Anatomy

The eyeball has three layers: the inner retina, which contains the photoreceptors; the middle uvea (choroid, ciliary body, and iris); and the outer sclera, which includes the transparent cornea. The eyeball contains two cavities: the anterior cavity and the posterior cavity. The smaller anterior cavity is in front of the lens and is further divided by the iris into an anterior chamber, filled with aqueous humor, and a posterior chamber, filled with the vitreous. Behind the lens is the larger posterior cavity, which contains the vitreous. The lens is behind the iris, held in place by the ciliary body and suspensory ligaments called zonules. The visible portion of the sclera is covered by the conjunctiva. Six extrinsic muscles move the eyeball: the superior, inferior, medial, and lateral rectus muscles, and the superior and inferior oblique muscles.

Nerve supply: The optic (second cranial) nerve contains the fibers from the retina. The eye muscles are supplied by the oculomotor, trochlear, and abducens (third, fourth, and sixth cranial) nerves. The lid muscles are supplied by the facial nerve to the orbicularis oculi and the oculomotor nerve to the levator palpebrae. Sensory fibers to the orbit are furnished by ophthalmic and maxillary fibers of the fifth cranial (trigeminal) nerve. Sympathetic postganglionic fibers originate in the carotid plexus, their cell bodies lying in the superior cervical ganglion. They supply the dilator muscle of the iris. Parasympathetic fibers from the ciliary ganglion pass to the lacrimal gland, ciliary muscle, and constrictor muscles of the iris.

Physiology

Light entering the eye passes through the cornea, then through the pupil, and on through the crystalline lens and the vitreous to the retina. The cornea, aqueous humor, lens, and vitreous are the refracting media of the eye. Changes in the curvature of the lens are brought about by its elasticity and by contraction of the ciliary muscle. These changes focus light rays on the retina, thereby stimulating the rods and cones. The rods detect light, and the cones detect colors in the visible spectrum. The visual area of the cerebral cortex, located in the occipital lobe, registers them as visual sensations. The amount of light entering the eye is regulated by the iris; its constrictor and dilator muscles change the size of the pupil in response to varying amounts of light. The eye can distinguish nearly 8 million differences in color. As the eye ages, objects appear greener. The principal aspects of vision are color sense, light sense, movement, and form sense.

Patient care

When injury to the eye occurs, visual acuity is assessed immediately. If the globe has been penetrated, a suitable eye shield, not an eye patch, is applied. A penetrating foreign body should not be removed. All medications, esp. corticosteroids, are withheld until the patient has been seen by an ophthalmologist.

The patient is assessed for pain and tenderness, redness and discharge, itching, photophobia, increased tearing, blinking, and visual blurring. When any prescribed topical eye medications (drops, ointments, or solutions) are administered, the health care provider should wash his or her hands thoroughly before administering the agent. The patient's head is turned slightly toward the affected eye; his or her cooperation is necessary to keep the eye wide open. Drops are instilled in the conjunctival sac (not on the orb), and pressure is applied to the lacrimal apparatus in the inner canthus if it is necessary to prevent systemic absorption. Ointments are applied along the palpebral border from the inner to the outer canthus, and solutions are instilled from the inner to the outer canthus. Touching the dropper or tip of the medication container to the eye should be avoided, and hands should be washed immediately after the procedure.

Both patient and family are taught correct methods for instilling prescribed medications. Patients with visual defects are protected from injury, and family members are taught safety measures. Patients with insufficient tearing or the inability to blink or close their eyes are protected from corneal injury by applying artificial tears and by gently patching the eyes closed. The importance of periodic eye examinations is emphasized. Persons at risk should protect their eyes from trauma by wearing safety goggles when working with or near dangerous tools or substances. Tinted lenses should be worn to protect the eyes from excessive exposure to bright light. Patients should avoid rubbing their eyes to prevent irritation or possibly infection. See: eyedrops; artificial tears

CAUTION!

Treatment

Application of ice packs during the first 24 hr will inhibit swelling. Hot compresses after the first day may aid absorption of the fluids that produce discoloration.