.14 Cover/Uncover test. 27

Figure 15.15 Inspecting the cornea. 28

Assessment of the Eye Ophthalmoscope Fundus Advanced skill

Figure 15.16 Approaching the patient for the ophthalmoscopic exam. 30

Figure 15.17 Examining the eye using the ophthalmoscope. 31

Figure 15. 18 Use of diopter to adjust for problems of refraction. A 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. 32

Abnormal Findings Vision Eye movement Internal and external structures

Table 15.3 Abnormalities of the Eyelids continued on next slide

Table 15.5 Abnormalities of the Fundus continued on next slide

Figure 15.44 Cranial nerve III damage. 36

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

Abnormal Findings Visual fields Cardinal fields of gaze Damage to the retina Lesions in the optic nerve or chiasm Increased intraocular pressure Retinal vascular damage Cardinal fields of gaze Strabismus Esophoria Exophoria