• (epithelium) Absorbs O2 and nutrients from
Chapter 63-Assessment & tears to nourish
Management of Pt’s with eye & Uveal tract (iris, ciliary body, choroid)
vision Disorders • Iris
Eye Structure & Function • Give eye color
• Dilator (sympathetic) and sphincter
-Extraocular muscles move eye through fields of gaze (parasympathetic) control pupil size
-EOM innervated by CN III, IV, and VI Uveal tract
-Eyeball has 3 layers • Ciliary body
• outer dense fibrous layer (sclera- white part of • Form aqueous fluid, control focusing
the eye, cornea-you can put contact lenses on)
• middle vascular layer (iris, ciliary body, choroid- • Choroid
pink layer) • Supply blood and O2 to outer retina
• inner neural layer (retina, optic nerve, visual • Can absorb scattered light
pathway)
Lens
3 fluid-filling chambers
• Avascular, enables focusing through
• anterior chamber filled with aqueous between accommodation
posterior cornea and anterior iris and pupil
• posterior chamber – aqueous between Retina
posterior iris and pupil and anterior lens • Extension of optic nerve
• vitreous chamber (clear gelatinous) between • Macula – central vision
lens and retina • Rest is for peripheral vision
• Normal ICP is 10-21mmHg
-The point of entrance into the retina is the optic disc
Aqueous humor (blind spot of the eye).
• production is related to IOP (< 21 mm Hg) -The optic disc is pink, oval/round, and has sharp
• Transparent, nutrient containing fluid; fills margins.
anterior & posterior chambers
-The macula responsible for central vision.
Vitreous humor -maintains shape of eye
-In the center of the macula is the most sensitive area,
• Clear gelatinous gel becomes more liquefied the fovea.
with age and results in floater/s. (gelatinous
fluid to keep the shape of the eye, think of Assessment & Evaluation of vision
something being fluid with slime)
-Ocular history
Parts of the Eye
• Chart 63-1
Sclera (white avascular dense fibrous structure)
Visual acuity
• Maintains shape and protect intraocular
• Snellen chart: distance
contents
• Rosenbaum pocket screener: near- tiny card to
Cornea (domelike structure) read or read the small paragraph
• Finger count or hand motion
• Main refracting surface • OD-right eye OS-left eye
• Extremely sensitive to pain– nerves
Examination of the external structures
, -Note any evidence of irritation, inflammatory process, Presbyopia
discharge, and so on
• Loss of accommodative power in lens
-Assess eyelids and sclera • See Table 63-1
-Assess pupils and pupillary response; use darkened Common causes of blindness
room
• Diabetic retinopathy
-Note gaze and position of eyes • Macular degeneration
• Glaucoma
-Assess extraocular movements
• Cataracts
-Ptosis: drooping eyelid
Impaired Vision
-Ectropion: turning out of the lower eyelid
Refractive errors
-Entropion: turning in of the lower eyelid
• Can be corrected by lenses that focus light rays
-Trichiasis: turning in of eyelashes on the retina
-Nystagmus: oscillating movement of eyeball • Emmetropia: normal vision
Diagnostic Evaluations • Myopia: nearsighted (blurred distance vision)
Ophthalmoscopy • Hyperopia: farsighted (blurred near vision)
• Direct and indirect • Astigmatism: distortion caused by irregularity of
the cornea
-Slit-lamp examination- USED TO DX CATARACTS
Assessment of Low vision
-Color vision testing-
-History
-Amsler grid- used to test for macular degeneration
-Examination of distance and near visual acuity, visual
-Ultrasonography field, contrast sensitivity, glare, color perception, and
-Optical coherence tomography- to evaluate the retina refraction
and macular diseases, noninvasive -Special charts may be used for low vision
-Fundus photography- take pictures of the fundus of the -Nursing assessment must include assessment of
eye to check for any changes in the arteries & veins & functional ability and coping and adaptation in
for retinal lesions emotional, physical, and social areas
-Tonometry-measures IOP in your eye TO SCREEN & Management
MANAGE GLAUCOMA. Pts are cautioned to avoid
squeezing the eyelids, holding their breath, or -Support coping strategies, grief processes, and
performing a Valsalva maneuver, because these may acceptance of visual loss
result in abnormally increased IOP
Strategies for adaptation to the environment;
-Laser scanning – test for papilledema & glaucoma
• Placement of items in room
***Angiography-INVASIVE, used to evaluate macular • “Clock method” for trays
edema
-Communication strategies
-Perimetry testing- check for your perimetry
-Collaboration with low-vision specialist, occupational
Gerontologic Considerations therapist, or other resources
-½ those legally blind are > 65 years of age -Braille or other methods for reading and
communication
Chapter 63-Assessment & tears to nourish
Management of Pt’s with eye & Uveal tract (iris, ciliary body, choroid)
vision Disorders • Iris
Eye Structure & Function • Give eye color
• Dilator (sympathetic) and sphincter
-Extraocular muscles move eye through fields of gaze (parasympathetic) control pupil size
-EOM innervated by CN III, IV, and VI Uveal tract
-Eyeball has 3 layers • Ciliary body
• outer dense fibrous layer (sclera- white part of • Form aqueous fluid, control focusing
the eye, cornea-you can put contact lenses on)
• middle vascular layer (iris, ciliary body, choroid- • Choroid
pink layer) • Supply blood and O2 to outer retina
• inner neural layer (retina, optic nerve, visual • Can absorb scattered light
pathway)
Lens
3 fluid-filling chambers
• Avascular, enables focusing through
• anterior chamber filled with aqueous between accommodation
posterior cornea and anterior iris and pupil
• posterior chamber – aqueous between Retina
posterior iris and pupil and anterior lens • Extension of optic nerve
• vitreous chamber (clear gelatinous) between • Macula – central vision
lens and retina • Rest is for peripheral vision
• Normal ICP is 10-21mmHg
-The point of entrance into the retina is the optic disc
Aqueous humor (blind spot of the eye).
