ASSESSMENT OF EYE

1. JEEVA.D
NURSING TUTOR,
GANGA COLLEGE OF
NURSING,
COIMBATORE.

3. OUT LINE
 HISTORY COLLECTION
 PHYSICAL ASSESSMENT
 DIAGNOSTIC EVALUATION

4. HISTORY COLLECTION
1. Ocular History – The time and speed of onset, occular
associations.
2. Past Medical History- Previous Similar episodes.
3. Hereditary History / family history of eye disorders
4. Present History - Illness

5. PHYSICAL EXAMINATION
 EYE BROW
 Equal Hair distribution and alignment
 Symmetry
Skin quality
Movement

6. Surface Characteristics
Position in relation to the cornea
Ability to blink and frequency of blinking
Lesions/ edema/sty/signs of infection
Lid margin mark.
EYE LIDS

7. EYE LASHES
Even ness of distribution
Direction of curl
Signs of Infection/ Dandruff

8. CONJUCTIVA
 Observe for colour – Pale/ red
 Note any Discharge
Look for presence of follicles or papillae.
Look for foreign body embedded in that forenics or
hidden in folds.

9. SCLERA
 Gently pull the lower eyelid
downward and ask the patient to look
upward. In doing so can better
visualize the sclera and conjuctiva.
 Colour – white / yellow / bluish
pigmants
 Inflammation – Staphyloma,
Foreign body entraped.

10. CORNEA
Diameter - horizontal Dm – 11.75 mm /
Vertical DM – 11 mm.
 Shape - Corneal Curvature
 Surface – Ulceration / Abrasion /
Vascularization / Distortion
Transparency – Bright Shining, corneal edma
and opacity

11. CORNEAL REFLEX
It is also known as the Blink reflex. It is an
involuntary blinking of eyelids elicited by stimualtion
of the cornea, though could result from any periphral
stimulus. The reflex occurs at a rapid rate of 0.1
seconds.
Purpose
 To protect eye from foreign bodies and bright
lights.
 To know the sensing stimulus on the cornea.
(Neurologiucal Assessment)
 The reflex is areliable measure of afferent
trigeminal VI and efferent facial nerve VII.

12. IRIS
Similar appearance between eyes
Color of Iris.
Presence of Lesions / tears /
Laceration
Prolepses of Iris

13. PUPILS
Number of pupil – one or two
Location - centric or eccentric
Size – Normal is 2 to 4mm in Diameter in bright
light 4 to 8 mm in Diameter in the dark.
PERRLA – Pupils Equal Round Reactive to Light
and Accommodation.

14. PUPILARY DILATION TEST
An procedure that enables an eye cre professional to
see more of the retina, the lighy sensitive layer of tissue
at the back of the eye. Dilating the pupil permits the
retina to be examined for signs of diseases. To do this
drops are palced into the eye to dilate the pupil.
Purpose
•To examine the eye
•To prevent and to trreat the eye condition.
•To observe the optic nerve

15. OCCULAR MOVEMENS
 Ductions are monocular eye movements .
 Movement of the eye nasally is adduction:
 Temporal movement is abduction.
 Elevation and depression of the eye are termed.
sursumduction and deorsumduction.
 Intorsion is nasl rotaion of the vrtical meridian.
 Extorsion is temporal rotation of the vertical meridian.

16. VISUALACUITY TEST
It is an eye exam that checks how well you see the
dettails of letter or symbol from the specific distance.
For assessing distant vision –
1. Snellen test – the test uses a chart of letters or
symbols. The letters are different sizes and arrenged
in rows and colums. Viewed from 14 to 20 feet
distance by sitting or standing position.

17. VISUALACUITY TEST
2. Random E test – it is to identify the firection
of E letter is facing. The point in the direction
of letteris facing: up, down, left and right.
 For assessing near vision
 Jaegar Chart – it is an eye chart used in testing
near vision acuity. It is a card on which
paragraphs of text are printed, the card is held
14 inches from the persons eye for thretest

18. OTHER VISION TEST
COUNTING FINGER
HAND MOTION
LIGHT PERCEPTION
COVER TEST

19. COUNTING FINGER TEST
 The patient is ashed to gently occulate all the vision of the
eye with the palm of his hand and state at the nose of the
exmioner. The patient is then asked to count count fingers
the examinar is holdingar right anglesto the line of
periphral vision 1 to 3 feet.

