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Eye and Ear Assessment
Eye and Ear Assessment

by Sharon Kerr, MSN, RN Spring 2010

Normal Anatomy of the Eye
Normal Anatomy of the Eye
External Eye Exam
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
External Eye Exam continued

Pupil -- Check for response to:

  • Light

  • Accomodation

  • PERRLA

External Eye Exam continued
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
Normal Anatomy of the Eye
Normal Anatomy of the Eye  Cornea:  clear layer covering the front 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
Normal Anatomy of the Eye
Normal Anatomy of the Eye  Retina  internal layer  receives and transmits focused images.
  • Retina

    • internal layer

    • receives and transmits focused images.

    • normally red due to its rich blood supply.

Retina
Retina
Retina  Can be seen with an ophthalmoscope  Allows the examiner to see through the
  • Can be seen with an ophthalmoscope

  • Allows the examiner to see through the

pupil and lens to the

retina

  • Called a funduscopic exam

Retina
Retina
Retina  Examination of fundus includes  Retina  Optic disc  Blood vessels.
  • Examination of fundus includes

    • Retina

    • Optic disc

    • Blood vessels.

Funduscopic Exam

Ophalmoscope
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
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
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
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
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
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
Inspecting the optic disk
  • Clarity should have sharp margins

  • Symmetry of both eyes

Inspecting the retina
Inspecting the retina
  • Visualize arteries and veins

  • Identify any lesions in retina

    • Red spots, streaks, light spots

Normal Anatomy of the Ear
Normal Anatomy of the Ear
Normal Anatomy of the Ear  external, middle, and inner structures.  eardrum and the three
  • 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
External Ear Exam
  • Symmetry, size, shape

  • Position: pinna level with corner of eye

  • Lesions

  • Drainage

Examine Auditory Acuity
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
Normal Anatomy of the Ear
Normal Anatomy of the Ear  The tympanic membrane, or eardrum  separates the ear canal
  • 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
Otoscopic Examination
Otoscopic Examination  An otoscope  is an instrument used to look into the ear canal
  • 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
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
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:
Abnormal Findings:
  • Perforations

  • Bulging

  • Retraction

  • Blue ,red, or amber coloring

  • dullnss

Otoscopic Examination
Otoscopic Examination
Otoscopic Examination  The speculum is angled slightly toward the person's nose to follow the canal.
  • 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
That’s all folk’s

The End