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316 PHYSICAL EXAMINATION
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9. Which of the following is a normal nding of lymph
node assessment?
a. Small, discrete, movable nodes
UNIT 2
b. Enlarged node in the left supraclavicular area
c. Nontender, xed, hard node
d. Nonmobile, rubbery, erythematous node
10. The consumer with a sore throat is most likely to have tender
and enlarged lymph nodes in which area?
a. Preauricular
b. Tonsillar
FURTHER RESOURCES
> ABC Health and Wellbeing: http://www.abc.net.au/health/
library/stories/2005/06/16/1831822.htm
> Australian Government Department of Health and Aged
Care – Aboriginal and Torres Strait Islander health: https://
www.health.gov.au/health-topics/aboriginal-and-torresstrait-islander-health?utm_source=health.gov.au&utm_
medium=callout-auto-custom&utm_campaign=digital_
transformation
> Australian Thyroid Foundation: https://www.thyroidfoundation.
org.au/
> Better Health Channel: http://www.betterhealth.vic.gov.au/
> Cancer Council: http://www.cancer.org.au/
c. Supraclavicular
d. Postauricular
CLINICAL SKILLS
The following Clinical Skill is relevant to this chapter and can
be found in Tollefson & Hillman, Clinical Psychomotor Skills,
8th edition:
> 27 Healthcare teaching.
> Endocrine Society of Australia: http://www.endocrinesociety.
org.au/
> healthdirect Australia: http://www.healthdirect.gov.au/
> Health Navigator New Zealand: https://www.healthnavigator.
org.nz/health-a-z/o/overactive-thyroid/
> International Headache Society (IHS): https://ihs-headache.
org/en/resources/guidelines/
> Lymphoma Australia: http://www.lymphoma.org.au/
> Mayo Clinic: http://www.mayoclinic.com
> Migraine & Headache Australia: http://headacheaustralia.
org.au/
> New Zealand Ministry of Health: http://www.health.govt.nz/
REFERENCES
Australian Government Department of Health and Aged Care. (2020).
Smoking and tobacco and Aboriginal and Torres Strait Islander peoples.
Retrieved 27 October 2022 from https://www.health.gov.au/topics/
smoking-and-tobacco/smoking-and-tobacco-throughout-life/smokingand-tobacco-and-aboriginal-and-torres-strait-islander-peoples
Australian Indigenous HealthInfoNet. (2017). National Aboriginal and
Torres Strait Islander social survey 2014–15 released. Retrieved 27
October 2022 from https://healthinfonet.ecu.edu.au/about/news/4088/
Australian Institute of Health and Welfare (AIHW). (2020). 1.11 Oral Health.
Aboriginal and Torres Strait Islander Health Performance Framework.
Retrieved 8 December 2022 from: https://www.indigenoushpf.gov.au/
measures/1-11-oral-health
Australian Institute of Health and Welfare (AIHW). (2022a). Cancer data
in Australia. Retrieved 6 December 2022 from: https://www.aihw.gov.
au/getmedia/43903b67-3130-4384-8648-39c69bb684b5/Cancer-data-inAustralia.pdf.aspx?inline=true
Australian Institute of Health and Welfare (AIHW). (2022b). Oral and dental
care in Australia. Retrieved 8 December 2022 from: https://www.aihw.
