Examining the Eyes

Head and Neck Assessment

What are the pupil sizes you can chart in the EHR?

1 mm to 7 mm

How do you test for pupillary accommodation?

1. Hold your forefinger, a pencil, other straight objects about 4 to 6 inches from the bridge of the nose

2. Ask the patient to first look at the object then at a distant object then back at the object being held

How do you test for pupillary size and pupillary response to light?

1. Darken the room

2. Ask the patient to look straight ahead

3. Bring the penlight from the side of the patient’s face AND briefly shine the light on the pupil

4. Observe the pupil’s reaction; it normally constricts rapidly (direct response). Note pupil size.

5. Repeat the procedure and observe the other eye; it too normally will constrict*** (Consensual Reflex)

6. Repeat the procedure with the other eye

What is direct response?

Pupil’s reaction to light should normally constrict RAPIDLY

What is consensual reflex?

The pupil of the eye you shine a light on will constrict BUT also the other eye (no light on it) should constrict as well

What is pupillary accommodation?

The pupil’s ability to constrict when looking at near object and dilate when looking at distant objects

What cranial nerve is being tested when you test for pupillary response to light (consensual reflex)?

Cranial Nerve III (Oculomotor Nerve)

What cranial nerve is being tested when you test for accommodation?

Cranial Nerve III (Oculomotor Nerve)

What cranial nerve(s) are being tested when you assess for extraocular movements (EOMs, Six Cardinal Fields)?

Cranial Nerve III (Oculomotor Nerve)

Cranial Nerve IV (Trochlear Nerve)

Cranial Nerve VI (Abducens Nerves)

What nerve are you testing when you test for cranial nerve III?

Oculomotor Nerves

What nerve are you testing when you test for cranial nerve IV?

Trochlear Nerves

What nerve are you testing when you test for cranial nerve VI?

Abducens Nerves

How do you test for convergence?

1. Hold your finger about 6 to 8 inches from the bridge of the patient’s nose

2. Move your finger toward the patient’s nose

3. The patient’s eyes should normally converge (assume a cross-eyed appearance)

What is convergence?

The eyes should follow an object to within 5 cm of the nose (appear cross-eyed appearance)

What does PERRLA stand for?

Pupils equal, round, reactive to light, accommodating

If you examined the patient’s pupils, tested for consensual reflex, and tested for accommodation; how would you chart that everything was normal?

Pupils are equal, round, reactive to life with accommodation

PERRLA

What does it mean when you chart that “pupils are equal”?

BOTH pupils are the same size

What does the P in PERRLA mean? Or what are you charting?

P = Pupils Size (1mm to 7mm) + note if the pupils are dilated, pinpoint, or normal

What does the L in PERRLA stand for?

L = Light

Check if the pupils respond briskly OR sluggishly to light

Charting “reactive to light”