20. HAND MOTIONS AND
LIGHT PERCEPTION
 Wave of hand in front of the eye and if the patient can see
your hand move. Distance visual acuity can be calculated
or tested.
 If the patient cannot see your hand waving then shine a
light in the patients eye, if the patient sees the light record
it as light perception.

21. COVER TEST
 It is a test used to determine if there is a heterotropia
or tropia, which is a manifest strabismus or
misalignment that is always present. The first eye is
covered for approximately 1-2 seconds.
 As this eye is covered, the uncovered eye is observed
for any shift in fixation.

23. OPTHALMOSCOPY
Definition
It is also called funduscopy. It is a test that allows a health
professional to see inside the fundus of the eye and other
structures using on opthalmoscope. It is done as part of
an eye examination and may be done as a part of routine
physical examination. It is crucial in determining the
health of retina , optic disc, and vitreous humor.
Types
Direct Opthalmosscopy – one that produces an upright,
or unreversed, image of approximately 15 times
magnification.
Indirect Opthalmoscopy – One that produces an
inverted, or reversed, image of 2 t0 5 times magnification.
Uses
To detect and evaluate retinal vascular diseases, swollen
optic discs, occular retinopathyand arterial hyper tension.

24. TONO METRY
 It is a procedure perform to
determine the intraoccular
pressure, the fluid pressure inside
the eye.
 It is an important test in the
evaluation of patients at risk from
glaucoma.
 Most tonometers are calibrated to
measure pressure in millimeters of
mercury.

25. TYPES OF TONOMETRY
 Goldmann Tonpometry
 Schiotz Tonometry
 Ectric Tonometry/ Tonopen
 Pnuemo Tonometry
 Perkins Handheld Tonometer
 Finger Tension
 Applanation method

26. SLIT LAMP EXAMIANTION
 It is also called optometry or opthalmology. It
allows the doctor to microscopically examine your
eyes for any abnormalities or problems.
Once you are in the examination chair, the doctor
will place an instrument in front of you on which to
rest your chin and forehead. This helps steady your
head for the exam.
Before the procedure administer yellow dye called
fluroescein, which will wash your tears and allow
pupils to dilate.
It helps to fine the diseases like macualr degeration,
retinal detachment, cataract, injury to the cornea and
blockage or obstructions of blood vessels in the eye.

27. CORNEAL TOPOGRAPHY
It is a computer assisted diagnostic tool that creates a three
dimensional map of the surface curvature of the cornea. It
can show problems with your eye’s surface, like swelling or
scaring or conditions such as astigmatism.
It is used to diagnose, monitor, and treat variious eye
condition
It is also used in fitting contact lensesand for planning
surgery, including laser vision correction.

28. REFRACTION TEST
It is usually given as part of a routine eye
examiantion. It amay aslo be called a vision test.
With this test doctor prescribe glasses or
contact lens.
Normally a value of 20/20 is considered to be
optimum or perfect vision
It used to diagnose astigmatism, hyepropia,
nyopia, presbyopia, macular degenaration, retinal
vessal occulasion, retinitis and retinal
detachment.

29. ULTRA SONOGRAPHY
It is placed against the front surface of the eye.
The ultrasound uses high frequency sound waves
that travel through the eye.
Reflections of the sound waves form a picture of
the structure of the eye. These test takes 15
minutes.
It uses to diagnose tumors, foreign body
substances, detachment of the retina, glaucoma,
cataract and lens implants.

30. FLUORESECIN ANGIOGRAPHY
FA is done by an opthalmologist
after a yellowish colored dye is
injected in avein , usually in your arm.
It takes about 10-15 seconds for the
dye to travel throughout your body.
As the dye passes through your
retina, a special camera takes
pictures.
It is used to diagnose macualr
edema, diabetic retinopathy, macualr
degenaration, macualr pucker and
occular melanoam.

31. INDOCYANINE GREEN
ANGIOGRAPHY

32. INDOCYANINE GREEN
ANGIOGRAPHY
 It is a water soluble tricarbocyanine dye with a
molecualr weight of775 daltons is injected IV .
 After that the infra red wavelenths passed through
the eye and it photographed with the sensitive
camera.
 It is used to acquire an angiogram of the choroid.
 It is helped to diagnose age related maculopathy,
retinopathy and inflammatory disorders.

