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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
Slide 14-2
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Chapter 14: Eyes
External anatomy
Palpebral fissure
Limbus
Slide 14-3
Pat Thomas, 2006.
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Chapter 14: Eyes
External anatomy
Tarsal plates
Meibomian glands
Conjunctiva
Lacrimal apparatus
Slide 14-4
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Chapter 14: Eyes
Extraocular muscles
Superior rectus
Inferior rectus
Lateral rectus
Medial rectus
Superior oblique
Inferior oblique
Slide 14-5
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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Chapter 14: Eyes
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
Slide 14-8
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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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Chapter 14: Eyes
Additional history for infants and children
Vaginal infection during delivery
Developmental milestones
Routine vision testing
Safety measures
Slide 14-12
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Chapter 14: Eyes
Additional history for aging adult
Visual difficulty
Glaucoma test
Cataracts
Eye dryness
Decreased activities
Slide 14-13
C
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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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Ch t 14 E
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Chapter 14: Eyes
Central visual acuity Snellen eye chart
Near vision
Visual fields Confrontation test
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Ch t 14 E
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Chapter 14: Eyes
Extraocular musclefunctionInspect
Corneal light reflex
(Hirschberg test) Cover test
Diagnostic positionstest
Slide 14-16
Ch t 14 E
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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
Slide 14-17
Chapter 14 E es
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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
Slide 14-19
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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
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Chapter 14: Eyes
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Chapter 14: Eyes
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Chapter 14: Eyes
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Chapter 14: Eyes
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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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Chapter 14: Eyes
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
Slide 14-29
Chapter 14: Eyes
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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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Chapter 14: Eyes
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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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p y
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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Chapter 14: Eyes
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y
Conjunctivitis
Subconjunctival hemorrhage
Iritis (circumcorneal redness) Acute glaucoma
Slide 14-33
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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
Slide 14-37
Chapter 14: Eyes
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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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Chapter 14: Eyes
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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?
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