Definition:

An assessment was performed to examine the client’s vision and ability to focus on certain
objects. A visual acuity test is done to assess how well you see the details of a given letter or symbol from
afar or within a specific distance. Common eye disorders may lead to vision loss, low vision, and other
serious complications which is why an early stage of treatment/prevention is necessary. Having our vision
examined is very important as it helps improve the quality of our day-to-day life.
An assessment involves thoroughly observing the client’s ears and hearing functionality. This
assessment is very important as it helps us assess the overall condition of the client’s ears and hearing and
to note signs of ear problems such as poor hearing, hearing loss, discharge, or foreign objects in the ears
which may lead to serious health complications
Purpose:
- To observe and describe the general appearance of the client’s eyes.
- To assess the client’s vision and ability to see the details of a certain letter or symbol given a specific
distance
- To observe the general appearance of the client’s ears.
- To assess the client’s hearing functionality
Equipment:
Cotton-tipped applicator, Examination gloves, Millimeter ruler, Penlight, Snellen’s or E chart, Opaque
card, Otoscope or ear speculum

PROCEDURE RATIONALE

ASSESSING THE EYES AND EARS

1. Explain the procedure to the patient. Provide During examination provide privacy to client by
privacy. exposing only the body part we will be
examine by folding the bath blankets and also to
provide privacy to clients by keeping the windows
close or the door closed, to protect the client's
dignity and have the client’s safe environment.

