(1) Eye Exam Flashcards
General History for patient’s presenting with eye complaints
- Age
- Pregnant?
- Glasses/contacts
- Injuries/trauma
- Surgeries
- Eye infections
- Recent travel/activities
- Current eye issue (OLD CAAARTS)
What are examples of associated symptoms with eye complaints?
- Pain
- Drainage
- Itching/burning
- Vision change
- Blurry vision
- Flashing lights
What are some examples of relevant past medical hx with eye complaints?
Glaucoma
DM
Thyroid disease
ASCD
Collagen Vascular Disease
HIV
Inflammatory bowel disease
***All of these are associated with some form of eye involvement
What are some classes of medications that can have ocular side effects?
- Steroids
- Plaquenil
- Antihistamines
- Antidepressants
- Antipsychotics
- Antiarrhythmics
- Beta blockers
What do we ALWAYS do first during the physical exam?
INSPECT
What are you looking for on external examination of the eyes?
- Symmetry
- Plucking?
- “Falling out”
- Scaly skin -aka seborrheic dermatitis
- Scars
What do you look for in the periorbital area?
General:
- Edema
- Bruising
- Injury
- Rash
Specific:
- Change in elasticity
- Allergic shiners (look like low on sleep, brusing under eyes)
- Xanthelasma (check cholesterol level)
- Proptosis/Exophtalmos (eyes buldging out)
- Dacrocystitis (infection in tear duct)
What do you always want to do when you are inspecting the eyelids/eyelashes?
Remove glasses
What are you looking for when inspecting the eyelids/eyelashes?
- Do the lids close completly?
- Do lids invert/evert?
- Flakiness/crustiness
- Erythema
- Swelling
- Scabs/new skin lesions
- Ptosis (drooping of eye)
What is the picture on the LEFT revealing?
Entropion
Lash line is INVERTED
What is the picture on the RIGHT revealing?
Ectropion
Lash line is facing outward
What is this called?
Where is it found?
Hordeloum
ALONG THE LASHLINE
What is this called?
Where do you find it?
Chalazion
IN THE LID
What is a similarity between hordeolum and chalazions?
Both blocked meibomian gland
What are the differences between hordeolum and chalazion?
Hordeloum: Tender/painful, located along lash line
Chalazion: Non painful (unless becomes inflammed), located in the lid
What is this called?
Blepharitis
(right side=chronic)
Lacrimal apparatus:
What do you want to look for?
What can deformations of this strucure indicate?
Look at the punctae
Could indicate skin lesions/cancer or autoimmune diseases
How do you inspect the conjunctiva?
What should it look like?
Lower the lower eyelid and have patient look up
Raise the upper eyelid and have patient look down
Should be clear
Conjunctiva
If you see:
- Erythema
- Purulence
What could they indicate?
- Erythema = subconjunctival hemorrhage
- Purulence = “pink eye”, conjunctivitis
What is pterygium?
Overgrowth of the conjunctiva
The cornea should be:
Clear and equal
How do you test for corneal sensitivity?
What CNs does this test for?
Cotton
*Tests cranial nerve V (trigeminal) : Sensory to “feel the cotton
*test cranial nerve VII (facial) motor to “blink
What is this?
Are these common?
Are they painful?
Corneal abrasion/ulcer
VERY common in ER
Very painful
What is this called?
Who is this common in?
Arcus senilis
Common in older adult population
If under <40yrs consider checking cholesterol level
When examining for the “red reflex”, what are abnormal findings?
-Reflex is NOT equal in both eyes
(*note, reflex does not have to be red to be normal “red reflex”)
-Brown speckles
What is this?
Cataract
Sclera
What do brown or gray spots in the sclera mean?
–> Birthmarks
- There could be an increased amount of melanin in sclera
- Can have incresed risk for glaucoma
Sclera
What does a blue sclera mean?
Inherited
Seen frequently in brittle bone disease
Sclera
What does a yellow sclera mean?
What is the medical term for a yellow sclera?
Neonatal liver disease
Pancreatic cancer
Gallbladder disease
“Icterus”
What is this presentation called?
Nevus of Ota
How would you document fully functional extraocular muscles in your SOAP note?
EOMI
“Extraocular muscles intact”
Defects in extraocular muscles can cause?
Diplopia
Nystagmus
What are the cranial nerves that are associated with each extraocular muscle?
LR6SO4AR3
Lateral rectus m.= CN 6
Superior oblique m. = CN 4
“All the rest”= CN 3
What test to you do to check for extraocular muscle function?
H test
What is the abnormal movement of the child’s left eye called?
Esotropia
“eye turns in”
What is the abnormal movement of the pts left eye called?
Exotropia
“Eye turns out”
How do you perform a cover/uncover test?
Have pt. stare ahead at a near fixed point
Cover one eye and observe uncovered eye as it focuses on point
Remove cover and watch for movement of newly uncovered eye as it fixes on point
Repeat on other side
How do you treat strabismus in young children?
Patching
If patching fails, surgery
What happens if strabismus goes untreated?
Brain will choose to focus with unaffected eye and the other eye will lose vision
How do you document normal iris/pupil in your SOAP note?
PERRLA
Pupils equal round reactive to light and accomodation
NEVER dilate the eyes until you have checked for..
A shallow anterior chamber
What does mydriasis mean?
Dilating of the pupil
How do you hold the opthalmoscope and perform an eye exam?
Your right hand holds opthalmoscope to look with right eye in patient’s right eye
Your left hand holds opthalmoscope to look with left eye in the patient’s left eye
With a funduscopic exam, what are the structures you are looking at?
Optic disc
Veins
Arteries
Macula
What is this?
What causes it?
Papilledema
Increased intracranial pressure
What is this?
What causes it?
Cotton Wool Spots
Vascular disease from HTN or DM
What is this?
Glaucomatous Cupping
What is this?
What causes this?
Retinal proliferation
HTN or DM
What are these?
Precursor to?
Drusen bodies
Precursor to macular degeneration
When performing a visual acuity test, how far does pt. stand away from chart?
20 ft
What does the first and second number in a visual acuity test indicate?
(eg. 20/20)
First number = distance from chart
Second number = distance at which a normal eye can read the line of letters
