PRS Eyes

DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION
COLLEGE OF NURSING
PERFORMANCE EVALUATION CHECKLIST
ASSESSMENT OF THE EYES
Date: ___________________
Name: ____________________________________ Year/Sec: ___________ Clinical Group: __________
Not
Procedure Done Remarks
Done
Procedure
1. Introduces self and verifies the client’s identity.
Explains to the client what you are going to do, why
it is necessary, and how the client can cooperate.
2. Performs hand hygiene and observes other
appropriate infection control procedures.
3. Provides for client privacy.
4. Inquires if client has any history of the following:
 Family history of diabetes, hypertension, or
blood dyscrasia
 Eye disease, injury, or surgery
 Last visit to an ophthalmologist
 Current use of eye medications
 Use of contact lenses or eyeglasses
 Hygienic practices for corrective lenses
 Current symptoms of eye problems
Assessment
5. Inspects the eyebrows for hair distribution and
alignment and for skin quality and movement.
6. Inspects the eyelashes for evenness of distribution
and direction of curl.
7. Inspects the eyelids for surface characteristics,
position in relation to the cornea, ability to blink,
and frequency of blinking. Inspect the lower eyelids
while the client’s eyes are closed.
8. Inspects the bulbar conjunctiva for color, texture,
and the presence of lesions.
9. Inspects the palpebral conjunctiva for color,
texture, and the presence of lesions.
10. Everts the upper lids if a problem is suspected.
a. Asks the client to look down while keeping the
eyelids slightly open.
b. Gently grasps the client’s eyelashes with thumb
and forefinger. Pull lashes gently downwards.
c. Places a cotton-tipped applicator stick about
1cm above the lid margin, and pushes it gently
downward while holding the eyelashes.
d. Holds the margin of the everted lid or
eyelashes against the ridge of the upper bony
orbit with the applicator stick or your thumb.
e. Inspects the conjunctiva for color, texture,
lesions, and foreign bodies.
11. Inspects and palpates the lacrimal gland.
a. Palpates the lacrimal gland using the tip of the
index finger.
b. Observes for edema between the lower lid and
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the nose.
12. Inspects and palpates the lacrimal sac and
nasolacrimal duct.
a. Observes for evidence of increased tearing.
b. Palpates inside the lower orbital rim near the
inner canthus, using the tip of the index finger.
13. Inspects the cornea for clarity and texture. Asks the
client to look straight ahead. Holds a penlight at an
oblique angle to the eye and moves the light slowly
across the corneal surface.
14. Performs the corneal sensitivity (reflex) test to
determine the function of the fifth (trigeminal)
cranial nerve. Asks the client to keep both eyes
open and look straight ahead. Approaches from
behind and beside the client and lightly touches the
cornea with a corner of the gauze.
15. Inspects the anterior chamber for transparency and
depth. Uses the same oblique lighting used when
testing the cornea.
16. Inspects the pupils for color, shape, and symmetry
of size.
17. Assess each pupil’s direct and consensual reaction
to light.
a. Partially darkens the room.
b. Asks the client to look straight ahead.
c. Uses a penlight and approaches from the side.
Shines a light on the pupil.
d. Observes the response. The pupil should
constrict (direct response).
e. Shines the light on the pupil again and observes
the response of the other pupil. It should also
constrict (consensual response).
18. Assesses each pupil’s reaction to accommodation.
a. Holds an object about 10cm from the client’s
nose.
b. Asks the client to look first at the top of the
object and then at a distant object behind the
penlight. Alternates the gaze between the near
and far objects.
c. Observes the pupil response. Pupils should
constrict when looking at the far object.
d. Next, moves the penlight or pencil towards the
client’s nose. The pupils should converge. Uses
the abbreviation PERRLA to record normal
assessment of the pupils.
Visual Fields
19. Assesses peripheral visual fields.
a. Asks the client to sit directly facing at a distance
of 60-90cm.
b. Asks the client to cover right eye with the card
and look directly at the nose of the nurse.
c. Covers or closes the eye directly opposite the
client’s covered eye and looks directly at the
client’s nose.
d. Holds an object using the fingers, extends the
arm and moves the object into the visual field
from various points in the periphery. The object
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should be at an equal distance from the nurse

and the client. Asks the client to tell when was
the moving object is first spotted.
e. To test the temporal field of the left eye,
extends and moves the right arm in from the
client’s right periphery. Temporally, peripheral
objects can be seen at right angles to the
central point of vision.
f. To test the upward field of the left eye, extends
and moves the right arm down from the
upward periphery. The upward field of vision is
normally 50 degrees because the orbital edge is
in the way.
g. To test the downward field of the eye, extends
and moves the right arm up from the lower
periphery. The downward field of vision is
normally 70 degrees. Because the cheekbone is
in the way.
h. To test the nasal field of the left eye, extends
and moves the left arm in from the periphery.
The nasal field of vision is normally 50 degrees
away from the central point because the nose
is in the way.
i. Repeats the above steps for the right eye.
Extraocular Muscle Test
20. Assess six ocular movements to determine eye
alignment and coordination.
a. Stands directly infront of client and holds the
penlight at a comfortable distance such as
30cm infront of the client’s eyes.
b. Asks the client to hold the head in a fixed
position facing at the nurse and follows the
movements of the penlight with the eyes only.
c. Moves the penlight in a slow, orderly manner
through the six cardinal fields of gaze.
d. Stops the movement of the penlight
periodically so that nystagmus can be detected.
21. Assess the location of light reflex by shining a
penlight on the pupil in corneal surface (Hirschberg
Test).
22. Asks the client to fixate on a near or far object.
Covers one eye and observes for movement in the
uncovered eye (cover test).
Visual Acuity
23. Assess near vision by providing adequate lighting
and ask the client to read from a magazine or
newspaper.
24. Assess distance vision by asking client to wear
corrective lenses, unless they are used for reading
only (e.g. for distances of only 36 cm/14 in).
 Ask the client to stand or sit 6 m or 20 ft
from the Snellen or character chart. Cover
the eye not being tested and identify the
letters or characters on the chart.
 Take three readings: right eye, left eye,
both eyes.
 Record the readings of each and both eyes
COLLEGE OF NURSING
(i.e. the smallest line from which the

person is able to read one-half or more of
the letters).
 At the end of each line of the chart are
standardized numbers (fractions). The top
line is 20/200. The numerator (top number)
is always 20, the distance the person
stands from the chart. The denominator
(bottom number) is the distance from
which the normal eye can read the chart.
Therefore, a person who has 20/40 vision
can see at 20 feet from the chart what a
normal-sighted person can see at 40 feet
from the chart. Visual acuity is recorded as
“s– –c” (without correction), or “c– –c”
(with correction). You can also indicate how
many letters were misread in the line, e.g.,
“visual acuity 20/40 – 2 c– –c” indicates
that two letters were misread in the 20/40
line by a client wearing corrective lenses.
 If the client is unable to see even the top
line (20/200) of the Snellen chart, perform
selected vision tests.
 Document findings in the client record.
Clinical Instructor: _________________________________________

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DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

PERFORMANCE EVALUATION CHECKLIST

ASSESSMENT OF THE EYES

Name: ______________________________ Year/Sec: _ Clinical Group: ______

should be at an equal distance from the nurse

(i.e. the smallest line from which the

Clinical Instructor: _________________________________________

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