CH 15: Eyes

Subjective eye assessment (current symptoms)

Ask about:

• Vision changes

• Eye pain

• Discharge

• Light sensitivity or halos around lights

Function of eyelids & eyelashes

Protect the eye from debris and excessive light. Eyelids contain meibomian glands that produce oils to prevent tear evaporation

Conjunctiva function 

Thin, transparent membrane covering the white part of the eye and inner eyelids. Produces mucus to lubricate the eye.

Produces, distributes, and drains tears. Includes lacrimal glands, puncta, canaliculi, and nasolacrimal duct.

Lacrimal System

Light Entry

Light passes through cornea, which bends light rays toward the pupil opening controlled by the iris.

Focusing (vision)

Lens adjusts shape to focus light precisely on the retina, with ciliary muscles controlling lens curvature.

Signal Conversion (vision)

Retinal photoreceptors convert light into electrical signals transmitted via optic nerve to visual cortex.

Subjective eye assessment (medical history)

Ask about:

• Previous eye conditions or surgeries

• Family history of eye disease

• Systemic conditions (diabetes, hypertension)

• Current medications affecting vision

Subjective eye assessment (lifestyle factors)

Ask about:

• Occupational or recreational eye hazards

• Use of protective eyewear

• Screen time and digital eye strain

• Last comprehensive eye examination 

Objective eye assessment (general inspection)

Observe facial symmetry, eyebrow position, eyelid alignment, and overall eye appearance. Note any obvious abnormalities or asymmetry.

Eyelid Assessment (objective)

Check for ptosis, edema, lesions, or inflammation. Ensure complete eyelid closure and normal blinking reflex.

Drooping of upper eyelid due to muscle weakness or nerve damage. May be congenital or acquired. Can obstruct vision if severe

Ptosis

Conjunctival examination (objective

Inspect for redness, discharge, foreign bodies, or signs of infection. Gently evert lower lid if indicated.

Vision acuity testing

• Snellen chart at 20 ft distance

• Test each eye separately, than together

• Record as fraction (20/20, 20/40, etc.)

• Use pinhole test if vision is impaired

20/40

Top number = what patient can read at 20 ft

Bottom number = what average person can see at 40 ft

Eye tests

• Snellen chart

• Near vision using reading card

• Peripheral vision (confrontation) test

• Color vision screening

• Depth perception assessment

Normal size of pupils

3-5 mm in normal light.

PERRLA

P – pupils:

3-5mm in normal light. Note size, shape (should be round), and equality between eyes.

E – Equal:

Both pupils should be the same size. Anisocoria (unequal pupils) may indicate neurological issues.

RR – Round/Reactive:

Pupils should be perfectly round and constrict (react) briskly when light is applied directly

L – Light:

Test direct and consensual light reflex. Both pupils should constrict when light hits either eye.

A – Accommodation:

Pupils constrict when focusing on near objects. Test by having patient focus from distant to near object.

Unequal pupils. May indicate neurological issues

Anisocoria 

Lens loses flexibility, making near vision difficult. Reading glasses or bifocals often needed for close work

Presbyopia (occurs age 40s-50s)

Age-related eye changes

• Presbyopia (40s-50s)

• Common changes (60-70s)

• Increased risk of (70s)

Higher incidence/increased risk of cataracts, glaucoma, macular degeneration, and diabetic retinopathy requiring regular monitoring. At what age does this occur?

70s+

Decreased tear production, reduced peripheral vision, increased sensitivity to glare, and slower dark adaptation

Common age-related eye changes

Clinical presentation for this disease is:

• Red, tender bump on eyelid margin

• Localized swelling and pain

• May have purulent drainage

• External (zeisian gland) or internal (meibomian gland)

Hordeolum (Stye)

Nursing interventions for Hordeolum (Stye)

• Apply warm, moist compresses 10-15 minutes, 3-4 times daily

• Educate about proper hand hygiene

• Advise against squeezing or manipulating

• Monitor for spreading infection

An acute localized staphylococcal infection of sebaceous gland in eyelid. It is painful, red, and swollen—a superficial, elevated lump or pustule at the lid margin. Rubbing the eyes can cause cross-contamination and development of another stye. Managed with warm compresses, topical antibiotic ointment, may be combined with steroid ointment

Hordeolum (Stye)

Silent Thief of Sight

Glaucoma

Increased intraocular pressure damages optic nerve, causing progressive vision loss. Often asymptomatic until advanced stages.

Pathophysiology of glaucoma

Risk factors for this disease include

• Age > 40

• Family history

• African American

• Diabetes

• HTN

• High myopia

• Previous eye trauma

Glaucoma

Myopia

Near-sighted; can’t see far

Hyperopia

Far-sighted; can’t see close

Assessment findings for glaucoma

Peripheral vision loss, halos around lights, eye pain, N/V (acute angle-closure), elevated IOP >21 mmHg.

Patient education for glaucoma

Emphasize importance of regular eye exams, medication compliance, and recognizing symptoms requiring immediate attention.

Elevated IOP > 21 mm Hg indicates

Glaucoma

PHINVE (glaucoma assessment findings)

P – peripheral vision loss

H – Halos around lights

I – Intraocular pressure (IOP) > 21 mm Hg

NV – nausea/vomiting

E – Eye pain

Clinical manifestations of this disease includes

• Gradual, painless vision loss

• Increased glare sensitivity

• Difficulty with night driving

• Colors appear faded or yellowed

• Frequent prescription (glasses/contacts) changes

• Cloudy or milky appearance of lens

Cataracts (clouded vision)

Nursing care for cataracts

Educate about surgical options, pre/post-operative care (eye shield prevent rubbing), and safety measures. Emphasize that surgery is the only effective treatment

Risk factors for cataracts

• Aging (most common)

• UV light exposure

• DM

• Smoking and alcohol use

• Steroid medications

• Previous eye trauma

Thick, purulent discharge, usually yellow-green. Highly contagious. Treatment includes antibiotic drops and strict hygiene measures

Bacterial Conjunctivitis

Watery discharge, often associated with upper respiratory infection. Self- limiting but highly contagious. Supportive care only.

Viral Conjunctivitis 

Bilateral itching, tearing, and redness. Not contagious. Treatment includes antihistamines and avoiding triggers.

Allergic Conjunctivitis

Abnormal protrusion of eyeballs, often associated with hyperthyroidism. May cause difficulty closing eyelids completely, leading to corneal dryness and damage

Exophthalmos

Eye safety & health promotion

• Protective eyewear

• UV Protection

• Digital Eye Strain

• Regular examinations

Protective eyewear (Eye Safety & Health Promotion)

Use appropriate safety glasses, goggles, or face shields during work, sports, and recreational activities with eye injury risk

UV protection (Eye Safety & Health Promotion)

Wear sunglasses with 100% UV protection outdoors. Choose wraparound styles for maximum coverage and reduce cataract risk

Digital Eye Strain (Eye Safety & Health Promotion)

Follow 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds. Adjust screen brightness and distance.

Regular Examinations ((Eye Safety & Health Promotion)

Annual comprehensive eye exams for adults >40, or as recommended based on risk factors and family history