Eye and Ear Assessment

Normal Anatomy of the Eye

External Eye ExamInspect for:SymmetryDischarge or lesionsEyelids: blink, position (ptosis), swellingSclera: should be white (not red or yellow)Cornea: assess for opacity or scratchConjunctiva: should be pink

External Eye Exam continued Pupil -- Check for response to:

LightAccomodationPERRLA

External Eye Exam continuedExtraocular Muscle FunctionCheck eye movement (parallel movement) Nystagmus (involuntary rapid rhythmic movement)

Normal Anatomy of the EyeCornea: clear layer covering the front of the eye. works with the lens to focus images on the retina.

Normal Anatomy of the EyeRetina internal layer receives and transmits focused images.normally red due to its rich blood supply.

RetinaCan be seen with an ophthalmoscopeAllows the examiner to see through the pupil and lens to the retinaCalled a funduscopic exam

RetinaExamination of fundus includes

RetinaOptic discBlood vessels.

Funduscopic Exam Ophalmoscope

Seated in a darkened roomExaminer projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball

Using the OphalmoscopeTurn on and adjust to round beam of white lightPlace scope light on dim settingSet lens disc to 0 diopters (neutral)Keep index finger on lens disc to adjust during examination

Approaching the patientRight hand and right eye to pt. Right eyeLeft hand and left eye to pt. Left eyeHold opthalmoscope firmly against your bony orbitGlasses off (both examiner and patient)Contacts are OK

The examinationHave patient look over your shoulder and across the room at a specific point on the wallFrom about 15 inches and 15 degrees lateral to the patients line of vision, shine the light beam on the pupil

Getting a closer look

Should see an orange glow (the red reflex reflection of light off retina)Move in on the 15 degree line toward the pupil , almost touching the patients lashes

Finding the optic diskOn NASAL side of each retinaYellowish orange to creamy pink oval or roundFollow a blood vessel centrally until you see it

Inspecting the optic disk

Clarity should have sharp margins

Symmetry of both eyes

Inspecting the retina

Visualize arteries and veins

Identify any lesions in retinaRed spots, streaks, light spots

Normal Anatomy of the Earexternal, middle, and inner structures.eardrum and the three tiny bones conduct sound from the eardrum to the cochlea: malleus, incus, stapes

External Ear Exam

Symmetry, size, shapePosition: pinna level with corner of eyeLesionsDrainage

Examine Auditory AcuityWhisper two syllable word (out of view)

Weber Test: lateralization of sound..

Rinne test: bone vs air conduction of sound

Normal Anatomy of the EarThe tympanic membrane, or eardrumseparates the ear canal and the middle ear. ossicles : can see the short process of the malleous, handle of the malleous, and the incusThere is a cone of light that is a reflection of the otoscope light

Otoscopic ExaminationAn otoscope is an instrument used to look into the ear canalear speculuma cone-shaped viewing piece of the otoscope) Use largest size possible

Otoscopic ExaminationDim lights in roomPatient in sitting positionPull ear up and back (down for kids)SLOWLY insert otoscope into ear canal while looking into viewer

Otoscopic LandmarksTympanic membrane: should be intact, pearly gray, translucent, shinyCone of light: right side 4/5 oclock; left side 7/8 oclockMalleus short process -- knob

Abnormal Findings:PerforationsBulgingRetractionBlue ,red, or amber coloringdullness

Otoscopic ExaminationThe speculum is angled slightly toward the person's nose to follow the canal.A light beam extends beyond the viewing tip of the speculum. The otoscope is gently moved to different angles to view the canal walls and eardrum.

Thats all folksThe End

Ptosis drooping of upper eyelid*PERRLA pupils equally round and reactive to light accomodation*Parallel very similar and often happening at the same time**Weber Test: Place vibrating tuning form on top of head or middle of forehead. Client should hear tone equally in both ears.

Rinne test: compares air and bone conduction of sound. Place vibrating tuning fork on mastoid process (bone conduction) and ask client to indicate when he can no longer hear sound. Then quickly move tuning fork in front of auditory meatus (air conduction). Have client indicate when sound ends. Air conduction should be twice as long as bone conduction. *