Assessment of Eyes

Assessment of the eyes should be completed as part of a comprehensive client assessment or as part of a focused exam when a client is experiencing ocular issues, such as eye pain or blurred vision.

This assessment gives the nurse information about vision and general eye health while helping to identify ocular problems at an early stage, such as glaucoma or cataracts.

Assessment of the eyes includes several tests which will examine the eye itself as well as screen for ocular diseases or systemic diseases that manifest through the eye, like diabetes or liver disease.

Let’s review the process of completing an eye assessment.Okay, the supplies you’ll need for the eye assessment include a Snellen or Sloan chart, a Rosenbaum or Jaeger near vision card, a penlight, and an eye cover.

You should prepare for the eye exam by ensuring you have adequate light, and that your client is comfortable in either a standing or sitting position.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent.

Then, perform hand hygiene and collect your supplies.Now, locating the anatomical landmarks of the eyes and surrounding tissue will help guide your assessment.

These landmarks include the upper eyelids and lower eyelids, eyebrows, the inner canthus and the outer canthus, pupil, lacrimal sac, conjunctival sac, and iris.

Alright, the methods of ocular assessment include inspection and palpation as well as a series of visual tests.First, you should inspect the external eyes and the surrounding structures, starting at the eyebrows and moving downward.

Eyelashes and eyebrows should be evenly distributed. Eyelids should be able to close and open all the way, and upper eyelids should extend equally over both eyes.

If an upper eyelid droops and partially covers the eye, ptosis is present, which may be due to neuromuscular weakness from conditions such as myasthenia gravis or damage to cranial nerve III.The surrounding structures of the eyes should be without edema, puffiness, lesions, drainage or nodules.

Raised, misshaped, yellow lesions on the surrounding eye tissue, called xanthelasma, may indicate abnormal lipid metabolism.

You’ll also inspect the sclera and conjunctiva for redness and vascularity. The sclera should normally be white but it can appear yellow in clients with liver disease.

The conjunctiva should be translucent, but can become pinkish-red in clients with conjunctivitis. The iris should be round with an even distribution of color.

When shining your penlight into the eye, the lens should be transparent; but if it appears cloudy, this can indicate cataracts.Next, assess your client’s pupils.

Both pupils should be round and of equal size bilaterally. To test for the pupillary reaction to light, turn down the lights to allow the pupils to dilate.

Then, shine your penlight directly into one eye, observing for constriction of the pupil. At the same time, assess for a consensual response, meaning, the opposite eye will also constrict along with the illuminated pupil.

Repeat this assessment on the other eye. There are several abnormalities that can arise with the pupil, such as miosis, where the pupils are abnormally constricted which can result from taking opioids, or anisocoria, where the pupils are unequal, which can be a normal finding, but can also be related to several diseases.The strength of the extraocular muscles and the function of cranial nerves III, IV, and VI is tested by checking the movement of the six extraocular muscles.

To do this, ask your client to keep their head still while they follow your finger with their eyes as you move through the six cardinal fields of gaze.

During the test, observe for smooth, symmetrical movement of the eyes. Be sure to stop for 1 to 2 seconds at each extreme of gaze to observe for nystagmus, or a repetitive jerky eye movement, which can be a normal finding or an indication of a weakness in the extraocular muscles.

The strength of the extraocular muscles can be further checked by performing the cover-uncover test. To do this test, ask your client to look ahead at a fixed point while you cover one of the eyes.

The uncovered eye should stay focused on the fixed point. Then remove the cover from the covered eye.

The gaze of the newly uncovered eye should remain steady. Repeat this procedure on the other eye.

An abnormal finding during testing is strabismus, where one eye deviates to the middle due to weakened extraocular muscles.Next, you can palpate the eyelids and surrounding tissues for nodules, discomfort, and warmth.

Upon palpation, the eyes should be equally soft, and can be gently pushed into the orbit with no discomfort.An eye that feels firm or resistant to palpation could indicate glaucoma or a tumor.Okay, moving on to special techniques for eye assessment.

You can test the function of cranial nerve II by assessing your client’s visual acuity. Using a Snellen or Sloan chart, ask your client to stand 20 feet or 6 meters away from the chart.

Then, ask your client to cover one eye, and read the letters on the lines until the letters become too small for them to read.

Repeat with the other eye. You’ll record their visual acuity as a fraction, where the numerator indicates the distance your client is from the chart, and the denominator indicates the distance at which a normal eye can read the line on the chart.

For example, 20/25 vision means that the client can read at 20 feet what the average client can read at 25 feet. In other words, the larger the denominator, the worse the vision.

Vision that’s not able to be corrected to better than 20/200 means the client is legally blind. Finally, near vision can be assessed using a handheld card, such as the Rosenbaum or Jaeger pocket screening card, held about 14 inches or 35 centimeters from the eyes.

Then, ask your client to read the numbers or letters, just like they did with the Snellen chart, until the numbers or letters become too small for them to read.As the nurse, it’s your responsibility to correctly assess, interpret, report, and document findings.

If your assessment reveals something that is potentially abnormal or emergent, such as severe eye pain or inflammation, you should report this immediately to the healthcare provider, while continuing to monitor your client’s progress or changes from baseline.Alright, as a quick recap… Assessment of the eyes gives the nurse information about vision and general eye health while helping to identify ocular problems at an early stage.

Supplies needed for the eye assessment include a Snellen or Sloan chart, a Rosenbaum or Jaeger near vision card, a penlight, and eye cover.

The methods of ocular assessment include inspection and palpation as well as a series of visual tests. As the nurse, it’s your responsibility to correctly assess, interpret, report, and document your assessment findings.