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Assessment (Test #1) > Chapter 14 - Eyes > Flashcards

Chapter 14 - Eyes Flashcards

1
Q

What does the denominator represent on the Snellen Eye Chart?

A

Larger denominator = poor vision

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2
Q

When inspecting the eyeballs of an African American individual, what might the examiner expect to observe?

A

Small brown macules on the sclera

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3
Q

The normal color of the optic disc is…

A

creamy yellow-orange to pink

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4
Q

What is expected of the covered eye on the cover test?

A

The covered eye maintains its position when uncovered

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5
Q

What is Horner Syndrome?

A

Horner syndrome is caused by a lesion of the sympathetic nerve. An individual with Horner syndrome will have a unilateral, small, regular pupil that does react to light and accommodation. There will be unilateral ptosis and absence of sweat on the same side.

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6
Q

canthus

A

is the corner of the eye, the angle where the lids meet

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7
Q

caruncle

A

is a small, fleshy mass containing sebaceous glands

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8
Q

meibomian glands

A

modified sebaceous glands in the tarsal plates that secrete an oily lubricating material onto the lids.

This stops the tears from overflowing and helps form an airtight seal when the lids are closed

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9
Q

conjugate movement

A

When each muscle is coordinated, or yoked, with one in the other eye.

This ensures that when the two eyes move, their axes always remain parallel

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10
Q

Movement of the extraocular muscles is stimulated by three cranial nerves. Name them.

A

III = the oculomotor nerve, innervates the superior, inferior, and medial rectus and the inferior oblique muscles.

IV = the trochlear nerve, innervates the superior oblique muscle

VI = the abducens nerve, innervates the lateral rectus muscle (which abducts the eye)

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11
Q

What are three concentric coats of the eye?

A

(1) the outer fibrous sclera
(2) the middle vascular choroid
(3) the inner nervous retina

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12
Q

What are the only parts accessible to examination of the eye?

A

sclera anteriorly and the retina through the ophthalmoscope.

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13
Q

sclera

A

a tough, protective, white covering.

It is continuous anteriorly with the smooth, transparent cornea, which covers the iris and pupil.

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14
Q

corneal reflex

which cranial nerves are involved and how?

A

The trigeminal nerve (cranial nerve V) carries the afferent sensation into the brain

the facial nerve (cranial nerve VII) carries the efferent message that stimulates the blink.

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15
Q

choroid

A

has dark pigmentation to prevent light from reflecting internally and is heavily vascularized to deliver blood to the retina.

Anteriorly, the choroid is continuous with the ciliary body and the iris

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16
Q

retina

A

the visual receptive layer of the eye in which light waves are changed into nerve impulses

transforms the light stimulus into nerve impulses that are conducted through the optic nerve and the optic tract to the visual cortex of the occipital lobe

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17
Q

optic disc

A

(or optic papilla) is the area in which fibers from the retina converge to form the optic nerve.

Located toward the nasal side of the retina, it has these characteristics:

  • a color that varies from creamy yellow-orange to pink; a round or oval shape
  • margins that are distinct and sharply demarcated, especially on the temporal side
  • a physiologic cup, the smaller circular area inside the disc where the blood vessels exit and enter
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18
Q

An object in the upper temporal visual field of the right eye reflects its image onto the _____________ of the retina

A

lower nasal area

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19
Q

The pupillary light reflex

A

the normal constriction of the pupils when bright light shines on the retina.

It is a subcortical reflex arc (i.e., a person has no conscious control over it)

the sensory afferent link is cranial nerve II (the optic nerve), and the motor efferent path is cranial III (the oculomotor nerve)

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20
Q

Why do the Direct Light Reflex and the Consensual Light Reflex happen simultaneously?

A

because the optic nerve carries the sensory afferent message in and then synapses with both sides of the brain

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21
Q

fovea centralis

A

the center of the visual field

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22
Q

Fixation

A

reflex direction of the eye toward an object attracting a person’s attention

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23
Q

Accommodation

A

adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of the ciliary muscles

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24
Q

Presbyopia

A

glasslike quality decreases the lens’s ability to change shape to accommodate for near vision. Indicated by a person moving an object farther away when reading.

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25
Q

In older adults, the most common causes of decreased visual functioning are:

A

Cataract formation
Glaucoma
Macular degeneration

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26
Q

Cataract formation

A

lens opacity, resulting from a clumping of proteins in the lens.

Some cataract formation should be expected by age 70 years.

Studies indicate that 46% of people ages 75 to 85 years have cataracts.

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27
Q

Glaucoma

A

increased intraocular pressure.

The incidence increases with age to 7.2% at ages 75 to 85 years, affecting men at higher rates than women.

Chronic open-angle glaucoma is the most common type; it involves a gradual loss of peripheral vision

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28
Q

Macular Degeneration

A

breakdown of cells in the macula of the retina.

