DIAGNOSTIC TEST

•Tonometry•Corneal Staining

GROUP 3

TONOMETRY

Test that measures the pressure inside your eye intraocular pressure (IOP)

This test is used to check for glaucomaan eye disease that can cause

blindness by damaging the nerve in the back of the eye (optic nerve).

METHODS

Applanation (Goldmann) tonometry

Electronic indentation tonometry.

Noncontact tonometry (pneumotonometry).

Indentation (Schiotz) tonometry

APPLANATION (GOLDMANN) TONOMETRY

A type of tonometry uses a small probe to gently flatten part of your cornea to measure eye pressure and a microscope called a slit lamp to look at your eye

measured by how much force is needed to flatten your cornea

very accurate and is often used to measure IOP after a simple screening test

ELECTRONIC INDENTATION TONOMETRY

used more often to check for increased IOP

different than applanation tonometry

doctor gently places the rounded tip of a tool that looks like a pen directly on your cornea.

NONCONTACT TONOMETRY (PNEUMOTONOMETRY)

Air-puff tonometry does not touch your eye but uses a puff of air to flatten your cornea

not the best way to measure but simple way to check for high IOP and is the easiest way to test children

does not use numbing eyedrops

INDENTATION (SCHIOTZ) TONOMETRY

uses a plunger to gently push on your cornea is measured by how much weight is needed

to flatten your cornea

This test is not as accurate as applanation tonometry and is not used very much by ophthalmologists and optometrists. However, other doctors, such as family medicine doctors or urgent care doctors, may still commonly use this test

PURPOSE

To Determine The Fluid Pressure Inside The Eye.

To help diagnose glaucoma.

Normal eye pressure is different for each person and is usually higher just after you wake up

IOP changes more in people who have glaucoma.

Women usually have a higher IOP than men, and IOP normally gets higher as you get older.

Intraocular pressure (IOP)Normal:10–21 millimeters of mercury (mm Hg)

High values A high IOP may mean that you have glaucoma or

that you are at high risk for developing glaucoma. People who have ongoing pressures above 27 mm Hg usually develop glaucoma unless the pressure is lowered with medicines.

People who have an ongoing IOP higher than 21 mm Hg but do not have optic nerve damage have a condition called ocular hypertension. These people may be at risk for developing glaucoma over time.

NURSING RESPONSIBILITIES

1.) Explain the procedure and purpose to the client

2.) Explain that the procedure is not painful but instruct the patient that it may have a scratchy feeling on your cornea. This usually goes away in 24 hours.

3.) Tell that the test requires the client's eyes to be anesthetized using anesthetic eye drop, the numbing drops wear off in about 20 minutes

4.) Reassure the patient that the procedure is painless

5.) You may ask the patient to remove corrective lenses, such as contact lenses

6.) Tell it is important not to rub the patient’s eye while it is numb or (at least 30 mins after the procedure)

7.)Do not put your contacts back in for 2 hours after the test. Bring your eyeglasses to wear after the test until you can wear your contact lenses.

8.) Loosen or remove any tight clothing around patient’s neck. Pressure on the veins in your neck can increase the pressure inside patient’s eyes. Stay relaxed.

9.) Contact your doctor immediately if you experience any of the following eye discomforts:

Burning Excessive itching Swelling Inflammation (the eye is excessively pink or

reddish) Decreased vision Any other eye problem

10.) Remind patient to have an eye pressure check at least every 2 years if his pressure is normal

CORNEAL STAINING OR FLUORECEIN EYE STAIN

test that uses orange dye (fluorescein) and a blue light to detect foreign bodies in the eye.

can also detect damage to the cornea, the outer surface of the eye.

WHY THE TEST IS PERFORMED?

It is useful in identifying superficial scratches or other problems with the surface of the cornea

also help reveal foreign bodies on the eye surface

can be used after contacts are prescribed to determine if there is irritation of the surface of the cornea.

TYPES

Micropunctate

Macropunctate

Calescent Macropunctate

Patch

HOW THE TEST IS PERFORMED

piece of blotting paper containing the dye will be touched to the surface of your eye

You will be asked to blink. Blinking spreads the dye around and coats the "tear film" covering the surface of the cornea.

A blue light is then directed at your eye. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.

The health care provider can determine the location and likely cause of the cornea problem depending on the size, location, and shape of the staining.

A patient with significant aqueous deficient dry eye condition. The pre-corneal tear film is very poor with inferior corneal staining.

RisksIf the fluorescein touches the skin surface, there may be a slight, brief, discoloration.

remove your contact lenses before the test

If eyes are extremely dry, the blotting paper may be slightly scratchy. The dye may cause a mild and brief stinging sensation.

How to Prepare for the Test?

How the Test Will Feel?

NORMAL RESULTS

If the test result is normal, the dye remains in the tear film on the surface of the eye and does not adhere to the eye itself.

WHAT ABNORMAL RESULTS MEAN

Abnormal tear production (dry eye) Corneal abrasion (a scratch on the surface of

the cornea) Foreign bodies, such as eyelashes or Infection Injury or trauma Severe dry eye associated with arthritis

(keratoconjunctivitis sicca)

NURSING RESPONSIBILITIES

Identify the patient to ensure that correct patient will receive the treatment.

If the patients wearing any contact lenses instruct him to remove it.

Explain that the procedure is painless.

Wash hands and instill topical anesthesia to both eye to reduce discomfort.

Instruct the patient not to rub eyes 45 minutes after the procedure.