Visual and Auditory

Function
Anatomy and
Physiology
Function (Eyes)

Encodes the patterns of light from the environment through photoreceptors

and to carry the coded information from the eyes to the brain.

The brain gives meaning to the coded information, allowing us to make sense
of what we see.
Extraocular Structures

Eyebrows - shades the eyes

Eyelashes - traps foreign particles that prevents from entering the eyeball.

Eyelids- protect the eye from foreign bodies. Helps distribute moisture on the eye surface. Regulates entry of
light into the eye.

Conjunctiva- is a thin, transparent mucous membrane that lines the inner surfaces of the eyelids. It folds over
the anterior surface of the eyeball, lubricating the eyes.
Palpebral conjunctiva lines the upper and lower eyelids, whereas the bulbar conjunctiva loosely covers the
anterior sclera (the white part of the eye).

Lacrimal - compose of lacrimal gland, the puncta, the lacrimal sac, and the nasolacrimal duct. Together, these
structures secrete, distribute, and drain tears to cleanse and moisten the eye’s surface.

Six extrinsic eye muscles control movement of the eye, allowing it to follow a moving object and move
precisely. The muscles also help maintain the shape of the eyeball.
Intraocular Structures

The intraocular structures transmit visual images and maintain homeostasis of the inner
eye.

Those in the anterior portion of each eyeball are the sclera and the cornea (forming the
outermost coat of the eye, called the fibrous tunic), the iris, the pupil, and the anterior
cavity.
Sclera and Cornea

The white sclera lines the outside of the eyeball and protects and gives shape to the eyeball.

The sclera gives way to the cornea over the iris and pupil.

The cornea is transparent, avascular, and sensitive to touch. It forms a window that allows light to
enter the eye and is a part of its light-bending apparatus. When the cornea is touched, the eyelids
blink (the corneal reflex) and tears are secrete.
Iris and Pupil

The iris is a disc of muscle surrounding the pupil and lying between the cornea and the lens.

The iris gives the eye its color and regulates light entry by controlling the size of the pupil.

The pupil is the dark center of the eye through which light enters.

The pupil constricts when bright light enters the eye and when it is used for near vision; it dilates when light
conditions are dim and when the eye is used for far vision. In response to intense light, the pupil constricts
rapidly in the pupillary light reflex.
Aqueous Fluid

Anterior Chamber (the space between the cornea and the iris) and the posterior chamber (the space
between the iris and the lens).
Internal Chamber

The intraocular structures that lie in the internal chamber of the eye are the lens, the posterior cavity and
vitreous humor, the ciliary body, the uvea, and the retina.

The lens is a biconvex, avascular, transparent structure located directly behind the pupil. It can change shape
to focus and refract light onto the retina.

The posterior cavity lies behind the lens. It is filled with a clear gelatinous substance, the vitreous humor,
which supports the posterior surface of the lens, maintains the position of the retina, and transmits light
Uvea - is the middle layer of the eyeball. This pigmented layer has three components: the iris, ciliary body,
and choroid.

The ciliary body encircles the lens, and along with the iris, regulates the amount of light reaching the retina
by controlling the shape of the lens. Most of the uvea is made up of the choroid.

Retina - is the innermost lining of the eyeball. This is responsible for visual processing.

Rods- enable vision in dim light as well as peripheral vision.

Cones - enable vision in bright light and the perception of color.

The optic disc - a cream-colored round or oval area within the retina, is the point at which the optic nerve
enters the eye.

Macula - central vision

Visual Pathway

Refraction - is the bending of light rays as they pass from one medium to another medium of different optical
density. As light rays pass through the eye, they are refracted at several points: as they enter the cornea, as
they leave the cornea and enter the aqueous humor, as they enter the lens, and as they leave the lens and
enter the vitreous humor. At the lens, light is bent so that it converges at a single point on the retina.

Accommodation - focusing of the image.

Convergence - the medial rotation of the eyeballs so that each is directed toward the viewed object allows
the focusing of the image.
Extraocular muscles by Cranial Nerves
Diagnostic Tests
Ophthalmoscopy (Retinoscopy)

To inspect the fundus (back portion) of the eyeball to detect abnormalities of the retina, macula, optic disc,
and retinal vessels
Visual acuity

To determine status of vision. The Snellen eye chart is used.

It is placed 20 feet from the patient; first one eye is occluded, then the other eye is occluded. The person
begins reading lines of letters that decrease in size.

Visual acuity is expressed as a fraction for each eye. The numerator figure indicates the distance between the
patient and the chart. The denominator figure expresses the distance at which the person with 20/20 vision
could read the letters in the line correctly.

Visual acuity of 20/20 in each eye is normal; vision of 20/200 (with correction) is legally defined as blindness
Near vision test

To determine status of near vision.

The patient is given a Jaeger Test Type card with different sizes of type on it. One eye is occluded while the
patient reads the lines of type.

Determination of vision status is made on the basis of what a person with normal vision can read.
Visual fields test (confrontation test)

To examine the patient's visual fields, detecting problems with peripheral vision.

The examiner faces the patient and asks her to look directly into his eyes. The examiner covers his right eye,
and the patient covers her left eye. Then the examiner's finger is moved from an area outside of the
peripheral vision into the line of vision. The patient should detect the finger about the same time as the
examiner. The test is repeated with the other eye covered.
Extraocular muscle function test

To test the function of the extraocular muscles.

