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Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Eyes

Chapter 14

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Chapter 14: Eyes

Structure and Function Subjective DataHealth History Questions Objective DataPhysical Exam Abnormal Findings

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Chapter 14: Eyes

External anatomy

Palpebral fissure

Limbus

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Pat Thomas, 2006.

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External anatomy

Tarsal plates

Meibomian glands

Conjunctiva

Lacrimal apparatus

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Extraocular muscles

Superior rectus

Inferior rectus

Lateral rectus

Medial rectus

Superior oblique

Inferior oblique

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Pat Thomas, 2006.

Pat Thomas, 2006.

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Chapter 14: Eyes

Internal anatomy Outer layersclera Middle layer

choroid

Ciliary body and iris Pupil Lens Anterior chamber

Inner layerretina Optic disc Retinal vessels Macula

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Visual pathways andvisual fields

Refraction of light rays

Crossing of fibres atoptic nerve

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Chapter 14: Eyes

Visual reflexes

Pupillary light reflexes

Fixation

Accommodation

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Chapter 14: Eyes

Developmental care

Infants and children

Aging adult

Cataracts

Glaucoma

Macular degeneration

Cultural considerations

Racial variations

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Chapter 14: Eyes

Vision difficulty(decreased acuity, blurring, blind spots)

Pain

Strabismus, diplopia

Redness, swelling

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Chapter 14: Eyes

Watering, discharge

History of ocular problems Glaucoma

Glasses or contact lenses

Self-care behaviours

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Additional history for infants and children

Vaginal infection during delivery

Developmental milestones

Routine vision testing

Safety measures

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Chapter 14: Eyes

Additional history for aging adult

Visual difficulty

Glaucoma test

Cataracts

Eye dryness

Decreased activities

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Chapter 14: Eyes

Preparation

Position

Equipment

Snellen eye chart

Handheld visual screener

Opaque card or occluder

Penlight

Applicator stick

Ophthalmoscope

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Chapter 14: Eyes

Central visual acuity Snellen eye chart

Near vision

Visual fields Confrontation test

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Chapter 14: Eyes

Extraocular musclefunctionInspect

Corneal light reflex

(Hirschberg test) Cover test

Diagnostic positionstest

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Chapter 14: Eyes

External ocular structuresInspect General Eyebrows

Eyelids and lashes Eyeballs Conjunctiva and sclera Eversion of the upper lid Lacrimal apparatus

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Chapter 14: Eyes

Anterior eyeball structuresInspect

Cornea and lens

Iris and pupil Size and shape

Pupillary light reflex

Accommodation

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Chapter 14: Eyes

Ocular fundusInspect Use of the ophthalmoscope Red reflex Optic disc

Colour Shape

Retinal vessels Color A:V ratio Calibre

General background of the fundus Macula

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Chapter 14: Eyes

Developmental care

Infants and children Visual acuity

Visual fields

Colour vision

Extraocular muscle function

External eye structures

Eyelids and lashes

Conjunctiva and sclera Iris and pupils

Ocular fundus

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Chapter 14: Eyes

Developmental care (cont.)

Aging adults Visual acuity

Ocular structures Ocular fundus

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Chapter 14: Eyes

Leading cause of preventable blindness in Canada

Risk Factors >60 years Of African descent Female Increased intraocular pressure Family history Steroid use Decreased central corneal thickness Hypertension

Eye injury Severe myopia Diabetes Use of certain medications

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Chapter 14: Eyes

Strabismus

Esotropia

Exotropia

Paralysis

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Visual acuity testing Visual field testing

Dilated eye examination

Tonometry to measure the pressure insidethe eye

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C apte yes

Periorbital edema

Exophthalmos (protruding eyes)

Enophthalmos (sunken eyes)

Ptosis (drooping upper lid)

Upward palpebral slant

Ectropion Entropion

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p y

Blepharitis (inflammation of the eyelids)

Chalazion

Hordeolum (stye) Dacryocystitis (inflammation of the lacrimal

sac)

Dacryoadenitis (inflammation of the lacrimalgland)

Basal cell carcinoma

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p y

Unequal pupil sizeanisocoria Monocular blindness

Constricted and fixed pupilsmiosis Dilated and fixed pupilsmydriasis Argyll Robertson pupil Tonic pupil (Adies pupil) Cranial nerve III damage Horners syndrome

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Retinal damage

Lesion in globe or optic nerve

Lesion at optic chiasm

Lesion of outer uncrossed fibres at opticchiasm

Lesion R optic tract or R optic radiation

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y

Conjunctivitis

Subconjunctival hemorrhage

Iritis (circumcorneal redness) Acute glaucoma

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Pterygium

Corneal abrasion

Hyphema Hypopyon

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Central grey opacitynuclear cataract

Star-shaped opacitycortical cataract

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Optic atrophy (disc pallor)

Papilledema (choked disc)

Excessive cup:disc ratio

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Arteriovenous crossing (nicking)

Narrowed (attenuated) arteries

Vessel nicking

Diabetic retinopathy

Microaneurysms

Intraretinal hemorrhages

Exudates

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A. Do spots move in front of your eyes?

B. Do your eyes feel tired?

C. Do your eyes seem watery?

D. Do you have night blindness?

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A. Do you have difficulty driving?

B. Do you use eyedrops for glaucoma?

C. Do your eyes seem excessively moist?D. Have activities such as reading decreased?