{"id":2988,"date":"2024-08-13T10:33:52","date_gmt":"2024-08-13T14:33:52","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/?post_type=chapter&#038;p=2988"},"modified":"2025-01-03T15:09:24","modified_gmt":"2025-01-03T20:09:24","slug":"subjective-assessment-7","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/subjective-assessment-7\/","title":{"raw":"Subjective Assessment","rendered":"Subjective Assessment"},"content":{"raw":"<span style=\"color: #000000\">Subjective assessment of the ophthalmic system involves asking questions about the health of the client as related to the eye. A full exploration of these <strong>pathologies<\/strong> is beyond the scope of this chapter, but common conditions associated with the ophthalmic system include eye trauma (injury to the eye), [pb_glossary id=\"3453\"]conjunctivitis[\/pb_glossary], [pb_glossary id=\"3454\"]refractive errors[\/pb_glossary], [pb_glossary id=\"3455\"]cataracts[\/pb_glossary], [pb_glossary id=\"3456\"]glaucoma[\/pb_glossary], [pb_glossary id=\"3457\"]macular degeneration[\/pb_glossary], [pb_glossary id=\"2411\"]retinal detachment[\/pb_glossary], [pb_glossary id=\"3459\"]vitreous detachment[\/pb_glossary], [pb_glossary id=\"3460\"]diabetic retinopathy[\/pb_glossary], and [pb_glossary id=\"3461\"]colour vision deficiency[\/pb_glossary].<\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Common symptoms<\/strong> that may be related to the ophthalmic system include vision impairments, eye pain or strain, discolouration, pruritus, swelling, lesions, discharge, dry eyes, and [pb_glossary id=\"3463\"]gritty eyes[\/pb_glossary]. See <strong>Table 1<\/strong> for guidance on subjective health assessment: many of the questions in the table align with the PQRSTU mnemonic (or variations of it). Try to ask questions in order of importance \u2013 you will not necessarily follow the sequential order of PQRSTU.<\/span>\r\n\r\n<span style=\"color: #000000\">It is best to begin the assessment by inquiring if the client wears <strong>corrective lenses<\/strong> (glasses or contact lenses). If so, ask probing questions such as:<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">When did you begin wearing them? Tell me about the reasons you wear them? Do you wear them constantly or at particular times of the day?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any issues with them?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">When was your last appointment with an eye specialist?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had changes in your vision since your last appointment?<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">Ask the client if they have had eye surgery or any <strong>eye trauma<\/strong> such as a physical injury or chemical exposure. If so, assess details surrounding the surgery and\/or trauma, how the eye was affected, when it occurred, how it was treated, and whether it continues to affect them.<\/span>\r\n\r\n<span style=\"color: #000000\">Always ask about any <strong>medications<\/strong> (prescribed or over-the-counter) or supplements the client is taking: name, dose, frequency, reason it was prescribed, and how long they have been taking it.<\/span>\r\n\r\n<span style=\"color: #000000\">Remember to ask questions related to health promotion. Depending on the context of the assessment, you may ask these questions and engage in a discussion during a subjective assessment or after an objective assessment. A section on \u201cHealth Promotion Considerations and Interventions\u201d is included later in this chapter after the discussion of objective assessment.<\/span>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity - Blindness<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\"><strong>Blindness<\/strong> includes a spectrum of visual impairments from partial (low vision) to total blindness. In Canada, legal blindness is defined as \u201cvisual acuity of 20\/200 or less in both eyes after correction, and\/or a visual field of 20 degrees or narrower\u201d (Canadian National Institute for the Blind, 2024).<\/span>\r\n\r\n<span style=\"color: #000000\">In the province of Ontario, Canada, the <strong>Accessibility for Ontarians with Disabilities Act<\/strong> (AODA) (2005) provides legislation regarding accessibility for people with disabilities, including those who are blind. It includes the requirement that building and healthcare is accessible to people who are blind and accommodations are provided as needed.<\/span>\r\n\r\n<span style=\"color: #000000\">As a nurse, you must not make assumptions about the needs and accommodations of a person with visual impairment. Use a <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/moving-beyond-culture-in-health-assessment\/\" target=\"_blank\" rel=\"noopener\">cultural humility approach<\/a>: inquire about how to best support the client and provide accommodations as necessary. For example, health-related material may need to be provided in larger font, in an alternate format such as auditory, or in Braille. As shown in <strong>Figure 5<\/strong>, Braille is a tactile system used to read and write, in which patterns of tiny bumps on a page represent letters and symbols (Braille Literacy Canada, 2024).<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-300x201.jpg\" alt=\"\" width=\"469\" height=\"314\" class=\"wp-image-3134 aligncenter\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 5:<\/strong> Braille (Author: Stefan Malmesj\u00f6, This file is licensed under the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 2.0 Generic<\/a> <span style=\"color: #000000\">license. Link:<\/span> <a href=\"https:\/\/flickr.com\/photos\/39061023@N08\/4959534304\" target=\"_blank\" rel=\"noopener\">https:\/\/flickr.com\/photos\/39061023@N08\/4959534304<\/a><span style=\"color: #000000\">).<\/span>\r\n\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity: Optometric Screening Examinations<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Ask the client when their <strong>last eye exam<\/strong> was. They may need frequent optometric screening examinations to support eye health and detect eye conditions. See <strong>Table 2<\/strong> for the recommendations made by the Canadian Association of Optometrists related to eye examinations for clients who are low risk and asymptomatic. Frequencies are increased for individuals who are at higher risk, such as clients with diabetes, macular degeneration, and glaucoma.<\/span>\r\n\r\n<span style=\"color: #000000\">These recommendations may be problematic because jurisdictional (provincial and territorial) coverage for eye exams varies in Canada, and do not necessarily include coverage for corrective lenses. For example, OHIP (Ontario Health Insurance Plan) only covers certain age groups and people with certain eye conditions, as discussed in more detail later in this chapter: see section on <a href=\"https:\/\/www.ontario.ca\/page\/what-ohip-covers#section-6\" target=\"_blank\" rel=\"noopener\">\"optometry (eye-health services)\"<\/a>. Complicating the matter are structural inequities: for example, rural, remote, and Indigenous communities may lack access to eye specialists. As a nurse, you should be aware of any policy changes; for example, OHIP coverage may change. Some clients may have private insurance coverage. You may need to support clients by helping them find additional resources to support eye assessment and corrective lenses.<\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Table 2:<\/strong> Canadian Association of Optometrists screening recommendations for low-risk and asymptomatic clients.<\/span>\r\n<table class=\"grid landscape aligncenter\" style=\"height: 192px\">\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">Birth to 2 years.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">First exam between 6 to 9 months of age.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">2 to 5 years.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">At least one exam.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">6 to 19 years.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Annually.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">20 to 39 years.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Every 2 to 3 years.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">40 years to 64 years.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Every 2 years.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">65 years and older.<\/span><\/td>\r\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Annually.