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Assessing the Eye Structures and Visual Acuity

Anatomy of the Eye


Anatomical structures:
 Conjunctiva
 Sclera
 Pupil
 Iris
 Lacrimal gland
 Lens
 Cornea

Examination of the eyes includes:


1. Assessment of external structures
2. Visual acuity
3. Visual fields
Eye Ailments:
 Myopia, hyperopia, presbyopia, astigmatism
 Conjunctivitis, dacryocystitis,hordeolum, iritis
 Cataracts, glaucoma
 Ectropion, entropion
 Mydriasis, miosis
Assessment
1. Inquire if the client has any history of the following:
 Family history of diabetes, hypertension,
blood dyscrasia, or eye disease, injury or
surgery
 Client’s last visit to opthalmologist
 Current use of eye medications
 Use of contact lenses or eyeglasses, hygienic
practices for corrective lenses
 Current symptoms of eye problems
2. Inspect the eyebrows for hair distribution and alignment
3. Inspect the eyelashes for evenness of distribution and
distribution of curl
4. Inspect the eyelids for surface characteristics, position in
relation to the cornea, ability to blink
5. Inspect the color of the bulbar conjunctiva for color,
texture, and presence of lesions
6. Inspect the palpebral conjuctiva by everting the lids
7. Evert the upper lids if a problem is suspected
8. Inspect and palpate the lacrimal gland
9. Inspect and palpate the lacrimal sac and nasolacrimal
duct10. Inspect the cornea for clarity and texture
11. Perform the corneal sensitivity test
12. Inspect the anterior chamber for transparency and depth
13. Inspect the pupils, shape and symmetry of size
14. Assess each pupil’s direct and consensual reaction to
light
15. Assess each pupil’s reaction to accommodation
16. Assess six ocular movements to determine eye
alignment and coordination
> Ask the client to hold the head in a fixed position
facing you
> Stand directly in front of the client and hold the
penlight at a comfortable distance, 30cm (1ft)
1. Superior Rectus,CN III
2. Lateral Rectus, CN VI
3. Inferior Rectus, CN III
4. Superior Oblique, CN IV
5. Medial Rectus, CN III
6. Inferior Oblique, CN III

Extraocular Muscle Tests


Hirschberg Test: Assess for location of light reflex by
shining penlight on pupil in corneal reflex

Cover test:
• Have client fixate on a near or far object
• Cover one eye and observe for movement in the
uncovered eye

Visual Acuity
• Assess near vision : Ask the client to read from a
magazine or newspaper held at a distance of 36 cm (14
in)
• a Rosenbaum eye chart may be used
Assess distance vision
• A Snellen or character chart will be used
Stand at 6m (20ft) from the chart
Take 3 readings: right eye, left eye, both eyes
Record the readings of each eye and both eyes
If the client is unable to see even the top line of the
chart, perform functional vision tests (light perception,
hand movements, counting fingers)

Lifespan Considerations
• Visual acuity is about 20/300 at 4 months and
progressively improves
• Preschool children’s acuity can be checked with
picture cards or the E chart
• Acuity should approach 20/20 by 6 years of age
• Visual acuity of elders decreases, becomes more
opaque and loses elasticity
• Peripheral vision of elders diminishes
• Arcus senilis is common

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