WEEK 11- EYES

Question 1

Explain how to assess central visual acuity (refer to CNII-optic) using the Snellen Chart.

Answer 1

Snellen chart
- see where you can read up till- thats your vision
- 20/20- good
- 20/70- bad
tests your CNII optic nerve.

Question 2

Explain how to perform a diagnostic visions test (refer to CNIII-oculomotor, CNIV-trochlear & CNVI-abducens).

Answer 2

Diagnostic positions test
“6 cardinal positions”
Testing muscle weakness
Clockwise
Hold target at 30cm & ask client to hold head steady & follow with eyes
Normal findings
parallel tracking of eyes & no nystagmus

Question 3

Describe normal findings for inspection of external ocular structures (exclude eversion of upper lid & lacrimal apparatus)

Answer 3

6 extraocular muscles
Binocular single-image visual system
“Conjugate movement”
Eye movement
CN III (oculomotor)
Superior, inferior & medial rectus
Inferior oblique
CN IV (trochlear)
Superior oblique
CN VI (abducens)
Lateral rectus muscle

Upper eye lids overlap the superior part of the iris
Skin is intact
No redness
No swelling
No discharge
No lesions
Sclera white ( dark skin can be grey blue or “muddy”
Eyeballs moist and glossy
Eyelashes evenly distributed
Eyeballs are aligned no protrusion or sunken appearance
Those of African descent may have slight protrusion beyond supraorbital edge
Conjunctive no redness noted
Dark skinned individuals- small brown macules on sclera / yellowish fatty deposits beneath eyelids

Question 4

Inspect anterior eyeball structures –cornea, lens, iris & pupil.

Answer 4

Inspect anterior eyeball structures
Cornea & lens
Iris
Pupil & pupillary light reflex
Note pupil size, shape & equality before & after introduction of light source
Ask person to gaze into distance (darken room)
Advance light in from side on both eyes
Direct Light Reflex & Consensual light reflex

Question 5

Describe & assess: Confrontation Test

Answer 5

The examiner holds a target object, such as a finger or small object, at various positions within the patient’s peripheral visual field while maintaining central fixation.
Starting from the central position (directly in front of the patient), the examiner systematically moves the target object in different directions (up, down, right, left, and diagonally) within the patient’s peripheral visual field.
The examiner observes the patient’s responses and notes any indications of visual perception or awareness of the target object in each directio

Question 6

Describe & identify abnormal findings of ptosis, diplopia, strabismus & nystagmus, & glaucoma.

Answer 6

ptosis- dropping of upper eyelid
diplopia- 2 images of 1 single object; double vision
strabismus- cross eye
nystagmus- rapid eye movement back and forth
glaucoma- damage to the optic nerve, blindness if left untreated.

Question 7

Describe developmental considerations over the lifespan

Answer 7

neonates
- trouble fixating on things until 3-4 months
- far sighted

aging adult
- presbyopia
- cataracts
- glaucoma
- macular degeneration

Question 8

Identify health promotion strategies.

Answer 8

• eat healthy
• exercise
• lower blood pressure- if diabetic get screened for eyes
• eye exams

Question 9

Identify equipment needed for physical examination & safe infection prevention & control practices.

Answer 9

Snellen eye chart
Handheld visual screener
Opaque card or occluder
Penlight (some come with a pupil gauge to measure pupil size)
Applicator stick
Ophthalmoscope

Question 10

Presbyopia

Answer 10

decrease in lens ability to change shape to accommodate for near vision

Question 11

Amblyopia

Answer 11

lazy eye

Question 12

Diplopia

Answer 12

double vision

Question 13

Myopia

Answer 13

near sightedness

Question 14

Hyperopia

Answer 14

far sightedness

Question 15

external features- eye

Answer 15

Bony orbital cavity
Upper & lower eyelids & palpebral fissure
Sclera
Iris
Limbus
Pupil
Medial and lateral canthus
Conjunctiva
Cornea

Question 16

lacrimal apparatus

Answer 16

irrigation to conjunctiva, and cornea
- lacrimal gland secretes tears (drains into nasolacrimal duct)
- older people

Question 17

extraocular muscles (3)

Answer 17

CNIII- oculomotor
CNIV- trochlear
CNVI- abducens

Question 18

internal anatomy of eye

Answer 18

1. outer layer
   - sclera
   cornea- refracting light
   corneal reflex- CNV AND CNVII- trigemial, facial
2. middle layer
   - controls the amount of light that is admitted into the retina through iris and pupil
3. retina
   visual receptive layer
   - light waves transmitted into nerve impulses

Question 19

light response

Answer 19

Refraction of Light Rays
All objects reflect light
Light rays are refracted into the eye
Strike retina
Retina transforms light stimulus into nerve impulses through the optic nerve into the visual cortex
Right side of brain looks at left side of the world

Question 20

health history questions

Answer 20

Vision difficulty
Pain
Strabismus (crossed eyes), diplopia (double images)
Redness, swelling
Watering, discharge
History of ocular problems
Glaucoma
Glasses or contact lenses
Self-care behaviors
Medications
Coping with vision loss

Question 21

objective data- physical exam

Answer 21

Central visual acuity
Snellen eye chart
(tests CN II Optic nerve)
Normal visual acuity is 20/20
What does 20/70 mean?
What does 20/40 – mean?