Loss of central vision, the area of clearest vision, is the most common cause of blindness.

It affects 28% of those ages 75 to 85 years, with women affected more often than men

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29
Q

Blindness: ethnic value

A

The prevalence of blindness also has racial and ethnic variations. In whites older than 40 years, the leading cause of blindness is age-related macular degeneration (54%), followed by cataracts (9%).5 In Blacks older than 40 years, cataracts and open-angle glaucoma together cause 60% of blindness. In Hispanics older than 40 years, the leading cause of blindness is open-angle glaucoma

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30
Q

acute onset of floaters (“shade” or “cobwebs”) occurs with ________________.

A

retinal detachment

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31
Q

_________, a blind spot surrounded by an area of normal or decreased vision, occurs with glaucoma, with optic nerve disorders.

A

Scotoma

32
Q

Strabismus, diplopia

A

cross-eyed

33
Q

TEST CENTRAL VISUAL ACUITY:

Snellen Eye Chart

A

(If the person wear glasses/contact, leave on)
*Stand 20ft. away
*Use opaque card to cover one eye while the other reads the letters on the chart
*Read through chart to small letters possible
*Results in a fraction
20 = feet away
—
20 = what the average person can read
*the larger the denom. the pooer the vision

34
Q

TEST CENTRAL VISUAL ACUITY:

Near vision test

A

Jaegar card

  • Have the person read the various sizes of print from approx. 14 inches away.
  • if the person moves the card away, denom. goes up (much like the Snellen Chart)
35
Q

TEST VISUAL FIELDS:

Confrontation Test

A

(compares persons visual acuity to your own)

  • stand 2 feet away and cover same side (examiner-Left and patient-Right) w/ opaque card.
  • bring finger in from the periphery. You should both see it come into peripheral focus at the same time.
36
Q

INSPECT EXTRAOCULAR MUSCLE FUNCTION:

Corneal Light Reflex (The Hirschberg Test)

A
  • Assess the parallel alignment of the eye axes by shining a light toward the person’s eyes.
  • Direct the person to stare straight ahead as you hold the light about (12 inches) away.
  • reflection of the light on the corneas should be in exactly the same spot on each eye.
37
Q

INSPECT EXTRAOCULAR MUSCLE FUNCTION:

Cover Test

A

test detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel

  • Examiner cover one eye w/ opaque card while having the patient stare at your nose
  • If muscle weakness is present, the uncovered eye will relax or drift when the opposite eye is covered.
  • a normal response would be a steady, fixed, gaze
38
Q

phoria

A

a mild weakness noted only when fusion is blocked

39
Q

Tropia

A

a more severe—a constant malalignment of the eyes

40
Q

INSPECT EXTRAOCULAR MUSCLE FUNCTION:

Diagnostic positions test

A

have person follow an object in the 6 cardinal directions, working clockwise. Parallel tracking would be normal.

41
Q

nystagmus (seen during Diagnostic Positions Test)

A

a fine, oscillating movement best seen around the iris.

42
Q

Test for accommodation

A

asking the person to focus on a distant object
(This process dilates the pupils) then have the person shift the gaze to a near object, such as your finger held about 7 to 8 cm (3 inches) from the person’s nose.

A normal response includes

(1) pupillary constriction
(2) convergence of the axes of the eyes.

43
Q

Recording Ocular Findings

A

PERRLA, or

Pupils Equal, Round, React to Light, and Accommodation.

44
Q

diopter

A

The unit of strength of each lens on the opthalmoscope

45
Q

Optic Disc

A

The most prominent landmark is the optic disc, located on the nasal side of the retina.

46
Q

Optic disc characteristics:

color
shape
margins
cup-disc ratio

A

color = Creamy yellow-orange to pink

shape = round or oval

margins = Distinct and sharply demarcated, although the nasal edge may be slightly fuzzy.

cup-disc ratio = Distinctness varies. When visible, physiologic cup is a brighter yellow-white than rest of the disc. Its width is not more than one-half the disc diameter

47
Q

What are the two normal variations that ring around the optic disc?

A
  1. scleral crescent is a gray-white, new-moon shape. It occurs when pigment is absent in the choroid layer and you are looking directly at the sclera.
  2. pigment crescent is black; it is due to accumulation of pigment in the choroid.
48
Q

Where is the only place in the body where you can view blood vessels directly?

A

Ocular Fundus

49
Q

pseudoptosis

A

The upper lid may be so elongated as to rest on the lashes, resulting in a pseudoptosis

50
Q

Pingueculae

A

commonly show on the sclera . These yellowish, elevated nodules are due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust.