gov.au/reports/dental-oral-health/oral-health-and-dental-care-inaustralia/contents/hospitalisations
Australian Institute of Health and Welfare (AIHW). (2022c). Indigenous
health and wellbeing. Retrieved 8 December 2022 from: https://
www.aihw.gov.au/reports/australias-health/indigenous-health-andwellbeing#Hearing%20health,%20eye%20health%20and%20oral%20health
Australian Resuscitation Council and New Zealand Resuscitation Council
(ANZCOR). (2016). ANZCOR Guideline 9.1.6 – Management of suspected
spinal injury. Retrieved 21 October 2022 from https://resus.org.au/guidelines/
Cancer Australia. (2022a). Head and neck cancer. Retrieved 6 December
2022 from: https://www.canceraustralia.gov.au/cancer-types/
head-and-neck-cancer/statistics
Cancer Australia. (2022b). Thyroid cancer. Retrieved 6 December 2022
from: https://www.canceraustralia.gov.au/cancer-types/thyroidcancer/statistics
Headache Australia. (2023). Prevalence and cost of headache. Retrieved
25 May 2023 from http://headacheaustralia.org.au/what-is-headache/
prevalence-and-cost-of-headache/
Health Navigator New Zealand. (2021). Thyroid cancer. Retrieved 6
December 2022 from: https://www.healthnavigator.org.nz/health-a-z/t/
thyroid-cancer/
HealthED Ministry of Health New Zealand. (2019). Body-piercing and
tattooing: Protecting your health. Retrieved 19 October 2022 from
https://www.healthed.govt.nz/resource/body-piercing-and-tattooingprotecting-your-health
International Headache Society (IHS). (2018). The International
Classication of Headache Disorders, 3rd edition. Retrieved 19
October 2022 from https://ichd-3.org/
Laaksonen, M., MacInnis, R., Canfell, K., Shaw,J. E., Magliano,D. J.,
Banks,E., … Vajdic, C. M. (2021). Thyroid cancers potentially
preventable by reducing overweight and obesity in Australia: A pooled
cohort study. International Journal of Cancer 150(8), 1281–90.
https://doi.org/10.1002/ijc.33889
Ministry of Health. (2018). Oral health. Māori health. Retrieved 8 December
2022 from: https://www.health.govt.nz/our-work/populations/maorihealth/tatau-kahukura-maori-health-statistics/nga-mana-hauoratutohu-health-status-indicators/oral-health
NSW Health. (2022). Body art and tattooing businesses. Retrieved
19 October from https://www.health.nsw.gov.au/environment/
factsheets/Pages/tattooing.aspx
Queensland Government. (2017). Body piercing – so you are thinking of
getting a piercing. Retrieved 19 October 2022 from http://conditions.
health.qld.gov.au/HealthCondition/condition/20/40/17/body-piercingso-you-are-thinking-of-gettin
Queensland Government, Queensland Health (2016). Personal appearance
services. Retrieved 27 October 2022 from https://www.health.qld.
gov.au/public-health/industry-environment/personal-appearance/
services/legislation
CHAPTER
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10
EYES
LEARNING OUTCOMES
By the end of this chapter you should be able to:
1 identify the structures of the eyes
2 discuss the system-specic history for the eyes
3 describe normal ndings in the physical examination of the eyes
4 describe common abnormalities found in the physical examination of the eyes
5 perform a foundation level physical examination of the eyes
6 identify health education opportunities for consumers in regard to specic eye conditions
7 discuss the clinical reasoning in evaluating outcomes of health assessment and physical examination
including documentation requirements for recording information, health education given and relevant
health referral.
317
BACKGROUND
Health assessment and physical examination of the eyes provides information
about the consumer’s nutritional, endocrine, cardiovascular, gastrointestinal and
neurological systems. This chapter provides a comprehensive guide to examining
the eye, and the factors that affect it. How comprehensive your assessment is may
also depend on your role and scope of practice. For example, most nurses in general
areas do not undertake examination of the retina or conduct field tests; however,
nurses in specialised areas or advanced practice roles may do so. Nevertheless,
eye-related health problems occur in over 55% of the Australian population (more
commonly in females than males) (AIHW, 2021a), which makes eye-related health
issues one of the most common health problems in Australia.
Common conditions that will be discussed include:
> refractive error issues such as myopia, presbyopia and hyperopia
> cataracts
> glaucoma
> age-related macular degeneration
> diabetic retinopathy
> eye injuries/trauma such as corneal ulceration and foreign bodies.
