I can guide you through the step-by-step eye and visual acuity assessment based on
your uploaded nursing interview guide. Below is a detailed breakdown:
Step-by-Step Eye and Visual Acuity Assessment
1. Preparation
• Gather all necessary equipment:
• Snellen chart (for distance vision)
• Handheld vision chart (for near vision)
• Penlight (to check pupils and corneal light reflex)
• Opaque card (for cover test)
• Ophthalmoscope (to examine internal eye structures)
• Explain the procedure to the patient to gain cooperation and reduce
anxiety.
3. Assess Visual Acuity (Perform Vision Tests)
A. Distant Visual Acuity (Snellen Chart)
• Place the Snellen chart 20 feet away from the patient.
• Have the patient cover one eye with an opaque card.
• Ask them to read the smallest line they can.
• Repeat with the other eye.
• If they wear corrective lenses, test with and without glasses.
• Normal vision is 20/20; record any deviations (e.g., 20/40 means the
patient sees at 20 feet what a normal person sees at 40 feet).
B. Near Visual mnAcuity (Handheld Chart)
• Hold the handheld chart 14 inches away.
• Ask the patient to read the smallest line they can.
• Normal near vision is 14/14.
• This test checks for presbyopia (age-related near vision loss).
C. Peripheral Vision (Confrontation Test)
• Sit 2 feet away from the patient.
• Cover your right eye while the patient covers their left.
• Move your fingers from the periphery toward the center.
• Ask the patient to signal when they see the fingers.
• Repeat in all quadrants.
• Purpose: Tests for visual field loss (e.g., glaucoma).
4. Extraocular Muscle Function Tests
A. Corneal Light Reflex Test (Hirschberg Test)
• Shine a penlight at the bridge of the nose.
• Observe light reflection in both corneas.
• Normal: Reflection should be in the same spot in both eyes.
• Abnormal: Uneven reflection suggests strabismus (eye misalignment).
B. Cover Test
• Ask the patient to focus on a distant object.
• Cover one eye with an opaque card.
• Observe the uncovered eye for movement.
• Normal: No movement.
• Abnormal: The uncovered eye shifts, indicating muscle imbalance.
C. Positions Test (Cardinal Fields of Gaze)
• Ask the patient to follow your finger in six directions.
• Normal: Smooth movement, no nystagmus (shaky eyes).
• Abnormal: Jerky or limited movement suggests cranial nerve dysfunction.
5. Inspect External Eye Structures
A. Eyelids and Lashes
• Check for symmetry, swelling, drooping (ptosis), or discharge.
• Observe if the eyelashes are curled inward (entropion) or outward
(ectropion).
B. Eyeball Positioning
• Look for bulging (exophthalmos in hyperthyroidism) or sunken eyes
enophthalmus.
C. Conjunctiva and Sclera
• Pull down the lower eyelid for palpebral conjuctiva and pull the upper
eyelid for bulbar conjuctiva and inspect for:
• Redness (infection)
• Yellowing (jaundice)
E. Lacrimal Apparatus
• Press lightly on the lacrimal sac and nasolacrimal sac.
• Check for excessive tearing or pus discharge.
D. Cornea and Lens
• Shine a light at an angle over the cornea.
• Look for cloudiness (cataracts) or scratches.
. Iris and Pupil
• Iris should be round, flat and evenly colored
• Pupil must be round and centered in the iris
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6. Assess Pupil Response
A. Pupillary Reaction to Light
• In a dimly lit room, shine a penlight from the side.
• Observe direct (same eye) and consensual (opposite eye) reaction.
• Normal: Both pupils constrict.
• Abnormal: No reaction (suggests nerve damage).
B. Accommodation Test
• Ask the patient to focus on a distant object, then shift focus to a
near object.
• Normal: Pupils constrict when focusing on a near object.