<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Table 1:<\/strong> Common symptoms, questions, and clinical tips.<\/span>\r\n<table class=\"grid aligncenter\" style=\"border-collapse: collapse;width: 693px\" border=\"0\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 930.790405px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Symptoms<\/strong><\/span><\/td>\r\n<td style=\"width: 353.308807px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Questions<\/strong><\/span><\/td>\r\n<td style=\"width: 465.404388px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Clinical Tips<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Visual impairments<\/strong> is an umbrella term for vision difficulty.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Refractive errors<\/strong> are a common type of impairment in which the eye\u2019s shape results in light being incorrectly focused on the retina. These conditions most often include:<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3273\"]Myopia[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3274\"]Hyperopia[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3275\"]Astigmatism[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3276\"]Presbyopia[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Other common eye conditions include:<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3277\"]Strabismus[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3278\"]Amblyopia[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">In addition to blurry vision, other symptoms include:<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3279\"]Floaters[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3280\"]Halos[\/pb_glossary] [pb_glossary id=\"3280\"]around[\/pb_glossary] [pb_glossary id=\"3280\"]lights[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">[pb_glossary id=\"3281\"]Diplopia[\/pb_glossary].<\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"width: 353.308807px;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Do you currently have or have you recently had any difficulty seeing? You may need to ask specific questions about the presence of: blurry vision, double vision, floaters like black dots that move across their eyes, blind spots, colourful circles such as a rainbow around light sources like a streetlight, and difficulty seeing at night or in a dimly lit environment.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Can you describe it? How bad is it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? Did it begin suddenly or gradually? Is it constant or intermittent? If intermittent, how long does it last? Have you seen a doctor for it? Has it been treated?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: What makes it better? What makes it worse?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">All people have <strong>occasional floaters<\/strong>; these become more frequent with age. To assess the seriousness, ask whether there has been a sudden increase in the number of floaters and whether they are permanent and\/or associated with flashes of light or a dark shadow like a curtain. Refer clients experiencing <strong>halos<\/strong> to a physician because halos can be associated with specific eye diseases. Prompt attention may be needed if halos are associated with other symptoms such as pain and blurred vision. <strong>Diplopia<\/strong> may also be indicative of an urgent condition such as a cerebral bleed (stroke, aneurysm) so immediate referral is required, particularly when associated with related symptoms such as confusion, slurred speech, weakness, and dizziness. As the nurse, you should immediately notify the physician or nurse practitioner and conduct a primary survey<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye pain<\/strong> or <strong>eye strain<\/strong> are unpleasant sensations.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye pain<\/strong> is subjectively described in many ways such as tenderness, discomfort, burning, throbbing, stabbing, and sharp pain on, around, or behind the eye. Pain can be associated with trauma, infection, corneal abrasion, foreign body, and glaucoma.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye strain<\/strong> is described as tired and achy eyes. It can sometimes be associated with looking at something for a long period of time such as a computer screen or wearing an incorrect or new corrective lens prescription.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you recently had any eye pain or eye strain? If yes, do you currently have it now?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region\/radiation<\/strong>: Where is it located? Is it in one or both eyes? Does it radiate anywhere?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: What does it feel like? How bad is it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Severity<\/strong>: Can you rate it on a scale of 0 to 10 with 0 being no eye pain (or strain) and 10 being the worst you have ever had?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? Did it begin suddenly? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you taken any medications?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life?<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Eye pain can have many causes. The cause may be obvious as the client may have experienced an injury. Refer clients to a physician or nurse practitioner if they have had recent eye surgery or a history of glaucoma or the pain is:<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Severe with sudden onset.<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Associated with an injury or redness or discharge.<\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Eye strain is a common symptom today because of the increased use of computers and smartphones. One common recommendation is that individuals should limit screen time and follow the <strong>20-20-20 rule:<\/strong> every 20 minutes, take a 20-second break to focus on something approximately 20 feet away to help relax the eye muscles.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discolouration<\/strong> (erythema, jaundice), <strong>pruritus<\/strong>, <strong>swelling<\/strong>, and <strong>lesions<\/strong> (open sores, bumps).<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discolouration<\/strong> is often associated with the sclera of the eye or lesions surrounding the eye. For example, a client might tell you that the whites of their eyes are reddened or have become yellow.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Pruritus<\/strong> may be generalized over the area of the whole eye or associated with a specific<strong> lesion<\/strong> on the eyelid. Lesions can be small bumps that are often red with evidence of <strong>swelling<\/strong>. Lesions can also be open sores that may be draining discharge.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you noticed any discolouration of your eyes or around the eyes (such as redness or yellowish colour)? Have you noticed any swelling (or itching, sores, or bumps) on or around the eye?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:\u00a0<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Tell me about it? What does it look like? What does it feel like? How bad is it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region\/radiation<\/strong>: Where is it located? Has it extended into other areas?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Severity<\/strong>: Pruritus is the only one of these symptoms you might ask a client to rate on a scale of 0 to 10.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you applied anything on the eye to treat it? Have you taken any medications?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life? When asking about open sores, you may ask about any discharge and the colour.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Conjunctivitis<\/strong> (pink eye) is a condition in which the sclera become red. Erythema can appear around the eye. With darker skin tones, erythema may appear reddish\/purple in colour. With very dark skin tones, it may be difficult to visualize. With lighter skin tones, erythema is typically dark pink to red.<\/span>\r\n\r\n<span style=\"color: #000000\">Conjunctivitis can be caused by allergies or contact with chemicals (make-up, chlorine) and be accompanied by related symptoms such as pruritus and swollen eyes. It can involve bacterial or viral infections. When the cause isn\u2019t obvious (like allergies), refer the client to a doctor or nurse practitioner. Tell clients to wash their hands well, avoid touching their eyes, and avoid sharing anything that touches their eyes such as towels and make-up. If relevant, advise clients to remove their contact lenses.