11. Anatomy/Physiology of the Eye/Ocular Exam Flashcards
orbicularis oculi innervation
CN VII
levator palpebrae innervation
CN III
muller’s muscle innervation
sympathetic
ciliary body, posterior chamber, anterior chamber, cornea, pupil, iris, zonules, sclera, lens, vitreous body, optic disc, retina, fovea centralis, central retinal artery, central retinal vein, optic nerve
anatomical structures of the eye
epithelium, bowman’s membrane, stroma, descemet’s membrane, endothelium
anatomy of the cornea
minor arterial circle of the iris, major arterial circle of the iris, anterior ciliary artery, long posterior ciliary artery, vorticose vein, short posterior ciliary artery
vascular supply to the uveal tract
ciliary body, zonular fibrils, anterior chamber, trabecular meshwork
relevant anatomy for drainage of aqueous humor
red reflex
scotoma, hemianopia, homonymous
visual field defects
reduced or absent vision
scotoma
loss of half of visual field
hemnianopia
either a right or left sided visual defect
homonymous
lesion anterior to optic chiasm
monocular loss
lesion at the optic chiasm
bitemporal hemniaopia
lesion posterior to chiasm
homonymous hemianopia
unilateral field loss
left or right optic nerve compression
chiasmal compression from pituitary tumor
bitemporal hemianopia
left cerebrovascular event
homonymous hemianopia
optic nerve swelling
papilledema
rhodopsin, anaerobic glycolysis, aerobic glucose metabolism, hexose monophosphate shunt, sorbitol pathway, galactosemia-dulcitol
biochemical pathways used by the eye
metabolism directed towards maintaining transparency of the lens epithelium, glucose enters the lens from the aqueous humor and is rapidly metabolized, hyperglycemia shunts glucose to the sorbitol pathway causing lens edema and acute refractive error changes such as blurred vision which may take 4-6 weeks to equilibrate after stabilization of blood sugars, chronically can lead to cell rupture and early cataract development in diabetics
lens metabolism
cornea and lens, cornea is 2/3 of refractive power, lens is 1/3 of refractive power
refractive surface of the eye
refractive power of the cornea and lens being different in one meridian versus the other
astigmatism
ability of the ciliary muscle to contract or relax the zonules allowing lens to focus at near objects
accommodation
farsighted, axial length too short
hyperopia
nearsighted, axial length too long
myopia
distorted vision
astigmatism
decreased ability to focus at near objects with age, cannot be corrected with refractive surgery
presbyopia
good and equal vision in both eyes, monocular or binocular, central or peripheral, acute or gradual, variation throughout the day, pain, metamorphopsia, diplopia both monocular and binocular
history of ocular chief complaints
diabetes mellitus, hypertension, thyroid disease, autoimmune disease like collagen vascular or inflammatory bowel disease, glaucoma, malignancy
past medical history for ocular complaints
trauma, refractive surgery, cataract surgery
past surgical history for ocular complaints
employment, living situation, activities/hobbies, smoking, alcohol, illicit drugs, spectacles/contact lenses, last ocular exam
social history for ocular complaints
retinoblastoma, amblyopia, strabismus, glaucoma, macular degeneration, diabetes, hypertension, color blindness, retinitis pigmentosa
family history for ocular complaints
disturbances of vision, pain or discomfort in or about the eyes, abnormal eye secretions
review of systems for ocular complaints
blurred or decreased vision, loss of vision either monocular/binocular/amaurosis, color vision abnormalities, decreased peripheral vision, iridescent vision like halos or rainbows
disturbances in vision
lacrimation, epiphora -overflow tearing-. purulent/mucous/serous exudate
abnormal eye secretions
superficial foreign body sensation, deep pain in iritis/glaucoma, burning, itching generally pointing to allergy, photophobia generally pointing to iritis, headaches
pain or discomfort with ocular complaints
best corrected visual acuity problem
monocular vision`
about 1 meter apart, monocular, test from peripheral to central, gross visual field testing, formal testing is available
confrontation visual fields
orbit, eyebrows for thinning in hypothyroidism, eyelids, eyelashes, lacrimal gland, lymph nodes, proptosis/exopthlamos
external exam for eye
patient looks down, grasp upper lashes & lid, cotton tipped applicated placed in lid crease, pull lid up over applicator, examine for foreign bodies
upper lip eversion
direct, consensual not performed instead swinging flashlight, swinging flashlight/afferent reflex
pupillary testing
direct examination including size, equal, anisocoria, round, central, reactivity to light, rapid swinging flashlight test, light-near association
pupil exam
important if patient is complaining of diplopia, check cardinal positions of gaze, check for diplopia monocular/binocular, paresis/palsy, nystagmus
extraocular muscle testing
corneal sensitivity, cranial nerve 5, inspect for epithelial defects, such as ulcer/abrasion, active/old opacifications, peripheral changes like arcus corneae
cornea exam
is able to detect epithelial defects, flouresces with cobalt blue filter, use strips to avoid contamination, remove soft contact lenses first
fluorescein staining of the corne
corneal abrasion
assessed by side penlight test
anterior chamber assessing depth
red reflex, optic nerve cup/disc/blurriness, retinal circulation including the artery/vein/av crossing, retinal background, and macula
opthalmoscopy
normal 10 10-21 mmHg anesthetize cornea with proparacaine, separate lids without pressure, schiotz tonometer is lowered on cornea/record the scale reading and convert to IOP, tonopen can be connected to an electric device and is less cumbersome, pneumotonmetry is an air puff, icare, goldman is the current gold standard
tonometry
psychiatric, functional, drugs/toxins, vasculaer, infectious, traumatic, autoimmune/allergy, metabolic, endocrine, idiopathic/iatrogenic, neoplastic, congenital
categories of systemic diseases necessary for ophthalmic examination
