EYE ASSESSMENT

Subjective Data

 Describe any recent visual difficulties or changes in your vision that you have experienced. Were
they sudden or gradual?
Rationale: Sudden changes in vision are associated with acute problems such as head trauma or
increased intracranial pressure.
Gradual changes in vision may be related to aging, diabetes, hypertension or neurologic
disorders.
 Do you see spots or floaters in front of your eyes?
Rationale: Spots and floaters are common among clients with myopia or in clients over age 40. They
are due to normal physiologic changes in the eye associated with aging and require no intervention.
 Do you experience blind spots? Are they constant or intermittent?
Rationale: A scotoma is a blind spot that is surrounded by either normal or slightly diminished
peripheral vision. It may be from glaucoma.
Intermittent blind spots may be associated with vascular spasms (ophthalmic migraines)
or pressure on the nerve by a tumor or increased intracranial pressure.
Consistent blind spots may indicate retinal detachment.
Any report of a blind spot requires immediate attention and referral to an
ophthalmologist.
 Do you see halos or rings around lights?
Rationale: Seeing these is associated with narrow-angle glaucoma.
 Do you have trouble seeing at night?
Rationale: Night blindness is associated with optic atrophy, glaucoma and vitamin A deficiency.
 Do you experience double vision?
Rationale: Double vision, called as diplopia, may indicate increased intracranial pressure due to
injury or a tumor.
 Do you have any eye itching or pain? Do you have pain with bright lights?
Rationale: Burning or itching pain is usually associated with allergies or superficial irritation.
Throbbing, stabbing or deep, aching pain suggests a foreign body in the eye or changes
within the eye.
Most common eye disorders are not associated with actual pain.
Photophobia – pain or sensitive with bright lights.
 Do you have any redness or swelling in your eyes?
Rationale: Redness or swelling of the eye is usually related to an inflammatory response cause by
allergy, foreign body, or bacterial or viral infection.
 Do you experience excessive tearing or watering of the eye? If so, is it in one or both eyes?
Rationale: Excessive tearing, called as epiphora, is caused by exposure to irritants or obstruction of
the lacrimal apparatus.
Unilateral epiphora is often associated with foreign body or obstruction.
Bilateral epiphora is often associated with exposure to irritants, such as make up or facial
cleansers, or it may be a systemic response.
 Have you had any eye discharge? Describe.
Rationale: Discharge other than tears from one or both eyes suggest a bacterial or viral infection.
 Have you ever had problems with your eyes or vision?
Rationale: It provides clues to the current health of the eye.
 Have you ever had eye surgery?
Rationale: It may alter the appearance of the eye and the results of the future examinations.
 Describe any treatments you have received for eye problems such as medication, surgery, laser
treatments, corrective lenses. Were they successful? Were you satisfied?
Rationale: Client may not be satisfied with past treatments for vision problems.
 What types of medications do you take?
Rationale: Some medications reported to have ocular side effects.

Alpha-1 blockers antiarrhythmics anticoagulants antimalarials

anticholinergics (antihistamines, antipsychotics, antidepressants) bisphosphonates

