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N307 E2 Eyes

N307 Eyes Assessment [Ch 14]

Identify the function of the eyelids. (2) protect eye, filter out dust and dirt
palpebral fissure elliptical open space between the eyelids
limbus border between cornea and sclera
canthus corner of eye; medial and lateral
caruncle small, fleshy mass at inner corner of eye containing sebaecous glands
tarsal plates strips of connective tissue, contain the meibomian glands, secrete oily lubricating material
conjunctiva thin, mucous membrane; palpebral and bulbar
Identify the function of the lacrimal apparatus. Provide constant irrigation to keep the conjunctiva and cornea moist and lubricated
Which gland secretes tears and where is it located? Lacrimal gland, located in upper outer corner over the eye, secretes tears
Identify the function of the 6 extraocular muscles. List them. Attach eyeball and give eye movement; 4 rectus and 2 oblique
Identify the normal color of the sclera. White
What population has narrowed palpebral fissures? Asians
Glaucoma is more prevalent in this population: _______. It is also more likely to cause blindness in this population. African-American
strabismus abnormal alignment of the eyes; deviation from axis; "cross-eyed"
Halos around lights occur with _______. acute narrow-angle glaucoma
Floaters are common with ________. myopia or after middle age (due to condensed vitreous fibers)
scotoma blind spot surrounded by area of normal or decreased vision, occurs with glaucoma and optic nerve disorders
Night blindness occurs with _______. (3) Optic atrophy, glaucoma, or vitamin A deficiency
photophobia inability to tolerate light
diplopia perception of two images of a single object; double vision
What causes lacrimation or epiphora? Irritants or obstruction in drainage of tears
lacrimation tearing
epiphora excessive tearing
Describe purulent discharge. Thick, yellow, crusts form at night
Allergens, such as ______ (3), cause irritation of conjunctiva or cornea. make-up, contact lens solution
How far away should you place the Snellen chart? 20 feet
Snellen chart chart used to measure visual acuity; has lines of letters arranged in decreasing size
What chart do you use for those that cannot read letters, ex. small children? Snellen picture chart
The larger the denominator, the _____ the vision. [better/poorer] poorer
Normal visual acuity is ______. 20/20
Identify the meanings of the numeric values in a patient's visual acuity score. Top number indicates distance person is standing from chart; bottom number is the distance at which a normal eye could have read that particular line
How do you document visual acuity? Right 20/30 -1 with glasses (right eye scored 20/30 missing one letter with glasses)
What do you do if the person is NOT able to see the largest letter? Shorten the distance to the chart
For the near vision test, how far should the person hold the card? What does this distance mean? 14" from the eye; distance quals print size on 20-foot chart
Identify normal result for near vision test. 14/14 without hesitation and without moving card closer or further away
If you have no near vision screening card available, is it okay to ask the person to read from a magazine? Yes
confrontation test gross measure of peripheral vision; compare person's peripheral vision with examiners
Describe how to perform the confrontation test. Stand 2 feet away from pt; Cover same eye as pt; look straight at each other; slowly advance flicking finger inward from several directions; tell pt to say now when they see it; repeat with other eye
The confrontation test screens for _____ in older adults. glaucoma
Identify normal results for the confrontation test. About 50 degrees upward, 90 degrees temporally, 70 degrees down, and 60 degrees nasally; "peripheral vision comparable to examiner's"
corneal light reflex test assess the parallel alignment of eye axes by shining light toward person's eyes
Identify an abnormal result for the corneal light reflex test. Asymmetry of light reflex indications deviation in alignment from eye muscle weakness or paralysis
Describe how to perform the corneal light reflex test. Direct pt to stare straight; hold light about 12" away; note reflection of light on corneas, should be the same spot on each eye
cover test detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps two eyes parallel
Describe how to perform the cover test. Direct pt to stare at your nose; cover 1 eye with opaque card; assess uncovered eye; uncover eye & assess for movement; repeat w/ other eye
Identify a normal response for the cover test. Uncovered eye is "steady, fixed gaze"
Identify an abnormal response for the cover test. Eye jumps to fixate on designated point mean it was out of alignment before
diagnostic positions test leading the eyes through the 6 cardinal positions of gaze will elicit any muscle weakness during movement
Describe how to perform the diagnostic positions test. Ask pt to hold the head steady & to follow the movement of your finger with eyes only. Hold the target back 12". Move it to each of the six positions, hold, then back to center. Progress clockwise.
