Eye and Ear Assessment by Sharon Kerr, MSN, RN Spring 2010

Normal Anatomy of the Eye

External Eye Exam Inspect for: Symmetry Discharge or lesions Eyelids: blink, position (ptosis), swelling Sclera: should be white (not red or yellow) Cornea: assess for opacity or scratch Conjunctiva: should be pink

External Eye Exam continued Pupil -- Check for response to: Light Accomodation PERRLA

External Eye Exam continued Extraocular Muscle Function Check eye movement through the six cardinal directions of gaze. Watch for parallel movement Nystagmus (involuntary rapid rhythmic movement)

Normal Anatomy of the Eye Cornea: clear layer covering the front of the eye. works with the lens to focus images on the retina.

Normal Anatomy of the Eye Retina internal layer receives and transmits focused images. normally red due to its rich blood supply.

Retina Can be seen with an ophthalmoscope Allows the examiner to see through the pupil and lens to the retina Called a funduscopic exam

Retina Examination of fundus includes Retina Optic disc Blood vessels.

Funduscopic Exam Ophalmoscope Seated in a darkened room Examiner projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball

Using the Ophalmoscope Turn on and adjust to round beam of white light Place scope light on dim setting Set lens disc to 0 diopters (neutral) Keep index finger on lens disc to adjust during examination

Approaching the patient Right hand and right eye to pt. Right eye Left hand and left eye to pt. Left eye Hold opthalmoscope firmly against your bony orbit Glasses off (both examiner and patient) Contacts are OK

The examination Have patient look over your shoulder and across the room at a specific point on the wall From about 15 inches and 15 degrees lateral to the patient’s line of vision, shine the light beam on the pupil

Getting a closer look Should 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

Finding the optic disk On NASAL side of each retina Yellowish orange to creamy pink oval or round Follow a blood vessel centrally until you see it

Inspecting the optic disk Clarity – should have sharp margins Symmetry of both eyes

Inspecting the retina Visualize arteries and veins Identify any lesions in retina Red spots, streaks, light spots

Normal 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

External Ear Exam Symmetry, size, shape Position: pinna level with corner of eye Lesions Drainage

Examine Auditory Acuity Whisper two syllable word (out of view) Weber Test: lateralization of sound.. Rinne test: bone vs air conduction of sound Weber 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.

Normal Anatomy of the Ear The tympanic membrane, or eardrum separates the ear canal and the middle ear. ossicles : can see the short process of the malleous, handle of the malleous, and the incus There is a cone of light that is a reflection of the otoscope light

Otoscopic Examination An otoscope is an instrument used to look into the ear canal ear speculum a cone-shaped viewing piece of the otoscope) Use largest size possible

Otoscopic Examination Dim lights in room Patient in sitting position Pull ear up and back (down for kids) SLOWLY insert otoscope into ear canal while looking into viewer

Otoscopic Landmarks Tympanic membrane: should be intact, pearly gray, translucent, shiny Cone of light: right side 4/5 o’clock; left side 7/8 o’clock Malleus short process -- knob

Abnormal Findings: Perforations Bulging Retraction Blue ,red, or amber coloring dullnss

Otoscopic 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.

That’s all folk’s The End