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Eyes. External Anatomy. Sensory Organ for vision -Situated in bony, orbital cavity for protection Eyelids= shades that add protection form injury, strong light , dust Eyelashes= hairs to filter dust & dirt. External Anatomy. External Anatomy. Limbus – border b/t the cornea & sclera

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external anatomy
External Anatomy
  • Sensory Organ for vision

-Situated in bony, orbital cavity for protection

    • Eyelids= shades that add protection form injury, strong light , dust
    • Eyelashes= hairs to filter dust & dirt
slide3

External Anatomy

External Anatomy

slide4
Limbus – border b/t the cornea & sclera
  • Palpebral fissures – elliptical open space b/t lids
  • Canthus- corners of the eye where the lids meet, inner & outer
  • Caruncle – sm. Fleshy mass containing sebaceous glands at inner canthus
slide5
Within the upper eyelid
    • Tarsal plates, connective tissue gives upper lid shape
    • Meibomian glands, in the plates, lubricate the lids, stops overflow of tears, airtight seal when lids closed
slide6
Exposed part of the eye
    • Conjunctiva, folded envelope b/t eyelids & eyeball
      • thin mucous membrane, transparent protective covering of the exposed part of the eye.
      • Palpebral conjunctiva lines the lids, is clear but has sm .bld. Vessels
      • Bulbar conjunctiva is over eyeball, white sclera show through, merges at limbus with cornea
slide9
Lacrimal apparatus – irrigates conjunctiva & cornea
    • 3 parts
      • Lacrimal gland, upper, outer corner of eye = tears
      • Puncta= inner canthus, tear drainage
      • Nasolacrimal duct= allows tears to drain from puncta to nasolacrimal sac. Tears then empty into the inferior meatus of the nose
extraoccular muscles
Extraoccular muscles
  • 6 muscles
    • Attach eyeball to orbit
    • Straight and rotary movement
    • Four straight muscles
      • Superior rectus
      • Inferior rectus
      • Lateral rectus
      • Medial rectus
slide12
Two slanting/ oblique muscles
    • Superior
    • Inferior

Humans have a Binocular, single – image visual system – Eyes normally move as a pair

