👁️ Flashcards
What do you inspect in the eye ?
Symmetry
- corneal light reflex
Abnormality in the eyelid
Palpebral fissure
- shape, size, symmetry
Sclera :
- clarity of sclera
- hyperaemia
Clearness of cornea and pupil
Conjunctiva
- color : too pale => anaemia, diabetes
- discharge
- clarity
What do you inspect in the eyelids ?
Skin : swelling, discoloration, tumor, eyelashes
Alignment :
- symmetrical
- droop
- turn inward or upward
Is the eye completely covered when it closes ?
- lagophthalmos can cause dehydration of cornea : proptosis, enophthalmos
Relation to the cornea :
-upper eyelid should be 1-5 mm over the cornea
- lower eyelids should touch the cornea at 6 o’clock
Inspection of the pupils ?
Pupils constricted ==> drink
Pupils dilated ==> ADHD medication.
Should be round
Inspection of the cornea
Should be shiny and transparent.
Redness
- local : subconjunctival hemorrhage
- diffuse : hyperaemia
— peripheral of cornea : uveitis
— everywhere : infectious or allergic
Technique of pupillary response test ?
Subdued light. Sitting opposite to each other. Ask patient to look at point in the distance.
Shine light straight into one eye (block other eye from the light).
- direct pupillary response
- indirect pupillary response
Pupillary response to convergence :
- patient watch finger while it move towards them
- both pupil contract
Relative afferent pupil defect ?
The affected eye does not show direct pupillary response
The unaffected eye does not show indirect pupillary response
Technique of corneal light reflex ?
= ocular alignment
Shine penlight at both eye from a distance of 50 cm. Reflection of the light should be symmetrical.
Diplopia examination ?
Ask patient to follow your finger while you move it to the sides. Observe when they tell you they can see one / two images.
Does it disappear when they cover one eye ?
- binocular (only with 2 eyes open) : loss of cranial nerve, abnormality of the eye muscle, displacement of the eyeball
- monocular (with one eye open) : refractive error, cataract
Technique of visual field measuring ?
Donder test : peripheral vision field
Amsler test : central visual field
- patient fix their gaze on a dot in the middle of the grid and describe where the scotoma are
Type of scotoma ?
Scotoma : visual field abnormality or blind spot
Central scotoma : central part of visual field may be lost as well as visual acuity
Paracentral scotoma : visual acuity normal, loss of vision field around the center
Measuring intraocular pressure ?
Subtle change in intraocular pressure need proper equipment.
Severe change : detected using palpation with both index on closed eyelids and compare
- normal : firm and elastic
- acute glaucoma : hard eye, severe pain and nausea
What are the test on indication ?
Visual acuity :
- optotype test
- pinhole occluder
Fluorescent staining
Fundoscopy : to examine the retina
What is visual acuity ?
Ratio between distance at which the eye is able to discriminate a particular optotype and the distance at which a normal eye can.
Relative measure, expressed in decimal in the Netherlands.
Vocabulary of eye prescription :
OD : right eye
OS : left eye
OU : both eyes
Negative number : myopia
Positive number : hyperopia
Positive lens : converging ray = convexe lens
Negative lens : diverging ray = concave lens
Technique of optotype testing ?
Patient 6 meters away from the snelle chart. Looking at it in a relax way. Stop examination when they have 3 bad in a row. Last row they can see is their visual acuity.
If they cannot see anything at 6 meter then do the finger test instead. If they still can’t see ask them to step one meter forward.
Effect of the pinhole occluder ?
If patient can’t see the snelle chart you can make them wear the pinhole occluder.
The sharp narrowing a light beam make eye refraction less important to have sharp projection on the retina. It reduces the effect of refractive error and media opacification.
- visual acuity improve : refractive error
- visual acuity does not improve : problem on the retina or at the nerve
Technique of corneal fluorescent staining ?
Hold up fluorescent strip against conjunctiva after moistening it with drop of water.
Shine blue into the eye. Damage of the epithelium will shine green.
To identify superficial corneal injury caused by damage to the corneal epithelium.
Red flags of vision loss :
Flashes and floaters : retinal detachment or tear
Acute diplopia : compression of the nerve, ischemia of the eye
Loss of part of visual field
Temporary visual loss in one eye : insufficiënt blood supply to the retina => amaurosis fugax
Acute visual loss : retinal detachment, trauma, vascular occlusion
Red flag of a red eye ?
Pain
Photophobia
Nausea, vomiting
Reduced visual acuity
Type of eyelid disorder ?
Blepharitis : chronic inflammation of eyelids
- red and swollen, skin flakes, yellowish discharge
- associated with seborrhoiec dermatitis, eczema, rosacea
Localised swelling : chalazion = inflamed granuloma originating from blocked meibomian gland duct
- acute : red, painful
- after : hard, painless
Malignant tumor : firm painless lesion
Palpebral fissure abnormality :
Ptosis :
-neurological cause (loss of CN3, Horner’s syndrome)
- myasthenia gravis
- mechanical cause (aging of levator palpebrae muscle, prolonged contact lens use)
Entropion or ectropion : aging, facial palsy, scarring
Abnormality of eyeball ?
Proptosis = exophthalmos
- tumor in the eye socket, inflamed tissue
Sunken eye = enophthalmos
- fracture of orbital floor/wall
Abnormality of the cornea ?
Haziness : dehydratation
- irritation, bruning, blurred vision, lacrymation
Local clouding : scars or infections
Damage to corneal epithelium by foreign object
- gritty sensation
Arcus senilitis : circular whiteish discoloration parallel to corneal margin
- common and harmless in elderly
Disorder seen using fluorescence.
Abnormality seen on fluorescence ?
Abrasion of cornea when scratched by sharp object.
Whitish lesion : cornea infiltrate
- serious infection of corneal stroma
Staining looking like tree = dendritic lesion
- herpes simplex virus : herpes keratitis
Redness in the sclera = hyperaemia ?
Deep red discoloration of nasal or temporal segment : subconjunctival hemorrhage
- harmless, no visible blood vessel
Diffuse redness with increased vascularisation : conjunctivitis
- bacterial : with pus, eyelids stuck together
- viral : worse hyperaemia with lacrimation, subtle bump on conjunctiva. Can be caused by adenovirus => highly infectious
Others causes :
- keratitis
- intraocular inflammation : uveitis, iridocyclitis
Abnormality of the anterior chamber ?
Clouding => always pathological
Severe inflammation : leukocyte form whiteish mirror in the anterior chamber
- hypopyon
Precipitation of red blood cell in anterior chamber
- hyphaema
