Eye Assessment

Terms 1. 2. 3. O.D. (Oculus Dexter) right eye O.S. (Oculus Sinister) left eye O.U. (Oculus Uterque) both eyes; left and right

Assessment 1. Assess EYELIDS a. Check if puffy, protruded, and has dark under eye circles (maybe anemic) b. Check no. of blinks Main Ave: 8 12 involuntary blinks per min Average: 15 20 involuntary blinks per min c. Procedure: Ask PT to open and close the eyes if they close completely (Normal: no pain and closes completely) Ptosis or Lid Lag drooping of eyelid; delayed downward movement of upper eyelid

Expothalmos or Proptosis protrusion of the eyeball; occurs in Hyperthyroidism & Graves Disease.

d.

Check if theres Dirty Sclera (Retract lower eyelid and see if theres brown in color)

Ophthalmic Installations Retract lower eyelid with tissue IF eyedrops middle to outer If ointment inner to outer canthus Close the eyes and dont blink to allow meds to penetrate and dont rub

Abnormal Findings 1. 2. 3. 4. 5. 6. Anopthalmia absence of the eye Ablepharon absence of eyelid Lagopthalmia eyes entirely covered with eyelid Achromatopia color blindness Distichiasis extra eyelashes Ephiphora Excessive tearing; problem with Nasolacrimal duct and lacrimal sac Procedure: Apply pressure along inner eye canthus to check tearing and discharge.

2.

Assessment of Pupil Normal: Equal in size (3 7 mm in diameter) PERLAC - Pupil Equally Round Reactive to Light and Accommodation and Convergence a. Pupils direct and consensual reaction to light st Illuminated pupil should constrict (1 shine direct response) Non illuminated pupil constricts Equal responses on both pupil Procedure: Ask PT to look straight, penlight at the side and shine pupil directly. Opposite eye should also constrict (consensual reflect) Pupils reaction to Accommodation Procedure: Ask PT to look at the object 4 6 inches away and then in line with the bridge of the nose (papalapit) Normal: a. Pupil dilates when looking at far objects b. Pupil constricts when looking at near objects c. Pupil converge when near objects are moved towards the nose (becomes cross eyed)

b.

3.

Assessment of Visual Acuity (Near and Distance Vision)

2 Visual Acuity Charts 1. Snellen Alphabet Chart Most common to test vision Assessing visual acuity in distance vision Procedure: a. Ask PT to stand at 20ft away from the chart and cover his Left Eye with an opaque object. b. Ask to read the letters on one line from top (E) to bottom until patient can no longer read the letters. c. Repeat procedure to right eye. Note: 1. 2. Normal Vision of 0 / 20 on Snellen Chart Visual Acuity is recorded as fraction: 20 Distance between patient & snellen chart 20 Distance from which the patient with normal vision could read the lines at 20 feet away from chart. The higher the denominator, the poorer vision Not usually demonstrated until 5 6 y/o.

3. 4.

Other: Assessing Visual Acuity (Near Vision) if theres no snellen provide reading material Procedure: Ask PT to read newsprint from large to small letters (with corrective lenses if client has one) Normal: PT can read newsprint from large to small letters 2. Snellen E Chart For children and adults who cant read Procedure: a. Cover left eye of PT then point to E. b. Ask where the letter faces c. Repeat to right eye.

Snellen E Chart

Snellen Alphabet Chart

Assess Peripheral Vision Normal: When looking straight ahead, client can see objects at periphery (sides) Procedure: a. Stand or sit directly across patient to have his eyes focus her gaze on your eyes. b. Ask not to move head only her eyes c. Nurse will move hands at SUPERIOR & INFERIOR positions (Hand Movement)

Assess Extraocular Muscles 1. 6 Cardinal Rule of Gaze or 6 Ocular Movements Goal: determine eye alignment and coordination Evaluates the ff: a. CN 3 Oculomotor most eye movement b. CN 5 Trigeminal corneal reflex and protective blink c. CN 6 Abducens lateral eye movement d. Extraocular Muscles Procedure: a. Stand directly in front of PT and Hold penlight at 1 Feet Distance b. Ask to follow the penlight movement and not to move his head c. Move penlight in a slow, orderly manner thru 6 Cardinal Positions of Gaze from center of eye along the lines of arrows (periphery)

2.

Eyes should move in Yolk Fashion Procedure: Ask PT to follow the object w/o moving his head. Move the object using 6 cardinal positions of gaze.

Abnormal Findings 1. 2. 3. Conjugate Movement of eyes or gaze movement of eyes symmetrical and synchronous Dysconjugate or Disjunctive movement of eyes simultaneously movement of eye in opposite direction. Strabismus or Squinting - cross eyed; muscle imbalance d/t improper alignment of visual axes of 2 eyes.

2 Types of Strabismus

1. 2. 3. 4. 5.

Esotropia or Convergent Strabismus One eye focused on the object, the other eye deviates inward (adduction) Exotropia or Divergent Strabismus Unilateral or simultaneous abduction of eyes Diplopia Double vision Myopia Near sightedness (close objects are seen clearly, far objects are blurred) Hyperopia Far sightedness (far objects are seen clearly, near objects are blurred)

3. Finger Counting Test (FC) 4. If patient can identify or count fingers If patient cant identify or hard to identify perform hand movement.

Hand Movement Test (HM) To identify movement of hands in different directions If hand movement is not perceived perform Light perception. Light Perception (Using Penlight) Note: Examiner should move backwards every time the PT is able to respond well to each test.

5.

Abnormal Findings 1. 2. 3. Cataract opacity of lens, halo, cloudy Amaurosis complete absence of light Gaze Palsies paralysis of eye muscles

Assess Cornea (Blinking Test or Corneal Sensitivity Test) Procedure: Use a wisp of cotton and lift upper eyelid then place cotton at lateral surface Normal: client blinks when cornea is touched (CN5 Trigeminal is intact)

Assess Palpebral Conjunctiva and Bulbar Conjunctiva Procedure: retract upper and lower eyelid Normal: a. Palpebral: pink and moist b. Bulbar: capillaries sometimes evident; sclera appears white; yellowish in dark skinned. Conjunctivitis: pink eyes; Blood Injection baka mataas BP To check Convergence 1. Cover PTs eye. If eye converge at center or laterally its abnormal.

Important Questions for Eye Test 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Does Patient wear corrective lenses? Is it for distance or reading? Is it hard or soft lens? Does patient experience blurring of vision? (ex. blind spots, floaters, halos, double vision, photo sensitivity) Problem seeing at night? Any past eye injury or surgery? When and where? Allergies Last eye exam Does patient complain eye pain and head ache Any color blindness Pathologic Diseases (Ex. Diabetic Malabo paningin) Medical History (use of optic drugs) Occupation maybe exposed to fumes, welding, debris, smoke Elders: When did eye problem start? How can you manage ADL? Children: ask mom if NSD or CS (may have eye infection d/t vaginal infection put erythromycin) Does child can identify colors and objects