<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-300x180.jpg\" alt=\"\" width=\"250\" height=\"150\" class=\"alignnone wp-image-3480\" \/>\r\n\r\nBy Microrao - Own work,\r\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a>\r\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution -Share<\/a>\r\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Alike 4.0 International\r\nLicense<\/a> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=82090761\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.\r\nwikimedia.org\/<\/a> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=82090761\" target=\"_blank\" rel=\"noopener\">w\/index.\r\nphp?curid=82090761<\/a>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-300x231.jpg\" alt=\"\" width=\"250\" height=\"192\" class=\"alignnone wp-image-3481\" \/>\r\n\r\n<span style=\"color: #000000\">By James Heilman. This file is licensed under the\r\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a>\r\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution -Share<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Alike\r\n4.0 International License<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Allergicconjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.\r\nwikimedia.org<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Allergicconjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">\/wiki\/File:\r\nAllergicconjunctivitis.jpg<\/a><\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Jaundice<\/strong> can result in the <strong>yellowing of the complete sclera<\/strong>. It can cause pruritus and skin discolouration. In persons with darker skin tones, the discolouration may be subtle or go unnoticed but visible in the sclera as shown in image below. In persons with lighter skin tones, jaundice can appear yellow or even orange in colour. Jaundice<span style=\"font-family: inherit;font-size: inherit\">\u00a0can be associated with infections, cancer, and other conditions affecting the liver, pancreas, and gallbladder. Always report this finding to the physician or nurse practitioner as it can be a sign of a new disease or the advancement of a disease.<\/span><\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-300x231.jpg\" alt=\"\" width=\"250\" height=\"193\" class=\"alignnone wp-image-3284\" \/>\r\n\r\n<span style=\"color: #000000\">Taken from<\/span> <a href=\"https:\/\/phil.cdc.gov\/details.aspx?pid=2860\">https:\/\/phil.cdc.\r\ngov\/<\/a><a href=\"https:\/\/phil.cdc.gov\/details.aspx?pid=2860\">details.aspx?pid=2860<\/a><span style=\"color: #000000\">\u00a0(This image is in the public domain and thus free of any copyright restrictions.)<\/span>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Blepharitis<\/strong> is an inflammatory condition in which the eyelids appear red and sometimes swollen and irritated. It is usually caused by an excessive amount of bacteria or clogged oil glands on the eyelids.<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-300x225.jpg\" alt=\"\" width=\"250\" height=\"188\" class=\"alignnone wp-image-3482\" \/>\r\n\r\n<span style=\"background-color: #00ffff\"><\/span><span style=\"color: #000000\">This work has been released into the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\" target=\"_blank\" rel=\"noopener\">public domain<\/a> <span style=\"color: #000000\">by its author,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/de:User:clubtable\" target=\"_blank\" rel=\"noopener\">clubtable<\/a><span style=\"color: #000000\">, at the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/de:\" target=\"_blank\" rel=\"noopener\">German\r\nWikipedia<\/a> <span style=\"color: #000000\">from:\r\n<\/span><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blepharitis.JPG\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.\r\norg<\/a><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blepharitis.JPG\" target=\"_blank\" rel=\"noopener\">\/wiki\/File:Blepharitis.JPG<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discharge<\/strong>,<strong> dry<\/strong>, or <strong>gritty<\/strong> <strong>eyes<\/strong> are symptoms that can be associated with a variety of conditions.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Small amounts of clear eye <strong>discharge<\/strong> can be normal: clients might wake up with a small amount of crusted mucous on the side of the eyes. However, persistent watery eyes can be associated with allergies, blocked lacrimal apparatus (tear duct), and infections. Yellow, green, or white discharge can be associated with infections and appear as mucous or crusty debris around the eyes, often associated with erythema and swelling.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Dry eyes<\/strong> can occur when the lacrimal gland doesn\u2019t make sufficient tears to irrigate the eyes. It can be associated with a <strong>burning<\/strong>, <strong>gritty<\/strong>, <strong>scratchy<\/strong> <strong>feeling<\/strong>. Dry and gritty eyes are commonly associated with aging and hormonal changes, but can also be associated with certain medications, environmental conditions, or diseases that affect normal blinking<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you noticed any discharge from your eyes? Have you had any problems with dry or gritty eyes?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Tell me about it? What does it feel like? How bad is it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region<\/strong>: Where is it located?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you taken any medications?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life?<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Refer any client with eye discharge, particularly when not associated with allergies, to a physician or nurse practitioner.<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-300x194.jpg\" alt=\"\" width=\"250\" height=\"161\" class=\"alignnone wp-image-3483\" \/>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">This file is licensed under the<\/span>\r\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution\r\n3.0 Unported<\/a> <span style=\"color: #000000\">license.\u00a0<\/span><span style=\"color: #000000\">Attribution:\r\nTanalai at English Wikipedia\u00a0 <\/span><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.\r\norg\/<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">wiki\/File:Swollen_eye_<\/a>\r\n<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">with_conjunctivitis.jpg<\/a><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Other <strong>symptoms<\/strong> can include headache, fever, light sensitivity (photophobia), twitching, confusion, and nausea and vomiting.<\/span><\/td>\r\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you experienced any headaches?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Ask about other symptoms: use variations of the PQRSTU mnemonic to assess symptoms further if the client\u2019s response is affirmative.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;\r\n\r\nT<span style=\"color: #000000\">hese symptoms can be related to other body systems and non-ophthalmic issues. Conduct a focused assessment on the related body systems.<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Personal<\/strong> and <strong>family history<\/strong> of conditions such as refractive errors, cataracts, glaucoma, diabetic retinopathy, and retinal detachment.<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Always inquire whether the client has had any eye injuries.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Do you have any chronic eye conditions? Do you have a family history of any of these conditions?<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Tell me about the condition. When did the symptoms begin? When were you diagnosed? How has it been treated? How well did the treatment work? How are you managing it?<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">The biological and non-biological nature of family may be important to explicate when asking questions, considering that the risk factors may be influenced by genetics and\/or culture. This assessment will help you gain a better understanding of the client and determine appropriate interventions and education.