slide13
Eye movement stimulated by Cranial Nerves
    • III Oculomotor
    • IV Trochlear
    • VI Abducens
internal anatomy
Internal Anatomy
  • The eye has 3 layers, the outer & inner layer can be viewed using opthalmascope
      • Sclera (outer layer) tough, protective, white covering connects with the -
        • Cornea – transparent, protects pupil & iris – helps focus light on retina
slide17
Middle layer
    • Choroid – dark pigmentation to prevent internal light reflection, supplies bld. to retina
    • Pupil – PERRLA
    • Lens – biconvex disc, transparent, thickness controlled by ciliary body, bulges = near; flattens = distant
    • Anterior chamber – posterior to cornea, anterior to iris & lens, has aqueous humor supplies nutrients & drains wastes
slide18
Inner layer – Retina – visual receptive layer – light waves changed to nerve impulses
    • Retinal structures
      • Optic disc – retinal fibers meet & form optic nerve, nasal side of retina, creamy yellow orange to pink, round or oval shape, physiologic cup inside the disc for bld.vessels to enter & exit
      • Retina vessels – paired arteries & veins
slide19
Macula – temporal side of fundus, darker pigmented region, surround the fovea centralis
  • Fovea Centralis- area of sharpest & keenest vision, Very sensitive to light
visual pathways fields
Visual Pathways & Fields
  • Objects reflect light
  • Rays refracted by cornea, aqueous humor, lens, vitreous body and onto retina.
  • Light stimulus is changed to nerve impulses, travel thru optic nerve to visual cortex in occipital lobe
  • Image on retina is upside down & reversed. At the optic chiasm retinal fibers cross over. Right side of brain looks at left side of world.
visual reflexes
Visual reflexes
  • Pupillary light reflex – bright light = constriction
    • Direct light reflex
    • Consensual light reflex
  • Fixation – ability to track an object & keep image on the fovea, can be impaired by drugs, alcohol, fatigue & inattention
  • Accomodation – for near vision = pupil constriction & convergence of eyes
subjective data
Subjective data
  • Vision difficulty
  • Pain
  • Strabismus, diplopia
  • Redness, swelling
  • Watering, discharge
  • Past history ocular problems
  • Glaucoma
slide27
Glasses/ contacts
  • Medications
  • Vision loss- coping mechanisms
  • Self–care behaviors
objective data the physical exam
Objective data The Physical Exam
  • Preparation
    • Position- sitting, head at eye level
  • Equipment
    • Snellen eye chart- visual acuity
    • Handheld visual screener-near vision
    • Opaque card
    • Penlight
    • Applicator stick
    • Ophthalmoscope
test visual acuity snellen eye chart
Test visual acuitySnellen eye chart
  • Stand 20 ft. from chart
  • Glasses / contacts (Document )
  • Remove eye wear, retest
  • Normal visual acuity is 20/20 – top # is distance person is standing from the chart
  • Vision 20/30 refer to opthalmologist or optometrist
  • If unable to see largest letters, move to 10 feet – record as 10/200
test for near vision
Test for near vision
  • Vision screener
  • People > 40yrs or difficulty reading
  • Test each eye with glasses
  • Hold card 14in. from eyes
  • Normal result 14 / 14
  • Test using any available reading material if no card available
slide31
Presbyopia is a normal physiological change in near vision occurs with aging = note if the person moves the card farther away
test visual fields confrontation test
Test visual fieldsConfrontation test
  • Compares peripheral vision with a tester who has normal peripheral vision
  • 2 ft. apart, eye level
  • Tester & client cover opposite eyes
  • Tester advances finger in the periphery
    • Superiorly ( 50 degrees )
    • Inferiorly ( 70 degrees )
    • Temporally ( 90 degrees )
inspect extraoccular muscle function
Inspect Extraoccular Muscle Function
  • Corneal light reflex
  • Cover test
  • Diagnostic positions test
    • 6 Cardinal Positions of Gaze
inspect extraocular muscle function
Inspect Extraocular Muscle Function
  • Corneal Light Reflex ( The Hirschberg Test) assesses parallel eye alignment
    • Shine light toward person’s eyes
    • Tell to stare directly ahead
    • Hold light 12 in. away
    • Light should reflect on both corneas in same spot
slide36
Cover Test- detects deviated alignment
    • Stare straight at examiner’s nose
    • Cover 1 eye of the person being examined with opaque card
    • Normally the uncovered eye should maintain a steady, fixed gaze
    • Covered eye- should stare straight ahead when covered & then uncovered. If muscle weakness exists the covered eye will relax and then jump to fixed position when uncovered..
diagnostic positions test
Diagnostic Positions Test
  • 6 cardinal positions of gaze –
    • Determines muscle weakness during movement
    • Person must hold head steady
    • Follow movement of object (examiner’s finger, pen etc) only with eyes
    • Hold object 12 in. from person
    • Move thru each position, clockwise, hold , then back to center
    • Normal response= parallel tracking with both eyes
slide39
During this test be aware of Nystagmus-fine jerky movement seen around the iris
  • Mild nystagmus in extreme lateral gaze is normal but not normal in any other position
inspect external structures
Inspect External Structures
  • General – movement & facial expression (squinting?)
  • Eyebrows – 2(bilateral), symmetrical (look the same; move the same)
  • Eyelids & Lashes – present, approximate when closed, no redness, swelling, discharge, lesions?
  • Eyeballs- alignment, ? Protrusion? Sunken?
  • Conjunctiva & Sclera – moist, glossy, clear, white sclera
slide41
Eversion of the upper eyelid FYI – we will not do this examine in lab see pg. 312 for technique – usually done for complaint of eye pain due to foreign body
slide44
Lacrimal Apparatus
    • Person looks down
    • Using thumbs, slide outer part of upper lid along bony orbit
    • Note redness or swelling
    • Press index finger against lacrimal sac at inner canthus
    • Normal response is slight eversion of lower lid, no tearing or discharge
anterior eyeball structures
Anterior Eyeball Structures
  • Cornea & lens
  • Iris & pupil
    • Size & shape
    • Pupillary light reflex
    • Accommodation
cornea lens
Cornea & Lens
  • Shine light from side across cornea
  • Check smoothness, clarity
  • Normally no opacities
iris and pupil
Iris and Pupil
  • Iris = flat, round, regular, even color bilaterally.
  • Pupils = PERRLA
    • Resting size norm = 3-5mm
    • 5% population have pupils of 2 diff. Sizes called Anisocoria
slide49
Pupillary Light Reflex
    • Darken room
    • Person gazes straight ahead
    • Advance light from the side
      • Direct light reflex
      • Consensual light reflex
    • Measure pupil size before & after light reflex
    • Measurement R3/1 L3/1 =both pupils measure 3mm in resting state & 1mm with light
slide50
Accomodation
    • focus on distant object -dilatation of pupils
    • Shift gaze to near object – pupils constrict & converge
  • Record the normal response to these tests as
  • PERRLA = Pupils Equal, Round, React to Light and Accomodation
ocular fundus internal surface of retina
Ocular Fundus (internal surface of retina)
  • Use Opthalmoscope- try keeping both eyes open- practice looking at a ring on your finger. Become familiar with the instrument before you examine your partner’s eyes
slide52
Diopter of opthalmoscope
    • Black numbers = +diopter, focus on near objects
    • Red numbers = - diopter, focus on further objects
  • Use ophthalmoscope in darkened room = dilates pupils
slide53
Remove examiner’s and person’s eyeglasses but contact lenses may be left in.
  • Select lg. White aperture light
  • Person should focus on a distant object and try & remain still
  • Examiner hold ophthalmoscope in Right hand to right eye to eamine person’s right eye
slide54
Begin 10in away at 150 lateralangle & advance
  • Keep sight of red reflex
  • Adjust lens to +6 as you advance till your foreheads almost touch. Adjust diopter to focus.
    • Normal vision set at 0. Nearsighted use red #s. Farsighted use black.
retinal background
Retinal background
  • Light – dark red normally
  • Note Lesions
    • Size, shape, color, distribution
macula fovea centralis
Macula & Fovea Centralis
  • Last in Funduscopic exam
    • 1 DD in size
    • Darker than rest of fundus
    • Foveal light reflex
    • Exam last
read aging developmental considerations

Read Aging & Developmental Considerations

Review Abnormalities of the Eyes

3 most common causes of decreased visual functioning in the older adult
3 most common causes of decreased visual functioning in the older adult
  • Cataract (lens opacity)
  • Glaucoma (increased ocular pressure) = loss of peripheral vision
  • Macular degeneration (breakdown of cells in the macula lutea) = loss of central vision