Physical Assessment

Objectives
 At the end of the discussion the
participants will be able to:
– identify the structures of the eyes
– describe normal findings in the physical
assessment of the eyes
– describe common abnormalities found in
the physical assessment of the eyes
– perform the physical assessment of the
eyes
Assessing the Eye Structures and Visual
Acuity

The Windows of the SOUL

Looking Through the Eyes of Every
Patient
 Anatomy of the Eye

Anatomical
structures:
Conjunctiva
Sclera
Pupil
Iris
Lacrimal
gland
Lens
Cornea
 Equipments
 Opthalmoscope

 Penlight

 Clean gloves
 Equipments
 Snellen Chart, E Chart, Rosenbaum
near vision pocket screening card
 Vision occluder

 Cotton tip applicator

Assessing the Eye Structures and Visual
Acuity
Examination of the eyes includes:
2. Assessment of external structures
3. Visual acuity
4. Visual fields
Eye Ailments:
 Myopia, hyperopia, presbyopia, astigmatism
 Conjunctivitis, dacryocystitis,hordeolum, iritis
 Cataracts, glaucoma
 Ectropion, entropion
 Mydriasis, miosis
Assessing the Eye Structures and Visual
Acuity
1. Inquire if the client has any history
of the following:
 Family history of diabetes, hypertension,
blood dyscrasia, or eye disease, injury or
surgery
 Client’s last visit to opthalmologist
 Current use of eye medications
 Use of contact lenses or eyeglasses,
hygienic practices for corrective lenses
 Current symptoms of eye problems
Assessing the Eye Structures and Visual
Acuity
2. Inspect the eyebrows
for hair distribution
and alignment
3. Inspect the eyelashes
for evenness of
distribution and
distribution of curl
4. Inspect the eyelids
for surface
characteristics,
position in relation to
the cornea, ability to
blink
 Assessing the Eye Structures and Visual
Acuity
5. Inspect the color of the bulbar
conjunctiva for color, texture,
and presence of lesions
6. Inspect the palpebral
conjuctiva by everting the lids
7. Evert the upper lids if a
problem is suspected
8. Inspect and palpate the
lacrimal gland
9. Inspect and palpate the
lacrimal sac and nasolacrimal
duct
Assessing the Eye Structures and Visual
Acuity
10. Inspect the cornea
for clarity and texture
11. Perform the corneal
sensitivity test
12. Inspect the anterior
chamber for
transparency and
depth
13. Inspect the pupils,
shape and symmetry
of size
 Assessing the Eye Structures and Visual
Acuity
14. Assess each pupil’s
direct and
consensual reaction
to light

Move penlight from the

side of the client’s face to
eye

Shine penlight into the eye and 15. Assess each

observe response of the opposite pupil’s reaction to
pupil accomodation
 Extraocular Muscle Tests
16. Assess six ocular
movements to
determine eye
alignment and
coordination

Stand directly in front of the client

and hold the penlight at a
comfortable distance, 30cm (1ft)

Ask the client to hold

the head in a fixed
position facing you
 Extraocular Muscle Tests
Move the penlight
in a slow 2. Lateral
orderly manner Rectus, CN VI
through the six
cardinal fields of
gaze.

3. Inferior
Rectus, CN III

1. Superior Rectus,CN
III
 Extraocular Muscle Tests

5. Medial 6. Inferior
Rectus, CN III Oblique, CN III

4. Superior Stop the movement of penlight

Oblique, CN IV periodically so that nystagmus
can be dtected
 Extraocular Muscle Tests
Hirschberg Test: Assess for location of
light reflex by shining penlight on
pupil in corneal reflex

Cover test:
• Have client fixate on a near or far
object
• Cover one eye and observe for
movement in the uncovered eye
 Visual Acuity
 Assess near vision :
Ask the client to read
from a magazine or
newspaper held at a
distance of 36 cm (14
in)
• a Rosenbaum eye chart
may be used
 Assess distance vision
• A Snellen or character
chart will be used
 Visual Acuity
• Stand at 6m (20ft) from
the chart
• Take 3 readings: right
eye, left eye, both eyes
• Record the readings of
each eye and both eyes
• If the client is unable to
see even the top line of
the chart, perform
functional vision tests
(light perception, hand
movements, counting
fingers)
 Lifespan Considerations
• Visual acuity is about 20/300 at 4
months and progressively improves
• Preschool children’s acuity can be
checked with picture cards or the E chart
• Acuity should approach 20/20 by 6 years
of age
• Visual acuity of elders decreases,
becomes more opaque and loses
elasticity
• Peripheral vision of elders diminishes
• Arcus senilis is common
 References
 Kozier & Erb’s, (2008) Fundamentals of
Nursing, 4th Edition, Volume II
 Ellis, (2003) Basic Nursing Skills, 2nd
Edition, Volume II
 Daniel’s, (2007) Fundamental’s of Nursing,
Volume I
 Health Assessment, (2008), 8th Edition, p
341-370
 Delmar Learning – Audio Visual
 www.imageask.com