Ch.15 Eyes Flashcards
What is the purpose of a comprehensive eye examination?
To detect vision-related problems and systemic diseases
Comprehensive eye examinations assess various aspects of eye health and can identify underlying health issues.
What areas are assessed during an eye examination?
- Vision difficulty
- Pain
- Strabismus and Diplopia
- Redness and Swelling
- Watering/Discharge
These areas help in identifying specific eye conditions and symptoms.
What are some questions to ask regarding the use of glasses or contact lenses?
- Do you wear glasses or contact lenses?
- How well do they work for you?
- When was the last time your prescription was checked?
These questions help evaluate the effectiveness of the current vision correction and the need for updates.
Why are regular eye exams necessary?
- To adjust prescriptions
- To screen for eye diseases
Regular examinations are essential for maintaining optimal vision and eye health.
What is a key consideration for contact lens wearers?
Care to prevent infection and irritation
Proper care of contact lenses is crucial for eye health.
What are the objectives of an eye examination?
- Assess central visual acuity
- Test near vision
- Test visual fields
- Inspect extraocular muscle function
- Evaluate external ocular structures
- Examine anterior eyeball structures
These objectives ensure a comprehensive evaluation of visual and ocular health.
What is the recommended positioning for a person during vision screening?
Standing for vision screening, then sitting up at eye level
Proper positioning is important for accurate assessment of visual acuity.
What equipment is needed for an eye examination?
- Snellen eye chart
- Handheld visual screener
- Opaque card or occluder
- Penlight
- Ophthalmoscope
These tools are essential for conducting various tests during the examination.
What is the procedure for testing central visual acuity using the Snellen eye chart?
Place chart at eye level, person stands 20 feet away, shields one eye at a time, and records the smallest line read
This procedure helps determine visual acuity accurately.
What does a normal result of 20/20 visual acuity indicate?
The person can see at 20 feet what a normal eye can see at 20 feet
This is considered the standard for normal vision.
What does a result of 20/30 indicate?
You can read at 20 feet what the normal eye can see from 30 feet away
This indicates a slight reduction in visual acuity.
What should be done if vision is worse than 20/30?
Refer to ophthalmologist
This is important for further evaluation and potential treatment.
What should be recorded if a patient cannot see even the largest letters on the Snellen chart?
Shorten the distance and record the closest distance
This helps to assess the level of vision impairment.
What does a larger denominator in visual acuity results indicate?
The poorer the vision
This reflects a decreased ability to see clearly at a distance.
What alternative is available for patients who cannot read or speak English during visual acuity testing?
Snellen Picture Chart
This allows for visual assessment without reliance on language.
What is the method used for testing near vision?
Use a handheld vision screener (e.g., Jaeger card)
Typically for individuals over 40 or at the bedside.
What is the normal result for near vision testing?
‘14/14’ in each eye, read without hesitancy
Indicates good near vision.
What does it suggest if a person moves the near vision card farther away?
Presbyopia
Decreased accommodation due to aging.
What is the purpose of the confrontation test?
Test for loss of peripheral vision
Assesses visual fields.
What is the procedure for the confrontation test?
Position self 2 feet from the person, eye level, and cover opposite eyes
Move a wiggling finger from the periphery towards the center.
What does it indicate if a person does not see the target as you do during the confrontation test?
Peripheral field loss
May suggest glaucoma or stroke.
What is the normal result for the corneal light reflex (Hirschberg test)?
Reflection of light should be symmetrical on both corneas
Indicates proper alignment.
What does asymmetry in the corneal light reflex test indicate?
Misalignment or muscle weakness
May require a cover test.
What condition is characterized by eyes not aligning properly when looking at an object?
Strabismus
Also known as crossed eyes.
What does the diagnostic positions test assess?
Muscle weakness by leading the eyes through six cardinal positions of gaze
Tests cranial nerves III, IV, VI.
What is a normal response in the diagnostic positions test?
Parallel tracking of the object with both eyes
No nystagmus or lid lag noted.
What is nystagmus?
Fine oscillating movements around the iris
Mild at extreme lateral gaze is normal.
What does lid lag indicate?
Upper eyelid does not fully overlap the iris when looking down
Associated with hyperthyroidism.
What should be observed during the inspection of external ocular structures?
Ability to move around and avoid obstacles, relaxed facial expression
Indicates adequate vision.
What are signs to watch for indicating poor vision?
- Groping with hands
- Squinting
- Craning forward
These behaviors suggest vision issues.
What is the normal appearance of eyebrows?
Present bilaterally, moving symmetrically with facial expressions
No scaling or lesions.
What may indicate nerve damage in eyebrow inspection?
Unequal or absent movement
Indicates potential neurological issues.
What is the normal condition of eyelids?
Upper lids should overlap the superior iris and close completely with lower lids
Skin should be intact, with no redness or lesions.
What abnormal conditions can be observed in eyelids?
- Lid lag
- Ptosis (drooping upper lid)
- Incomplete closure
Increases risk for corneal damage.
What is ectropion?
Outward turning of the eyelid
Can lead to exposure and irritation.
What is entropion?
Inward turning of the eyelid
May cause eyelashes to rub against the cornea.
What is the normal alignment of eyeballs?
Eyeballs are aligned in their sockets, with no protrusion or sunken appearance.
What is exophthalmos?
Protruding eyes.
What is enophthalmos?
Sunken eyes.
