Assessment of the Eyes Flashcards
How do you assess extra ocular movements (EOMs) and what is the purpose? How far should pencil or finger be from patient?
Testing the 6 EOMs. This tests the 6 extraocular eye muscles. Also assesses CN III, IV, and VI -About 12-14 inches, but might need to increase distance for older age b/c it can be difficult for older adults to focus on closer objects
During the 6 EOM test, pause during the upward and lateral gaze to detect what?
Nystagmus
In paralysis of the left CN VI, the eyes are conjugate in what gaze but not in what gaze?
Conjugate means they move together (normal finding) In paralysis of the left CN VI, the eyes are conjugate in right lateral gaze, but not in left lateral gaze.
Proptosis
An abnormal protrusion of the eyeballs in hyperthyroidism, leading to a characteristic “stare” on frontal gaze. If unilateral consider an orbital tumor or retrobulbar (behind eyeball) hemorrhage from trauma
What is convergence test? In what condition is convergence poor
This test is called the near point of convergence (NPC). This test measures the ability of the patient to keep a target single as it moves closer to the nose. Think of this as the distance from your eyes to the point where both eyes are just unable to maintain focus and start to experience double vision. Use pencil test midline and go closer. Convergence is poor in hyperthyroidism.
What is this a picture of?
Papilledema is a serious medical condition where the optic nerve at the back of the eye becomes swollen. Symptoms can include visual disturbances, headaches, and nausea. Papilledema occurs when there is a buildup of pressure in or around the brain, which causes the optic nerve to swell.
Papilledema signals serious disorders of the brain, such as meningitis, subarachnoid hemorrhage, trauma, and mass lesions.
Loss of SVPs (spontaneous venous pulsations - normal finding) occurs with high ICP (above 190mmH2O). Other causes include glaucoma and retinal vein occlusion.
Identified hemorrhage on right disc margin and use a clock to determine where that would be
Flame hemorrhage - might see in patients with HTN or diabetes
Cotton-wool patches.
Seen in diabetic and HTN retinopathy
Note something like: seen at 11 and 12 o’clock, 1 to 2 disc diameters from the disc. Each measures about 1/2 by 1/2 disc diameters
These are fluffy white patches on the retina of the eye
Diabetic retinopathy
Acute and infectious inflammation of the eyelid. What is the name of it? What normally causes it? Symptoms and tx?
Hordeolum (stye)
- usually caused by staph aureus
- tender, localized
- abrupt onset with pain and erythema
- treatment: warm compress
- sometimes w/exudate
Painless, beady nodule on the eyelid stemming from Meibomian gland.
Chalazion
- typically resulting from infection or obstruction of the glands’ excretory duct
- flakey eyelashes
- sometimes takes weeks to go away
- treatment: wait and monitor; warm compress if large; if really severe maybe inject w/corticosteroids
- painless beady nodule* document as
Inflammatory condition of the eyelid typically caused by staph aureus or obstruction of the eyelid glands.
Can be chronic as a result of seborrheic dermatitis of the lid edge.
Blepharitis
- red, scaly, greasy flakes on the eyelid skin and thickened crusted lid margins
- Blepharitis commonly occurs when tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness.
- Treatment: hot, moist compresses and baby shampoo scrubs; antibiotic ointment if needed
Retinal detachment
- separation of light sensitive membrane (retina) from the supporting layeres located in the back of the eye
- requires emergent surgical intervention: Emergency referral to ophthalmology
- Symptoms: blurred vision, floaters in the eye, flashes of light in their peripheral vision, discrepencies like shadows or blindness in a portion of thee visual field of one eye
Eye changes with age
- decreased corneal sensitivity
- presbyopia - farsightedness caused by loss of elasticity of the lens of the eye
- cataracts
- loss of central vision
- dry eyes - can be medication related or age related
- brown scleral spots - conjuctival nevi is brown spot on eye. Ask how long it has been there.
Pinguecula - a harmless yellowish triangular nodule in the bulbar conjuctiva on either side of the iris
-Appears frequently with aging, first on the nasal and then on the temporal side
Pterygium - a triangular thickening of bulbar conjuctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening may occur. May interfere with vision as it encroaches on the pupil.