Eye conditions are very common, with an estimated 13 million Australians
having one or more chronic (long-term) eye conditions, including 131000 with
complete or partial blindness (AIHW, 2021a). Vision impairment is not, however,
equally distributed across the Australian population. Aboriginal and Torres Strait
Islander people are three times as likely as non-First Nations Australians to be blind
or have low vision (AIHW, 2021b), and despite these higher rates of vision loss,
research shows that Aboriginal and Torres Strait Islander people use eye health
318 PHYSICAL EXAMINATION
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UNIT 2
services at lower rates than non-First Nations Australians. Barriers to accessing eye
care include a lack of specialist services in rural and remote areas, the complexity
of the patient journey, a lack of coordination within and between services, and
uncertainty about service providers and the cost of treatment (Razavi, Burrow &
Trzesinski, 2018). The main causes of vision impairment in Australia are refractive
error and cataracts (AIHW, 2021a).
In New Zealand, it is estimated that there are 180000 New Zealanders with
moderate to severe functional vision loss. The most common eye conditions
underlying blindness and low vision are age-related macular degeneration (AMD),
diabetic retinopathy, glaucoma and cataracts (Blind Low Vision NZ, 2022). The
Māori people have a higher prevalence of diabetic retinopathy and keratoconus,
develop cataracts 10 years younger than non-Māori people, and have decreased
access to strabismus surgery (Chilibeck, Mathan, Ng & McKelvie, 2020).
LEADING EYE HEALTH RELATED CONCERNS
> Globally, at least 2.2 billion people have a near or distance vision impairment.
In 50% of these cases, vision impairment could have been prevented or has
yet to be addressed. These 1 billion people include those with moderate or
severe distance vision impairment or blindness due to unaddressed refractive
error (88.4 million), cataract (94 million), age-related macular degeneration (8
million), glaucoma (7.7 million) and diabetic retinopathy (3.9 million), as well
as near vision impairment caused by unaddressed presbyopia (826 million)
(World Health Organization, 2022). Recent modelling by Vision 2020 Australia
suggests that around 840000 Australians are currently living with vision loss,
and that by 2030 this could exceed 1.04 million (Vision 2020, 2021).
> Glaucoma is the leading cause of irreversible visual impairment internationally
with
primary open angle glaucoma (POAG) being the predominant subtype
of glaucoma (Zhang, Wang, Li & Jiang, 2021). Currently, about 80 million
people worldwide have glaucoma and numbers are increasing due in part to the
rapidly ageing population (Glaucoma Research Foundation, 2022). In Australia,
over 300000 people have glaucoma and one in 50 will develop glaucoma in
their lifetime. It is estimated that about half of the cases of glaucoma remain
undetected (Glaucoma Australia, 2022). Primary open angle glaucoma is a
condition in which increased intraocular pressure causes damage to the optic
nerve (Glaucoma Australia, 2022). The rise in pressure is often due to impaired
drainage of fluid out of the eye. There is no pain or other related symptoms to
warn of its presence. While anyone may develop glaucoma, some people are at
a higher risk, including those with a family history of the disease and anyone
over the age of 50. There is a 10-fold chance of immediate relatives of an affected
person contracting POAG (CERA, 2022).
> Age-related macular degeneration (ARMD) is the leading cause of
blindness in both Australia and New Zealand (Macular Disease Foundation
Australia, n.d.(a); Macular Degeneration New Zealand, 2020; Vision Australia,
2022). As its name suggests, ARMD affects the macular region of the retina. Early
detection is the best chance of halting progression in cases of wet ARMD where
sudden loss of vision occurs. Dry ARMD results in a gradual loss of central vision
(Macular Degeneration New Zealand, 2020). One in seven people over 50 will
develop ARMD (Macular Degeneration New Zealand, 2020).
> Other conditions and injuries also impact vision, such as diabetes mellitus
(people with diabetes mellitus are at risk of developing diabetic-related
retinopathy) (AIHW, 2021a; Macular Disease Foundation Australia, n.d.(b)). Eye
injuries (falls, assaults, sport and work-related accidents) are also a significant
proportion of reasons for visual impairment, responsible for10–27% of
operating department, 38–65%of emergency department and 5–16% ofall eye
EYES 319
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hospital patient admissions. The majority of people hospitalised for eye injuries
are male (Hoskin, 2020).