Question 22

NEAR VISION

Answer 22

40 yrs + or people who report difficulty reading
Use handheld screener
Hold card in good light – 14 inches from eyes
Test each eye separately
Normal = 14/14
Use magazine or newspaper if screener unavailable

Question 23

EXTERNAL OCULAR STRUCTURES

Answer 23

Inspect external ocular structures
General
Eyebrows, eyelids & lashes
Eyeballs
Conjunctiva & sclera

Question 24

CONJUNCTIVITS
What are the characteristics of conjunctivitis that the nurse should assess?

Answer 24

Conjunctivitis, also known as pink eye, is an inflammation of the conjunctiva, the thin, clear tissue that covers the white part of the eye and lines the inside of the eyelid.

Question 25

SUBCONJUCTIVAL HEMMORAGE What are the characteristics of subconjunctival hemorrhage?

Answer 25

A subconjunctival hemorrhage is a common and usually benign condition characterized by bleeding underneath the conjunctiva, the clear tissue that covers the white part (sclera) of the eye.

Question 26

What are the characteristics of cataracts?

Answer 26

Cataracts are a common age-related eye condition characterized by clouding of the natural lens inside the eye, leading to progressive vision impairment.

Question 27

What are the characteristics of Exophthalmos and how does it differ from Ptosis?

Answer 27

Exophthalmos refers to the protrusion or bulging of one or both eyeballs from their normal position within the eye sockets (orbits). Ptosis refers to drooping or sagging of the upper eyelid, causing it to cover part of the eye or reduce the visible area of the iris and pupil.

Question 28

What are the characteristics of the eyes of those who are elderly?

Answer 28

- macular degeneration - presbyopia - cataracts pupil size decreases. The lens loses elasticity, becoming hard and glasslike, which decreases the lens’s ability to change shape to accommodate for near vision; this condition is termed presbyopia

Question 29

ANTERIOR EYEBALL STRUCTURES

Answer 29

Test for Accommodation Adaptation of eye for near vision Increasing curvature of the lens Assessment: Ask person to focus on distant object Place finger 8cm from nose Ask person to shift gaze to your finger Pupillary constriction & convergence of the axis

Question 30

normal pupils

Answer 30

PERRLA Pupils Equal, Round, React to Light and Accommodation

Question 31

COVER TEST

Answer 31

Test checks for alignment of the eyes This test assess if eyes are working well parallel Ask person to cover one eye and look directly at you- Normal response for both eyes is to gaze ahead Ask person to uncover eye and observe for any movements of the eye- for those individuals with muscle weakness you will note the eye jumping every so slightly to be aligned with the other eye

Question 32

tests

Answer 32

Cover test Confrontation Test Corneal Light Reflex

Question 33

pupillary light reflex

Answer 33

The pupillary light reflex is the normal constriction of the pupils when bright light shines on the retina

Question 34

accommodation

Answer 34

Accommodation is adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of the ciliary muscles. Although the lens cannot be observed directly, the components of accommodation that can be observed are convergence (motion toward) of the axes of the eyeballs and pupillary constriction

Question 35

full eye exam

Answer 35

1. Test visual acuity: Snellen eye chart Near vision (in patients older than 40 years of age or those having difficulty reading) 2. Test visual fields: confrontation test 3. Inspect extraocular muscle function: Corneal light reflex (Hirschberg’s test) Cover–uncover test Diagnostic positions test 4. Inspect external eye structures: General Eyebrows Eyelids and lashes Eyeball alignment Conjunctiva and sclera Lacrimal apparatus 5. Inspect anterior eyeball structures: Cornea and lens Iris and pupil Size, shape, and equality Pupillary light reflex Accommodation 6. Inspect the ocular fundus: Optic disc (colour, shape, margins, cup–disc ratio) Retinal vessels (number, colour, artery–vein ratio, calibre, arteriovenous crossings, tortuosity, pulsations) General background (colour, integrity) Macula 7. Engage in teaching and health promotion