assessment of eye (2) (2).ppsx

Health assessment of eyes Prepared by Dr. seham Mohamed Anatomy of the eye: The eyes are delicate sensory organs equipped with many extra-ocular and intra-ocular structures. Some structures are easily visible, whereas others can only be view...

Health assessment of eyes Prepared by Dr. seham Mohamed Anatomy of the eye: The eyes are delicate sensory organs equipped with many extra-ocular and intra-ocular structures. Some structures are easily visible, whereas others can only be viewed with special instruments, such as an ophthalmoscope Parts in the eye:  Ciliary body: part of the eye that produces the aqueous humor.  Aqueous Humor: the watery fluid that produced in the eye and fill anterior and posterior chamber.  Trabecular Meshwork: aqueous humor flows out of the eye through this spongy tissue located near the cornea  Cornea: Front part or "window" of the eye.  Iris: "Colored" part of the eye.  Pupil: Regulate amount of light that entering the eye.  Sclera: the tough outer coat that protects the entire eyeball.  Choroid: layer of the eye containing blood vessels that nourish the retina.  Retina: Innermost layer of the eye, it lines the back of the eye and composed of light sensitive cells which pick up the images seen by the eye.  Lens: Part of the eye that focuses images onto the retina.  Macula: That sensitive part of the  Anterior chamber: the region of the eye between the cornea and the iris.  Posterior chamber: the region of the eye between the iris and the lens.  Vitreous: clear jelly-like substance that fills the eye from the lens on back  Optic Nerve: Collection of nerve endings attached to the retina connecting the eyeball to the "seeing" centers of the brain. Performing the Eye Assessment :including  Taking health history  Performing a physical examination.  Data obtained are combined and analyzed  to determine the patient’s existing health status and identify potential health risks and disorders of the eye.  Subjective Assessment ( ask about)  Have you noticed any changes in your vision?  Do you wear glasses or contact lenses?  Have you ever had an eye injury?  Have you ever had eye surgery?  Have you ever had blurred vision?  Have you ever seen spots or floaters, flashes of light, or halos around lights?  Do you have a history of frequent or recurring eye infections, tearing, or dryness?  When was your last eye examination?  Have you had any redness, swelling, watering, or discharge from the eyes?  Have you ever been diagnosed with an eye condition such as cataracts, glaucoma, or macular degeneration?  Do you have a history of diabetes or high BP?  What medications are you currently taking eye drops, or supplements for your eyes?  Do you use any prescription or eye drops?  PHYSICAL EXAMINATION Approach to assess the eye  use the techniques of inspection and palpation begin by testing visual acuity.  For visual acuity: test and record the findings for each eye separately and then together.  Tools used for physical assessment for eye For visual acuity charts Snellen &snellen E chart Allen cards Jaeger charts  Color vision chart (Ishihara’s cards ophthalmoscope Penlight Inspecting the eyes With the scalp line as the starting point, determine whether the eyes are in a normal position. They should be about one-third of the way down the face and about one eye’s width apart from each other 1. Identify external structures & landmarks for assessment. Eyelid: Each upper eyelid should cover the top quarter of the iris so the eyes look alike. Look for redness, edema, inflammation, or lesions on the lids. Eyelashes Canthus: corner of the eye, angle where lids meet Conjunctiva: transparent protective covering, exposed part of the eye Lacrimal: upper outer corner over the eye  Cornea: The corneas should be clear and without lesions and should appear convex.  Examine the corneas by shining a penlight first from both sides and then from straight ahead. Test corneal sensitivity by lightly touching the cornea with a wisp of cotton. Irises: The irises should appear flat and should be the same size, color, and shape.  Conjunctivae and sclera:  The conjunctivae should be clear and shiny. Note excessive redness or exudate. The sclera should be white or buff.  To inspect the bulbar conjunctiva, ask the patient to look up and gently pull the lower eyelid down. Then have the patient look down and lift the upper lid to examine the palpebral conjunctiva.  Pupils Pupils should occupy about one-fourth the size of the iris in normal room light. PERRLA  P- Pupils Clear E- Equal & between 3-7 mm in diameter R- Round RL- Reactive to light A- Accommodation of the pupils when they dilate to look at an object far away & then coverage & constrict to focus on a near object  Visual Acuity Near Vision; hand-held card Measure the client’s ability to see small details. 1.Distant Vision: Snellen & Rosenbaum charts.. If the client has eyeglasses or contact lenses, have the client use them during the test Ensure reading material is in the client’s language  Snellen Chart Use to screen for myopia (impaired far vision). The Snellen ( E ) chart is used for clients who cannot read. Rosenbaum eye chart Hold 14 inches from the client’s face to screen for presbyopia (impaired near vision or farsightedness Test cranial nerves (CN) during the eye examination  CN II (optic); visual acuity, visual fields  CN III (oculomotor), CN IV (trochlear), CN VI (abducens): External movements  CN III (oculomotor): pupillary reaction to light  CN V corneal light reflexes  Examining intraocular structures: The ophthalmoscope allows you to directly observe the eye’s internal structures Unexpected abnormal finding of the eye Conjunctivitis: his condition is characterized by hyperemia of the conjunctiva with predominate redness in the eye periphery. Acute angle-closure: glaucoma is characterized by a rapid onset of unilateral inflammation, severe eye pain and pressure, and photophobia. It also causes decreased vision, moderate pupil dilation, nonreactive Pupillary response, and clouding of the cornea but no eye discharge Ptosis: or a drooping upper eyelid, may be caused by an interruption in sympathetic innervation to the eyelid, muscle weakness, or damage to the oculomotor nerve. Cataract A common cause of vision loss, a cataract is a clouding of the lens or lens capsule of the eye that can result from trauma, diabetes, and some medications. Macular degeneration atrophy or deterioration of the macular disk —is a cause of severe irreversible loss of central vision in people older than age 50. Dry macular degeneration, in which tissue deterioration isn't accompanied by bleeding, is the most common form.