Identify a normal response in the diagnostic positions test. Parallel tracking of object with both eyes
Identify an abnormal response in the diagnostic positions test. Eye movement is not parallel. Failure to follow in a certain direction indicates weakness of an extraocular muscle (EOM) or dysfunction of cranial nerve innervating it.
nystagmus a fine, oscillating movement best seen around the iris
Nystagmus occurs with _______. (4) disease of the semicircular canals in the ears, a paretic eye muscle, multiple sclerosis (MS), or brain lesions
Lid lag occurs with _______. hyperthyroidism
Identify the cause for unequal/asymmetrical or absent eyebrow movement. Nerve damage
ptosis drooping of upper eyelid; asymmetrical
exophthalmos protruding eyes
enophthalmos sunken eyes
Pallor near the outer canthus of the lower lid may indicate _____. anemia
scleral icterus an even yellowing of the sclera extending up to the cornea, indicating jaundice
Is eversion of the upper eyelid part of the normal examination? No
arcus senilis gray, white arc or circle around the limbus due to deposits of lipid material; no effect on vision
How does a corneal abrasion present? Causes irregular ridges and reflected light, producing a shattered look to light rays
Identify the normal size of pupils in resting adult. 3-5 mm
TRUE/FALSE: Small number of people have 2 different sized pupils. TRUE. This is called anisocoria.
How do you document the pupillary light reflex? PERRLA direct and consensual
Constriction of the same-side pupil ______. direct light reflex
Constriction of the other-side pupil ______. consensual light reflex
esotropia inward turning of eye
exotropia outward turning of the eye
Identify how the following disease/condition would present: periorbital edema (3). What does this occur with? (3) lids swollen, red, and puffy; occurs with crying, local infections, and systemic conditions (CHF, renal failure, allergy, hypothyroidism)
Identify how the following disease/condition would present: blepharitis. (3) s/s: (4) red scaly, flakey, crusted lid margins (seborrhea); s/s burning, itching, tearing, foreign body sensation
hordeolum infection of the hair follicle that is painful, red, and swollen; stye
chalazion infection of internal glands of the eye; internal stye
dacryocyctitis/dacryoadenitis inflammation of the lacrimal sac/gland
conjunctivitis infection of the conjunctiva, “pink eye”
Describe the discharge associated with conjunctivitis. infectious, yellow to green, thick, eyes will be matted shut
subconjunctival hemorrhage; cause(s): 6 secondary to increased intraocular pressure (from coughing, vomiting, lifting weights, giving birth, straining with stool, trauma); sclera will be bloody
iritis increased redness around iris only, "ring of redness"; usually needs immediate referral
Why does iritis need immediate referal? It can cause blindness.
corneal abrasion scratch, irregular ridges, spot noted with fluorescein
fluorescein orange dye, C20H12O5, with a yellowish-green fluorescence, used as an indicator and tracer.
anisocoria unequal pupils; pupils not symmetrical
mydriasis dilated and fixed pupils
miosis constricted and fixed pupils
Are fixed pupils normal or abnormal? What are they associated with? Fixed is abnormal, associated with trauma
myopia nearsightedness; can see near, but not far
hyperopia farsightedness; can see far, but not near
cataract congenital; round, circular black dot, occluding red reflex aging
diabetic retinopathy multiple microaneurysms or small red dots or dilations of 
the vessels noted on the fundiscopic exam
Which lymph node is commonly swollen with conjunctivitis and a hx of URI? Preauricular lymph nodes
The red reflex seen during an ophthalmoscope examination is the result of ______. light from scope reflecting back from choroid
A 9 y/o pt complains of his eye itching and tearing up. Upon examination, his sclera is reddened. Why eye abnormality is suggested? Conjunctivitis
A nurse is inspecting a 10 y/o child's pupils. Shining indirect light into right eye causes what normal response? Both eyes constrict
Created by: nikkirosety