Diseases, disorders and injuries affecting vision can have enormous effects on
the individual’s ability to care for self and others, and therefore makes assessment
of the eyes extremely important. Among older people, vision-related issues become
more pronounced, significantly reducing their quality of life and contributing to
depression (Sturrock, 2018). Risk factors for eye-related problems can be useful to
consider when preparing to assess a consumer (see
TABLE 10.1 Risk factors for eye problems
AGE AND SEX Increased prevalence of problems as age increases
Women are more likely than men to suffer vision impairment
Diet
High intake of protein, vitamins A, B and riboavin protects against some forms of
cataract
High dietary fat is a risk for macular degeneration
High sh consumption may protect against macular degeneration
GENETICS People who have a family member with macular degeneration are three times more likely
to develop it.
Aboriginal Australians have lower levels of refractive error and better visual acuity, which
is likely to be genetic.
Table 10.1).
CHAPTER 10
OTHER
FACTORS
FOR DIABETIC
PEOPLE
ADAP TED FRO M KAMIŃ SKA , PINKA S, WRZEŚN IEWSK A-WAL, OS TROWSK I & JANKOWS KI, M. (202 3); AUST RALIA N DEPART MENT OF HE ALTH AND A GED CARE (2 023)
Smoking and excessive alcohol consumption can increase the risk of some types of
cataracts as well as macular degeneration.
Excessive sun exposure also may pre-dispose to eye-related problems.
Population groups: Specic population groups can be at higher risk of avoidable vision
loss and include Aboriginal and Torres Strait Islanders, the elderly, people with a family
history of eye disease, those with diabetes mellitus, and societal groups that are
marginalised or disadvantaged.
15–30% will also have diabetic retinopathy
Accounts for signicantly worse vision than those without diabetes
Are at a higher risk for glaucoma and cataracts
ANATOMY AND PHYSIOLOGY
External structures
The external structures of the eye comprise the eyelids or palpebra, the conjunctiva,
the lacrimal glands, and the extraocular muscles. The eyelids consist of smooth
muscle covered with a very thin layer of skin; they admit light to the eye while
protecting and maintaining lubrication of the eye. The interior surface of the
lid muscle is covered with a pink mucous membrane called the
conjunctiva. Alongside the palpebral conjunctiva is the bulbar conjunctiva.
The bulbar conjunctiva folds back over the anterior surface of the eyeball and
merges with the cornea at the limbus, the junction of the sclera and the cornea
(Figure 10.1). The conjunctiva contains blood vessels and pain receptors that respond
quickly to outside insult. Eyelashes are evenly spaced along lid margins and curve
outwards to protect the eye by filtering particles of dirt and dust from the external
environment. Eyebrows are symmetrical and evenly distributed above the eyelids.
The opening between the eyelids is called the palpebral fissure. Upper and
lower eyelids meet at the inner canthus on the nasal side and at the outer canthus
on the temporal side. Embedded just beneath the lid margins are the meibomian
glands, which secrete a lubricating substance onto the surface of the eye. The tarsal
plates are connective tissue that gives shape to the upper lids.
palpebral
320 PHYSICAL EXAMINATION
Eyelashes
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Temporal side
Lacrimal gland
fissure
Lower lid
(under eyelid)
Conjunctiva
Limbus
UNIT 2
Outer
canthus
Palpebral
FIGURE 10.1 External view of the right eye
Upper lid
Iris
Sclera
Nasal side
Pupil
Inner canthus
Caruncle
Lacrimal apparatus
The lacrimal apparatus is made up of the lacrimal gland and ducts. The lacrimal
glands, located above and on the temporal side of each eye, are responsible for
the production of tears, which lubricate the eye. Tears drain through the inferior
and superior puncta at the inner canthus, through the nasolacrimal duct and the
lacrimal sac to the inferior turbinate in the nose. The
sebaceous glands, is the round, red structure in the inner canthus.
caruncle, which contains
Extraocular muscles
Six extraocular muscles extend from the scleral surface of each eye and attach to the
bony orbit. These voluntary muscles work in concert to move the eyes with great
precision in several directions to provide a single image to the brain. These muscles are
the superior, inferior, medial and lateral recti, and the superior and inferior obliques.