digoxin corticosteroids erectile dysfunction medications fluoroquinolones

some other antibiotics

 When was your last eye examination?
Rationale: All clients at risk for eye problem should be examined annually or as recommended by
their primary care provide.
For ages 18-60 – Eye examination is recommended for healthy clients every 2years.
For ages 61 and older – annual check-up is recommended.
 Do you perform the test for macular degeneration using the Amsler chart? How do you use this
chart and how often? What do you see when you see it?
Rationale: In using the Amsler chart properly, the client should wear their glasses if they normally do
so. They should use the bottom portion to view the chart if they wear bifocals. The chart should be
posted on a wall at eye level. Client should stand 12-14 ft away from it and cover one eye. With the
other eye, they should look at the center dot.
Any areas of distortion, graying, blurring or blank spots should be marked on the chart
and they should notify their physician.
 Do you have a prescription for corrective lenses? Do you wear them regularly? If you wear contacts,
how long do you wear them? How do you clean them?
Rationale: Clients who do not wear the prescribed corrective lenses are susceptible to eye strain.
Improper cleaning or prolonged wear of contact lenses can lead to infection and corneal
damage.
 Have you ever been tested for glaucoma? What were the results?
Rationale: Tonometry – is used to measure pressure within the eye.
Normal eye pressure – range from 10-21 mmHg.
Eye pressures greater than 22 mmHg increases risk for developing glaucoma.
People with normal eye pressure may develop glaucoma.
 Is there a history of eye problems or vision loss in your family?
Rationale: Many eye disorders have familial tendencies. Ex., glaucoma, refraction errors, allergies
and macular degeneration.
 Are you exposed to conditions or substances in the workplace or home that may harm your eyes or
vision? Do you wear a safety glasses during exposure to harmful substance?
Rationale: Teach the client to use protective eyewear when engaging in recreational activities and
hazardous situations.
 Do you wear sunglasses during exposure to the sun?
Rationale: Exposure to ultraviolet radiation puts the client at risk for the development of cataracts.
 Do you have any vision loss? Has your vision loss affected your ability to care for yourself? To work?
Rationale: Vision problems may interfere with the client’s ability to perform usual activities of daily
living.
 What visual aids do you use to assist you with your visual loss?
 Describe your typical diet. What have you eaten last 24 hours? Do you take any vitamins or
supplements?
Rationale: Nutrition to a decreased risk of age-related macular degeneration as follows:
A well-balanced diet is essential.
Lutein and zeaxanthin – found in green leafy vegetables, eggs, and other foods reduce
the risk of chronic eye disease. Food rich in these nutrients include kale, spinach,
collards, turnip greens, corn, green peas, broccoli, romaine lettuce, green beans, eggs
and oranges.
Vitamin C – can decrease the risk of cataracts and the risk of age-related macular
degeneration.
Vitamin E – in its most biologically active form is a powerful antioxidant. It is found in
nuts, fortified cereals and sweet potatoes.
Zinc – it is an essential trace mineral or “helper molecule”.
 Do you smoke? How many packs or for how long?
Rationale: Tobacco smoking has been found to be strongly associated with eye diseases. It doubles
the chance of forming cataracts and causing a threefold risk of developing AMD.

AMSLER CHART

Instructions:

1. Tape this page at eye level where light is consistent

and without glare.
2. Put on your reading glasses and cover one eye.
3. Fix your gaze on the center black dot.
4. Keeping your gaze fixed, try to see if any lines are
distorted or missing.
5. Mark the detect on the chart
6. Test each eye separately.
7. If the distortion is new or has worsened, arrange to
see your ophthalmologist at once.
8. Always keep the Amsler’s chart at the same distance
from your eyes each time you test.
VISUAL FIELD DEFECTS Abnormal Findings

 When a client reports losing full or partial vision in one or both eyes, the nurse can usually anticipate
a lesion as a cause.

FINDING POSSIBLE SOURCE

Unilateral blindness (ex. Blind right eye) Lesion in (right) eye or (right optic nerve)
Bitemporal hemianopia (loss of vision in both Lesion of optic chiasm
temporal fields)
Left superior quadrant anopia or similar loss of Partial lesion of temporal loop (optic radiation)
vision (homonymous) in quadrant of each field.
Right visual field loss—right homonymous Lesion in right optic tract or lesion in temporal
hemianopia or similar loss of vision in half of loop (optic radiation)
each field

EXTRAOCULAR MUSCLE Abnormal Findings

CORNEAL LIGHT REFLEX TEST ABNORMALITIES

 Pseudostrabismus – normal in young children, the pupils will appear at the inner canthus (due to
epicanthic fold).
 Strabismus (or tropia) – a constant malalignment of the eye axis, strabismus is defined according to
the direction toward which the eye drifts and may cause amblyopia.
Esotropia – eye turns inward
Exotropia – eye turns outward

COVER TEST ABNORMALITIES

 Phoria (Mild Weakness) – it is less likely a cause amblyopia than strabismus.

The uncovered eye is weaker; when the stronger eye is covered, the weaker eye moves to
refocus.
When the weaker eye is covered, it will drift to a relaxed position.
Once the eye is uncovered, it will quickly move back to reestablish fixation.

POSITIONS TEST ABNORMALITIES

 Paralytic Strabismus – is usually the result of weakness or paralysis of one or more extraocular
muscles. The nerve affected will be on the same side as the eye affected.
6th nerve paralysis – the eye cannot look to the outer side.
For example, the client tries to look to the left. The right eye moves left, but the left eye
cannot move left.

