can be broad to a narrow beam of

light for different parts of the eye.

EYE TONOMETRY
 Measures IOP to screen for and
manage glaucoma. The device used
for measuring IOP is an accurately
DIRECT OPHTHALMOSCOPY calibrated applanation tonometer,
which measures the pressure needed
- Uses a direct
to flatten the cornea.
ophthalmoscope
with various lenses
enabling the
examiner to bring the
cornea, lens and retina
into focus.
 Topical anesthesia is given prior
 Room should be darkened test, since the probe touches the
 Patient’s eye should be at the highly sensitive cornea
same level as the examiner’s eye  AVOID squeezing the eyelids,
holding their breath, or
Free of any lesions
performing Valsalva- may increase
Red smudges- intraretinal hemorrhages
IOP.
Lipid with yellowish appearance-
hypercholesterolemia
(Ishihara Polychromatic Plates)
-Can be used to establish
whether a person’s color
INDIRECT
vision is within normal range.
OPHTHALMOSCOPY
Plates are bound together in a
 Uses an indirect
booklet. Each plate of the
ophthalmoscope
booklet are dots of primary
to see larger areas
colors that are integrated into
of the retina, in an
a background of secondary
unmagnified state.
colors. The dots are arranged
 The light source is
in simple patterns
affixed with a pair of binocular lenses
 Diminished color vision- unable to
mounted on the examiner’s head.
identify hidden shapes
 Central vision conditions- difficulty
SLIT-LAMP EXAMINATION
identifying colors
 Binocular
microscope
mounted a table,
AMSLER GRID
enables the user to
Test for patients with
examine the eye
macular degeneration.
with magnification
Geometric grid of
of 10 to 40 times
identical squares with a
the real image. It
central fixation point. Grid should be viewed
by the patient wearing normal reading - Light is used to evaluate retinal and
glasses. Each eye is tested separately. macular disease as well as anterior
segment conditions.
 Patients with macular problems, will Noninvasive. No physical contact with
view the squares faded, or the lines the eye.
may be wavy.
 Monitor frequently macular function FUNDUS PHOTOGRAPHY
for early detection of changes - detect and document
requiring attention. retinal lesions.
- Pupils are usually
ULTRASONOGRAPHY widely dilated before
Lesions in the globe or orbit are evaluated by the procedure.
ultrasonography. - Resulting fundus
photographs can be viewed
stereoscopically so that elevations
such as macular edema can be
identified.

LASER SCANNING
- Confocal laser
B-scan- identifies pathology such as orbital scanning
tumors, retinal detachment, and vitreous ophthalmoscopy
hemorrhage provides a three-
A-scan- used to measure the axial length for dimensional image
implants prior cataract surgery. of the optic nerve
topography.
OPTICAL COHERENCE TOMOGRAPHY - Laser scanning polarimetry is used to
Involves low-coherence interferometry measure nerve fiber layer thickness
and is an important indicator of
glaucoma progression.

ANGIOGRAPHY
- Done using fluorescein or indocyanine
- Light is used to evaluate retinal and green as contrast agents.
macular disease as well as anterior
segment conditions. Fluorescein angiography is used to evaluate
- Noninvasive. significant macular edema, document macular
No physical contact with the eye. capillary nonperfusion and identify retinal and
OPTICAL COHERENCE TOMOGRAPHY choroidal neovascularization.
Involves low-coherence Invasive since dye is injected into an
interferometry antecubital vein.

Indocyanine green is used to evaluate

abnormalities in the choroidal vasculature,
which often are seen in macular  ABSORPTION→DISTRIBUTION→MET
degeneration. Dye is injected intravenously. ABOLISM→EXCRETION

METABOLISM
 Entry of a medication into the aqueous
NURSING RESPONSIBILITIES humor through the different routes of
ocular medication administration.
 Prior the procedure, check the BUN  Rate and Extent of aqueous humor
and Creatinine level. absorption are determined by the
 Patient should be well hydrated, and characteristics of the medication and the
anatomy and physiology of the eye.
clear liquids are usually permitted up
 NORMAL BARRIERS:
to the time of the test.  Limited size of the conjunctival sic
 Instruct the patient to remain N:50 mcL
immobile and is told to expect a brief  Corneal membrane barriers
 Blood-ocular barriers
feeling of warmth and a metallic taste Separate the bloodstream from the ocular
when the contrast is injected. tissue and keep foreign substances from
 Post procedure, check the entering the eye - limiting medication’s
efficacy.
angiography site for bleeding or  Tearing, blinking, and drainage
hematoma formation. - ↑ tear production may dilute or wash out
 Fluorescein may impart deep yellow an instilled eye drop; blinking expels eye
drop from the conjunctival sac.
or orange urine.
 Fluids are encouraged. DISTRIBUTION
 Varies by tissue type-conjunctiva, cornea,
lens, iris, ciliary body and choroids.
 Medications penetrate the corneal
epithelium by diffusion.
 Water-soluble (hydrophillic)
- medications diffuse through
intracellular route.
 Fat soluble (lipophilic)
PERIMETRY TESTING - medications diffuse through
intracellular route.
- Evaluates the field of vision. It helps
identify which part of the central or
TOPICAL ADMINISTRATION
peripheral fields have useful vision. DOES NOT reach the RETINA
- Most helpful in detecting central
scotomas- blind or partially blind
areas in the visual field.  Space between the ciliary process and
the lens is SMALL.
 Medication diffusion is SLOW.