Internal structures
The globes of the eyes are spherical structures that are encased in the protective
bony orbits of the face, along with the lacrimal gland and extrinsic muscles of the
eye. Only a small portion of the anterior surface of the eye is exposed. The eye itself
is approximately 2.5cm in diameter and has three layers: a tough, outer fibrous
tunic (sclera); a middle, vascular tunic; and the innermost layer, which contains the
retina (Figure 10.2).
Outer layer
The outer tunic consists of the transparent cornea on the outer portion, which is
continuous with the
and covers the structures inside the eye. The cornea is a nonvascular, transparent
surface that covers the iris and is continuous with the conjunctival epithelium.
The sclera protects the eye and is a surface for the attachment of the extraocular
muscles. The posterior portion of the sclera contains an opening for the entrance of
the optic nerve and various blood vessels.
Middle layer
The pigmented, middle vascular tunic, or uveal layer, is composed of the choroid,
the ciliary body, and the iris. The choroid is a vascular tissue that lines the inner
surface of the eye just beneath the retina. It provides nutrition to the retinal
pigment epithelium and helps absorb excess light.
sclera, an opaque material that in most people appears white
EYES 321
Ciliary body
Pupil
Vitreous cavity
Optic disc
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and muscle
Posterior chamber
(vitreous humour)
Bulbar
conjunctiva
Iris
Path of light
Anterior chamber
(aqueous humour)
Cornea
Lens
Suspensory
ligament (zonules)
FIGURE 10.2 Lateral cross section of the interior eye
Retina
Retinal arteries
and veins
Fovea
centralis
(macula)
Choroid
Sclera
Optic
nerve
The ciliary body is an anterior extension of the uveal tract; it siphons serum
from the systemic blood flow to produce the aqueous humour needed to nourish
the corneal endothelium. Zonules are small strands of tissue extending from the
ciliary body to the crystalline lens. Zonules hold the lens in place and allow it to
change shape in order to refract light from various focusing distances. The
iris,
the most anterior portion of the uveal tract, provides a distinctive colour for the
eye that is genetically determined. It is comprised of smooth muscle that regulates
the entrance of light. The pupil, an opening in the centre of the iris, regulates
the amount of light entering the eye. The pupil reacts to light and the closeness of
objects by stimulation of the sympathetic nervous system, which dilates it, and the
parasympathetic nervous system, which constricts it.
The central cavity of the eye posterior to the lens is filled with a clear, gelatinous
material called
vitreous humour, which helps maintain the shape of the eye and
the position of the internal structures.
Visual images pass through the structures and aqueous humour of the
anterior
chamber, the space anterior to the pupil and iris, and the vitreous humour of the
posterior chamber, the space immediately posterior to the iris, to the fundus of
the eye, where the retina is located.
CHAPTER 10
Inner layer
The innermost layer of the eyeball, the retina, is an extension of the optic nerve,
which lines the inside of the globe and receives light impulses to be transmitted
to the occipital lobe of the brain. Paired retinal arteries and veins branch from
the optic disc towards the periphery, growing smaller as they extend outwards.
Generally, retinal arteries are smaller and a lighter red than veins and often have a
silver-looking ‘arterial light reflex’.
The optic disc is a round or oval area with distinct margins located on the
nasal side of the retina. Retinal fibres join at the optic disc to form the optic nerve.
Nerve fibres from the temporal visual fields cross at the optic chiasm.
The physiologic cup is a pale, central area in the optic disc occupying
one-third to one-fourth of the disc. In the temporal area of the retina, the
tiny, darker macula, with the fovea centralis at its centre, contains a high
concentration of the cones necessary for colour vision, reading ability, and other
tasks requiring fine visual discrimination. The fovea is the area of sharpest vision.
Other portions of the retina contain a high concentration of rods, which provide
dark and light discrimination and peripheral vision.
322 PHYSICAL EXAMINATION
Left visual field
Right visual field
Optic tract
Temporal
Occipital lobe
Visual cortex
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UNIT 2
Visual pathway
Objects in the field of vision reflect light, which is received by sensory neurones in
the retina; these images are received upside down and reversed. From there they
pass along nerve fibres through the optic disc and the optic nerve. Fibres from the
left half of each eye pass through the optic chiasm to the right side of the brain, and
fibres from the right side of each eye pass to the left side of the visual cortex of the
occipital lobe of the brain (see
Temporal TemporalNasal Nasal
Figure 10.3).