<\/span>\r\n\r\n&nbsp;<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">Any <strong>eye trauma<\/strong> or <strong>sudden change in vision<\/strong> is a priority of care. Changes may include blurry vision, dark spots, shadows or a dark curtain across the central or peripheral vision, dim, distorted or double vision, or halos or flashing lights. These may require immediate treatment to avoid permanent damage to vision, among other consequences. For example, sudden changes to vision may be related to a stroke, retinal tears, detachments, or hemorrhages. Conduct a primary survey and report the findings to the physician or nurse practitioner. Prompt attention is also needed when clients report eye pain, conjunctivitis, and any symptoms suggestive of infections such as purulent discharge, redness, and swelling.\u00a0<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><strong>Cultural Inclusivity<\/strong><\/h2>\r\n<span style=\"color: #000000\">In some cultures, certain substances are used for <strong>newborn eye care<\/strong> in the first 24 hours following birth (Osman et al., 2018). Approach this kind of tradition with cultural humility, but also ensure patient safety with regard to how these substances may affect the integrity of the eyes and vision. Additionally, some individuals use <strong>over-the-counter eye drops<\/strong> when they have dry, red, and\/or itchy eyes. Some of these eye drops can constrict the vasculature, not address the actual problem, and actually worsen the issue (Mukamal, 2024). Consider referring the client to the physician or nurse practitioner to discuss their symptoms and find safer alternatives. If the client has used eye drops for more than a few weeks or the client is uncertain of the cause, refer them to an eye doctor for a proper diagnosis and effective treatment.<\/span>\r\n\r\n<\/div>\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"h5p-action-bar-settings h5p-panel\"><span style=\"color: #000000\">[h5p id=\"262\"]<\/span><\/div>\r\n<div>\r\n<h3><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h3>\r\n<span style=\"color: #000000\">Government of Ontario (2005). Accessibility for Ontarians with Disabilities Act, 2005.<\/span> <a href=\"https:\/\/www.ontario.ca\/laws\/statute\/05a11\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ontario.ca\/laws\/statute\/05a11<\/a>\r\n\r\n<span style=\"color: #000000\">Braille Literacy Canada (2024). Learn about Braille.<\/span> <a href=\"https:\/\/www.brailleliteracycanada.ca\/en\/braille\" target=\"_blank\" rel=\"noopener\">https:\/\/www.brailleliteracycanada.ca\/en\/braille<\/a>\r\n\r\n<span style=\"color: #000000\">Canadian Association of Optometrists (2023). Position Statement: Recommended frequency of the comprehensive eye examination.<\/span> <a href=\"https:\/\/opto.ca\/sites\/default\/files\/resources\/documents\/Position%20Statement%20Eye%20Exam%20Frequency%202023%20EN.pdf\" target=\"_blank\" rel=\"noopener\">ttps:\/\/opto.ca\/sites\/default\/files\/resources\/documents\/Position%20Statement%20Eye%20Exam%20Frequency%202023%20EN.pdf<\/a>\r\n\r\n<span style=\"color: #000000\">Canadian National Institute for the Blind (2024). What is blindness?<\/span> <a href=\"https:\/\/www.cnib.ca\/en\/sight-loss-info\/blindness\/what-blindness?region=on\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cnib.ca\/en\/sight-loss-info\/blindness\/what-blindness?region=on<\/a>\r\n\r\n<span style=\"color: #000000\">Mukamal, R. (2024). Choosing the best lubricant eye drops for dry eyes.<\/span> <a href=\"https:\/\/www.aao.org\/eye-health\/tips-prevention\/how-to-choose-lubricant-drops-dry-eyes\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aao.org\/eye-health\/tips-prevention\/how-to-choose-lubricant-drops-dry-eyes<\/a>\r\n\r\n<span style=\"color: #000000\">Osman, A., Gaffer, Y., Sharkawy, A., &amp; Brandon, D. (2018). Maternal cultural practices for neonates\u2019 care in upper Egypt. Women and Birth, 31, e278-e285.\u00a0<\/span><a href=\"https:\/\/doi.org\/\/10.1016\/j.wombi.2017.09.022\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/\/10.1016\/j.wombi.2017.09.022<\/a>\r\n\r\n<\/div>\r\n<\/div>","rendered":"<p><span style=\"color: #000000\">Subjective assessment of the ophthalmic system involves asking questions about the health of the client as related to the eye. A full exploration of these <strong>pathologies<\/strong> is beyond the scope of this chapter, but common conditions associated with the ophthalmic system include eye trauma (injury to the eye), <button class=\"glossary-term\" aria-describedby=\"2988-3453\">conjunctivitis<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3454\">refractive errors<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3455\">cataracts<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3456\">glaucoma<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3457\">macular degeneration<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-2411\">retinal detachment<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3459\">vitreous detachment<\/button>, <button class=\"glossary-term\" aria-describedby=\"2988-3460\">diabetic retinopathy<\/button>, and <button class=\"glossary-term\" aria-describedby=\"2988-3461\">colour vision deficiency<\/button>.<\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Common symptoms<\/strong> that may be related to the ophthalmic system include vision impairments, eye pain or strain, discolouration, pruritus, swelling, lesions, discharge, dry eyes, and <button class=\"glossary-term\" aria-describedby=\"2988-3463\">gritty eyes<\/button>. See <strong>Table 1<\/strong> for guidance on subjective health assessment: many of the questions in the table align with the PQRSTU mnemonic (or variations of it). Try to ask questions in order of importance \u2013 you will not necessarily follow the sequential order of PQRSTU.<\/span><\/p>\n<p><span style=\"color: #000000\">It is best to begin the assessment by inquiring if the client wears <strong>corrective lenses<\/strong> (glasses or contact lenses). If so, ask probing questions such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">When did you begin wearing them? Tell me about the reasons you wear them? Do you wear them constantly or at particular times of the day?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had any issues with them?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">When was your last appointment with an eye specialist?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Have you had changes in your vision since your last appointment?<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">Ask the client if they have had eye surgery or any <strong>eye trauma<\/strong> such as a physical injury or chemical exposure. If so, assess details surrounding the surgery and\/or trauma, how the eye was affected, when it occurred, how it was treated, and whether it continues to affect them.<\/span><\/p>\n<p><span style=\"color: #000000\">Always ask about any <strong>medications<\/strong> (prescribed or over-the-counter) or supplements the client is taking: name, dose, frequency, reason it was prescribed, and how long they have been taking it.<\/span><\/p>\n<p><span style=\"color: #000000\">Remember to ask questions related to health promotion. Depending on the context of the assessment, you may ask these questions and engage in a discussion during a subjective assessment or after an objective assessment. A section on \u201cHealth Promotion Considerations and Interventions\u201d is included later in this chapter after the discussion of objective assessment.<\/span><\/p>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity &#8211; Blindness<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\"><strong>Blindness<\/strong> includes a spectrum of visual impairments from partial (low vision) to total blindness. In Canada, legal blindness is defined as \u201cvisual acuity of 20\/200 or less in both eyes after correction, and\/or a visual field of 20 degrees or narrower\u201d (Canadian National Institute for the Blind, 2024).<\/span><\/p>\n<p><span style=\"color: #000000\">In the province of Ontario, Canada, the <strong>Accessibility for Ontarians with Disabilities Act<\/strong> (AODA) (2005) provides legislation regarding accessibility for people with disabilities, including those who are blind. It includes the requirement that building and healthcare is accessible to people who are blind and accommodations are provided as needed.