Assessment of the Eye

I. Health History A. Current Health Status Problems Corrective lenses B. Past Health Status Lens change Blurred vision Spots, floaters, halos Infections or inflammations of the eyes Eye surgery or injury Styes (hordeolums) High blood pressure Diabetes Eye medications C. Family health status II. Examination of the Eye A. Vision Distance vision a. Snellen chart SNELLEN CHART 1. Keep area well lit. 2. Client stands 20 feet from chart. 3. Test one eye at a time and then both eyes. 4. Read smallest line of print possible. 5. Record visual acuity as a fraction (20/20). Alterations on visual acuity: - Emmetropia - Hyperopia - Myopia - Presbyopia Near vision Color vision B. Extraoccular Muscle Function 1. Position and alignment 2. Six cardinal positions of gaze - Failure of lid closure - Failure of lid opening (ptosis) - Nystagmus 3. Cover/uncover test 4. Corneal light reflex test C. Peripheral Vision 1. Visual Fields The visual field is the entire area seen by an eye when its gaze is fixed on a central point. Visual fields are limited by the eyebrows, the cheeks, and by the nose. To test visual fields by confrontation you need to face the subject directly at about 2 feet away with eyes at the same level. Test one eye at a time. Slowly bring a pencil in from the periphery into the field of vision. Do this in eight different directions. D. Inspection Position and alignment of the eyes a. Abnormalities - Exophthalmos - Lid lag Eyebrows a. Abnormalities - Seborrheic dermatitis - Loss of lateral 1/3 of eyebrows Eyelids a. Inspect for - Edema - Color - Lesions - Lashes (condition and direction) - Adequacy of closure b. Abnormalities - Blepharitis (inflammation of the eye lids) - Ectropion (margin of lid turned outward) - Entropion (inward turning of lid margin) - Periorbital edema (seen in inflammation, myxedema, nephrotic syndrome - Herniated fat (involves lower lids) - Ptosis (drooping of upper lid) - Sty (hordeolum; infection around hair follicle) - Chalazion (chronic inflammatory lesion of Meibomian gland) - Xanthelasma (raised yellowish plaques that appear on nasal portion of eyelids - Failure of lid closure - Epicanthal fold Lacrimal apparatus a. Observe for - Swelling - Tearing (may occur from conjunctival inflammation, corneal irritation, inadequate drainage [ectropion], or naso-lacrimal duct obstruction - Dryness of the eyes b. Abnormalities - Dacryocystitis (inflammation of the lacrimal sac) Conjunctiva a. Inspect lower lids b. Inspect upper palpebral conjunctiva c. Subconjunctival hemorrhage d. Chemosis (edema) e. Pinguecula f. Pterygium g. Conjunctivitis Sclera Cornea a. Corneal reflex b. Inspect with light Iris a. Shape Pupils a. Size - anisocoria b. Shape c. Reaction to light - Direct reaction - Consensual reaction E. Palpation Palpate eyelids for swelling and tenderness Palpate eyeball Palpate lacrimal sac F. Ophthalmoscopic examination Increase light intensity by turning rheostat clockwise Apertures a. Large round beam b. Small round beam c. Slit-like beam d. Green (red-free) e. Grid Lens +40 to -20 a. Positive diopters (black) b. Negative diopters (red) Ophthalmoscope exam a. Red reflex b. Optic fundus c. Optic disk - Size - Shape - Color - Margins - Cup d. Blood vessels Arterioles Veins color light red dark purple size small large light reflex bright absent pulsations none present e. Macula f. Periphery g. Vitreous/lens h. Abnormalities - Papilledema - Optic atrophy - Glaucoma - Hypertension - Diabetic retinopathy - Macular degeneration - Superficial retinal hemorrhage - Deep retinal hemorrhage - Microaneurysms - Neovascularization - Cotton wool patches - Hard exudates Home | Back

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