Visual Acuity

Refraction Test

Visual Field Confrontation Test

IOP Measurement

Ophthalmoscopic Test

ASSESSMENT OF VISION
 Consensual Response
PUPILS
Normal: round & of equal size
Increasing light causes pupillary constriction
Decreasing light causes pupillary dilation
The client is asked to look straight ahead while the examiner
quickly brings a beam of light ( penlight) in from the side &
directs it onto the side
Constriction of the eye is a direct response to the light shining
into the eye; constriction of the opposite eye is known as
CONSENSUAL RESPONSE
 VISUAL ACUITY TEST
Measures the client’s distance & near vision
 SNELLEN CHART
simple tool to record visual acuity
• Normal: 20/20
➢
➢ the client stands 20 ft from the chart &
covers 1 eye and uses the other eye to
read the line that appears more clearly
➢ this procedure is repeated for the other
• The higher the
eye
➢ the findings are recorded as a
denominator, the
comparison between what the client can
read at 20 ft and the no. of feet
normally required by an individual to
poorer the vision
read the same line
 EXAMPLE: 20/50 • The big “E”
➢ The client is able to read at 20 ft from
the chart what a healthy eye can read at
50 ft
should be seen
by a normal eye
at 200 ft.
Rosenbaum Chart
 REFRACTION TEST
 Snellen’s Chart reading with  Mydriatic drugs are used in the eye,
corrective lenses the lens is unable to accommodate,
enabling the ophthalmologist to
 Measures error of focus determine eye function with the lens
 Myopia (nearsighted) completely at rest
 Hyperopia (farsighted)
 Astigmatism (inability to focus
horizontally and vertically)
 CONFRONTATIONAL TEST
• Performed to examine visual fields or peripheral vision
• The examiner & the client sit facing each other
• The test assumes that the examiner has normal peripheral vision
 EXTRAOCULAR MUSCLE FUNCTION
Tests
1. Client’s right (lateral position)
2. Upward & right (temporal position)
3. Down & right
4. Client’s left (lateral position)
5. Upward & left (temporal position)
6. Down & left
➢ Client holds head still & asked to move eyes & follow a small object
➢ The examiner looks for any parallel movements of the eye or for nystagmus - an
involuntary rhythmic rapid twitching of the eyeballs
 COLOR VISION TEST
Tests for color vision which involve picking nos. or
letters out of a complex & colorful picture
 ISHIHARA CHART
➢ Consists of nos. that are composed of colored dots
located within a circle of colored dots
➢ Client is asked to read the nos. on the chart
➢ Both eye is tested separately
➢ The test is sensitive for the diagnosis of red/green
blindness but not effective for the detection of the
discrimination of blue
COLOR VISION TEST
 Measurement of intraocular pressure by means of placing
a sensitive instrument (tonometer) directly on the partially
anesthetized eyeball
 2 types
1. Tonometry (Schiotz)
2. Applanation Tonometry – measures the force required to
flatten rather than indent a small area of the central cornea and
is more accurate
 Tonometer applied to
an anesthetized
cornea

 Normal: 10 – 21
mmHg

 IOP increased in
glaucoma
NURSING CARE
 Each eye is anesthetized.

 The client is asked to stare forward at a point above the

examiner’s ear
 A flattened cone is brought in contact with the cornea

 The amount of pressure needed to flatten the cone is

measured
 The client is instructed to avoid rubbing the eye

following the examination if the eye has been

anesthetized due to the potential for scratching the
cornea exists
 Fluorescein Angiography
Procedure:
√ Assess for allergies
√ Secure consent
√ Pre-op meds an hour before procedure
√ Dye injected into a vein in client’s arm
√ Inform client that the dye may cause yellowish
discoloration on the skin for a couple of hours
after the test
√ Inform the client that he may experience N&V,
sneezing, paresthesia of the tongue or pain at the
injection site
 Fluorescein Angiography
Postprocedure
➢ Encourage rest
➢ Encourage increased oral fluids
➢ Inform client that urine may appear bright green
➢ Instruct to avoid direct sunlight for a few hours
➢ Instruct that photophobia will continue until pupil size returns to
normal
 Corneal Staining
 Procedure where a topical dye is
instilled into the conjunctival sac to
outline irregularities of the corneal
surface that are not easily visible. The
eye is viewed through a blue filter and a
bright green color indicates areas of
non-intact corneal epithelium
 Corneal Staining
Interventions
➢ Contact lenses must be removed if client is wearing
one
➢ Instruct client to blink once dye have been instilled in
order to distribute it evenly across the cornea
 INSPECTION OF THE
EXTERNAL EAR
 Inspect for:
 • Size
 • Shape
 • Symmetry
 • Landmarks • Color
• Position •
Deformity or Lesion
 PALPATION
Palpate auricles and
mastoid area for:
• Tenderness
• Swelling
• Nodules
• Firmness
25
 OTOSCOPIC EXAMINATION
 Provides illumination for examining
the external auditory canal and
tympanic membrane
 A) Have client sit comfortably with
head tilted slightly away from you
 B) Use largest speculum that is
comfortable
 C) Grasp auricle and pull up, out,
and back to straighten canal
 D) Hold instrument up
 E) Insert speculum gently down
and forward into the ear canal
approximately 0.5 inches
 F) Do not touch inner portion of
the canal wall with speculum 2)
Inspect auditory canal
noting: Cerumen Color Lesions
Discharge or foreign bodies 3)
Inspect the tympanic membrane
for Landmarks Color Perferation
 OTOSCOPIC EXAMINATION
 Inspect auditory canal
noting: Cerumen Color Lesions
Discharge or foreign bodies 3)
Inspect the tympanic membrane
for Landmarks Color Perferation
s
 TYMPHANIC MEMBRANE

