Patients with narrow-angle closure glaucoma if pupil dilation is performed; dilation can initiate a severe and sight-threatening open-angle attack.
Patients with allergies to mydriatics if pupil dilation using mydriatics is performed.
| Core Dx |
Synonym/Acronym
slit-lamp examination.
Rationale
To detect abnormalities in the external and anterior eye structures to assist in diagnosing disorders such as corneal injury, hemorrhage, ulcers, and abrasion.
This Core Diagnostic Study is a noninvasive test commonly used to screen and periodically assess eye health, especially important in patients with known diseases that affect vision (e.g., diabetes, glaucoma).
Patient Preparation
There are no food or fluid restrictions unless by medical direction. Instruct the patient to withhold eye medications (particularly miotic eyedrops, which may constrict the pupil, preventing a clear view of the fundus, and mydriatic eyedrops in order to avoid instigation of an acute open-angle attack in patients with narrow-angle glaucoma) for at least 1 day prior to the procedure. Patients with blue or hazel eye color have the option of requesting dilating drops with a lower concentration than standard drops, as blue or hazel eyes dilate faster than brown eyes and will remain dilated for a longer period of time. Ensure that the patient understands that they must refrain from driving until the pupils return to normal (about 4 hr) after the test and has made arrangements to have someone else be responsible for transportation after the test.
Normal Findings
(Study type: Sensory, ocular; related body system: .)
This noninvasive, traditional procedure is used to visualize the anterior portion of the eye and its parts, including the eyelids and eyelashes, sclera, conjunctiva, cornea, iris, lens, and anterior chamber, and to detect pathology of any of these areas of the eyes. The slit-lamp has a binocular microscope and light source that can be adjusted to examine the fluid, tissues, and structures of the eyes. For example, slit-lamp ophthalmoscopy can be performed using the microscope part of the slit-lamp and a special lens (goniolens) placed close to the health-care provider’s (HCP) eye to examine the entire retina, optic disc (optic nerve head), choroid, and blood vessels in the back or fundus of the eye. Ophthalmoscopy is helpful in the identification of retinal detachment, diseases such as glaucoma that affect the movement of eye fluid, and diseases that affect the blood vessels in the eyes, such as hypertension and diabetes. Special attachments to the slit-lamp are used for special studies and more detailed views of specific areas. Dilating drops or mydriatics may be used to enlarge the pupil in order to allow the examiner to see the eye in greater detail. Mydriatics work by either temporarily paralyzing the muscle that makes the pupil smaller or stimulating the iris dilator muscle. Dilation is an important tool to assist in diagnosing conditions that involve the retina (e.g., diabetic retinopathy) and optic nerve (e.g., glaucoma).
The Optomap is an imaging technology that allows eye professionals to visualize up to 80% of the retina without the need for dilating drops in a few quick minutes; Optomap received clearance from the U.S. Food and Drug Administration in 1999. It is easy to see how some of these features are especially helpful in pediatric ophthalmology. Images can be saved and compared in future examinations to identify clinically significant changes. The cost of Optomap imaging is usually not covered by insurance as it is considered an advanced tool rather than an element of a standard comprehensive eye examination. The Optomap is an important advancement in optical imaging, especially of the retina. However, availability may be limited, and if a problem is identified, a dilated examination may be needed for further investigation.
The components of an eye examination may vary by patient problem (e.g., color blindness See the study titled [“Color Perception Test,”], diabetes, glaucoma, no disease/routine examination) or by type of HCP (MD or OD). There are four levels of eye examinations as defined by the Centers for Medicare and Medicaid Services: problem focused (must document 1 to 5 elements), expanded problem focused (must document 6 to 8 elements), detailed (must document 9 to 12 elements), and comprehensive (must document all 12 elements and a 13th element that assesses orientation, mood, and affect). Examination elements
Patients with narrow-angle closure glaucoma if pupil dilation is performed; dilation can initiate a severe and sight-threatening open-angle attack.
Patients with allergies to mydriatics if pupil dilation using mydriatics is performed.
Abnormal Findings Related to
Potential Problems: Assessment & Nursing Diagnosis/Analysis
| Problem | Signs and Symptoms | ||
| Injury risk (related to visual deficiencies associated with chronic disease or injury) | Diminished visual acuity; insufficient use of assistive devices; cluttered environment; insufficient lighting | ||
| Knowledge deficit (related to diminished visual acuity associated with chronic disease; diabetes, glaucoma, macular degeneration, etc.) | Insufficient knowledge of disease process; poor instruction follow-through; lack of interest in learning; presentation of inaccurate information |
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
Procedural Information
Potential Nursing Actions
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
Treatment Considerations
Injury Risk
Knowledge
Clinical Judgement
Follow-Up Evaluation and Desired Outcomes