Chapter 17 – Ophthalmic System Assessment – The Eyes
Brief Scan of the Ophthalmic System
A brief scan of the ophthalmic system allows you to quickly recognize ophthalmic signs, changes in clinical status, and/or cues of clinical deterioration. This brief scan will influence your decision on whether immediate action is required and whether a focused assessment is needed.
Steps of a brief scan include checking the following:
- Are there any observable cues that suggest the client may have a vision impairment (e.g., eyeglasses, cane, ocular prosthesis, eye patch)?
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- Knowing whether a client has a potential existing vision impairment may inform how you conduct your assessment. For example, where you physically position yourself as the nurse may be influenced by the presence of an ocular prosthesis in one of the client’s eyes.
- Is the client using their hands to guide their movement, bumping into objects, squinting and/or having difficulty maintaining eye contact?
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- This cue needs to be explored as it can suggest vision impairment or other eye problems.
- Are there any observable signs of redness or discolouration, swelling, discharge, or lesions?
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- These signs are quickly observable when you see a client. They can provide cues that inform your clinical judgement. If present, wear gloves and examine these cues further as part of the external eye assessment.
Contextualizing Inclusivity
Do not make assumptions related to eye contact; be aware of cultural differences in terms of maintaining or avoiding eye contact. Eye contact is intentionally or subconsciously avoided among some groups: for example, eye contact led to punishment in some residential schools, so some Indigenous clients may begin an interaction with eye contact and then look away (Indigenous Corporate Training Inc., 2024). Some clients from Eastern and Caribbean cultures consider direct eye contact to be disrespectful and even aggressive (Bauer, 2015). In contrast, in many Western cultures there is an expectation to maintain eye contact, with the misguided assumption that a person who doesn’t maintain eye contact is dishonest or shy.
Activity: Check Your Understanding
References
Bauer, R. (2015). The impact of making eye contact around the world. World Economic Forum. https://www.weforum.org/agenda/2015/02/the-impact-of-making-eye-contact-around-the-world/
Indigenous Corporate Training Inc. (2024). Eye contact and Indigenous Peoples. https://www.ictinc.ca/blog/eye-contact-and-indigenous-peoples