<\/span><\/p>\n<p><span style=\"color: #000000\">As a nurse, you must not make assumptions about the needs and accommodations of a person with visual impairment. Use a <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/moving-beyond-culture-in-health-assessment\/\" target=\"_blank\" rel=\"noopener\">cultural humility approach<\/a>: inquire about how to best support the client and provide accommodations as necessary. For example, health-related material may need to be provided in larger font, in an alternate format such as auditory, or in Braille. As shown in <strong>Figure 5<\/strong>, Braille is a tactile system used to read and write, in which patterns of tiny bumps on a page represent letters and symbols (Braille Literacy Canada, 2024).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-300x201.jpg\" alt=\"\" width=\"469\" height=\"314\" class=\"wp-image-3134 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-300x201.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-1024x685.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-768x514.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-1536x1028.jpg 1536w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-65x44.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-225x151.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille-350x234.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Reading_Braille.jpg 1600w\" sizes=\"auto, (max-width: 469px) 100vw, 469px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 5:<\/strong> Braille (Author: Stefan Malmesj\u00f6, This file is licensed under the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 2.0 Generic<\/a> <span style=\"color: #000000\">license. Link:<\/span> <a href=\"https:\/\/flickr.com\/photos\/39061023@N08\/4959534304\" target=\"_blank\" rel=\"noopener\">https:\/\/flickr.com\/photos\/39061023@N08\/4959534304<\/a><span style=\"color: #000000\">).<\/span><\/p>\n<\/div>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity: Optometric Screening Examinations<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Ask the client when their <strong>last eye exam<\/strong> was. They may need frequent optometric screening examinations to support eye health and detect eye conditions. See <strong>Table 2<\/strong> for the recommendations made by the Canadian Association of Optometrists related to eye examinations for clients who are low risk and asymptomatic. Frequencies are increased for individuals who are at higher risk, such as clients with diabetes, macular degeneration, and glaucoma.<\/span><\/p>\n<p><span style=\"color: #000000\">These recommendations may be problematic because jurisdictional (provincial and territorial) coverage for eye exams varies in Canada, and do not necessarily include coverage for corrective lenses. For example, OHIP (Ontario Health Insurance Plan) only covers certain age groups and people with certain eye conditions, as discussed in more detail later in this chapter: see section on <a href=\"https:\/\/www.ontario.ca\/page\/what-ohip-covers#section-6\" target=\"_blank\" rel=\"noopener\">&#8220;optometry (eye-health services)&#8221;<\/a>. Complicating the matter are structural inequities: for example, rural, remote, and Indigenous communities may lack access to eye specialists. As a nurse, you should be aware of any policy changes; for example, OHIP coverage may change. Some clients may have private insurance coverage. You may need to support clients by helping them find additional resources to support eye assessment and corrective lenses.<\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Table 2:<\/strong> Canadian Association of Optometrists screening recommendations for low-risk and asymptomatic clients.<\/span><\/p>\n<table class=\"grid landscape aligncenter\" style=\"height: 192px\">\n<tbody>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">Birth to 2 years.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">First exam between 6 to 9 months of age.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">2 to 5 years.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">At least one exam.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">6 to 19 years.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Annually.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">20 to 39 years.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Every 2 to 3 years.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">40 years to 64 years.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Every 2 years.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"height: 32px;width: 207.781px;vertical-align: middle\"><span style=\"color: #000000\">65 years and older.<\/span><\/td>\n<td style=\"height: 32px;width: 411.844px;vertical-align: middle\"><span style=\"color: #000000\">Annually.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Table 1:<\/strong> Common symptoms, questions, and clinical tips.<\/span><\/p>\n<table class=\"grid aligncenter\" style=\"border-collapse: collapse;width: 693px\">\n<tbody>\n<tr>\n<td style=\"width: 930.790405px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Symptoms<\/strong><\/span><\/td>\n<td style=\"width: 353.308807px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Questions<\/strong><\/span><\/td>\n<td style=\"width: 465.404388px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Clinical Tips<\/strong><\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Visual impairments<\/strong> is an umbrella term for vision difficulty.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Refractive errors<\/strong> are a common type of impairment in which the eye\u2019s shape results in light being incorrectly focused on the retina. These conditions most often include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3273\">Myopia<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3274\">Hyperopia<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3275\">Astigmatism<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3276\">Presbyopia<\/button>.<\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"no-indent\"><span style=\"color: #000000\">Other common eye conditions include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3277\">Strabismus<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3278\">Amblyopia<\/button>.<\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"no-indent\"><span style=\"color: #000000\">In addition to blurry vision, other symptoms include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3279\">Floaters<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3280\">Halos<\/button> <button class=\"glossary-term\" aria-describedby=\"2988-3280\">around<\/button> <button class=\"glossary-term\" aria-describedby=\"2988-3280\">lights<\/button>.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><button class=\"glossary-term\" aria-describedby=\"2988-3281\">Diplopia<\/button>.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 353.308807px;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Do you currently have or have you recently had any difficulty seeing? You may need to ask specific questions about the presence of: blurry vision, double vision, floaters like black dots that move across their eyes, blind spots, colourful circles such as a rainbow around light sources like a streetlight, and difficulty seeing at night or in a dimly lit environment.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Can you describe it? How bad is it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? Did it begin suddenly or gradually? Is it constant or intermittent? If intermittent, how long does it last? Have you seen a doctor for it? Has it been treated?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: What makes it better? What makes it worse?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">All people have <strong>occasional floaters<\/strong>; these become more frequent with age. To assess the seriousness, ask whether there has been a sudden increase in the number of floaters and whether they are permanent and\/or associated with flashes of light or a dark shadow like a curtain. Refer clients experiencing <strong>halos<\/strong> to a physician because halos can be associated with specific eye diseases. Prompt attention may be needed if halos are associated with other symptoms such as pain and blurred vision. <strong>Diplopia<\/strong> may also be indicative of an urgent condition such as a cerebral bleed (stroke, aneurysm) so immediate referral is required, particularly when associated with related symptoms such as confusion, slurred speech, weakness, and dizziness. As the nurse, you should immediately notify the physician or nurse practitioner and conduct a primary survey<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye pain<\/strong> or <strong>eye strain<\/strong> are unpleasant sensations.