 Color/shape-pearly grey,
shiny, translucent, with no
bulging or retraction.
 2) Consistency - smooth.
 3) Landmarks.
 a) Cone shaped light
reflection of the otoscope
light is seen at 5:00 in the
right ear and at 7:00 in the
left ear.
 b) Short process, malleus
and umbo clearly visible.
 EVALUATION OF GROSS
AUDITORY ACUITY

1. WHISPER TEST
2. TURNING FORK TEST

 WEBER TEST

 RINNE TEST

3. WATCHER’S TEST
 WHISPER TEST
1.The examiner stands directly infront of the patient
1- 2 ft. on the side of the ear to be tested.
2. Instruct the client to occlude the ear canal of the
other ear.
3. The examiner then covers the mouth, and using a
soft spoken voice, whispers non-sequential number
(e.g. 3 5 7 ) for the client to repeat or common
phrases or 5 words are typically whispered to each
ear during the whisper test
4. Normally the client will be able to hear and repeat
the number or words. If the patient reports difficulty
understanding the whispered words during the test
refer the patient for audiological evaluation
5. Repeat the procedure at the other ear

>The following conditions may affect the accuracy of the

whisper test: Oitis media, Cerumen impaction,
Presbycusis
 Turning Fork Test
 This test is useful in determining
whether the client has a conductive
hearing loss or a perceptive hearing
loss .There are 2 types of tuning fork
test being conducted
 WEBER TEST
 Distinguishes between conductive and
sensorineural hearing.
 2) Place the vibrating fork on the middle of the
client's head
 3) Ask client if the sound is heard better in one
ear or the same in both ears

 Normal: hear sounds equally in both ears (No

Lateralization of sound)
 Conduction loss – Sound lateralizes to
defective ear (Heard louder on defective ear).
 Sensorineural loss – Sound lateralizes on
better ear.
 512 Hz is the type of tuning fork is commonly
used for the Weber test
33
 RINNE TEST
 Test compares air and bone
conduction hearing.
 Vibrating tuning fork handle is
placed on the mastoid process
b. Instruction client to inform
the examiner when he no
longer hears the tuning fork
sounding.
c. Position in the tuning fork
in front of the client’s ear canal
when he no longer hears it.
 Normal: Sound should be
heard when tuning fork is
placed in front of the ear canal
as air conduction< bone
 2 WAYS ON HOW WE HEAR
SOUNDS
 AIR CONDUCTION- sounds,as transmitted by
air
-uses the apparatus of the ear (pinna,
eardrum and ossicles) to amplify and direct
SOUNDS

 BONE CONDUCTION- through the mastoid

➢ via the MASTOID, bypasses some or all of
these and allows the sound to be
transmitted directly to the inner ear
35
 WATCHER’S TEST
1. Ask the client to close the
eyes.
2. Place a mechanical watch
1- 2 inches away the client’s
ear.
3. Ask the client if he hears
anything
4. If the client says yes, the
examiner should validate by
asking at what are you
hearing and at what side.
5. Repeat the procedure on
the other ear.
6. Normally the client can
identify the sound and at what
side it was heard
 Otoscopic Examination
 Otoscope used to:
➢ Evaluate inner ear for discharge and foreign bodies
➢ Assess eardrum

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
 Otoscopic Examination
 Select speculum

 Turn on otoscope

 Insert speculum into ear canal,

slightly down and forward

 Look for foreign bodies, lesions,

discharge

 Inspect tympanic membrane

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
 Otoscopic Examination
 Normal findings
➢ Cerumen is dry (tan or light yellow) or moist (dark yellow or brown)
➢ Ear canal
• Not inflamed
➢ Tympanic membrane
• Translucent or pearly gray

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.