Optic nerve
Optic chiasm
Optic
radiation
FIGURE 10.3 Visual pathway
ASSESSMENT: TAKING THE CONSUMER’S HEALTH HISTORY
Assessment is the first phase of the nursing process, and involves collecting
subjective information about the consumer’s health status in order to identify
consumer problem areas to focus on.
Left eye
Right eye
Frontal lobe
lobe
Subjective data is most frequently collected during a health history and serves as
the starting point for the health professional to base the depth of their assessment
on. The sections for the health history include:
> Consumer prole
> Chief complaint (explained systematically using variations of location, quality,
quantity, associated manifestations, aggravating factors, alleviating factors,
setting and timing. This is a variation on the OPQRST assessment mnemonic you
may use for other conditions such as pain assessment)
>>
EYES 323
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>>
> Past health history (including medical history, surgical history, allergies,
medications, injuries and accidents, special needs and childhood illnesses)
> Family health history
>
Social history (including alcohol, tobacco and drug use, sexual practice, work
and home environment, hobbies and leisure activities, stress and culture).
We have included a guide for foundation eye assessment below. Eye examination
scope of practice may differ depending on where you are located, so the foundation
assessment outline included here is relevant.
Many readers will find that some information included in this chapter
is at an advanced level. Please note the headings identified and adjust your
reading accordingly.
HEALTH HISTORY
CHAPTER 10
CONSUMER
PROFILE
CHIEF COMPLAINT Common chief complaints for the eyes are dened, and information on the characteristics of each sign or symptom is
The eye health history provides insight into the link between a consumer’s life/lifestyle and eye information and
pathology. Diseases that are age-, sex- and race-specic for the eyes are listed.
AGE
SEX
CULTURAL
BACKGROUND
provided.
1. CHANGES IN
VISUAL ACUITY
> Cataract (congenital, elderly)
> Presbyopia (middle age)
> Hypertensive retinopathy (middle age to elderly)
> Glaucoma (middle age to elderly)
> Age-related macular degeneration (elderly)
> Entropion, ectropion (elderly)
> Dry eyes (elderly)
FEMALE Dry eyes, thyroid-related ophthalmopathy
Cataract, diabetic retinopathy, trachoma (Aboriginal and Torres Strait Islander peoples) (Australia
is the only developed country to still have trachoma), diabetic retinopathy (Māori and Pasika),
age-related macular degeneration, and melanoma of the eye (Caucasians)
Change in ability to see clearly
LOCATION One eye or both eyes
QUALITY Dimming of vision, blurred vision, diplopia, visual eld loss, legal
blindness, fading of colour vision
ASSOCIATED
MANIFESTATIONS
Headache, rhinorrhoea, sneezing, vertigo, ‘oaters’ (spots of different
sizes that oat across the visual eld and are caused by changes in the
vitreous humour), ashes of light, aura, nausea and vomiting, generalised
muscle weakness, eye pain or pressure, infection (herpes simplex/herpes
zoster or cytomegalovirus)
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Work environment, increased reading, computer work, night driving
TIMING With ageing, at night, after trauma, with or after a headache, seasonal,
Allergens, stress, lack of sleep, decreased lighting, darkness (night),
refractive changes, systemic diseases
Improved lighting, medication, corrective glasses, rest or sleep, adequate
hydration
sudden onset, gradual onset
>>
324 PHYSICAL EXAMINATION
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>>
2. PAIN Discomfort in the eye
QUALITY Aching, sharp, throbbing, burning
UNIT 2
3. DRAINAGE Discharge of liquid from the eye
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Work environment (increased reading or computer work), recreational
TIMING Sudden onset, gradual onset, with reading
QUALITY Type, colour
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Outdoors, swimming pool
TIMING In the morning, continuous, intermittent, seasonal
Drainage, conjunctival injection, decreased vision, herpes simplex/herpes
zoster, increased tearing, headache