33. PERIMETRY
It measures all areas of your eye sight,
including your side or peripheral ,vision.
To do the test you sit and look inside a
bowl shaped instrument called a
perimeter. While you state the centre of
the bowl, lights flah. You press a button
each time you see a flash. A computer
records the spot of each flash and if you
pressed the button when the light flashed
in that spot.
 It is used to find certain patterns of
vision loss, nerve damage and to treat
glaucoma.

34. COLOUR VISION TEST
 It is alsoknown as the ishihara test, measure your
ability to tell the difference among the colours.
 In this have to sit in the lit room, cover onr eye, and
tehn using the uncovered eye, look at a series of test
cards. Each card contains a multi colored dot pattern.
 It is used to detect color blindness, genetic disorder,
aging, and eye disease.

35. AMSLER GRID
It is a tool that eye doctors use
to detect visin problems resulting
from damage to the maculaor on
the optic nerve.
 Hold the chart at a comfortable
reading distance.
Cover one eye abd focus on the
black dot in the middle of the
grid.
Cover the other eye and repeat
the same.
It is used to detect vision
problems from the damage to the
macula.

36. TEAR DUCT EXAMINATION
This test measure show
quickly your tears are
draining. One drop of a
special dye is placed on the
surface of each dye. You
any have a blocked tear
duct if after five minutes
most of the dye is still on
the surface of your eye.

37. SCHIRMER TEAT TEST/
TEAR SECRETION TEST
 It determines whether the eye produces
enough tears to keep it moist. This test is
used when a person experiences very dry
eyes or excessive watering of the eyes.
The test done by placing the strip in the
lower eye lid.
 A negative (more than 10mm of
moisture on the filter paper in 5 minutes)
test result is normal. Both eyes normally
secrete the same amount of tears.
It is used to assess the tear production of
eyes.

38. GONIOSCOPY
 Using a goniolens together with a slit lamp or operating
microscope to view the iridocorneal angle, or the
anatomical angle formed between the eye’s cornea and
iris.
 It is important in diagnosing and monitoring various eye
conditions associated with glaucoma.

39. ORBITAL RADIO GRAPHY
Orbital x – ray or
radiography is an X-ray of
both left and right eye
sockets, to include the frontal
sinus and maxillary sinuses.
It is used to detect
fracuture or injury around the
orbit, and to detect foreign
objects

40. KERATO SCOPY
 It some times known as palcido’s disk, it is an
opthalmic instrument used to assess the shape of the
anterior surface of the cornea.
 A series concentric rings is projected onto the cornea
and their reflection viewed by the examiner through a
small hole in the centre of disk.
 It is used to measure the curvatue of the cornea,
particularly for assessing the extent and axis of
astigmatism.

41. RETINO SCOPE
 It is a technique to obtain an objective measurement
of the refractive error of a patient’s eyes. The examinr
uses a retinoscope to shine light into the patient’s eye
and observe the reflection off the patient’s retina.
 A handled instrument called a retinoscope projects a
beem light into the eye. When the light is moved
vertically and horizontally across the eye
 It is used to obtain an objective measurement of the
refractive error of a a ptient’s eye..

42. ELECTRO RETINO GRAPHY
It is an eye test that detects
function of the retina.
Electrodes are placed on the
surface of cornea or on the
skin beneath the eye to
measure retinal responses.
It used to detect retinitis,
macular degeneration,
retinoblastoma, retinal
detachment and cone rod
dystrophy

43. COLOUR FUNDUS
PHOTOGRAPHY
The fundus or inner lining
of the eye is photographed
with specially designed
cameras through the dilated
pupil.
It is used to record the
condition of these structure
in order to documents the
presence of disorders and
monitor their change over
time.

44. SUMMARY
 An eye examination is series of tests performed by an
opthalmologist or optometrist or optician for assessing
vision and ability to focus on and discern objects, as
well as other tests and examinations pertaining to the
eyes.
 Health care professionals often recommend that all
people should have a periodic and thorough eye
examinations as apart of routine primary care.