Eye and Ear Assessment by Sharon Kerr, MSN, RN Spring 2010
External Eye Exam Inspect for: • Symmetry • Discharge or lesions • Eyelids: blink, position (ptosis), swelling • Sclera: should be white (not red or yellow) • Cornea: assess for opacity or scratch • Conjunctiva: should be pink
External Eye Exam continued Pupil -- Check for response to: • Light • Accomodation • PERRLA
External Eye Exam continued Extraocular Muscle Function • Check eye movement through the six cardinal directions of gaze. • Watch for parallel movement • Nystagmus (involuntary rapid rhythmic movement)
Normal Anatomy of the Eye • Cornea: • clear layer covering the front of the eye. • works with the lens to focus images on the retina.
Normal Anatomy of the Eye • Retina • internal layer • receives and transmits focused images. • normally red due to its rich blood supply.
Retina • Can be seen with an ophthalmoscope • Allows the examiner to see through the pupil and lens to the retina • Called a funduscopic exam
Retina • Examination of fundus includes • Retina • Optic disc • Blood vessels.
Funduscopic Exam Ophalmoscope • Seated in a darkened room • Examiner projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball
Using the Ophalmoscope • Turn on and adjust to round beam of white light • Place scope light on dim setting • Set lens disc to 0 diopters (neutral) • Keep index finger on lens disc to adjust during examination
Approaching the patient • Right hand and right eye to pt. Right eye • Left hand and left eye to pt. Left eye • Hold opthalmoscope firmly against your bony orbit • Glasses off (both examiner and patient) • Contacts are OK
The examination • Have patient look over your shoulder and across the room at a specific point on the wall • From about 15 inches and 15 degrees lateral to the patient’s line of vision, shine the light beam on the pupil
Getting a closer look • Should see an orange glow (the red reflex – reflection of light off retina) • Move in on the 15 degree line toward the pupil , almost touching the patient’s lashes
Finding the optic disk • On NASAL side of each retina • Yellowish orange to creamy pink oval or round • Follow a blood vessel centrally until you see it
Inspecting the optic disk • Clarity – should have sharp margins • Symmetry of both eyes
Inspecting the retina • Visualize arteries and veins • Identify any lesions in retina • Red spots, streaks, light spots
Normal Anatomy of the Ear • external, middle, and inner structures. • eardrum and the three tiny bones conduct sound from the eardrum to the cochlea: malleus, incus, stapes
External Ear Exam • Symmetry, size, shape • Position: pinna level with corner of eye • Lesions • Drainage
Examine Auditory Acuity • Whisper two syllable word (out of view) • Weber Test: lateralization of sound.. • Rinne test: bone vs air conduction of sound
Normal Anatomy of the Ear • The tympanic membrane, or eardrum • separates the ear canal and the middle ear. • ossicles : can see the short process of the malleous, handle of the malleous, and the incus • There is a cone of light that is a reflection of the otoscope light
Otoscopic Examination • An otoscope • is an instrument used to look into the ear canal • ear speculum • a cone-shaped viewing piece of the otoscope) • Use largest size possible
Otoscopic Examination • Dim lights in room • Patient in sitting position • Pull ear up and back (down for kids) • SLOWLY insert otoscope into ear canal while looking into viewer
Otoscopic Landmarks • Tympanic membrane: should be intact, pearly gray, translucent, shiny • Cone of light: right side 4/5 o’clock; left side 7/8 o’clock • Malleus short process -- knob
Abnormal Findings: • Perforations • Bulging • Retraction • Blue ,red, or amber coloring • dullnss
Otoscopic Examination • The speculum is angled slightly toward the person's nose to follow the canal. • A light beam extends beyond the viewing tip of the speculum. • The otoscope is gently moved to different angles to view the canal walls and eardrum.
That’s all folk’s The End