Eyes Chapter 15 PDF

EYES Chapter 15 SUBJECTIVE DATA: HEALTH HISTORY Vision difficulty (decreased Older Adult acuity, blurring, blind spots) Pain Movement and visual Strabismus, diplopia difficulty Redness, s...

EYES Chapter 15 SUBJECTIVE DATA: HEALTH HISTORY Vision difficulty (decreased Older Adult acuity, blurring, blind spots) Pain Movement and visual Strabismus, diplopia difficulty Redness, swelling Glaucoma testing Watering, discharge Cataracts History of ocular problems Glaucoma Dryness of eyes Glasses or contact lenses Decreased activities Self-care behaviours Medications Vision loss Copyright © 2019 Elsevier, Inc. DEVELOPMENTAL CONSIDERATIONS Older adults  Presbyopia  Macular degeneration  Cataracts  Glaucoma  Diabetic retinopathy Copyright © 2019 Elsevier, Inc. OBJECTIVE DATA: PHYSICAL EXAM Preparation  Position Equipment  Snellen eye chart/Handheld visual screener  Opaque card or occluder  Penlight  Applicator stick  Ophthalmoscope Copyright © 2019 Elsevier, Inc. DIRECTION OF MOVEMENT Copyright © 2019 Elsevier, Inc. VISUAL PATHWAYS AND VISUAL FIELDS Refraction of light rays Crossing of fibres at optic nerve Copyright © 2019 Elsevier, Inc. VISUAL REFLEXES Pupillary light reflexes Fixation Accommodation Copyright © 2019 Elsevier, Inc. EXTRAOCULAR MUSCLE FUNCTION Inspect  Corneal light reflex (Hirschberg test)  Cover–uncover test  Diagnostic positions test Copyright © 2019 Elsevier, Inc. INSPECTION External Ocular Anterior Eyeball Structures Structures General Cornea and lens Eyebrows Iris and pupil  Size and shape Eyelids and lashes  Pupillary light reflex Eyeballs  Accommodation Conjunctiva and sclera Eversion of the upper lid Lacrimal apparatus Copyright © 2019 Elsevier, Inc. USE OF OPHTHALMOSCOPE Functions as appendage of examiner’s eye Contains set of lenses – unit of strength is diopter  Positive dioptres (black) focus on near objects  Negative diopters (red) focus on objects farther away Copyright © 2019 Elsevier, Inc.  OCULAR FUNDUS - INSPECTION  Red reflex  Retinal vessels  Optic disc Number  Colour Colour  Shape  Margins Artery–vein ratio  Cup–disc ratio Calibre  General background Arteriovenous of the fundus crossing  Macula Tortuosity Pulsations Copyright © 2019 Elsevier, Inc. OPTIC DISC Copyright © 2019 Elsevier, Inc. DEVELOPMENTAL CONSIDERATIONS (2 OF 2) Older adults  Visual acuity  Ocular structures  Ocular fundus Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS Extraocular Motor Function Eyelid Abnormalities Periorbital edema Strabismus Exophthalmos (protruding Esotropia eyes) Exotropia Enophthalmos (sunken eyes) Paralysis Ptosis (drooping upper lid) Upward palpebral slant Ectropion (turned out) Entropion (turned in) Copyright © 2019 Elsevier, Inc. ABNORMAL FINDINGS Lesions on the Eyelids Pupils Blepharitis (inflammation of Unequal pupil size the eyelids) (anisocoria) Chalazion Monocular blindness Hordeolum (stye) Constricted and fixed pupils Dacryocystitis (inflammation (miosis) of the lacrimal sac) Dacryoadenitis Dilated and fixed pupils (inflammation of the lacrimal (mydriasis) gland) Tonic pupil (Adie’s pupil) Basal cell carcinoma Cranial nerve III damage Copyright © 2019 Elsevier, Inc.  EYE ABNORMALITIES 16 ABNORMAL FINDINGS Vascular Disorders of the Visual Field Loss External Eye Retinal Damage Conjunctivitis  Localized damage (scotoma)  Increased ocular pressure Subconjunctival  Retinal detachment hemorrhage Lesion in globe or optic nerve Iritis (circumcorneal redness) Lesion at optic chiasm Lesion of outer uncrossed Acute glaucoma fibres at optic chiasm Lesion in right optic tract or right optic radiation Copyright © 2019 Elsevier, Inc. EYE ABNORMALITIES 18 ABNORMAL FINDINGS Opacities in the Lens Cornea and Iris Pterygium Central grey opacity (nuclear cataract) Corneal abrasion Star-shaped opacity Hyphema (cortical cataract) Hypopyon Copyright © 2019 Elsevier, Inc. 20 ABNORMAL FINDINGS Retinal Vessels and Optic Disc Backgrounds Optic atrophy (disc pallor) Arteriovenous crossing (nicking) Papilledema (choked disc) Narrowed (attenuated) arteries Diabetic retinopathy Microaneursyms Intraretinal hemorrhages Exudates Copyright © 2019 Elsevier, Inc. 22