EYE ASSESSMENT

Distant Visual Acuity

• Position client 20 feet away.

• Normal: 20/20 vision with/without corrective lenses.

Myopia

• (impaired far vision): second number higher (e.g., 20/40).

Legal blindness

• 20/200 or worse in better eye with correction.

• Refer if vision is worse than 20/30.

Near Visual Acuity

• Client holds chart 14 inches from eyes.

• Test each eye separately.

• Normal: 14/14 with/without corrective lenses.

Presbyopia

• moves chart away to see clearly; caused by decreased accommodation.

Visual Fields

(Peripheral Vision – Confrontation Test)

• Sit 2 feet from client, same eye level.

• Cover opposite eyes, compare when each sees finger.

Corneal Light Reflex

• Shine light 12 inches away at bridge of nose.

• Normal: reflection in same spot on both eyes.

• Deviation: asymmetry = eye misalignment (muscle weakness/paralysis).

Cover Test

• Normal: Uncovered eye should stay fixed. Upon uncovering the other eye, it should remain fixed.

• Deviation: Movement to refocus = muscle weakness or alignment deviation.

Positions Test (Six Cardinal Gazes)

• Move object in six directions while client follows.

• Normal: smooth, symmetrical eye movement.

• Deviation: 

• Lack of coordination → muscle or cranial nerve issue.

• Nystagmus: shaking eye movement → may indicate inner ear disorder, MS, brain lesion, or narcotic use.

Nystagmus

shaking eye movement → may indicate inner ear disorder, MS, brain lesion, or narcotic use.

Eyelids and Eyelashes

• Normal: lower lid upright, lashes curve outward and evenly spaced.

Entropion

•  inward lid turn → corneal injury risk.

Ectropion:

• outward lid turn → conjunctival drying, poor tear drainage.

Eyelid Redness, Swelling, Lesions

• Normal: no redness, swelling, or lesions.

Seborrhea/Blepharitis

• redness, crusting (Staph infection).

Hordeolum (stye)

•  painful, red, swollen hair follicle infection.

Chalazion

Meibomian gland infection → extreme swelling, moderate redness, minimal pain.

Eyeball Alignment

• Normal: symmetrical, no protrusion or sinking.

Exophthalmos

• protrusion, lid retraction (Graves' disease).

Sunken eyes:

• seen in dehydration or wasting illnesses.

Bulbar Conjunctiva and Sclera

• Normal: clear, moist, smooth; sclera is white.

Conjunctivitis

• generalized redness.

Dry areas

allergies or trauma

Episcleritis

•  localized inflammation, nodules, or vessel dilation.

Palpebral Conjunctiva

• Normal: clear, no swelling or lesions.

• Deviation: cyanosis = possible heart/lung disorder.

Evert Upper Eyelid

• Normal: no foreign body, swelling, or trauma.

• Deviation: foreign body or lesion = irritation, burning, pain, swelling.

Lacrimal Apparatus Inspection

• Normal: no swelling or redness; puncta slightly turned toward eye.

Swollen lacrimal gland

• blockage, infection, inflammation.

Red/swollen puncta

• infection/inflammation.

Excess tearing

• nasolacrimal sac obstruction.

Lacrimal Apparatus Palpation

• Palpate nasolacrimal duct.

• Normal: no drainage from puncta.

• Deviation: drainage = duct blockage.

Cornea and Lens Inspection

• Shine light obliquely; observe through pupil.

• Normal: transparent cornea, smooth moist surface, clear lens.

• Deviation:

• Dryness/roughness: injury or allergies.

• Opacities in lens = cataracts.

Iris and Pupil

• Normal:

• Iris: round, flat, evenly colored.

• Pupil: round, regular borders, centered, 3–5 mm.

• Anisocoria < 0.5 mm in 20% of clients = normal.

• Deviation:

• Irregular iris, miosis (constricted), mydriasis (dilated), anisocoria > 0.5 mm.

• Size difference during light testing = abnormal.

Reaction to Light

• Darken room, focus on distant object.

• Shine light obliquely

Direct Response

• same eye constricts.

Consensual Response

• opposite eye constricts.

PERRLA

• Pupils are Equal, Round, Reactive to Light Accommodation

Monocular blindness

• Light to blind eye = no response in either pupil.

• Light to unaffected eye = both constrict.

• No response to either light = abnormal.

Accommodation

• Focus shifts from far to near object.

• Hold object 12–15 inches from client, move closer.

• Normal:

• Pupil constriction

• Convergence of eyes

• Deviation: pupils don't constrict or eyes don't converge.