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye pain<\/strong> is subjectively described in many ways such as tenderness, discomfort, burning, throbbing, stabbing, and sharp pain on, around, or behind the eye. Pain can be associated with trauma, infection, corneal abrasion, foreign body, and glaucoma.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Eye strain<\/strong> is described as tired and achy eyes. It can sometimes be associated with looking at something for a long period of time such as a computer screen or wearing an incorrect or new corrective lens prescription.<\/span><\/p>\n<\/td>\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you recently had any eye pain or eye strain? If yes, do you currently have it now?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region\/radiation<\/strong>: Where is it located? Is it in one or both eyes? Does it radiate anywhere?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: What does it feel like? How bad is it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Severity<\/strong>: Can you rate it on a scale of 0 to 10 with 0 being no eye pain (or strain) and 10 being the worst you have ever had?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? Did it begin suddenly? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you taken any medications?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life?<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Eye pain can have many causes. The cause may be obvious as the client may have experienced an injury. Refer clients to a physician or nurse practitioner if they have had recent eye surgery or a history of glaucoma or the pain is:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Severe with sudden onset.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Associated with an injury or redness or discharge.<\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"no-indent\"><span style=\"color: #000000\">Eye strain is a common symptom today because of the increased use of computers and smartphones. One common recommendation is that individuals should limit screen time and follow the <strong>20-20-20 rule:<\/strong> every 20 minutes, take a 20-second break to focus on something approximately 20 feet away to help relax the eye muscles.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discolouration<\/strong> (erythema, jaundice), <strong>pruritus<\/strong>, <strong>swelling<\/strong>, and <strong>lesions<\/strong> (open sores, bumps).<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discolouration<\/strong> is often associated with the sclera of the eye or lesions surrounding the eye. For example, a client might tell you that the whites of their eyes are reddened or have become yellow.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Pruritus<\/strong> may be generalized over the area of the whole eye or associated with a specific<strong> lesion<\/strong> on the eyelid. Lesions can be small bumps that are often red with evidence of <strong>swelling<\/strong>. Lesions can also be open sores that may be draining discharge.<\/span><\/p>\n<\/td>\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you noticed any discolouration of your eyes or around the eyes (such as redness or yellowish colour)? Have you noticed any swelling (or itching, sores, or bumps) on or around the eye?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:\u00a0<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Tell me about it? What does it look like? What does it feel like? How bad is it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region\/radiation<\/strong>: Where is it located? Has it extended into other areas?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Severity<\/strong>: Pruritus is the only one of these symptoms you might ask a client to rate on a scale of 0 to 10.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you applied anything on the eye to treat it? Have you taken any medications?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life? When asking about open sores, you may ask about any discharge and the colour.<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Conjunctivitis<\/strong> (pink eye) is a condition in which the sclera become red. Erythema can appear around the eye. With darker skin tones, erythema may appear reddish\/purple in colour. With very dark skin tones, it may be difficult to visualize. With lighter skin tones, erythema is typically dark pink to red.<\/span><\/p>\n<p><span style=\"color: #000000\">Conjunctivitis can be caused by allergies or contact with chemicals (make-up, chlorine) and be accompanied by related symptoms such as pruritus and swollen eyes. It can involve bacterial or viral infections. When the cause isn\u2019t obvious (like allergies), refer the client to a doctor or nurse practitioner. Tell clients to wash their hands well, avoid touching their eyes, and avoid sharing anything that touches their eyes such as towels and make-up. If relevant, advise clients to remove their contact lenses.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-300x180.jpg\" alt=\"\" width=\"250\" height=\"150\" class=\"alignnone wp-image-3480\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-300x180.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-1024x614.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-768x460.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-65x39.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-225x135.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis-350x210.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Viral_conjunctivitis.jpg 1200w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/p>\n<p>By Microrao &#8211; Own work,<br \/>\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a><br \/>\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution -Share<\/a><br \/>\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Alike 4.0 International<br \/>\nLicense<\/a> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=82090761\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.<br \/>\nwikimedia.org\/<\/a> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=82090761\" target=\"_blank\" rel=\"noopener\">w\/index.<br \/>\nphp?curid=82090761<\/a><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-300x231.jpg\" alt=\"\" width=\"250\" height=\"192\" class=\"alignnone wp-image-3481\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-300x231.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-1024x787.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-768x590.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-65x50.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-225x173.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis-350x269.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1170px-Allergicconjunctivitis.jpg 1170w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/p>\n<p><span style=\"color: #000000\">By James Heilman. This file is licensed under the<br \/>\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a><br \/>\n<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution -Share<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Alike<br \/>\n4.0 International License<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Allergicconjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.<br \/>\nwikimedia.org<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Allergicconjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">\/wiki\/File:<br \/>\nAllergicconjunctivitis.jpg<\/a><\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Jaundice<\/strong> can result in the <strong>yellowing of the complete sclera<\/strong>. It can cause pruritus and skin discolouration. In persons with darker skin tones, the discolouration may be subtle or go unnoticed but visible in the sclera as shown in image below. In persons with lighter skin tones, jaundice can appear yellow or even orange in colour. Jaundice<span style=\"font-family: inherit;font-size: inherit\">\u00a0can be associated with infections, cancer, and other conditions affecting the liver, pancreas, and gallbladder. Always report this finding to the physician or nurse practitioner as it can be a sign of a new disease or the advancement of a disease.<\/span><\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-300x231.jpg\" alt=\"\" width=\"250\" height=\"193\" class=\"alignnone wp-image-3284\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-300x231.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-65x50.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-225x174.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores-350x270.