Foreign body in the eye, sunlight or very bright light, contact lenses,
trauma, allergens
Closing of eye or eyes, removal of contacts, medications, sunglasses,
avoiding allergens
area, outdoors
Crusting on the lids, pain, itching, redness of the eye or the lids, headache
Allergens, eye make-up, chlorine, poor hygiene, upper respiratory
infection
Medications, hypoallergenic or no eye make-up, avoiding allergens, good
hand washing
4. ITCHING Irritation that causes the consumer to scratch or rub
QUALITY Mild, severe
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Indoors, outdoors
TIMING Seasonal, intermittent, continuous
5. DRYNESS Reduced amount of lubricating secretions in the eye
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Outdoors, indoors with decreased humidity
TIMING With ageing, during the winter (decreased humidity), post-menopause
Rhinitis, sneezing, drainage, burning sensation in the eye, gritty sensation
in the eye, conjunctivitis, headache
Allergens, contact lenses, eye make-up
Medications, cold compresses to the eyes, removal of contacts, avoiding
allergens and eye make-up
With systemic disease, redness of the eye, reduced tearing, itching
Decreased humidity, wind, reading
Articial tears, humidied air
>>
EYES 325
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>>
PAST HEALTH
HISTORY
The various components of the past health history are linked to eye pathology and eye-related information.
MEDICAL HISTORY
SURGICAL
HISTORY
ALLERGIES
MEDICATIONS
INJURIES AND
ACCIDENTS
SPECIAL NEEDS Legal blindness, glasses/contacts for driving/reading
CHILDHOOD
ILLNESSES
EYE-SPECIFIC Myopia, hyperopia, strabismus, diplopia, astigmatism, glaucoma,
cataracts, conjunctivitis, hordeolum, pterygium, blepharitis, chalazion,
trachoma, age-related macular degeneration, prosthesis
NON-EYESPECIFIC
Cataract extraction, lens implant, LASIK (laser-assisted in situ-keratomileusis; laser vision
correction), repair of detached retina, neurosurgery, enucleation of eye, optic nerve
decompression, prosthesis insertion
> Pollen: watery or itchy eyes
> Insect stings: swelling around the eyes
> Animal dander: watery or itchy eyes
Carbonic anhydrase inhibitors, nonselective
antihistamines, decongestants, corticosteroids, articial tears, mydriatics, myotics
Foreign bodies; trauma to the eyes or surrounding structures of the eyes
Rubella and visual sequelae (blindness), congenital syphilis, strabismus
Diabetes mellitus, renal disease, atherosclerotic disease, hypertension,
thyroid disease, inammatory processes, infections (viral or bacterial),
immunosuppressive disease, nutritional disturbances, collagen vascular
diseases, multiple sclerosis, myasthenia gravis, stroke, pituitary tumours
β
-blockers, mast cell stabilisers, antibiotics,
CHAPTER 10
FAMILY HEALTH
HISTORY
SOCIAL HISTORY The components of the social history are linked to eye factors and pathology.
Eye diseases that are familial are listed.
Myopia, hyperopia, strabismus, colour blindness, cataracts, glaucoma, age-related macular degeneration, retinitis
pigmentosa, retinoblastoma, neonatal blindness secondary to cataracts from mother contracting rubella in pregnancy.
TOBACCO USE Smoking is associated with macular degeneration and cataracts
TRAVEL HISTORY Prolonged facial exposure to sun; facial exposure to contaminated waste
WORK
ENVIRONMENT
STRESS Can be linked with decreased vision
Exposure to toxins/chemicals, infections, allergens, eye strain from long hours reading/computer
use
PERSON-CENTRED HEALTH EDUCATION
When conducting a health assessment, opportunities for the provision of personcentred health education will arise. This is a significant consideration in relation
to the assessment process for examination of the eyes due to conditions that
are impacted by lifestyle choices or related to genetic risk. These occasions are
identified as individualised education and may generate further data that can be
added to the assessment. All education given should be documented so that in
future, health professionals can assess the impact of previous information provided
to the consumer. (Refer to Chapter 1 for initiating health education.) Refer to the
following examples.
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