4.

ASSESSMENT OF THE EYES

 3. EYES

INSPECTION : INSPECT
1. EYEBALLS FOR PROTRUSION
2. PALPEBRAL FISSURES ( LONGITUDINAL OPENINGS
BETWEEN THE EYELIDS)- FOR WIDTH AND SYMMETRY.
3. LID MARGINS- FOR SCALING, SECRETIONS, ERYTHEMA
( REDNESS ), POSITION OF LASHES.
 INSPECTION OF THE EYES

4. BULBAR AND PALPEBRAL CONJUNCTIVAE-

FOR CONGESTION AND COLOR.
 BULBAR CONJUNCTIVA- MEMBRANOUS COVERING OF THE
SCLERA. CONTAINS BLOOD VESSELS.
 PALPEBRAL CONJUNCTIVA- MEMBRANOUS COVERING OF THE
INSIDE OF THE UPPER AND LOWER LIDS. CONTAIN BLOOD
VESSELS.
 INSPECTION OF THE EYE
5. SCLERA – FOR COLOR, IRIS- FOR COLOR
6. PUPILS – FOR SIZE, SHAPE, SYMMETRY, REACTION TO
LIGHT AND ACCOMMODATION ( ABILITY OF THE LENS TO
ADJUST TO OBJECTS AT VARYING DISTANCE.
• NORMAL PUPIL SIZE IN ADULTS VARIES FROM 2 TO 4 MM IN
DIAMETER IN BRIGHT LIGHT TO 4 TO 8 MM IN THE DARK.
• THE PUPILS ARE GENERALLY EQUAL IN SIZE.
• THEY CONSTRICT TO DIRECT ILLUMINATION (DIRECT
RESPONSE) AND
• TO ILLUMINATION OF THE OPPOSITE EYE (CONSENSUAL
RESPONSE).
• THE PUPIL DILATES IN THE DARK.
ABNORMALITIES IN SIZE AND SHAPE OF PUPILS
 INSPECTION OF THE EYES
7. EYE MOVEMENT – EXTRA OCULAR MUSCLES(6 CARDINAL
POSITIONS- CRANIAL NERVES III,IV,VI), NYSTAGMUS,
CONVERGENCE.
 NYSTAGMUS : RAPID LATERAL, HORIZONTAL,
OR ROTARY
MOVEMENT OF THE EYE.
 CONVERGENCE : ABILITY OF THE EYE TO
TURN IN AND FOCUS ON A VERY CLOSE OBJECT.
CONVERGENCE : COORDINATED MOVEMENT OF THE
EYES
EYE MOVEMENT
 INSPECTION OF THE EYES

8. VISUAL ACUITY –
CHECK WITH A SNELLEN CHART
 THE SNELLEN’S EYE CHART
- THE SNELLEN ALPHABET CHART IS USED TO MEASURE
VISUAL ACUITY. HAS LINES OF LETTERS ARRANGED IN
DECREASING SIZE.
 SNELLEN CHART

 PATIENT : 2O FEET AWAY FROM THE CHART.

 COVER ONE EYE WITH OPAQUE CARD
 TEST RIGHT EYE FIRST , THEN THE LEFT EYE.
 IF PATIENT IS WITH EYEGLASSES OR CONTACT LENSES,
LEAVE THEM ON. REMOVE READING GLASSES, WILL BLUR
DISTANCE VISION.
 SNELLEN CHART
 ASK PATIENT TO READ THROUGH THE
CHART TO THE SMALLEST LINE POSSIBLE.
 IF UNABLE TO READ : USE SNELLEN PICTURE CHART
 RECORD RESULT USING NUMERIC FRACTION .
 INDICATE IF THERE ARE MISSING LETTERS, IF CORRECTIVE
LENSES ARE WORN.
 EXAMPLE : “O.D.” 20/30-2 WITH GLASSES. (O.D.(OCULUS
DEXTRUS) RIGHT EYE)..”OS”(OCULUS SINISTER) LEFT EYE, “OU”
OCULUS UTERQUE) BOTH EYES
 NORMAL FINDINGS
• NORMAL RESULT OF THE SNELLEN TEST IS 20/20( NORMAL
VISION)
• NUMERATOR : INDICATES DISTANCE PATIENT FROM THE
CHART
• DENOMINATOR : INDICATES DISTANCE AT WHICH A
NORMAL EYE CAN READ THE LETTER.
NOTE : HESITANCY, SQUINTING, LEANING FORWARD,
MISREADING LETTERS- INDICATE DECREASED VISUAL ACUITY.
 NORMAL FINDINGS
1. NO PROTRUSION OF EYEBALLS( PROTRUSION INDICATES
EXOPHTHALMOS A MANIFESTATION OF HYPERTHYROIDISM).
2. PALPEBRAL FISSURES – APPEAR EQUAL IN SIZE WHEN EYES ARE
OPEN, UPPER LID – COVERS A SMALL PORTION OF THE IRIS AND
CORNEA, LOWER LID – MARGIN IS JUST BELOW THE JUNCTION
OF THE CORNEA AND SCLERA.
NO PTOSIS.
 NORMAL FINDINGS

