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Health Assessment

Health Assessment. Assessment of eye. Eye. Only a small portion of the eye is seen. Sclera Cornea Choroid Iris Pupil Dim light enlarges (mydriasis) Bright light decreases (miosis). Eye. Retina Sensory portion Optic disc

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Health Assessment

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  1. Health Assessment Assessment of eye

  2. Eye • Only a small portion of the eye is seen. • Sclera • Cornea • Choroid • Iris • Pupil • Dim light enlarges (mydriasis) • Bright light decreases (miosis)

  3. Eye • Retina • Sensory portion • Optic disc • Center is the point at which the vascular network enters the eye • Macula • Responsible for central vision

  4. Figure 15.2 Interior of the eye.

  5. Visual Pathways • Light waves must bend to focus correctly on the retina. • Refractory structures bend light waves onto retina. • Optic fibers of the optic nerve cross over at the chiasm and join temporal fibers from the opposite eye. • Impulse transmitted to occipital lobe of brain for interpretation

  6. Figure 15.3 Visual fields of the eye and the visual pathway to the brain.

  7. Accessory Structures of the Eye • Eyebrows • Protect the eye • Eyelids -Movable folds of skin that cover and protect the eyes • Palpebral fissure is opening between upper and lower eyelids.

  8. Accessory Structures of the Eye • Eyelids • Meibomian glands • glands that lubricate eyes and eyelids • Eyelashes • Project from eyelids and curl outward • Conjunctivae • Prevents foreign objects from entering eye

  9. Accessory Structures of the Eye • Lacrimal apparatus • Secretes tears that spread over conjunctivae when blinking • Extrinsic muscles • Lateral rectus • Medial rectus • Superior rectus • Inferior rectus • Inferior oblique • Superior oblique

  10. Figure 15.4 Lacrimal glands of the eye.

  11. Special Considerations • Age • Developmental level • Race • Ethnicity • Occupation • Socioeconomics • Emotional well-being

  12. Lifespan Considerations • Infants and children • Visual acuity not as sharp as adults • Children typically have 20/20 vision by age 7. • At birth, the iris has little color but changes to permanent color by 3 months of age. continued on next slide

  13. Lifespan Considerations • The pregnant female • Dryness of the eyes • Vision changes • Due to shifting fluid in cornea • Blurriness • Distorted vision • Up to 6 weeks postpartum

  14. Lifespan Considerations • The older adult • Cataracts • Macular degeneration

  15. Psychosocial Considerations • Impact of decreased visual acuity/visual impairment on independence and quality of life • Children may experience developmental delays. • Stress for families and individuals • Eye contact within culture, age, gender

  16. Cultural and Environmental Considerations • Changes that occur normally in various races and ethnic groups • Excessive sun exposure • Medications • Hygiene practices • Trauma or damage

  17. Focused Interview • Function and structures of the eye • Consider in relation to expectations based on age, gender, race, culture, environment, health practices, past and current problems, and therapies • Consider patient's ability to participate

  18. Focused Interview • Focused interview questions • General • Illness or infection • Symptoms, pain, and behaviors continued on next slide

  19. Assessment of the Eye • Techniques • Inspection • Palpation • Ophthalmoscope

  20. Figure 15.7 Testing distant vision.

  21. Figure 15.8 E chart for testing distant vision.

  22. Figure 15.9 Testing near vision.

  23. Assessment of the Eye • Visual acuity of distant and near vision using Jaeger or Rosenbaum charts • Visual fields by confrontation • Six cardinal fields of gaze • Corneal light reflex • Cover/uncover test • Pupils and pupillary response

  24. Assessment of the Eye • Accommodation of pupil response • Corneal reflex • External eye • Sclera

  25. Figure 15.12 Alternative method of testing cardinal field of gaze.

  26. Figure 15.13 Testing the corneal light reflex.

  27. Figure 15.14 Cover/Uncover test.

  28. Figure 15.15 Inspecting the cornea.

  29. Assessment of the Eye • Ophthalmoscope • Fundus • Advanced skill

  30. Figure 15.16 Approaching the patient for the ophthalmoscopic exam.

  31. Figure 15.17 Examining the eye using the ophthalmoscope.

  32. Figure 15.18 Use of diopter to adjust for problems of refraction. A. In the emmetropic (normal) eye, light is focused properly on the retina, and the 0 diopter is used. B. In the myopic eye, light from a distant source converges to a focal point before reaching the retina. Negative diopter numbers are used. C. In the hyperopic eye, light from a near source converges to a focal point past the retina. Positive diopter numbers are used.

  33. Abnormal Findings • Vision • Eye movement • Internal and external structures

  34. Table 15.3 Abnormalities of the Eyelids continued on next slide

  35. Table 15.5 Abnormalities of the Fundus continued on next slide

  36. Figure 15.44 Cranial nerve III damage.

  37. Abnormal Findings • Disorders of visual acuity • Myopia • Hyperopia • Astigmatism • Familial condition • Refraction of light spread over a wide area rather than a distinct point on the retina • Presbyopia

  38. Abnormal Findings • Visual fields • Damage to the retina • Lesions in the optic nerve or chiasm • Increased intraocular pressure • Retinal vascular damage • Cardinal fields of gaze • Strabismus • Esophoria • Exophoria

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