Med Surg

Nursing Management of
Patient with Disorder of

Eye
ANATOMY OF THE EYE:
EYE is also known as organ of vision .The vision
system consists of internal and eternal structure
of the eye.
The internal structure are lens, iris, retina ,and
ciliary body.
The external structures are orbit ,eyeball,
eyelashes, eyelids ,extraocular muscle.
The eye located below the forehead at the orbit
area of skull. The visual system is composed of
three main parts.
1.Eyeball
2.Orbit area
3.Accessory structures
Eyeball:
Eyeball is called a globe. It is about 2.5 cm diameter.
Vitreous humor is filled inside of the eyeball which is
jelly like fluid supports the internal structure and
maintain the shape.
3 layers of eyeball from inner to outer.
*Outer layer
*Middle layer
*Inner layer
Outer layer:
> it composed of sclera and transparent cornea
> tough and hard layer
> known as wall of eye
Sclera is a white part of eye, made up of tough connective tissues and
protect internal tissue.
Cornea covers pupil and iris and it is a dome shaped covering at the
front.
Middle layer:
> Middle layer is called uveal tract.
> it consist of iris, choroid and ciliary body.
Iris is small round muscular opening in the centre of the eye. The nerve
cells of iris allows light to enter the eye.
Choroid is the layer of tissue provides oxygen and nutrients to ciliary body
, iris ,and outer portion of retina
Ciliary body made up of muscular ring of tissues surrounds the lens which
help the eye to focus
INNER LAYER:
Inner layer of an eye is retina
Retina is inner layer that extends at the back of eyeball. There are
2 types cell present in retina RODS and CONES.
RODS cell are stimulated in dark environment
CONES are stimulated in light environment
ORBIT AND ACCESSORY STRUCTURES:
>The orbit is the cavity in skull bone which contains the eyeball and
accessory structures of the eye- eyelids ,conjunctiva and lacrimal gland.
>Eyelids and Eyelashes provide physical cover to the eye from dust
and any foreign particles.
>Conjunctiva is a transparent mucus membrane covers the outer
surface of eye and inner surface of eyelid.
>Lacrimal gland or tear gland produce mucus and tear and keep the
surface of eye and eyelids lubricated
MECHANISM OF VISION
Light rays enter in to the eye through cornea
Cornea refractive power bend the rays so the image can fall on retina
through pupils and lens
Retina nerve cells connect with brain cells through optic nerve and
transmit an image to the brain
Brain recognizes the image and interprets it.

NURSING ASSESSMENT: HISTORY TAKING and PHYSICAL
EXAMINATION
 Present health history
Any history of trauma of head and surgery of head ,any systemic
disease such as DM, HTN, Cancer, Rheumatoid arthritis any cardiac or
pulmonary diseases, altered sleeping pattern
 Ocular history
* History of any visual acuity test last obtained.
* Any changes in glass or lens: ask for surgery of eye ,amblyopia, cataract
etc …
* Any trauma to eyes : any medications taking for eye ,tablets, eyedrop etc …
* Elderly persons are more on high risk of glaucoma and cataract
* Any type of allergies in eye which may cause itching ,redness, burning
etc…
 Work history
Any hazardous activity, work with any fumes ,work in public spaces
PHYSICAL EXAMINATION:
• Redness
• Pain
• Blurred vision
• Dryness
• Diplopia(double vision)
ASSESSMENT OF ANATOMICAL STRUCTURES
 Eyelid/Eyelashes/Eyebrows: check swelling, redness, lumb, ulceration, or
any rashes.
use the topical local anaesthesia and two clean
cotton
buds to examine the eyelids
 Conjunctiva: observe colour of conjunctiva
 Cornea: normaly look clear, transparent and shiny
cornea become hazy during acute glaucoma and keratitis
 Pupil: in central nervous system disorders slight difference in the pupil size can
be seen
To check size of the pupil using ophthalmoscope
 Fundus( inside ,back surface of eye): using ophthalmoscope to examine both

eye to
check any haemorrhage
 Optic nerve: using ophthalmoscope to view arteries ,veins and optic nerve
ASSESSMENTOF PHYSOLOGIC FUNCTION
 VISUAL ACUITY : it is used determine the smallest letters you
can read
on Snellen chart from 6 meters away
 Intraocular pressure: it is usually measured with a tonometer.
IOP is
the fluid pressure inside the eye. IOP is an
important aspect in the evaluation of
patient at
risk of glaucoma
PUPILARY REACTION:
Eye allows for visualization of the world by receiving and
processing light stimuli. The pupillary light reflex constricts the
pupil in response to light
OPTIC NERVE FUNCTION:
*Visual acuity
*colour impaired check
*Asses brightness sensitivity
*Pupillary reaction
Extraocular muscle:
it is used to identify any weakness or other defect in the
extraocular muscle which results uncontrolled eye movements.
EYE MOVEMENTS:
To check the orbital problems floor fracture myasthenia gravis
DIAGNOSTIC TEST TO ASSES VISUAL SYSTEM
1. Visual acuity test
2. Fluorescein angiogram
3. Dialated pupillary examination
4. Refraction
5. Slit lamp examination
6. Ultrasonography
7. Visual field test
8. Tonometry
9. Retinal tomography
10. Colour blindness test
11. Pachymetry
 Visual field test:
It is also known as perimetry. It helps to find certain patterns of
vision
loss.
 Fluorescein angiography:
it helps to looks at your retina.it uses a contrast dye to
highlight your blood vessels.
 Dilated pupillary examination:
To identify signs of any disease of retina. It is simple and
painless. The
physician will give some eye drop to dilate your pupil and check eye
disease
 Refraction:
Eye exam that measure a persons prescription for eye glasses or
contact
lenses.
 ULTRASONOGRAPHY:
Uses high frequency sound waves that travel through the eye. It
helps to identify abnormalities in the eye. It helps to diagnose retinal
detachment or other disorder of eye
Slit lamp examination:
During this examination first dilate the pupils. It is common eye
care specialist will use to check your overall eye health
Tonometry:
under local anaesthesia this test is performed .it helps to
measure pressure inside your eye
Retinal tomography:
computerized test is done to identify the retinal detachment
Corneal topography:
it helps to identify corneal shape abnormalities through
topographer which projects the light rings in to the cornea and computer
analyse the reflected images. The functions of corneal topography are to
identify preoperative surgical risk, diagnose corneal disease and post
operative surgical management
Colour blindness test:
in this test multi-coloured dots are arranged in different patterns
of numbers and letters. The patient is asked to read the numbers and
letters. Colour blind person wont be able to read symbols in each pattern.
Pachymetry:
A probe called pachymeter is placed on front of the eye to
measure the thickness of cornea. The thickness of cornea indicate eye
pressure

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Med Surg

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Nursing Management of

Patient with Disorder of

Light rays enter in to the eye through cornea

Brain recognizes the image and interprets it.

 Fundus( inside ,back surface of eye): using ophthalmoscope to examine both

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