Pupils equal, round, reactive to light, and accommodation (PERRLA).
(4) Both eyes should constrict when light is directed into one eye. This is
the consensual reflex.
The eye should also constrict when focusing several inches from the
When you are checking the pupillary reaction, be sure the patient does
not look directly at the light. Looking directly at the light may cause
constriction just by accommodation.
(6) If the patient has lesions on the optic nerve or has tract lesions, the
pupillary response may be defective.
m. Extraocular Muscles. Extraocular muscles are muscles located outside the
eye but having to do with the eye. To assess these muscles, do the following:
Check to see if the patient's gaze is straight.
(2) Check the six cardinal positions of gaze. Ask the patient to look right,
look left, look to the upper right, look to the upper left, look to the lower right, and look to
the lower left.
(3) Conduct the cover-uncover test for strabismus. This test checks eye
muscle deviation. Have the patient fix his gaze on a small, stationary object first at a
distance of twenty inches and then at a distance of twelve inches. Cover one of the
patient's eyes while he looks at the object with the other eye. Look for any movement of
the uncovered eye. If the eye moves, it means it was not fixed on the object originally.
Any movement in the uncovered eye is abnormal. Also, note the direction the
uncovered eye moves, if it moves.
n. Intraocular Tension. Intraocular refers to conditions within the eye.
Intraocular pressure can be measured by Schiotz tonometry and applanation tonometry.
Instill a local anesthetic in the patient's eye. Put the Schiotz tonometer lightly on the
corneal surface and measure the indentation of the cornea made by a given weight.
The force necessary to flatten a small area of the central cornea is measured by
EXAMINATION OF EARS
a. Auricle. Look at the external ear. Inspect each auricle for and the
surrounding tissues for deformities, masses, and lesions.