Introduction
Retinoscopy is a clinical technique used to objectively assess refractive errors in the eye such as myopia, hyperopia, and astigmatism without relying on patient feedback. It’s especially valuable for evaluating infants, nonverbal individuals, or patients with cognitive impairments who can’t participate in standard vision tests.
Definition
Retinoscope is an instrument used to measure the optimum power of the eye.
Purposes
- It illuminates the retina.
- It is used to evaluate the refractive state in a nonverbal patient.
- It is used to evaluate the refractive state in a patient with low vision.
Principle
- Retinoscopy is based on the fact that when light is reflected from a mirror into the eye, the direction in which the light will travel across the pupil will depend on the refractive state of the eye.
Indications
- Vision <6/6 with spectacles.
- Higher level of astigmatism.
Contraindications
- Dry mouth.
- Flushing.
- Dizziness.
- Nausea.
- Vomiting.
- Narrow-angle glaucoma.
Articles
| Articles | Purpose |
| Room with dim lighting facility | To examine eye. |
| Retinoscope | To measure the patient’s refractive error. |
| Trial lens | To see visual function of the eye. |
| Trial frame | To hold corrective lens. |
| Visual acuity chart | To determine the visual acuity. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and gains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Make the patient sit at a distance of 1 m from the examiner. | To provide comfort during the procedure. |
| 4. | Ask the patient to look at the far point. | To relax the accommodated eye. |
| 5. | A beam of light is thrown into the patient’s eye. | To observe red reflex in the pupillary area of the patient. |
| 6. | The retinoscope is moved in horizontal and vertical directions keeping a watch on the red reflex. | To observe the reflected light from the retina. |
| 7. | Neutralize one meridian with plus spherical trial lens if reflex is with movement or with minus spherical lens if reflex is against movement. | To identify refractive error. |
| 8. | Neutralize the other meridian with plus cylindrical trial lens if reflex is with movement or with minus spherical lens if reflex is against movement. | To identify refractive error. |
| 9. | Document the procedure: Record the date, time, and patient’s response to the procedure. | Serves as legal evidence and prevents duplication of care. |
Special Considerations
- Use distant, non-accommodative targets to relax accommodation and improve accuracy.
- Especially important in children or young adults to paralyze accommodation and reveal latent hyperopia.
- Clean the retinoscope and any handheld lenses between patients.
- Use a lens rack or loose lenses if a phoropter is unavailable or impractical.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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