Eye and Ear Assessment

by Sharon Kerr, MSN, RN Spring 2010

Normal Anatomy of the Eye

External Eye Exam

Inspect for: Symmetry Discharge or lesions Eyelids: blink, position (ptosis), swelling Sclera: should be white (not red or

yellow) Cornea: assess for opacity or scratch Conjunctiva: should be pink

External Eye Exam continued

Pupil -- Check for response to:

Light Accomodation PERRLA

External Eye Exam continued

Extraocular Muscle Function Check eye movement through the

six cardinal directions of gaze. Watch for parallel movement Nystagmus (involuntary rapid

rhythmic movement)

Normal Anatomy of the Eye

Cornea: clear layer covering

the front of the eye. works with the lens

to focus images on the retina.

Normal Anatomy of the Eye

Retina internal layer receives and

transmits focused images.

normally red due to its rich blood supply.

Retina Can be seen with an

ophthalmoscope Allows the examiner

to see through the pupil and lens to the retina

Called a funduscopic exam

Retina Examination of

fundus includes

Retina Optic disc Blood vessels.

Funduscopic Exam Ophalmoscope

Seated in a darkened room Examiner projects a beam of light

from an ophthalmoscope through the pupil to view the back of the eyeball

Using the Ophalmoscope Turn on and adjust to round beam

of white light Place scope light on dim setting Set lens disc to 0 diopters (neutral) Keep index finger on lens disc to

adjust during examination

Approaching the patient Right hand and right eye to pt. Right

eye Left hand and left eye to pt. Left eye Hold opthalmoscope firmly against

your bony orbit Glasses off (both examiner and

patient) Contacts are OK

The examination Have patient look over your

shoulder and across the room at a specific point on the wall

From about 15 inches and 15 degrees lateral to the patient’s 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 patient’s lashes

Finding the optic disk On NASAL side of each retina Yellowish orange to creamy pink

oval or round Follow 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 retina Red spots, streaks, light spots

Normal Anatomy of the Ear

external, 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, shape Position: pinna level with corner of

eye Lesions Drainage

Examine Auditory Acuity Whisper two syllable word (out of

view)

Weber Test: lateralization of sound..

Rinne test: bone vs air conduction of sound

Normal Anatomy of the Ear

The tympanic membrane, or eardrum

separates the ear canal and the middle ear.

ossicles : can see the short process of the malleous, handle of the malleous, and the incus

There is a cone of light that is a reflection of the otoscope light

Otoscopic Examination An otoscope

is an instrument used to look into the ear canal

ear speculum a cone-shaped

viewing piece of the otoscope)

Use largest size possible

Otoscopic Examination Dim lights in room Patient in sitting position Pull ear up and back (down for

kids) SLOWLY insert otoscope into ear

canal while looking into viewer

Otoscopic Landmarks Tympanic membrane: should be

intact, pearly gray, translucent, shiny

Cone of light: right side 4/5 o’clock; left side 7/8 o’clock

Malleus short process -- knob

Abnormal Findings: Perforations Bulging Retraction Blue ,red, or amber coloring dullnss

Otoscopic Examination The 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.

That’s all folk’s

The End