• production is related to IOP (< 21 mm Hg) -The optic disc is pink, oval/round, and has sharp
• Transparent, nutrient containing fluid; fills margins.
anterior & posterior chambers
-The macula responsible for central vision.
Vitreous humor -maintains shape of eye
-In the center of the macula is the most sensitive area,
• Clear gelatinous gel becomes more liquefied the fovea.
with age and results in floater/s. (gelatinous
fluid to keep the shape of the eye, think of Assessment & Evaluation of vision
something being fluid with slime)
-Ocular history
Parts of the Eye
• Chart 63-1
Sclera (white avascular dense fibrous structure)
Visual acuity
• Maintains shape and protect intraocular
• Snellen chart: distance
contents
• Rosenbaum pocket screener: near- tiny card to
Cornea (domelike structure) read or read the small paragraph
• Finger count or hand motion
• Main refracting surface • OD-right eye OS-left eye
• Extremely sensitive to pain– nerves
Examination of the external structures
, -Note any evidence of irritation, inflammatory process, Presbyopia
discharge, and so on
• Loss of accommodative power in lens
-Assess eyelids and sclera • See Table 63-1
-Assess pupils and pupillary response; use darkened Common causes of blindness
room
• Diabetic retinopathy
-Note gaze and position of eyes • Macular degeneration
• Glaucoma
-Assess extraocular movements
• Cataracts
-Ptosis: drooping eyelid
Impaired Vision
-Ectropion: turning out of the lower eyelid
Refractive errors
-Entropion: turning in of the lower eyelid
• Can be corrected by lenses that focus light rays
-Trichiasis: turning in of eyelashes on the retina
-Nystagmus: oscillating movement of eyeball • Emmetropia: normal vision
Diagnostic Evaluations • Myopia: nearsighted (blurred distance vision)
Ophthalmoscopy • Hyperopia: farsighted (blurred near vision)
• Direct and indirect • Astigmatism: distortion caused by irregularity of
the cornea
-Slit-lamp examination- USED TO DX CATARACTS
Assessment of Low vision
-Color vision testing-
-History
-Amsler grid- used to test for macular degeneration
-Examination of distance and near visual acuity, visual
-Ultrasonography field, contrast sensitivity, glare, color perception, and
-Optical coherence tomography- to evaluate the retina refraction
and macular diseases, noninvasive -Special charts may be used for low vision
-Fundus photography- take pictures of the fundus of the -Nursing assessment must include assessment of
eye to check for any changes in the arteries & veins & functional ability and coping and adaptation in
for retinal lesions emotional, physical, and social areas
-Tonometry-measures IOP in your eye TO SCREEN & Management
MANAGE GLAUCOMA. Pts are cautioned to avoid
squeezing the eyelids, holding their breath, or -Support coping strategies, grief processes, and
performing a Valsalva maneuver, because these may acceptance of visual loss
result in abnormally increased IOP
Strategies for adaptation to the environment;
-Laser scanning – test for papilledema & glaucoma
• Placement of items in room
***Angiography-INVASIVE, used to evaluate macular • “Clock method” for trays
edema
-Communication strategies
-Perimetry testing- check for your perimetry
-Collaboration with low-vision specialist, occupational
Gerontologic Considerations therapist, or other resources
-½ those legally blind are > 65 years of age -Braille or other methods for reading and
communication