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/2860_lores.jpg 700w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/p>\n<p><span style=\"color: #000000\">Taken from<\/span> <a href=\"https:\/\/phil.cdc.gov\/details.aspx?pid=2860\">https:\/\/phil.cdc.<br \/>\ngov\/<\/a><a href=\"https:\/\/phil.cdc.gov\/details.aspx?pid=2860\">details.aspx?pid=2860<\/a><span style=\"color: #000000\">\u00a0(This image is in the public domain and thus free of any copyright restrictions.)<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Blepharitis<\/strong> is an inflammatory condition in which the eyelids appear red and sometimes swollen and irritated. It is usually caused by an excessive amount of bacteria or clogged oil glands on the eyelids.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-300x225.jpg\" alt=\"\" width=\"250\" height=\"188\" class=\"alignnone wp-image-3482\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-300x225.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-1024x768.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-768x576.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-65x49.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-225x169.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis-350x263.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/1200px-Blepharitis.jpg 1200w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/p>\n<p><span style=\"background-color: #00ffff\"><\/span><span style=\"color: #000000\">This work has been released into the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\" target=\"_blank\" rel=\"noopener\">public domain<\/a> <span style=\"color: #000000\">by its author,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/de:User:clubtable\" target=\"_blank\" rel=\"noopener\">clubtable<\/a><span style=\"color: #000000\">, at the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/de:\" target=\"_blank\" rel=\"noopener\">German<br \/>\nWikipedia<\/a> <span style=\"color: #000000\">from:<br \/>\n<\/span><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blepharitis.JPG\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.<br \/>\norg<\/a><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blepharitis.JPG\" target=\"_blank\" rel=\"noopener\">\/wiki\/File:Blepharitis.JPG<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Discharge<\/strong>,<strong> dry<\/strong>, or <strong>gritty<\/strong> <strong>eyes<\/strong> are symptoms that can be associated with a variety of conditions.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Small amounts of clear eye <strong>discharge<\/strong> can be normal: clients might wake up with a small amount of crusted mucous on the side of the eyes. However, persistent watery eyes can be associated with allergies, blocked lacrimal apparatus (tear duct), and infections. Yellow, green, or white discharge can be associated with infections and appear as mucous or crusty debris around the eyes, often associated with erythema and swelling.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Dry eyes<\/strong> can occur when the lacrimal gland doesn\u2019t make sufficient tears to irrigate the eyes. It can be associated with a <strong>burning<\/strong>, <strong>gritty<\/strong>, <strong>scratchy<\/strong> <strong>feeling<\/strong>. Dry and gritty eyes are commonly associated with aging and hormonal changes, but can also be associated with certain medications, environmental conditions, or diseases that affect normal blinking<\/span><\/p>\n<\/td>\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you noticed any discharge from your eyes? Have you had any problems with dry or gritty eyes?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Quality\/quantity<\/strong>: Tell me about it? What does it feel like? How bad is it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Region<\/strong>: Where is it located?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Provocative\/palliative<\/strong>: Is there anything that makes it worse? Is there anything that makes it better?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Timing\/treatment<\/strong>: When did it begin? What were you doing when it began? Is it constant or intermittent? How often do you get it? Have you taken anything to treat it? Have you taken any medications?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Understanding<\/strong>: Do you know what is causing it?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Other<\/strong>: How does it affect your daily life?<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Refer any client with eye discharge, particularly when not associated with allergies, to a physician or nurse practitioner.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-300x194.jpg\" alt=\"\" width=\"250\" height=\"161\" class=\"alignnone wp-image-3483\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-300x194.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-1024x660.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-768x495.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-65x42.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-225x145.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis-350x226.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Swollen_eye_with_conjunctivitis.jpg 1200w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">This file is licensed under the<\/span><br \/>\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution<br \/>\n3.0 Unported<\/a> <span style=\"color: #000000\">license.\u00a0<\/span><span style=\"color: #000000\">Attribution:<br \/>\nTanalai at English Wikipedia\u00a0 <\/span><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.<br \/>\norg\/<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">wiki\/File:Swollen_eye_<\/a><br \/>\n<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Swollen_eye_with_conjunctivitis.jpg\" target=\"_blank\" rel=\"noopener\">with_conjunctivitis.jpg<\/a><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Other <strong>symptoms<\/strong> can include headache, fever, light sensitivity (photophobia), twitching, confusion, and nausea and vomiting.<\/span><\/td>\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Have you experienced any headaches?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Ask about other symptoms: use variations of the PQRSTU mnemonic to assess symptoms further if the client\u2019s response is affirmative.<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p>T<span style=\"color: #000000\">hese symptoms can be related to other body systems and non-ophthalmic issues. Conduct a focused assessment on the related body systems.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 930.790405px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Personal<\/strong> and <strong>family history<\/strong> of conditions such as refractive errors, cataracts, glaucoma, diabetic retinopathy, and retinal detachment.<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Always inquire whether the client has had any eye injuries.<\/span><\/p>\n<\/td>\n<td style=\"width: 353.308807px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Do you have any chronic eye conditions? Do you have a family history of any of these conditions?<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">If the responses are affirmative, you might need to provide <strong>additional probes<\/strong>:<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Tell me about the condition. When did the symptoms begin? When were you diagnosed? How has it been treated? How well did the treatment work? How are you managing it?<\/span><\/p>\n<\/td>\n<td style=\"width: 465.404388px;text-align: left;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">The biological and non-biological nature of family may be important to explicate when asking questions, considering that the risk factors may be influenced by genetics and\/or culture. This assessment will help you gain a better understanding of the client and determine appropriate interventions and education.<\/span><\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">Any <strong>eye trauma<\/strong> or <strong>sudden change in vision<\/strong> is a priority of care. Changes may include blurry vision, dark spots, shadows or a dark curtain across the central or peripheral vision, dim, distorted or double vision, or halos or flashing lights. These may require immediate treatment to avoid permanent damage to vision, among other consequences. For example, sudden changes to vision may be related to a stroke, retinal tears, detachments, or hemorrhages. Conduct a primary survey and report the findings to the physician or nurse practitioner. Prompt attention is also needed when clients report eye pain, conjunctivitis, and any symptoms suggestive of infections such as purulent discharge, redness, and swelling.