PHYSICAL ASSESSMENT- EYE & EAR

ASSESSMENT: PART-3 (EYE & EAR)

Eye Anatomy: Why Study It?

Anatomy of Eyelid:

•        Eyelids: protect the cornea and eyeball from injury.

•        Canthi: (sing. canthus) are corners of the eye, also called angles of eye.

•        Caruncle: is located near medial canthus and contains sebaceous glands.

•        Tarsal plates are made of connective tissue and strengthen eyelid. They contain meibomian (tarsal) glands which secrete lipid to create an airtight seal when closed and also prevent eyelids from sticking together.

SUBJECTIVE DATA:

•        Vision difficulty:

–       Halos around lights: in glaucoma.

–       Scotoma: a blind spot in the visual field – in glaucoma, optic nerve, and visual pathway disorder.

–       Night blindness: Vitamin A deficiency, glaucoma.

•        Eye pain:

–       Photophobia:  inability to tolerate light.

•        Childhood strabismus:

–       A history of crossed eyes “lazy eye”. 

•        Redness or swelling:

–       Infections

•        Excessive or lack of tearing:

–       May be due to irritants or obstruction in drainage.

•        History of ocular problems

•        Glaucoma: Family history

•        Use of glasses or contact lenses

•        When tested last.

•        Any medications

 

Assess Visual Acuity:

•        Checks acuity with Snellen and from a proper distance.

•        Checks acuity both eyes separately.

•        Done by placing the client 20 feet from the Snellen eye chart and testing each eye alone.

•        Checks of near vision acuity with jaeger card Hold card approx. 14 inches. from the patient nose.

•        Ask the patient to cover one eye.

•        Read the smallest line.                         

•         Cover another eye and repeat.

Inspecting External Ocular Structures:

•        General

–       Note if facial expression is relaxing or tense

•        Eyebrows

–       Note if movement is symmetrical

•        Eyelids and lashes

–       Note if any redness, swelling, discharge or lesions

–       Note if eyelid closes completely and if drooping

–       The pallor of the lower lid is a good indicator of anemia.

–       For upper eyelid, use applicator stick to fold the eyelid over

•        Assess internal eye structures e.g. iris, retina, macula, etc.

•        Consider the following Factors:

–       Age use of corrective lens, artificial eye, allergies, pain, visual disturbances.

–       Health related factors such as increase Blood Pressure, or Diabetes mellitus.

•        Using the following equipment to assess the eyes:

–       Penlight, and ophthalmoscope.

Assessment of Extraocular Muscles:

•        4 rectus (straight)

•        2 obliques

•        Innervations:

–       SO4: Superior oblique muscle

§  CN IV “4” trochlear nerve

–       LR6: Lateral rectus muscle

§  CN VI ”6” abducens nerve

–       AO3: All other muscles

§  CN III “3” oculomotor nerve.

•        Extraocular muscle movement:

Ear Assessment:

•        Take history of ear surgery, trauma, frequent infection, ear pain, drainage, hearing loss, tinnitus, vertigo, ototoxic medications, and last hearing examination

•        Assess client in sitting position & inspects the auricle’s placement, size, symmetry, and color.

•        Redness: sign of inflammation or fever. The color of ears must be the same as of the face.

•        Pallor:  indicate frostbite.

•        Palpate the auricles for texture, tenderness, and skin lesion.

•        If the client complains of pain: pull the auricle and press on the tragus and behind the ear over the mastoid process if pain increase, means external ear infection, if pain is not increasing, means middle ear infection may be present.

•        Inspection the ear canal for size and discharge.

•        Assessment of cerumen, if it is yellow or green may indicate infection.

•        Assessment of hearing acuity: done simply by identification of voice tones, with the client repeating testing words were spoken by the nurse (whisper test).

•        deeper structure and middle ear can be observed only by otoscope.

•        Whisper Test (patient with normal acuity can correctly repeat what was whispered)

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•        Weber Test (uses bone conduction to test lateralization of sound by a tuning fork).

•        Rinne Test (useful for distinguishing between conductive and sensorineural hearing losses).

•        Carinal nerve Vlll “8”: “vestibulocochlear” intact.

•        The Otoscope Examination:

–       Using the Otoscope:

§  Otoscope should be held in the examiner’s right hand, in a pencil-hold position, with the bottom of the scope pointing up. This position prevents the examiner from inserting the otoscope too far into the external canal. Choose the largest appropriate speculum

§  Using the opposite hand, the auricle is grasped and gently pulled upper and back to straighten the canal in the adult, while pulled down and back in infant and child ( <3 age )

–       The External Canal:

§  Redness/ swelling/ lesion/ foreign body/ discharge.

–       Tympanic Membrane:

§  Color/ character/ perforation

§  The healthy tympanic membrane is shiny, translucent

 pearl-gray color.

§  Cone-shaped light reflex.