Eyes

open space between the eyelids

border between cornea and sclera

corner of the eye

small fleshy mass at inner corner containing sebaceous glands

strips of connective tissue, contain the meibomian glands, secrete oily lubricating material

• thin mucous membrane
• a. Palpebral Conjunctiva - lines the lids
• b. Bulbar Conjunctiva - overlays the eyeball with the white sclera showing through

provides constant irrigation

absorb tear drainage (upper and lower lids at the inner canthus)

• 6 muscles attach to the eyeball and give the eye
• movement
• a. Rectus Muscles - 4 straight
• b. Oblique Muscles - 2 slanting

• 1. Sclera - outer fibrous, protective white covering
• 2. Choroid - middle vascular, dark pigmented layer, delivers blood to the retina, prevents light from reflecting internally
• a. Pupil
• b. Lens - focus
• c. Anterior Chamber - continuous flow of fluid, serves to deliver, nutrients to surrounding tissues and drains metabolic waste
• 3. Retina - visual receptive layer of the eye, light waves are changed into nerve impulses (includes optic disc, retinal vessels)
• a. Optic Disc - retina fibers converge to form the optic nerve
• b. Macula - receives and transduces light from the center of the visual
• field

• A. Palpebral Fissures - narrowed in Asian population
• B. Glaucoma - more prevalent in African American population, and more severe
• which can lead to blindness

• A. Vision difficulty, decreased visual acuity, blurring, blind spots
• B. Eye pain
• C. Hx Strabismus, diplopia (double vision)
• D. Redness and/or swelling
• E. Watering and/or eye d/c
• F. Past hx of eye problems (ie.injury or surgery to eye)
• G. Hx glaucoma
• H. Use of glasses and/or contacts
• I. Self care behaviors (date of last eye exam)
• J. Medications

• A. Snellen eye chart
• B. Near Vision
• C. Confrontation Test
• D. Corneal Light Reflex (Hirschberg Test) - shine light from distance approx. 12-14"
• –> at same spot both eyes
• E. Cover Test - test for lazy eye/strabismus
• F. Diagnostic Positions Test (H) and 6 cardinal positions of gaze - EOM function and test for nystagmus
• G. Inspection of External Eye
• 1. Eyebrows - symmetrical movement with facial expressions, no lesions, no scaling, etc.
• 2. Eyelids and Eye Lashes - upper lids overlap top of iris, skin intact without redness, swelling, d/c or lesions
• 3. Eyeballs - alignment
• 4. Conjunctiva and Sclera - color, discharge
• 5. Eversion of Upper Eyelid (not performed in lab)
• 6. Lacrimal Apparatus - palpate with thumb inner eye for lacrimal sac and brow area for lacrimal gland
• H. Anterior Eyeball Structures
• 1. Cornea and Lens - smoothness and clarity
• 2. Iris and Pupil - shape, PERRLA
• a. Pupillary light reflex
• b. Accommodation - distant object, shift to close object - pupils should constrict
• I. Ocular Fundus - ophthalmaloscope
• 1. Red Reflex
• 2. Optic disc
• 3. Retinal Vessels
• 4. General Color/Background, Lesions
• 5. Macula

inward turning of eye

outward turning of the eye

eyes crossed (pseudostabismus - eyes look crossed secondary to epicanthal folds - normal for young children)

lids swollen, red, and puffy

drooping upper eyelid

red scaly, flakey crusted lid margins (seborrhea)

(stye) - infection of the hair follicle

(internal stye) - infection of internal glands of the eye

inflammation of the lacrimal sac/gland

infection of the conjunctiva, “pink eye”

secondary to increased intraocular pressure

increased redness around iris only, usually need immediate referral

scratch, irregular ridges, spot noted with fluorescein

unequal pupil

dilated and fixed pupils

constricted and fixed pupils

nearsighted

farsighted

multiple microaneurysms or small red dots or dilations of the vessels noted on the fundiscopic exam