4th nerve paralysis – the eye cannot look down when turned inward.
For example, a client with left 3rd nerve paralysis looks straight ahead.
ABNORMALITIES OF THE EXTERNAL EYE

 Ptosis – drooping eye

 Ectropion – outwardly turned lower lid
 Conjunctivitis – generalized inflammation of the conjunctiva
 Exophthalmos – protruding eyeballs and retracted eyelids
 Chalazion – infected meibomian gland
 Hordeolum – stye
 Entropion – inwardly turned lower eyelid
 Blepharitis – staphylococcal infection of the eyelid
 Diffuse episcleritis – inflammation of the sclera
 Subconjunctival hemorrhage – bright red areas of the sclera
 Scleral jaundice

ABNORMALITIES OF THE CORNEA AND LENS

Corneal Abnormalities

 Corneal scar – appears grayish white, usually is due to an old injury or inflammation.
 Early pterygium – a thickening of the bulbar conjunctiva that extends across the nasal side.

Lens Abnormalities

 Nuclear cataracts – appear gray when seen with a flashlight; they appear as a black spot against
the red reflex when seen through an ophthalmoscope.
 Peripheral cataracts – looks like gray spokes that points inward when seen with a flashlight.
They look like black spokes that point inward against the red reflex when seen through an
ophthalmoscope.

ABNORMALITIES OF THE IRIS

 Irregularly shaped iris – causes a shallow anterior chamber, which may increase the risk for narrow-
angle glaucoma (closed angle)

PUPILS

 Miosis – also known as pinpoint pupils, miosis is characterized by constricted and fixed pupils—
possibly a result of narcotic drugs or brain damage.
 Anisocoria – pupils of unequal size.in some cases, the condition is normal and in other cases, it is
abnormal.
 Mydriasis – dilated and fixed pupils, typically resulting from central nervous system injury,
circulatory collapse or deep anesthesia.

ABNORMALITIES OF THE OPTIC DISC

 Papilledema – swollen optic disc, blurred margins, hyperemic appearance from accumulation of
excess blood, visible and numerous disc vessels, lack of visible physiologic cup.
 Glaucoma – enlarged physiologic cup occupying more than half of the disc’s diameter, pale base of
enlarged physiologic cup, obscured and/or displaced retinal vessels.
 Optic Atrophy – white optic disc, lack of disc vessels
ABNORMALITIES OF THE RETINAL VLESSELS AND BACKGROUND

 Constricted Arteriole – narrowing of the arteriole, occurs with hypertension

 Copper Wire Arteriole – whitening of the light reflex and a coppery color, occurs with hypertension.
 Silver Wire Arteriole – opaque or silver appearance caused by thickening of arteriole wall, occurs
with long standing hypertension.
 Arteriovenous Nicking – arteriovenous crossing abnormality characterized by vein appearing to stop
short on either side of arteriole, caused by loss of arteriole wall transparency from hypertension.
 Arteriovenous Tapering – arteriovenous crossing abnormality characterized by vein appearing to
taper to a point on either side of the arteriole, caused by loss of arteriole wall transparency from
hypertension.
 Arteriovenous Banking – arteriovenous crossing abnormality characterized by twisting of the vein on
the arteriole’s distal side and formation of dark, knuckle-like structure, caused by loss of arteriole
wall transparency from hypertension.
 Cotton Wool Patches – also known as soft exudates, cotton wool patches have a fluffy cotton ball
appearance, with irregular edges, appear as white or gray moderately sized spots on retinal
background, caused by arteriole microinfarction, associated with diabetes mellitus and
hypertension.
 Hard Exudate – solid, smooth surface and well-defined edges, creamy yellow-white, small, round
spots typically clustered in circular, linear or star pattern, associated with diabetes mellitus and
hypertension.
 Superficial (flame-shape) Retinal Hemorrhages – appear as small, flame-shaped, linear red streaks
on retinal background, hypertension and papilledema are common causes.
 Deep (dot-shaped) Retinal Hemorrhages – appear as small, irregular red spots with blurred edges on
retinal background, lie deeper in retina than superficial retinal hemorrhages, associated with
diabetes mellitus.
 Microaneurysms – round, tiny dots with smooth edges on retinal background, localized dilations of
small vessels in retina, but vessels are too small to see, associated with diabetic retinopathy.