51
Q

Xanthelasma

A

soft, raised yellow plaques occurring on the lids at the inner canthus

52
Q

Retinal Damage

A

Macular central blindness (blind spot in central field of vision)

53
Q

Lesion in globe or optic nerve:

A

Injury here yields one blind eye, or unilateral blindness

54
Q

Lesion at optic chiasm (e.g., pituitary tumor)

A

injury to crossing fibers only yields a loss of nasal part of each retina and a loss of both temporal visual fields. Bitemporal (heteronymous) hemianopsia

55
Q

Esotropia

A

inward turning of the eye

56
Q

Exotropia

A

outward turning of the eye

57
Q

Exopthalmos

A

(Protruding eyes)

Exophthalmos is a forward displacement of the eyeballs and widened palpebral fissures

58
Q

ptosis

A

drooping upper lid

59
Q

Blepharitis

A

(inflammation of the lid)
Red, scaly, greasy flakes and thickened, crusted lid margins occur with staphylococcal infection or seborrheic dermatitis of the lid edge.

Symptoms include burning, itching, tearing, foreign body sensation, and some pain.

60
Q

Chalazion

A

A beady nodule protruding on the lid, chalazion is an infection or retention cyst of a meibomian gland. It is a nontender, firm, discrete swelling with freely movable skin overlying the nodule. If it becomes inflamed, it points inside and not on lid margin (in contrast with stye).

61
Q

Hordeiolum (stye)

A

Hordeolum is a localized staphylococcal infection of the hair follicles at the lid margin. It is painful, red, and swollen—a pustule at the lid margin.

Rubbing the eyes can cause cross-contamination and development of another stye.

62
Q

Dacryocystitis

A

(inflammation of the lacrimal sac)
infection and blockage of sac and duct. Pain, warmth, redness, and swelling occur below the inner canthus toward nose. Tearing is present. Pressure on sac yields purulent discharge from puncta.

63
Q

Basal Cell Carcinoma

A

Carcinoma is rare, but it occurs most often on the lower lid and medial canthus.

papule with an ulcerated center. Note the rolled-out pearly edges. Metastasis is rare but should be referred for removal.

64
Q

Lesion at optic chiasm (e.g., pituitary tumor)

A

injury to crossing fibers only yields a loss of nasal part of each retina and a loss of both temporal visual fields.

Bitemporal (heteronymous) hemianopsia

65
Q

Increasing intraocular pressure

A

decrease in peripheral vision (e.g., glaucoma). Starts with paracentral scotoma in early stage

66
Q

Lesion of outer uncrossed fibers at optic chiasm (e.g., aneurysm of left internal carotid artery exerts pressure on uncrossed fibers).

A

Injury yields left nasal hemianopsia

67
Q

Retinal detachment

A

a shadow or diminished vision in one quadrant or one half of visual field

68
Q

Conjunctivitis

A

a shadow or diminished vision in one quadrant or one half of visual field

69
Q

Subconjunctival Hemmorhage

A

A red patch on the sclera, subconjunctival hemorrhage looks alarming but is usually not serious. The red patch has sharp edges like a spot of paint, although here it is extensive.

It occurs from increased intraocular pressure from coughing, vomiting, weight lifting, labor during childbirth, straining at stool, or trauma.

70
Q

Iritis

A

(circumcorneal redness)
Deep, dull red halo around the iris and cornea. Note that redness is around iris, in contrast with conjunctivitis, in which redness is more prominent at the periphery.

Pupil shape may be irregular from swelling of iris. Person also has marked photophobia, constricted pupil, blurred vision, and throbbing pain.

Warrants immediate referral.

71
Q

Acute Glaucoma

A

shows a circumcorneal redness around the iris, with a dilated pupil. Pupil is oval, dilated; cornea looks “steamy”; and anterior chamber is shallow.

occurs with sudden increase in intraocular pressure from blocked outflow from anterior chamber. The person experiences a sudden clouding of vision, sudden eye pain, and halos around lights.

emergency treatment to avoid permanent vision loss.

72
Q

Pterygium

A

A triangular opaque wing of bulbar conjunctiva overgrows toward the center of the cornea. It looks membranous, translucent, and yellow to white, usually invades from nasal side, and may obstruct vision as it covers pupil.

usually from chronic exposure to hot, dry, sandy climate, which stimulates the growth of a pinguecula into a pterygium.

73
Q

Corneal Abrasion

A

This is the most common result of a blunt eye injury, but irregular ridges usually visible only when fluorescein stain reveals yellow-green branching.

Top layer of corneal epithelium removed, from scratches or poorly fitting or overworn contact lenses.

intense pain, a foreign body sensation, and lacrimation, redness, and photophobia.

74
Q

Strabismus

A

squint; misalignment of the eye

75
Q

limbus

A

border of the cornea and sclera

Assessment (Test #1) (9 decks)

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