METABOLISM
 Aqueous solutions - most commonly used
for the eye (least expensive, interfere
least with vision, corneal contact time is
OCULAR MEDICATION brief)
 Ophthalmic ointments-extended
ADMINISTRATION
retention time in the conjucntival sac and
provide higher concentration than eye
MAIN OBJECCTIVE:
drops.
 Maximize the amount of medication that
 D: blurred vision after administration
reaches the ocular site of action in
 Conjunctiva, limbus, cornea, and
sufficient concentration yo produce a
anterior chamber - treated most
beneficial therapeutic effect.
 effectively with instilled solution or preferred.
suspensions.  NSAID - alternative in controlling
inflammatory eye conditions and post
operatively to reduce inflammation.
 SUBCONJUNCTIVAL INJECTION
- better absorption of the anterior chamber. ANTIALLERGY MEDICATION
 INTRAVITREAL INJECTIONS  Corticosteroids - commonly used as
- better absorption in the posterior chamber
anti- inflammatory and
 EYELIDS and EYELID MARGINS
- are best treated with ointments.
immunosuppresive agents to conrtol
ocular hypersensitivity reactions.
COMMON OCULAR MEDICATIONS
 Topical Anesthetic
 Mydriatic and Cycloplegic
OCULAR IRRIGANTS AND LUBRICANTS
 Anti-Infective
 Used to cleanse the external lids to
 Corticosteroids and NSAID
 Antiallergy maintain external lid hygiene, irrigate
 Ocular Irrigants and lubricants external corneal surface to eliminate
debris, or inflate the globe
TOPICAL ANESTHETIC AGENT intraoperatively
 Propararacaine Hydrochloride +  Normal saline solution - commonly
tetracaine Hydrochloride - are usually used to irrigate the corneal surface.
istilled before diagnostic procedures such
as tonometry or minor ocular procedures
 Lubricants, such as artificial tears,
like removal of sutures or corneal help alleviate corneal irritation.
scrapings. INSTILLING EYE MEDICATIONS
 May also be used for severe eye pain to
 Never use eye solutions that have
allow patient to open eye for
examination. changed colors.
 Occurs within 20 seconds to 1 minute,  Perform hand hygiene before and after
and lasts 10 to 20 minutes. the procedure.
 Ensure adequate lighting
MYDIARTIC AND CYCLOPLEGIC AGENT  Read the label of the medication to
 Mydriasis (pupil dilation)
verify.
 Mydriatics potentiate alpha-adrenergic
sympathetic effect - resulting to relaxation  Remove contact lens as needed.
of the ciliary muscle causing pupil to  Avoid touching the tip of the
dilate. medication container to any part of the
 Cycloplegic agents are given to paralyze eye.
the iris sphincter.  Hold the lower lid down, do not press
 ALERT!
on the eyeball.
 Educate about effects on vision-glare
and inability to focus properly,  Instill eye drops before applying
difficulty reading that can last 3 ointments.
hours to several days.  Apply a 0.5 to 0.55 inch ribbon of
ointment to the lower conjunctival sac.
ANTI-INFECTIVE MEDICATION  Keep the eyelids closed. Apply gentle
 Antibiotic - Penicillin, Cephalosporin,
Aminoglycosides, Flouroquinolones pressure on the inner canthus for 1 to
 Antifungal - Amphotericin. 2 minutes after instilling the eye drop.
 SE: Severe pain, retinal toxicity,  Use a clean tissue to gently pat skin to
conjunctival necrosis. absorb excess eye drops.
 Antiviral - Acyclovir, ganciclovir.
 Wait 5 minutes before instilling
CORSTICOSTEROID AND NSAIDs another eye drop and 10 minutes
 Topical preparations of corticosteriods. before instilling another ointment.
 Posterior segment - topical agents are  Reinsert contact lens, if applicable.
less effective, parental or oral routes are