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Eye and Ear

Assessment

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 (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 patients 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 patients 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

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
oclock; left side 7/8 oclock
Malleus short process -- knob

Abnormal Findings:

Perforations
Bulging
Retraction
Blue ,red, or amber coloring
dullness

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.

Thats all folks

The End