Ophthalmic System Presentation

Ophthalmic System Study Notes

Assessment Overview

• Title: Ophthalmic System Assessment: The Eyes

• Copyright: Jlapum 2025

• Comprehensive study of the components and assessment techniques related to the eyes.

Components of the Ophthalmic System

• Vision

• Key Components:

  • Eyelids

  • Eyebrows

  • Palpebral fissures

  • Pupil

  • Iris

  • Sclera

  • Lens

  • Cornea

  • Conjunctiva

  • Canthus

  • Lacrimal apparatus

  • Extraocular eye muscles

  • Retina

  • Optic nerve

• Reference: (Lapum & Hughes, 2024)

Subjective Assessment

• Key Areas to Assess:

  • Visual impairments

  • Eye pain and eye strain

  • Signs of discolouration, pruritus, swelling, and lesions

  • Eye discharge, dry or gritty eyes

  • Additional symptoms

  • Personal and family history

• Priorities of Care:

  • Eye trauma

  • Sudden changes in vision

• Contextualizing Inclusivity:

  • Screening recommendations

  • Considerations for blindness

  • Newborn eyecare protocols

  • Over-the-counter eyedrops considerations

• Reference: (Lapum & Hughes, 2024)

Objective Assessment

• Brief Scan Technique:

  • Look for observable cues indicating vision impairment:

  • Use of hands to guide movement

  • Frequent squinting

  • Difficulty maintaining eye contact

  • Observable Signs:

  • Redness

  • Discolouration

  • Swelling

  • Discharge

  • Lesions

• Contextualizing Inclusivity:

  • Importance of maintaining eye contact

• Reference: (Lapum & Hughes, 2024)

External Eye Assessment and Anterior Eyeball Assessment

• General Inspection:

  • Check for symmetry in:

  • Eyebrows

  • Eyes

  • Eyelids

  • Palpebral fissures

  • Assess eyeball alignment

  • Note any lesions, swelling, or discolouration

  • Inspect discharge

  • Examine structures:

  • Cornea

  • Lens

  • Sclera

  • Conjunctiva

• Contextualizing Inclusivity:

  • Considerations for:

  • Periorbital hyperpigmentation and puffiness

  • Skin under the eyes

  • False eyelashes

  • Ptosis

  • Dry eyes

  • Presence of ocular prosthesis

• Priorities of Care:

  • New onset of drooping eyelid

  • Intraocular hemorrhage

  • Eye hordeolum and chalazions

• Reference: (Lapum & Hughes, 2024)

Pupillary Light Reflex and Accommodation

• Pupillary Light Reflex:

  • Assesses the eye's response to light

  • Tests the innervation of cranial nerves:

  • CN II (optic)

  • CN III (oculomotor)

• Technique Brief Description:

  • Method for testing each function

• Accommodation:

  • Assesses the ability of the eye to accommodate for near objects

  • Tests innervation of CN III (oculomotor)

• Contextualizing Inclusivity:

  • Tips for examining dark irises

• Priorities of Care:

  • Blown pupil

  • New onset anisocoria (unequal pupil size)

• Reference: (Lapum & Hughes, 2024)

Central Visual Acuity Assessment

• Distance Vision Testing:

  • Utilize the Snellen eye chart set at 20 feet

  • Leave corrective lenses on if necessary

  • Test one eye at a time while covering the opposite eye:

  • Read top down (as many lines as possible)

• Near Vision Testing:

  • Use reading material (newspaper/book)

  • Maintain material 35 to 45 cm from the eyes

  • Read a couple of sentences to assess acuity

• Clinical Tip:

  • When testing distance vision, note the line where the client can read all letters with a maximum of two errors.

  • Reference: (By Khex14 – Own work, Creative Commons Attribution-Share Alike 3.0 Unported license)

Peripheral Vision Assessment

• Confrontational Visual Field Exams:

  • Compare client’s peripheral vision to examiner's

  • Methods:

  • Wiggle finger method

  • Counting fingers method

• Priorities of Care:

  • Sudden onset of peripheral vision loss (e.g., dark spots or shadows) requires immediate emergency care.

  • Notify physician or nurse practitioner, stay with the client, take their blood pressure, and perform a primary survey.

• Reference: (Lapum & Hughes, 2024)

Extraocular Eye Movement Assessment

• Innervation Overview:

  • Innervated by cranial nerves:

  • CN III (oculomotor)

  • CN IV (trochlear)

  • CN VI (abducens)

• Diagnostic Positions Test:

  • Client focuses on the nurse's nose

  • Nurse moves index finger through the six cardinal positions of gaze

• Reference: (Lapum & Hughes, 2024)

Ophthalmoscope Examination

• Assessment Goals:

  • Assess for ocular opacities and examine the ocular fundus

• Ocular Fundus Reflex Test:

  • Use ophthalmoscope to assess and compare reflexes

• Ocular Fundus Test:

  • Directly view the ocular fundus with the ophthalmoscope

• Contextualizing Inclusivity:

  • Discuss the implications of terms like "red reflex" in the context of racism.

• Reference: (Lapum & Hughes, 2024)

Health Promotion and Disease Prevention

• Key Areas of Focus:

  • Smoking cessation

  • Diet and nutrition

  • Regular exercise

  • Environmental factors

  • Hygiene practices

• Reference: (Lapum & Hughes, 2024)

Key Takeaways

• The primary components of the ophthalmic system include:

  • Eyelids

  • Eyebrows

  • Pupil

  • Iris

  • Sclera

  • Lens

  • Cornea

  • Conjunctiva

  • Extraocular eye muscles

  • Retina and optic nerve

• Common symptoms to be aware of:

  • Visual impairments

  • Eye pain or strain

  • Signs of discolouration

  • Pruritus and swelling

  • Presence of lesions

  • Eye discharge

  • Dry or gritty eyes

• An objective assessment should include:

  • Brief scans and general inspection

  • External and anterior eyeball assessment

  • Central visual acuity assessment

  • Peripheral vision assessment

  • Extraocular eye movement assessment

  • Ophthalmoscope examination

• Health promotion interventions should be tailored to the client and focus on their individual health priorities.

• Reference: (Lapum & Hughes, 2024)