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Chapter 15: Eyes
WeberHealth Assessment in Nursing
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External Structure of the Eye•Eyelids•Lateral and medial canthus•Eyelashes, conjunctiva•Lacrimal apparatus•Extraocular muscles
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Structure of Eye
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Internal Structure of the Eye
•Sclera, cornea, iris, ciliary body, •Pupil, lens, choroid, retina, optic disc•Physiological cup, retinal vessels•Anterior chamber, posterior chamber
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Question
Tell whether the following statement is True or False.The lens flattens to focus on close objects and bulges to focus on far objects.
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Answer
False.The lens bulges to focus on close objects and flattens to focus on far objects. This is possible due to the refractive ability of the lens.
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Vision•Visual fields•Visual pathways•Visual reflexes
– Pupillary light reflex– Accommodation
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Collecting Subjective Data
•History of present health concern•Past health history•Family history•Lifestyle and health practices
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Cataract
•Opacity or clouding of the eye’s lens•Leading cause of blindness worldwide
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Risk Factors•Increasing age •Exposure to ultraviolet B light•Diabetes mellitus•Cigarette smoking•Alcohol use•Diet low in antioxidant vitamins
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Risk Factors (cont.)• High blood pressure• Eye injuries/surgery• Steroid use• Female gender• Persistent diarrhea• Gout • Abdominal obesity• Beta blocker use
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Risk Reduction
•Wear sunglasses•Quit smoking•Limit alcohol intake•Avoid eye injuries•Regular eye examination
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Question
Tell whether the following statement is True or False.Exposure to ultraviolet radiation increases the risk for development of cataracts.
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Answer
True.Exposure to ultraviolet radiation increases the risk for development of cataracts.
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Collecting Objective Data•Preparing the client•Equipment
– Snellen or E chart– Hand-held Snellen card or near vision
screener– Penlight– Opaque cards– Ophthalmoscope
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Distant Visual Acuity
•Snellen chart•Normal acuity is 20/20 with or without
corrective lenses
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Near Visual Acuity
•Handheld vision chart•Normal acuity is 14/14 with or without
corrective lenses
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Question
Tell whether the following statement is True or False.When testing near visual acuity the client should be asked to remove his or her glasses.
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Answer
False.When testing near visual acuity the client should keep his or her glasses on.
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Confrontation Test
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Testing Extraocular Muscle Function•Corneal light reflex test: use penlight to
observe parallel alignment of light refection on corneas
•Cover test: use opaque card to cover an eye to observe for eye movement
•Positions test: observe for eye movement
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Testing Extraocular Muscle Function
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Extraocular Muscle Dysfunction•Corneal light reflex test abnormalities
– Pseudostrabismus, strabismus•Test abnormalities
– Phobia•Positions test abnormalities
– Paralytic strabismus, 6th, 4th, 3rd nerve paralysis
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External Eye Structures•Inspect the eyelids and eyelashes•Observe the position and alignment of
the eyeball in the eye socket•Inspect the bulbar conjunctiva and
sclera•Inspect the palpebral conjunctiva•Inspect the lacrimal apparatus
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External Eye Structures (Cont’d)
•Palpate the lacrimal apparatus•Inspect the cornea and lens•Inspect the iris and pupil•Test pupillary reaction to light•Test accommodation of pupils
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Abnormalities of External Eye
•Ptosis, exophthalmos•Entropion, chalazion•Blepharitis, ectropion•Conjunctivitis•Hordeolum, diffuse episcleritis
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Pupillary Reaction to Light
• Darkened room• Have client focus on a distant object• Shine light obliquely into the pupil and
observe the pupil’s reaction to light• Normally, pupils constrict
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Accommodation
•Shifting gaze from far to near•Normally, pupils constrict
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Ophthalmoscope
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Internal Eye Structures
•Inspect the optic disc•Inspect the retinal vessels•Inspect retinal background•Inspect fovea and macula•Inspect anterior chamber
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Visual Field Defects
•Unilateral blindness•Bitemporal hemianopia •Lesion in optic nerve•Lesion of optic chiasm•Left superior quadrant anopia •Right visual field loss
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Abnormalities of Cornea and Lens
•Corneal abnormalities– Corneal scar, pterygium
•Lens abnormalities– Nucleus cataract, peripheral
cataract
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Abnormalities of Iris and Pupil
•Irregularly shaped iris•Miosis•Anisocoria•Mydriasis
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Abnormalities of Retinal Vessels and Background•Constricted arteriole•Copper wire arteriole•Silver wire arteriole•Arteriovenous nicking•Arteriovenous tapering•Arteriovenous banking
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Abnormalities of Retinal Vessels and Background (Cont’d)•Cotton wool patches•Hard exudate•Superficial retinal hemorrhages•Deep retinal hemorrhages•Microaneurysms
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Abnormalities of Optic Disc
•Papilledema•Glacoma•Optic atrophy
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Question
Tell whether the following statement is True or False. In 3rd nerve paralysis, the eyes cannot look down when turned inward.
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Answer
False.In 3rd nerve paralysis, the eye looks straight ahead. If the eyes cannot look down when turned inward it indicates 4th nerve paralysis.