\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><strong>Cultural Inclusivity<\/strong><\/h2>\n<p><span style=\"color: #000000\">In some cultures, certain substances are used for <strong>newborn eye care<\/strong> in the first 24 hours following birth (Osman et al., 2018). Approach this kind of tradition with cultural humility, but also ensure patient safety with regard to how these substances may affect the integrity of the eyes and vision. Additionally, some individuals use <strong>over-the-counter eye drops<\/strong> when they have dry, red, and\/or itchy eyes. Some of these eye drops can constrict the vasculature, not address the actual problem, and actually worsen the issue (Mukamal, 2024). Consider referring the client to the physician or nurse practitioner to discuss their symptoms and find safer alternatives. If the client has used eye drops for more than a few weeks or the client is uncertain of the cause, refer them to an eye doctor for a proper diagnosis and effective treatment.<\/span><\/p>\n<\/div>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<div class=\"postbox h5p-sidebar\">\n<div class=\"h5p-action-bar-settings h5p-panel\"><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-262\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-262\" class=\"h5p-iframe\" data-content-id=\"262\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"H5P Activity Subjective Assessment Eyes\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/div>\n<div>\n<h3><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h3>\n<p><span style=\"color: #000000\">Government of Ontario (2005). Accessibility for Ontarians with Disabilities Act, 2005.<\/span> <a href=\"https:\/\/www.ontario.ca\/laws\/statute\/05a11\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ontario.ca\/laws\/statute\/05a11<\/a><\/p>\n<p><span style=\"color: #000000\">Braille Literacy Canada (2024). Learn about Braille.<\/span> <a href=\"https:\/\/www.brailleliteracycanada.ca\/en\/braille\" target=\"_blank\" rel=\"noopener\">https:\/\/www.brailleliteracycanada.ca\/en\/braille<\/a><\/p>\n<p><span style=\"color: #000000\">Canadian Association of Optometrists (2023). Position Statement: Recommended frequency of the comprehensive eye examination.<\/span> <a href=\"https:\/\/opto.ca\/sites\/default\/files\/resources\/documents\/Position%20Statement%20Eye%20Exam%20Frequency%202023%20EN.pdf\" target=\"_blank\" rel=\"noopener\">ttps:\/\/opto.ca\/sites\/default\/files\/resources\/documents\/Position%20Statement%20Eye%20Exam%20Frequency%202023%20EN.pdf<\/a><\/p>\n<p><span style=\"color: #000000\">Canadian National Institute for the Blind (2024). What is blindness?<\/span> <a href=\"https:\/\/www.cnib.ca\/en\/sight-loss-info\/blindness\/what-blindness?region=on\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cnib.ca\/en\/sight-loss-info\/blindness\/what-blindness?region=on<\/a><\/p>\n<p><span style=\"color: #000000\">Mukamal, R. (2024). Choosing the best lubricant eye drops for dry eyes.<\/span> <a href=\"https:\/\/www.aao.org\/eye-health\/tips-prevention\/how-to-choose-lubricant-drops-dry-eyes\" target=\"_blank\" rel=\"noopener\">https:\/\/www.aao.org\/eye-health\/tips-prevention\/how-to-choose-lubricant-drops-dry-eyes<\/a><\/p>\n<p><span style=\"color: #000000\">Osman, A., Gaffer, Y., Sharkawy, A., &amp; Brandon, D. (2018). Maternal cultural practices for neonates\u2019 care in upper Egypt. Women and Birth, 31, e278-e285.\u00a0<\/span><a href=\"https:\/\/doi.org\/\/10.1016\/j.wombi.2017.09.022\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/\/10.1016\/j.wombi.2017.09.022<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"2988-3453\" hidden><p>a condition when the sclera and the area around the eye becomes red, sometimes it is infectious.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3454\" hidden><p>are a condition in which the eye has problems bending and focusing light appropriately onto the retina (back of the eye) making it difficult to see.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3455\" hidden><p>are when the eye's lens becomes cloudy resulting in symptoms such as blurred vision. Often caused by the breakdown of proteins in the eye that happens at the age of 40 to 60 and older.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3456\" hidden><p>is the build-up of fluid and intraocular pressure that damages the optic nerve resulting in blindness.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3457\" hidden><p>refers to damage to the macula in the back of the eye (retina) that results in the loss of central vision.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-2411\" hidden><p>is an emergency situation when the retinal tissue pulls away from the back of the eye (without immediate treatment it can result in permanent loss of vision).<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3459\" hidden><p>is when the vitreous pulls away from the retina resulting in floaters and flashes of light (the vitreous is a jelly-like substance that fills the inside of the eye and is connected to the retina). Although in of itself is not serious, it can cause retinal detachment.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3460\" hidden><p>a disease caused by diabetes in which high blood sugar levels damage the retina's blood vessel resulting in vision impairment such as dark spots floating across the eyes, blurred vision, and vision loss.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3461\" hidden><p>is the reduced ability to see colour or distinguish between colours, sometimes referred to as colour blindness.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3463\" hidden><p>refers to the sensation that there is some sort of grit or sand in the eyes.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3273\" hidden><p>is nearsightedness meaning that distant objects are blurry.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3274\" hidden><p>is farsightedness meaning that close-up objects are blurry<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3275\" hidden><p>is an irregular-shaped cornea\/lens that results in close-up and distant objects being seeing as out-of-focus (not as sharp) and appearing blurry.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3276\" hidden><p>refers to a condition that affects the aging eye (40 to 50 years of age) resulting in difficulty seeing close-up objects (objects become blurry).<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3277\" hidden><p>is misalignment of the eyes in which they don't work together because one is pointed in a different direction. This results in double vision, poor revision, and amblyopia (image suppression from the affected eye meaning that the brain relies on the unaffected eye's vision). Often clients are born with it or develop it at a young age, but adults can also develop it as a result of neurological conditions.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3278\" hidden><p>is sometimes referred to as lazy eye and involves image suppression from the affected eye meaning that the brain relies on the unaffected eye's vision. One main cause is strabismus.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3279\" hidden><p>are small dots or wiggly lines that move across a person's vision. They are composed of cellular debris within the eye's vitreous.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3280\" hidden><p>are colourful circles (like a rainbow) around light sources such as a streetlight.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2988-3281\" hidden><p>is double vision in which two of the same image are seen.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-2988","chapter","type-chapter","status-publish","hentry"],"part":1653,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":64,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2988\/revisions"}],"predecessor-version":[{"id":3677,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2988\/revisions\/3677"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1653"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2988\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=2988"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=2988"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=2988"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=2988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}