EXTERNAL EYE STRUCTURES

2. Inspect the eyebrows for hair distribution and -Eyebrow asymmetry may indicate common
alignment and for skin quality and movement and problems. Eyebrow hair loss may be caused by
the eyelashes for evenness of distribution and infections, hormonal changes, nutritional
direction of curl. deficiencies, and etc.
-Alopecia areata may result from a patchy lash
loss. There might be the presence of plaques, and
irregularities which may indicate eyelid
malignancy such as basal cell carcinoma,
squamous cell carcinoma, etc. Entropion can cause
damage to the cornea, eye infections, and even
vision loss. Ectropion can cause the eyes to feel
 dry, gritty, and sandy.
3. Inspect the eyelids for surface characteristics, There might be indications of hypothyroidism and
position in relation to the cornea, ability to blink, the presence of ptosis or drooping of the eyelid
and frequency of blinking. Inspecting the lower which may be attributed to oculomotor nerve
eyelids while the client’s eyes are closed. damage.
4. Inspect the bulbar conjunctiva for color, texture, Generalized redness may suggest conjunctivitis.
and the presence of lesions. There might be the presence of sclera disorders
such as jaundiced sclera, excessively pale sclera,
and reddened sclera.
5. Inspect the palpebral conjunctiva by everting the -Cyanosis of the lower lid suggests a heart or lung
lids. Evert the upper lids if a problem is suspected. disorder.
-Any foreign body or lesion in the upper lids may
cause irritation, burning, pain, and/or swelling.
6. Inspect and palpate the lacrimal gland. Inspect -Enlarged glands may be caused by infections and
and palpate the lacrimal sac and nasolacrimal duct. inflammatory conditions.
-Palpate lower orbital rim near inner canthus. If the
temporal aspect of the upper lid feels full, evert the
lid and inspect the gland. EXPECTED: Slight
elevations with central depression on both upper
and lower lid margins.
7. Inspect the cornea for clarity and texture. Ask Normal Findings: Transparent, shiny, and smooth;
the client to look straight ahead. Hold a penlight at details of the iris are visible In older people, a thin,
an oblique angle to the eye, and move the light grayish-white ring around the margin, called arcus
slowly across the corneal surface. senilis, may be evident Deviations from Normal:
Opaque; surface not smooth (may be the result of
trauma or abrasion) Arcus senilis in clients under
age 40
8. Perform the corneal sensitivity (reflex) test to For the 5th (trigeminal) nerve, the 3 sensory
determine the function of the fifth (trigeminal) divisions (ophthalmic, maxillary, and mandibular)
cranial nerve. Ask the client to keep both eyes open are evaluated by using a pinprick to test facial
and look straight ahead. Approach from behind and sensation and by brushing a wisp of cotton against
beside the client, and lightly touch the cornea with the lower or lateral cornea to evaluate the corneal
a corner of the gauze. reflex. If facial sensation is lost, the angle of the
jaw should be examined; sparing of this area
(innervated by spinal root C2) suggests a
trigeminal deficit. A weak blink due to facial
weakness (e.g., 7th cranial nerve paralysis) should
be distinguished from depressed or absent corneal
sensation, which is common in contact lens
wearers. A patient with facial weakness feels the
cotton wisp normally on both sides, even though
blink is decreased.
9. Inspect the anterior chamber for transparency Normal Findings: Approximately 15 to 20
and depth. Use the same oblique lighting used involuntary blinks per minute; bilateral blinking
when testing the cornea. When lids open, no visible sclera above corneas,
and upper and lower borders of the cornea are
slightly covered Deviations from Normal: Rapid,
monocular, absent, or infrequent blinking Ptosis,
ectropion, or entropion; the rim of sclera visible
between lid and iris
10. Inspect the pupils for color, shape, and Normal Findings: Black in color; equal in size;
symmetry of size. normally 3 to 7 mm in diameter; round, smooth
border, iris flat and round Deviations from Normal:
Cloudiness, mydriasis, miosis, anisocoria; bulging
of iris toward cornea
11. Assess each pupil’s direct and consensual -Observe the response of the illuminated pupil. It
reaction to light. should constrict (direct response).
- Shine the light on the pupil again, and observe the
response of the other pupil. It should also constrict
(consensual response).
12. Assess each pupil’s reaction to - Ask the client to look first at the top of the object
accommodation. and then at a distant object (e.g., the far wall)
behind the penlight. Alternate the gaze from the
near to the far object. Observe the pupil's response.
-Next, ask the client to look at the near object and
then move the penlight or pencil toward the client’s
nose.
13. Assess peripheral visual fields. • Ask the client to cover the right eye with a card
and look directly at your nose.
• Cover or close your eye directly opposite the
client’s covered eye (i.e., your left eye), and look
directly at the client’s nose.
• Hold an object (e.g., a penlight or pencil) in your
fingers, extend your arm, and move the object into
the visual field from various points in the
periphery. The object should be at an equal
distance from the client and yourself. Ask the
client to tell you when the moving object is first
spotted.
14. EXTRAOCULAR MUSCLE TESTS: Assess • Stand directly in front of the client and hold the
six ocular movements to determine eye alignment penlight at a comfortable distance, such as 30 cm
and coordination. (1 ft) in front of the client’s eyes.
• Ask the client to hold the head in a fixed position
facing you and to follow the movements of the
penlight with the eyes only.
15. VISUAL ACUITY
a. Assess near vision distance vision. If the client can read, assess near vision by
providing adequate lighting and asking the client to
read from a magazine or newspaper held at a
distance of 36 cm (14 in.). If the client normally
wears corrective lenses, the glasses or lenses
should be worn during the test. The document must
be in a language the client can read. Ask the client
to stand or sit 6 m (20 ft) from a Snellen or
character chart, cover the eye not being tested, and
identify the letters or characters on the chart.
• Take three readings: right eye, left eye, and both
eyes.
• Record the readings of each eye and both eyes
(i.e., the smallest line from which the person can
 read one-half or more of the letters).
b. Perform functional vision tests if the client is At the end of each line of the chart are standardized
unable to see the top (20/20) of Snellen’s chart. numbers (fractions). The top line is 20/200. The
numerator (top number) is always 20, the distance
the person stands from the chart. The denominator
(bottom number) is the distance from which the
normal eye can read the chart. Therefore, a person
who has 20/40 vision can see at 20 feet from the
chart what a normal-sighted person can see at 40
feet from the chart. Visual acuity is recorded as “s
––c” (without correction), or “c ––c” (with
correction). You can also indicate how many letters
were misread in the line, e.g., “visual acuity 20/40
– 2 c ––c” indicates that two letters were misread
in the 20/40 line by a client wearing corrective
lenses
16. Inspect the auricles for color, symmetry of size, Cyanosis due to the bluish color of the earlobe,
and position. pallor, and inflammation, or Dever due to
excessive redness, and congenital abnormality
might be noted.
17. Palpate the auricles for texture, elasticity, and Tenderness when moved or pressed may indicate
areas of tenderness. inflammation or infection of the external ear.

18. External Ear Canal and Tympanic Membrane

a) Using an otoscope, inspect the external Infections and problems related to the ears might
ear canal for cerumen, skin lesions, be detected such as otitis media, skull trauma,
pus, and blood. Inspect the tympanic conductive hearing loss, and etc.
membrane for color and gloss.
19. Gross Hearing Acuity Tests
a) Assess the client’s response to normal
voice tones. If client has difficulty hearing
the normal voice, proceed with the
following tests.
b) Perform the watch tick test.
c) Have the client occlude one ear. Out of the
client’s sight, place a ticking watch 2-3 cm (1-2 in)
from the unoccluded ear.
d) Ask what the client can hear. Repeat with
the other ear.

e) Tuning Fork Tests

f) Perform Weber test.

 g) Conduct Rinne test.

20. Documentation

Clinical Instructor Student’s Signature