Visual Assessment
Unit 4

Overview

Developmental Factors

Infant

@ 24 weeks

School Age

begin to see refractive errors:

20 imbalanced muscle alignment
3-5% of pediatric population

double vision occurs with strabismus muscular weakness that can be corrected

Middle/Older Adult

to close objects

Older Adult

  • 90% is open angle
  • slow build-up of pressure
  • noticed usually when there is a decrease in peripheral vision
  • Acute Narrow Angle
  • abrupt rise in pressure causing symptoms
    • intense pain
    • N & V
  • Emergency!
  • needs more light
  • difficulty adapting to changes in light
  • decreased tolerance of direct light

Assessment

(1) visual acuity

(2) peripheral vision

(3) EOMs

(4) pupil

1. History according to age and family history

Infant, Toddler School age Adult

Assessment

  1. History
  2. External eye- Inspect, Palpate
  3. Eye function: 
    visual acuity
    peripheral vision
    EOMs
    pupil
  4. Opthalmoscopic Examination
  5. Developmental

2. External eye

 

Inspect For
eyelids/lashes position, appearance, ptosis

palpebral fissures, lid lag
conjunctiva

bulbar and palpebral

 color
sclera color
cornea opacity, light reflection
iris, pupil shape, equality, color
lens clarity, opacity
ant. chamber depth

The sclera, iris, and fundus are typically darker in dark-skinned persons.

Inspect/Palpate                      For
 lacrimal apparatus

    can only inspect...?                    color, inflammation

    can only palpate...?                     response to pressure, tenderness

 3. Eye function: 

peripheral vision
EOMs
pupil

(1) Visual acuity

Testing visual acuity

Visual Acuity - distance vision

(2) Peripheral vision

In glaucoma, optic nerve damage > loss of visual fields, beginning at periphery

(3) Extraocular muscles (EOM)

Testing:

Testing EOMs

       results in binocular vision
symmetrical movement
no nystagmus
        (OK extreme lateral)
symmetrical corneal light reflex
        (if not, do Cover/Uncover test)

(4) Pupil

Assess

(Bates: near reaction)

should be = and round
(5% population - anisocoria)
  • response to light
    •

    Accommodation **

    (usually tested only if questionable response to light)

    distant = dilate
    near = constrict

    **Bates (p 169):

    When shifting gaze to near object, pupils constrict.

    Eyes also converge (EOM)
    and
    accommodate     (|convexity of lens) to bring near objects into focus

    Documenting pupil findings:

    Equality
    Shape
    Rx to light
    Rx to distance

    *******************

    PERRLA Since we don’t usually test accomodation we should document as PERRL

    Assessment

    (1) visual acuity
    (2) peripheral vision
    (3) EOMs
    (4) pupil

    4. Opthalmoscopic Exam

    We generally do not dilate pupils


    Opthalmoscopic Exam

    Inspect                                   For

        red reflex                            presence, color, shape
        retinal vessels                      color, regularity
        optic disc                            color, shape, size, margins
        macula                                seen better if pupils dilated
        fovea

    Nursing Diagnostic Statements

    P:Sensory/perceptual alteration: visual

    E:

    P:Risk for injury

    E:

    P:Pain

    E:

    Nursing Implications

    1. If pt is unconscious, do pupil check asap.
    2. If pt is unconscious, check for and remove contacts.
    3. For visually impaired or pt with bandaged eyes:
    speak before touching
    use clock face when eating
    4. In charting and doctor’s orders, abbreviations for:

    right eye OD
    left eye OS
    both eyes OU