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Health assessment of eyes Prepared by Dr. seham Mohamed Anatomy of the eye:  The eyes are delicate sensory organs.  The eyes are equipped with many extra-ocular structures that easily visible and intra-ocular structures which can only be viewed with special instruments, such as an oph...

Health assessment of eyes Prepared by Dr. seham Mohamed Anatomy of the eye:  The eyes are delicate sensory organs.  The eyes are equipped with many extra-ocular structures that easily visible and intra-ocular structures which can only be viewed with special instruments, such as an ophthalmoscope 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, surgery, and blurred vision?  Have you ever seen spots or floaters, flashes of light, or halos around lights?  Do you have a history of frequent eye infections, tearing, or dryness?  Have you had any redness, swelling or discharge from the eyes?  Have you ever been diagnosed with an eye condition such as cataracts, glaucoma?  Do you have a history of diabetes or high BP?  What medications are you currently taking eye drops, or supplements?  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 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 or 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) and presbyopia (impaired near vision).  The Snellen ( E ) chart is used for clients who cannot read. Test cranial nerves (CN) during the eye examination  CN II: (optic); visual acuity, and visual fields  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 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.