11.7.1 Eye Revision Overview Flashcards
Summary of eye complaints
VISUAL DISTURBANCE
- E.g. sudden or gradual loss of vision, light flashes, diplopia.
OCULAR OR PERIOCULAR DISCOMFORT
- E.g. pain, itch, burning, scratching, photophobia, headache.
DISCHARGE
- Tears, mucus, pus.
ABNORMAL APPEARANCE
- E.g. ocular or periocular swelling, abnormal eyelid position, squint.
Interpretation of specific visual disturbance visual system symptoms
DECREASED VISUAL ACUITY (VA)
- Refractive error or serious visual system disease.
LOSS OF VISUAL FIELD (VF)
- Serious retinal or neural abnormality.
FLASHES OF LIGHT
- Retinal traction with risk of retinal detachment.
COLOURED HALOS AROUND LIGHTS
- Corneal oedema, usually as a result of raised intraocular pressure.
DIPLOPIA
- Acquired strabismus
Interpretation of specific discomfort visual system symptoms
ITCH
- Usually means that allergy is an important component of the problem.
BURNING & SCRATCHING
- Almost any ocular surface problem.
PHOTOPHOBIA
- Usually indicates the presence of either keratitis or anterior uveitis, and thus requires the attention of an ophthalmologist.
EYE PAIN
- Acute, deep seated, boring, unilateral eye pain which radiates into the entire ipsilateral hemicranium, and which is severe enough to cause prostration, nausea and vomiting, is diagnostic of acute angle closure glaucoma.
HEADACHE in the periocular and/or retrobulbar area.
- related to visual tasks: uveitis, eye strain due to either a refractive error or extraocular muscle imbalance.
- unrelated to visual tasks: sinusitis is the commonest cause (must always be excluded.) A headache that is present on waking is never due to eye strain.
Interpretation of specific discharge visual system symptoms
TEARS
- Any cause of ocular discomfort, blockage of the lacrimal drainage apparatus.
MUCUS
- Usually a result of allergy.
PUS
- Infection, usually bacterial.
- Small amounts of pus, too little to be seen by either the patient or the doctor, dry on the eyelids at night and result in the eyelids sticking together when the patient wakes in the morning.
Screening tests
Types
Description
VISUAL ACUITY (VA)
- Distance visual acuity without and with correction and pinhole as appropriate.
VISUAL FIELD (VF)
- Confrontation and central visual fields as indicated.
PUPILS
- Position, shape, absolute size and size relative to the other pupil.
- Reaction to light:
(i) Direct
(ii) Consensual
(iii) Swinging flashlight test: for a relative afferent pupil defect.
(iiii) Test for anterior uveitis: always perform one of the specific tests for anterior uveitis
ALIGNMENT & MOTILITY
- Corneal light reflexes.
- Cover test with distance and near fixation.
- Cardinal movements: with cover test if necessary.
Inspection
- HEAD - Position and shape of the face and cranium.
- ORBITS - Position, prominence and size of the eyes.
- EYELIDS - Lid position, closure, skin, eyelashes, tarsal gland orifices, puncta.
- CONJUNCTIVA, EPISCLERA & SCLERA - Note the pattern of any redness with eversion of the lower lid.
- CORNEA
-
ANTERIOR CHAMBER
- Clarity
- Depth: eclipse test. - IRIS
- LENS
-
OPHTHALMOSCOPY
- Red reflex and medial opacities.
- Disc: margin, colour, cup. Vessels
- Retina
- Macula -
FLUORESCEIN STAINING
- In external diseases, add fluorescein and repeat the examination of the conjunctiva and cornea in cobalt blue light.
Palpation
-
ORBITAL MARGIN
- A fracture or tumour may be palpable. -
OCULAR TENSION
- Digital or Schiøtz as indicated
- Not in open injuries! -
LACRIMAL SAC
- Note signs of acute or chronic dacryocystitis. -
PREAURICULAR LYMPH NODES
- Caused mainly by intracellular organisms: viruses and chlamydia. -
SINUSES
- Frontal, maxillary, ethmoid.
Snellen visual acuity formula
Greatest distance pt can see object
—————————————————
Greatest distance norm person can see object
What tests must be preformed if pt can’t identify the largest symbol on a standard test chart?
- counting fingers (CF)
- perception of hand movements (HM)
- perception of light (PL)
Special observations and tests for preschool children
1. 0 – 3 months
- Responds to a light and to the mother’s face.
2. 3 months – 2 years
- Fixes on and follows a target such as a light or toy.
- Objects to occlusion.
2 – 6 years
- 100s & 1000s can be picked up individually.
- Identification tests: pictures, letters.
- Orientation tests: illiterate E, little hands.
Pinhole test
Why
When
- Exclude subnormal visual acuity due to refractive error
- Pinhole ⬇️ effect of residual refractive error
- If visual acuity is abnormal; repeat with pinhole
Confrontation of visual fields
1. Periphery
- Can pt see target (moving finger tip) at distance of 50-80cm from pt cornea -> test 8 points
- Delimiters:
1. Temporally: 100o from the visual axis, i.e. behind the coronal plane.
2. Superiorly: the upper lid or brow, depending on the patient’s anatomy.
3. Inferiorly: the cheek. 4 Nasally: the nose.
2. Midperiphery
- Test 8 points halfway between periphery and visual axis
- Also 50-80cm
Central fields
- tested with Amsler grid
- Pt: 30cm away form eye and cover contralateral eye; look at central lines
- Dr: in-front of pt and watch eye for flicker movement
- any flicker movement of eye: fixation on dot has been lost -> test=null/void -> start over
Pupil reactions
- dim lighting
- pt fix on distant object (prevents miosis)
- first only look at pupil without shining light in eye
- direct reflex: light in eye and look at reflex
- indirect: shine in one eye but look at contralateral eye
- swinging flashlight test
Alignment
1. Cover test
- pt fix on object (distant or near)
- cover one eye and observe contralateral eye
- Contralateral eye still= was fixing on target= alignment
- Moves= direction of movement tells the nature of misalignment
2. Corneal light reflex test
Near test
- off torch 30cm form pt
- observe reflection when switched on (both corneas)
- Alignment - both eye reflexes appear symmetrically & near centre of pupils
- Not in alignment = light reflex in deviating eye is displaced
Distance test
- 80-100cm
- same as above