3. LID MARGINS – CLEAR, LACRIMAL DUCT OPENINGS ARE

EVIDENT AT THE NASAL ENDS OF THE UPPER AND LOWER
LIDS.
 EYE LASHES- EVENLY DISTRIBUTED AND TURN OUTWARD.
 NORMAL FINDINGS
4. BULBAR CONJUNCTIVA ( COVER OF THE SCLERA)-
CONSISTS OF TRANSPARENT RED VESSELS, (WHICH MAY
BECOME DILATED AND PRODUCE THE CHARACTERISTIC
“BLOODSHOT” EYE).
-PALPEBRAL CONJUNCTIVA- ARE PINK AND CLEAR(
CONJUNCTIVITIS)
 NORMAL FINDINGS

5. SCLERA – WHITE AND CLEAR

6. PUPILS – NORMALLY CONSTRICT WITH INCREASING
LIGHT AND ACCOMMODATION.
NORMALLY ARE ROUND, 3 TO 5MM IN SIZE
PERRLA : PUPILS EQUAL, ROUND, REACTIVE TO LIGHT,
ACCOMMODATION). PINPOINT AND DILATED PUPILS
INDICATE NEUROLOGIC PROBLEMS0.
 NORMAL FINDINGS
7. EXTRAOCULAR MOVEMENT – MOVEMENT OF THE EYE IN
CONJUGATE FASHION, EXCEPT WHEN CONVERGING ON
AN OBJECT THAT IS MOVING CLOSER.
 NYSTAGMUS- RESULTS FROM EYE FATIGUE
 CONVERGENCE – FAILS IF WITH DOUBLE VISION
 PERIPHERAL VISION IS FULL IN BOTH EYES.
 ABNORMAL FINDINGS
1. PHOTOPHOBIA- INABILITY TO TOLERATE LIGHT
2. STRABISMUS- ALSO CALLED SQUINTING
3. DIPLOPIA – DOUBLE VISION
4. LACRIMATION- TEARING
5. SCOTOMA- BLIND SPOT IN THE VISUAL FIELD
6. MYOPIA- NEARSIGHTEDNESS
7. HYPEROPIA- FARSIGHTEDNESS
 ABNORMAL FINDINGS
8. PRESBYOPIA – LOSS OF ACCOMMODATION
DUE TO OLD AGE
9. NYSTAGMUS – ROLLING OF THE EYEBALLS
10. PTOSIS- DROOPING OF THE UPPER EYELID
12. ECTROPION- LOWER EYELID ROLLED UPWARD
13. ENTROPION – LOWER EYELID ROLLED INWARD
14. EXOPHTHALMOS- PROTRUDING EYEBALLS
15. ENOPTHALMOS- SUNKEN EYES
 ASSESSING VISUAL FIELDS
• A VISUAL FIELD TEST
• IS AN EYE EXAMINATION THAT CAN DETECT DYSFUNCTION
IN CENTRAL AND PERIPHERAL VISION
• WHICH MAY BE CAUSED BY VARIOUS MEDICAL
CONDITIONS SUCH AS GLAUCOMA, STROKE, PITUITARY
DISEASE, BRAIN TUMORS OR OTHER NEUROLOGICAL
DEFICIT
 VISUAL FIELDS
1. SIT OR STAND APPROXIMATELY 2 TO 3 FEET AWAY AND OPPOSITE
PATIENT , WITH SAME EYE LEVEL
2. HAVE PATIENT COVER RIGHT EYE WITH RIGHT HAND
3. COVER YOUR LEFT EYE
4. HAVE PATIENT LOOK AT YOUR UNCOVERED EYE
5. HOLD YOUR FREE HAND AT ARM’S LENGTH
6. MOVE HAND / OR WITH AN OBJECT ( PEN ) INTO YOUR AND
PATIENT’S FIELD OF VISION FROM NASAL , TEMPORAL, SUPERIOR,
INFERIOR, AND OBLIQUE ANGLES.
7. REPEAT PROCEDURE ON THE OTHER EYE.