Hi, I'm Meris. And in this video, I'm going to be talking to you about how to assess the eye. I'm going to be following along using our health assessment flashcards. These are available on our website, leveluprn.com, either as hard cards like these that you can have in your possession and flip through whenever you want, or as our digital flashcards called Flashables, which are in your hands wherever you are, and they are the coolest tool in the world. So either way, I would recommend you go ahead and pull these out and study along with me. All right. Let's get started.
So first off, let's talk about how you're just going to assess using inspection. We're going to be looking at the eyes, making sure that they are symmetrical, that they are approximately the same shape, that there's no unusual drainage or crusting or tearing or redness, anything that we would be, "What is that? What's going on here?" We're going to be looking for that.
Any kind of protrusion or sunken appearance of the eyes is going to be important for us to note as well. That can have to do with different kinds of imbalances, including fluid imbalances. So that's an important part of our assessment.
We're going to assess the color of the conjunctiva and the sclera.
So remember, the conjunctiva is that mucous membrane that lines the front of the eyelid and the inside of the-- I'm sorry, the front of the eyeballs and the inside of the eyelids. And then the sclera is that white portion of the eye. So the conjunctiva is supposed to be pink. The expected color for the conjunctiva is for it to be a nice pink color. And the sclera is expected to be white. Sometimes you will hear this called "china white" as in the white associated with a china dish. But this is supposed to be a very clear, bright white color. That's what you're looking for with the sclera.
Now, when we are doing an eye assessment, the thing that I think of the most as an ER nurse is checking the pupillary light reflex. So a very, very common thing that I do as an ER nurse and as a trauma nurse is looking in my patient's eyes to see, do the pupils respond to light? This gives me a lot of really important, super valuable information. It tells me, do they respond? Do they respond at the same time, as quickly as one another? Are they the same shape? And then I will also do something called accommodation.
So let's talk about this first. The pupillary light reflex is where I'm going to start with my patient either with their eyes closed or perhaps we're in a dark room. And I'm simply just going to have them look straight ahead. This is where I might say, "Focus on my finger," or something like that, "Look straight ahead." And then I'm just going to bring in a penlight from the side, and I'm going to shine it in the eye. What I expect to see is that when I shine it in the right eye, both eyes should constrict at the same time and the same speed to the same diameter.
So let's say my pupils are five millimeters right now and you come in and you shine that bright light in my eyes, I would expect to see that they're both going to constrict down to maybe two or one millimeter depending on how bright that light is. And that it's going to happen at the same time, the same speed, and they're going to be the same shape and size.
Then I will let my patient still look straight ahead, maybe keep those eyes closed, however I'm going to do it. And I'm going to bring the penlight in to the opposite side, now into the left side. And I'm going to expect that both pupils are going to respond bilaterally, symmetrically, and at the same time and same speed when I shine it in the other eye as well. So how do I document normal findings here? Well, just for the pupillary light reflex, I'm going to document this as PERRL. Pupils are equal, round, reactive to light.
However, you're not done assessing the eyes. So we're actually going to test for accommodation as well. What is accommodation, you may ask? And that's a great question. I would love to tell you.
To accommodate is to take your focus of vision from far away. I'm focusing right now about 10 feet in the distance-- 10 feet in the distance. And then if we bring this pencil up, I'm going to have my patients stare off into the distance, and then I'm going to bring up something that is going to give them a point to focus on right here. And I'm going to have them accommodate, bring those eyes together to focus on something that's closer. So that is how accommodation works.
We're going to focus on a distant object, and that could be a poster on the wall or looking off into the hallway. And the pupils should be dilated here.
My pupils are dilated to bring in extra light and to allow me to focus far off in the distance.
When I accommodate, I should see two things. The first thing I should see is that both of my eyeballs come in together to focus on the closer object at the same time, that they are both pointing to focus on this in the same direction, right? It's not one eye is accommodating, and one is looking off in the distance.
When my patient accommodates, I should see their pupils constrict as well. Pupillary constriction here is going to allow me to focus on the near object. So it's the same idea. I expect to see constriction, but it's a different way of assessing for that. And it's also going to assess to see if my patients can accommodate for that near vision as well.
So altogether, we document this as PERRLA, P-E-R-R-L-A. PERRLA, pupils are equal, round, reactive to light and accommodation. That A is for accommodation. So that is how you are going to do a complete assessment of your patient's pupillary reflex, and then also of their ability to accommodate.
Now, we're not done because if indicated-- and it's not always indicated, but if indicated, we're going to assess cranial nerve 2, which is our optic nerve, and then cranial nerve 3, oculomotor, 4, trochlear, and 6, abducens.
Remember, why is this part of my normal eye assessment or a more detailed eye assessment?
Well, optic nerve is the one that's going to control for vision. So it's actually going to control my visual acuity, my ability to see.
But cranial nerves 3, 4, and 6 are responsible for the movement of the eyes. So by assessing cranial nerves 3, 4, and 6, I can assess for the normal movement of the eyes. A fun way to remember this is cranial nerves 3, 4, and 6, make your eyes do tricks.
All right. I'm going to ask you some questions about key facts I provided in this video.
How should a normal pupillary light reflex with accommodation be documented?
PERRLA, pupils are equal, round, reactive to light and accommodation.
Which cranial nerves are responsible for ocular motion?
Cranial nerve 3, oculomotor, cranial nerve 4, trochlear, and cranial nerve 6, abducens.
What is the expected color of a patient's sclera?
The sclera is expected to be white.
All right. That is it for this video on normal eye assessment. I hope you found something useful out of that.
And I would love for you to leave me a comment and let me know how many of those quiz questions you got correct. I'm going to see you in the next one. I can't wait to talk to you more. Thanks so much and happy studying.
