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Questions and Answers
Pupils should occupy about one-half the size of the iris in normal room light.
Pupils should occupy about one-half the size of the iris in normal room light.
False (B)
The conjunctivae should be clear and shiny without excessive redness or exudate.
The conjunctivae should be clear and shiny without excessive redness or exudate.
True (A)
The Snellen chart is commonly used to measure a person's ability to see near objects clearly.
The Snellen chart is commonly used to measure a person's ability to see near objects clearly.
False (B)
PERRLA stands for Pupils Equal, Reactive, and Light Accommodating.
PERRLA stands for Pupils Equal, Reactive, and Light Accommodating.
Cranial nerve II is assessed by testing visual acuity and visual fields.
Cranial nerve II is assessed by testing visual acuity and visual fields.
A visible redness in the eye periphery could indicate conjunctivitis.
A visible redness in the eye periphery could indicate conjunctivitis.
The Rosenbaum eye chart is used to test for impaired far vision.
The Rosenbaum eye chart is used to test for impaired far vision.
The ophthalmoscope is used to examine external features of the eye.
The ophthalmoscope is used to examine external features of the eye.
The pupil's main function is to regulate the amount of light entering the eye.
The pupil's main function is to regulate the amount of light entering the eye.
The sclera is the inner layer of the eye that contains light-sensitive cells.
The sclera is the inner layer of the eye that contains light-sensitive cells.
Cranial nerve assessment is not relevant during an eye examination.
Cranial nerve assessment is not relevant during an eye examination.
Abnormal eye findings may include changes in visual acuity and irregular pupil response.
Abnormal eye findings may include changes in visual acuity and irregular pupil response.
The macula is responsible for peripheral vision.
The macula is responsible for peripheral vision.
Visual acuity tests measure the sharpness and clarity of vision.
Visual acuity tests measure the sharpness and clarity of vision.
The vitreous humor is a solid structure that shapes the eye.
The vitreous humor is a solid structure that shapes the eye.
The ciliary body is responsible for protecting the eyeball.
The ciliary body is responsible for protecting the eyeball.
The upper eyelid should cover the top quarter of the iris for normal appearance.
The upper eyelid should cover the top quarter of the iris for normal appearance.
The Ishihara's cards are used to test visual acuity in individuals.
The Ishihara's cards are used to test visual acuity in individuals.
Visual acuity should be tested for each eye separately and then together.
Visual acuity should be tested for each eye separately and then together.
The cornea should appear cloudy and flat during examination.
The cornea should appear cloudy and flat during examination.
The position of the eyes should be about one-third of the way down the face.
The position of the eyes should be about one-third of the way down the face.
The penlight can be used to examine both corneas by shining light from straight ahead only.
The penlight can be used to examine both corneas by shining light from straight ahead only.
Edema in the eyelids may indicate underlying inflammation.
Edema in the eyelids may indicate underlying inflammation.
Frequent tearing and dryness are signs of normal eye function.
Frequent tearing and dryness are signs of normal eye function.
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Study Notes
Eye Examination Techniques
- Test corneal sensitivity using a wisp of cotton to lightly touch the cornea.
- Assess the irises for flatness, uniform size, color, and shape.
- Conjunctivae should be clear and shiny; observe for redness or exudate.
- Sclera should appear white or buff, and inspected by asking the patient to look up while pulling down the lower eyelid.
Pupil Assessment
- Normal pupils occupy about one-fourth of the iris size in room light.
- PERRLA acronym:
- P: Clear pupils
- E: Equal, ranging from 3-7 mm in diameter
- R: Round
- RL: Reactive to light
- A: Accommodation (constriction for near objects, dilation for far).
Visual Acuity Tests
- Near vision assessed with a hand-held card for small detail recognition.
- Distant vision evaluated using Snellen and Rosenbaum charts.
- Clients should wear corrective lenses during testing if applicable.
Snellen and Rosenbaum Charts
- Snellen chart screens for myopia (impaired far vision); commonly uses the letter 'E' for non-readers.
- Rosenbaum chart held 14 inches away screens for presbyopia (impaired near vision).
Cranial Nerve Testing
- CN II (optic) checks visual acuity and fields.
- CN III (oculomotor), CN IV (trochlear), CN VI (abducens) assess external eye movements.
- CN III evaluates pupillary reaction to light.
- CN V checks corneal light reflexes.
Intraocular Structure Examination
- The ophthalmoscope allows direct observation of the eye's internal structures.
Abnormal Eye Findings
- Conjunctivitis shows hyperemia of conjunctiva with peripheral redness.
- Inquiry for previous eye injuries, surgeries, blurred vision, spots or floaters, history of eye infections, and medications.
Physical Examination Approach
- Begin with visual acuity testing, recording findings for each eye separately and then together.
Tools for Eye Assessment
- Visual acuity charts: Snellen, Snellen E, Allen cards, Jaeger charts.
- Color vision chart (Ishihara’s cards), ophthalmoscope, penlight.
Eye Positioning
- Eyes should be positioned about one-third down the face and one eye's width apart.
External Structures and Landmarks
- Eyelids should cover the top quarter of the iris.
- Inspect for redness, edema, inflammation, or lesions on eyelids.
- Identify eyelashes, canthus (corner of the eye), conjunctiva (protective covering), and lacrimal glands.
Anatomy of the Eye
- Ciliary body produces aqueous humor; aqueous humor fills anterior and posterior chambers.
- Trabecular meshwork facilitates aqueous humor drainage.
- Cornea is the eye's front part; iris is the colored part that controls light entry.
- Sclera encases the eyeball, while choroid nourishes the retina.
- Retina has light-sensitive cells, the lens focuses images, and the macula is particularly sensitive.
- Chambers: Anterior (between cornea and iris) and posterior (between iris and lens).
- Vitreous humor fills the rear of the eye; optic nerve connects to brain for vision processing.
Eye Assessment Procedure
- Collect patient health history, perform a physical exam, and analyze data to determine health status and potential eye disorders.
- Subjective assessment includes inquiries about vision changes and the use of glasses or contact lenses.
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