1 - Examining Eye And Orbit Flashcards
- Define exophthalmos.
- Define enophthalmos.
- Strabismus.
- Blepharospasm.
- Buphthalmos.
- Abnormal protrusion of the eye from the orbit.
- Abnormal recession of the eye into the orbit.
- Eyes are not aligned towards same object.
- Spasm of orbicularis oculi so eyelid closure.
- Enlargement of the globe due to glaucoma.
- Define episclera.
- Lagophthalmos.
- Photophobia.
- Vessels and tissue exterior to sclera and under conjunctiva.
- Incomplete eyelid closure and globe coverage.
- Ocular discomfort induced by bright light.
Normal ocular conformation.
Mesocephalic skull.
Almond shaped eyes.
No sclera show.
No discharge.
Just see 3rd eyelid.
Sharp and clear corneal reflection.
- Equipment available in primary care practice for eye exam.
- In hospital / referral?
- Pen torch.
Direct ophthalmoscope.
Schirmer tear tests.
Topical anaesthetics.
Fluorescein. - 20D condensing lens.
Tonometer.
Slit lamp.
Indirect headset.
Basic steps of ophthalmic exam?
Hx and general clinical exam.
Distance hands off exam.
Subjective hands on exam.
Schirmer tear test.
Neuro-ophthalmic exam.
Close direct - adnexa and anterior segment exam.
Sampling if necessary.
Intraocular pressure measurement e.g. tonometer.
Apply mydriatic.
Posterior segment exam.
Vital stain application e.g. fluorescein.
Additional Dx.
Establish if eye problem at all?
Could be facial or orbit problem.
Look at ocular surface and inside the globe.
Observational skills for hand on and hands off exam.
Signalment, distant gross exam, conformation, living environment/lifestyle.
history taking ideas for ophthalmology consult.
spp, age, sex, breed, coat colour.
vaccination status, parasite tx, travelled, kept environment.
ongoing/prior systemic disease, previous eye problem, previous tx.
describe, onset, progression, vision changes.
5 ophthalmoscopy techniques.
- Illumination with light source.
- Distant direct – away from patient, looking through the scope.
- Close direct – close to patient, looking through scope (use magnifying lenses to focus – anterior +5D to +20D, posterior +0D).
- Distant indirect ophthalmoscopy – ophthalmoscope as light source and condensing lens to gain image of back of eye.
Distance exam for detection of ocular signs associated with orbital disease…
1. Behaviour.
2. Face.
3. Palpebral fissure.
4. Eyelids.
5. Globe.
6. Pupils.
7. Retroillumination ophthalmoscope technique.
- Attitude and ability to navigate.
- Symmetry, ocular discharge.
- space between upper and lower eyelids.
- length, colour, swelling.
- position, size, direction, movements, retropulsion.
- symmetry, size, shape.
- distant direct ophthalmoscopy to assess for shadowing, obstructions and cloudiness.
Assessing globe position.
assess from above.
look for symmetry.
which eye is the problem?
position of eye, size of eye.
visual axis.
Neuro-ophthalmic reflexes and nerves tested with these.
Vision – Cranial nerve II (optic).
Palpebral reflex and corneal reflex – CNV (trigeminal).
PLR – CNII and III (optic and oculomotor).
Dazzle reflex.
Oculo-cephalic reflex (globe movement with the skull).
Exophthalmos exam.
Visual axis.
position in orbit.
size of globe.
retropulsion – pain?
inspect oral cavity (last molar).
inspect nasal/sinus cavities.
Strabismus.
deviation of the axis – conformational in come breeds e.g. pugs.
Exophthalmos clinical signs.
Ocular pain – blepharospasm, epiphora, photophobia.
protrusion of 3rd eyelid.
reduced ocular motility.
change in tear production.
episcleral redness due to impaired venous return.
Strabismus.
Lagophthalmos causing exposure keratitis.
Usually unilateral.
Serous to mucopurulent discharge.
Unable to open mouth fully.
Acute onset.
Orbital space occupying lesion differentials.
Inflammation – abscess, cellulitis, myositis (extraocular, masticatory).
Neoplasia – primary orbital, extension from adjacent.