Ask the patient to hold her head still and to move her eyes to follow a small object such as a pen to each of
the six cardinal points: right; upward and right; downward and right; left; upward and left; downward and
left.
Color vision test

To determine whether the patient has any color blindness.

Use the Ishihara chart book, which shows numbers composed of dots of one color within an area of dots of a
different color. Ask the patient what she sees on the page for each chart. Test each eye separately. Reading
the numbers correctly indicates normal color vision.
Refraction

To determine amount of lens correction necessary to restore person's vision to as near normal as possible
with glasses.

A series of glass lenses are placed in front of the patient's eyes to determine which lens provides the best
vision correction. Each eye is tested separately.
Intraocular pressure test

To determine the amount of pressure within the eye; aids in diagnosis of glaucoma.

A tonometer is used to measure the pressure. This may be a handheld instrument, but it usually is a device
that measures pressure by taking a reading while air is directed at the eye by a pneumotonometer. Another
type of tonometer is the applanation tonometer. Normal intraocular pressure is 10-21 mm Hg.
Slit-lamp biomicroscopic examination

To examine the surface of the eye.

A beam of light is reduced to a narrow slit that illuminates only a small section of the eye, allowing
examination of a thin section of the eye structures at a time.
Topical dye (corneal staining)

To detect abrasions of the cornea or the presence of a foreign body on the cornea.

Fluorescein dye drops are administered to the affected eye. The dye remains on the injured tissue or
surrounds a foreign body. Such areas usually appear as green spots.
Fluorescein angiography (retinal angiography)

To detect tumors of the interior of the eye and to help diagnose and measure the extent of retinopathy.

An IV injection of sodium fluorescein is given. A short time later, photographs of the fundus are taken with a
special camera.
Electroretinography

To test the functional integrity of the retina; evaluates degeneration of the photoreceptor cell.

Electrodes embedded into a contact lens are placed directly on the anesthetized eye. A light stimulus is
introduced. The change in electrical potential of the eye caused by the flash of light is measured.
Optical coherence tomography (OCT)

To record images of retinal structures. To differentiate the anatomic

layers within the retina and allow measurement of retinal thickness.
To detect macular holes, epiretinal membranes, cystoid macular
edema, and other pathologies.

Focused beams of light are directed into the eye that scan the
structural features of the retina. A cross-sectional image similar to a
topographic map is produced.
Amsler grid test

To detect macular degeneration.

Using a handheld card printed with a grid of black lines similar to graph paper, the patient fixates on a center
dot and records abnormalities of the grid lines.
Ultrasonography

To evaluate the characteristics of a lesion and its size and growth

over time, or to determine the presence of a foreign body.

A probe is placed directly on the eyeball. Sound waves are

transmitted into the eye, bounce back off the various tissues, and
are collected by a receiver and amplified on an oscilloscope screen
Common Disorders of the
Eye
Conjunctivitis

The inflammation of the conjunctiva, is the most common

eye disease.

Cause - bacterial, fungal, viral infection. Allergen, Chemical

irritants and radiant energy.

Mode of transmission- direct contact from eye (e.g., hands,

tissues, towels).
Pathophysiology

Acute Conjunctivitis

Bacterial conjunctivitis caused by Staphylococcus or Haemophilus. (for children)

Adenovirus infection. (for adults)

- Viral Infection (infected with Gonococcus)

Trachoma

Cause: Chlamydia trachomatis

Trachoma is contagious, transmitted primarily by close personal contact (eye-to-eye,

hand-to-eye) or by fomites such as towels, handkerchiefs, and flies.
Manifestations

Acute: Redness and itching of the affected eye. May also experience scratchy, burning, or gritty sensation.

Photophobia, tearing with watery, purulent or mucoid discharge.

Chronic: Early ( redness, eyelid edema, tearing, and photophobia)

Late: ulceration and scarring

Diagnosis

Culture and Sensitivity

Fluorescein stain with slit lamp examination

Conjunctival Scrapings
Medication

Antibiotic, Antiviral or anti-inflammatory.

A. Drops or Ointment - erythromycin, gentamicin, penicillin, bacitracin, sulfacetamide sodium,

amphotericin B, or idoxuridine.
B. Severe infections ROA: IV or Subconjunctival Injections
C. Antihistamine
Nursing Care

Physical Assessment Instructions:

Saline Compress No high level of Visual Activities

Frequent Eye Irrigation
May use dark sunglasses
Removal of Crusts or exudate in conjunctivitis.

Reduce lighting intensity

Errors of Refraction

A. Myopia (nearsightedness) - occurs when the image is focused in front of the

lens, because the eyeball is too long.
B. Hyperopia (farsightedness) - develops if the eyeball is too short and the image
is focused behind the retina.
C. Presbyopia - loss of lens elasticity due to aging. Unable to focus for close work and images fall behind the
retina.

D. Astigmatism - occurs because of the irregular curvature of the cornea. Images focuses at 2 different points
on the retina.
Assessment

A. A refractive errors are diagnosed through a process called refraction.

B. The client will view eye charts while various lenses are placed in front of the eye.
C. Nonsurgical interventions: Eyeglasses or contact lenses
D. Surgical Interventions
a. Radial Keratotomy
b. Photorefractive Keratotomy
c. Laser-assisted in-situ keratomileusis (LASIK)
d. Corneal Ring
Radial Keratotomy
Photorefractive Keratotomy
LASIK
Corneal Ring