What procedure is used to inspect the conjunctiva and sclera?
Ask the person to look up and slide lower lids down along the bony orbital rim.
What are normal findings during conjunctiva and sclera inspection?
Eyeball appears moist and glossy, small blood vessels visible in the transparent conjunctiva, conjunctiva is clear: pink over lower lids, white over the sclera.
What are signs of conjunctiva and sclera abnormalities?
- General reddening
- Cyanosis of lower lids
- Pallor near the outer canthus
- Scleral Icterus
What is the normal color of the sclera?
China white.
What may the sclera appear like in dark-skinned individuals?
- Gray-blue or ‘muddy’ sclera
- Small brown macules (like freckles).
What is the purpose of the lacrimal apparatus?
To protect and lubricate the cornea and conjunctiva.
What procedure is used to inspect the lacrimal apparatus?
Ask the person to look down and slide the outer part of the upper lid up.
What are normal findings when inspecting the lacrimal apparatus?
No visible bulge in the outer upper lid.
What signs indicate abnormalities in the lacrimal apparatus?
- Swelling of the lacrimal gland
- Excessive tearing.
What is a method for testing for blockage in the nasolacrimal duct?
Press index finger against the lacrimal sac inside the lower orbital rim.
What indicates dry, irritated eyes?
Decreased tear production due to a problem with the lacrimal apparatus.
What procedure is used to inspect the cornea and lens?
Shine a light from the side across the cornea.
What are normal findings when inspecting the cornea and lens?
Clear cornea, no opacities in the cornea, anterior chamber, or lens.
What are corneal abrasions?
Irregular ridges causing shattered light reflections.
What is arcus senilis?
A grayish ring around the cornea, normal in older adults.
What should be checked when inspecting the iris and pupil?
Iris shape, color, regularity, and pupil size, shape, and equality.
What are normal findings for the iris and pupils?
- Iris: Flat, round, regular shape, even coloration
- Pupils: Equal size and round.
What indicates dilated pupils?
Pupil size of 6, 7, 8, or 9.
What indicates constricted pupils?
Pupil size of 2.
What is anisocoria?
Normal unequal pupils in 5% of the population.
What may irregular pupil shape suggest?
Neurological issues.
What procedure is used to test the pupillary light reflex?
Darken the room and shine light from the side.
What are normal findings for the pupillary light reflex?
- Direct Light Reflex: Constriction of the same pupil
- Consensual Light Reflex: Constriction of the opposite pupil.
What is a common change in older adults regarding pupils?
Pupils are small and the light reflex may be slowed.
What are abnormal findings for the pupillary light reflex?
- Constricted and Fixed Pupils (Pinpoint)
- Dilated Pupils
- Fixed and Dilated Pupils.
What conditions may cause fixed and dilated pupils?
- Opiates or Narcotic Use
- Head Injury
- Circulatory Arrest
- Deep Anesthesia
- Hypoxia.
What is the procedure for testing accommodation?
Ask the patient to focus on a distant object, then follow the penlight to approximately 3 inches from the nose.
What is a normal response when testing accommodation?
Pupillary constriction and convergence of both eyes bilaterally.
What are abnormal findings in accommodation testing?
Absence of constriction or convergence and asymmetric response.
What does PERRLA stand for in documentation?
Pupils Equal, Round, React to Light & Accommodation.
What is the definition of the red light reflex?
The reddish-orange reflection of light from the retina when a light is shined into the eye.
What is the procedure for assessing the red light reflex?
Use an ophthalmoscope to shine light into the patient’s eye from about 12 inches away.
What are normal findings when observing the red light reflex?
A bright, uniform red/orange reflection from the retina.
What are the abnormal findings in the red light reflex?
Absent or white reflex (leukocoria) and asymmetry between the eyes.
What is the clinical relevance of the red light reflex?
It is a critical screening tool for early detection of ocular conditions.
What additional history questions should be asked for aging adults regarding eye health?
Difficulty climbing stairs, driving, night vision issues, last glaucoma test, history of cataracts, dry or burning eyes.
Why is regular glaucoma testing important for older adults?
To manage cataracts and maintain eye health.
What ocular changes occur in visual acuity for aging adults?
Visual acuity decreases with age, especially after 70; peripheral vision may diminish.
What is the fall risk associated with severe vision impairment in older adults?
50% of adults with severe vision impairment report falls.
What changes occur in the eyebrows and skin of aging adults?
Loss of hair and wrinkles, including crow’s feet.
What is pseudoptosis in aging adults?
Upper lid may rest on lashes.
What are pingueculae?
Yellowish nodules from sun exposure, considered harmless.
What is pterygium?
Growth over the cornea.
What ocular changes occur in the cornea and lens with aging?
Cloudiness and arcus senilis (lipid deposits).
What are xanthelasma?
Yellow lipid plaques on lids, benign in nature.
What changes occur in pupils and retinal structures in aging adults?
Smaller pupils, slower light reflex, opaque lens, narrower and paler blood vessels.
What are drusen?
Benign yellow dots on the retina that have no effect on vision.
Why do older adults need annual eye exams?
Increased risk of eye disease and to screen for vision changes and age-related eye diseases.
What are some age-related eye diseases that require screening?
- Macular degeneration
- Cataracts
- Glaucoma
- Diabetic retinopathy
True or False: Age-related eye diseases develop quickly with noticeable symptoms.
False
