N307 Eyes Assessment [Ch 14]
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| Identify the function of the eyelids. (2) | protect eye, filter out dust and dirt
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| palpebral fissure | elliptical open space between the eyelids
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| limbus | border between cornea and sclera
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| canthus | corner of eye; medial and lateral
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| caruncle | small, fleshy mass at inner corner of eye containing sebaecous glands
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| tarsal plates | strips of connective tissue, contain the meibomian glands, secrete oily lubricating material
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| conjunctiva | thin, mucous membrane; palpebral and bulbar
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| Identify the function of the lacrimal apparatus. | Provide constant irrigation to keep the conjunctiva and cornea moist and lubricated
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| Which gland secretes tears and where is it located? | Lacrimal gland, located in upper outer corner over the eye, secretes tears
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| Identify the function of the 6 extraocular muscles. List them. | Attach eyeball and give eye movement; 4 rectus and 2 oblique
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| Identify the normal color of the sclera. | White
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| What population has narrowed palpebral fissures? | Asians
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| Glaucoma is more prevalent in this population: _______. It is also more likely to cause blindness in this population. | African-American
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| strabismus | abnormal alignment of the eyes; deviation from axis; "cross-eyed"
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| Halos around lights occur with _______. | acute narrow-angle glaucoma
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| Floaters are common with ________. | myopia or after middle age (due to condensed vitreous fibers)
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| scotoma | blind spot surrounded by area of normal or decreased vision, occurs with glaucoma and optic nerve disorders
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| Night blindness occurs with _______. (3) | Optic atrophy, glaucoma, or vitamin A deficiency
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| photophobia | inability to tolerate light
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| diplopia | perception of two images of a single object; double vision
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| What causes lacrimation or epiphora? | Irritants or obstruction in drainage of tears
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| lacrimation | tearing
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| epiphora | excessive tearing
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| Describe purulent discharge. | Thick, yellow, crusts form at night
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| Allergens, such as ______ (3), cause irritation of conjunctiva or cornea. | make-up, contact lens solution
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| How far away should you place the Snellen chart? | 20 feet
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| Snellen chart | chart used to measure visual acuity; has lines of letters arranged in decreasing size
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| What chart do you use for those that cannot read letters, ex. small children? | Snellen picture chart
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| The larger the denominator, the _____ the vision. [better/poorer] | poorer
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| Normal visual acuity is ______. | 20/20
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| 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
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| How do you document visual acuity? | Right 20/30 -1 with glasses (right eye scored 20/30 missing one letter with glasses)
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| What do you do if the person is NOT able to see the largest letter? | Shorten the distance to the chart
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| 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
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| Identify normal result for near vision test. | 14/14 without hesitation and without moving card closer or further away
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| If you have no near vision screening card available, is it okay to ask the person to read from a magazine? | Yes
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| confrontation test | gross measure of peripheral vision; compare person's peripheral vision with examiners
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| 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
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| The confrontation test screens for _____ in older adults. | glaucoma
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| 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"
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| corneal light reflex test | assess the parallel alignment of eye axes by shining light toward person's eyes
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| Identify an abnormal result for the corneal light reflex test. | Asymmetry of light reflex indications deviation in alignment from eye muscle weakness or paralysis
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| 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
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| cover test | detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps two eyes parallel
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| 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
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| Identify a normal response for the cover test. | Uncovered eye is "steady, fixed gaze"
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| Identify an abnormal response for the cover test. | Eye jumps to fixate on designated point mean it was out of alignment before
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| diagnostic positions test | leading the eyes through the 6 cardinal positions of gaze will elicit any muscle weakness during movement
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| 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.
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| Identify a normal response in the diagnostic positions test. | Parallel tracking of object with both eyes
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| 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.
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| nystagmus | a fine, oscillating movement best seen around the iris
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| Nystagmus occurs with _______. (4) | disease of the semicircular canals in the ears, a paretic eye muscle, multiple sclerosis (MS), or brain lesions
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| Lid lag occurs with _______. | hyperthyroidism
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| Identify the cause for unequal/asymmetrical or absent eyebrow movement. | Nerve damage
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| ptosis | drooping of upper eyelid; asymmetrical
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| exophthalmos | protruding eyes
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| enophthalmos | sunken eyes
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| Pallor near the outer canthus of the lower lid may indicate _____. | anemia
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| scleral icterus | an even yellowing of the sclera extending up to the cornea, indicating jaundice
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| Is eversion of the upper eyelid part of the normal examination? | No
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| arcus senilis | gray, white arc or circle around the limbus due to deposits of lipid material; no effect on vision
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| How does a corneal abrasion present? | Causes irregular ridges and reflected light, producing a shattered look to light rays
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| Identify the normal size of pupils in resting adult. | 3-5 mm
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| TRUE/FALSE: Small number of people have 2 different sized pupils. | TRUE. This is called anisocoria.
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| How do you document the pupillary light reflex? | PERRLA direct and consensual
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| Constriction of the same-side pupil ______. | direct light reflex
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| Constriction of the other-side pupil ______. | consensual light reflex
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| esotropia | inward turning of eye
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| exotropia | outward turning of the eye
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| 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)
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| 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
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| hordeolum | infection of the hair follicle that is painful, red, and swollen; stye
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| chalazion | infection of internal glands of the eye; internal stye
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| dacryocyctitis/dacryoadenitis | inflammation of the lacrimal sac/gland
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| conjunctivitis | infection of the conjunctiva, “pink eye”
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| Describe the discharge associated with conjunctivitis. | infectious, yellow to green, thick, eyes will be matted shut
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| 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
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| iritis | increased redness around iris only, "ring of redness"; usually needs immediate referral
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| Why does iritis need immediate referal? | It can cause blindness.
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| corneal abrasion | scratch, irregular ridges, spot noted with fluorescein
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| fluorescein | orange dye, C20H12O5, with a yellowish-green fluorescence, used as an indicator and tracer.
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| anisocoria | unequal pupils; pupils not symmetrical
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| mydriasis | dilated and fixed pupils
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| miosis | constricted and fixed pupils
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| Are fixed pupils normal or abnormal? What are they associated with? | Fixed is abnormal, associated with trauma
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| myopia | nearsightedness; can see near, but not far
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| hyperopia | farsightedness; can see far, but not near
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| cataract | congenital; round, circular black dot, occluding red reflex
aging
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| diabetic retinopathy | multiple microaneurysms or small red dots or dilations of
the vessels noted on the fundiscopic exam
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| Which lymph node is commonly swollen with conjunctivitis and a hx of URI? | Preauricular lymph nodes
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| The red reflex seen during an ophthalmoscope examination is the result of ______. | light from scope reflecting back from choroid
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| 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
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| A nurse is inspecting a 10 y/o child's pupils. Shining indirect light into right eye causes what normal response? | Both eyes constrict
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