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COA Vocabulary > Chapter 8: Comprehensive Medical Eye Exam > Flashcards

Chapter 8: Comprehensive Medical Eye Exam Flashcards

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1
Q

Purpose of Medical Eye Exam

A

To detect and diagnose abnormalities and diseases

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2
Q

Major parts of Eye Exam

A

1) Patient History
2) Exam and Testing
3) Evaluation of Findings, Diagnosis, and Treatment/Management

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3
Q

Aspects of Eye Function, Anatomy, and Physical Appearance and Condition

A

1) Visual Acuity
2) Alignment and Motility
3) Pupillary Examination
4) Visual Field Examination
5) Intraocular Pressures
6) External Examination
7) Biomicroscopy
8) Ophthalmoscopy

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4
Q

Visual Acuity

A

Testing of the patient’s ability to see distance and near

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5
Q

Lensometry

A

The measurement of certain qualities of lenses using a lensometer

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6
Q

Refractometry

A

The measurement of refractive error with a variety of instruments and techniques

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7
Q

Keratometry, or Corneal Topography

A

The measurement of corneal curvature

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8
Q

Alignment and Motility Examination

A

Testing to confirm the alignment of a patient’s eyes
Done through Cover-Uncover and Cross Cover Testing

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9
Q

Pupillary Examination

A

Examination of the pupils when exposed to light in order to detect pupillary malfunctions (EX APD)

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10
Q

Visual Field Examination

A

A test of the patient’s full ability to see and central and peripheral objects when the patient’s gaze is fixed straight ahead

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11
Q

Intraocular Pressure Measurement

A

The measurement of the pressure within the eye

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12
Q

Tonometry

A

The measurement of intraocular pressure by means of a tonometer

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13
Q

External Examination

A

The Ophthalmologist examining the external portions of the eye

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14
Q

Biomicroscopy

A

Examination of the entire eye, from the cornea and adnexa to the fundus and retina

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15
Q

Biomicroscope, or Slit Lamp

A

An instrument used for close examination of the lids, lashes, cornea, lens, membranes, and clear fluids within the eye.
Consists of microscope of low magnifying power and a light source that projects a rectangular beam that changes in size and focus.

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16
Q

Ophthalmoscopy

A

The Ophthalmologist uses an Ophthalmoscope in order to examine the fundus

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17
Q

Fundus

A

A collective term for the retina, optic disc, and macula

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18
Q

Asymptomatic

A

Without symptoms of a disease

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19
Q

Importance of Eye Exams

A

1) Detecting eye disease that may be asymptomatic in the early stages
2) Assessment of ocular health can indicate overall health
3) Determine pre-existing factors for eye disease and monitor them for the future

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20
Q

Frequency of Exams

A

Adults 20-39: Every 3-5 years
Adults 40-64 (asymptomatic): 2-4 years
After 65: 1-2 years
Established eye conditions: As often as your doctor recommends

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21
Q

Chief Complaint

A

The part of the health history in which the patient describes the primary reason for seeking health care that day.
Should be recorded in the patient’s own words
Should contain: What the issue is, When it started, How it has been going right now (better or worse), What they have already tried

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22
Q

Past Ocular History

A

The patient’s past history with their eyes.
Includes:
1) Do they currently wear glasses, or did they in the past?
2) Any surgeries or procedures?
3) Past treatments for eye diseases (glaucoma, AMD)
4) Eyedrops, prescription and OTC

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23
Q

General Medical and Social History

A

An overall history of their medical history
Includes:
1) Any current medical conditions (hypertension, DM)
2) Previous surgeries or medical treatments
3) Outright ask about DM, Pulmonary disease, Hypertension, Thyroid Disease, Neurological conditions, or cancer

Ask about social habits: smoking, drinking, pregnancy/breast feeding, diets

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24
Q

Family History

A

Ask if anyone in the family has been diagnosed with ocular conditions. There are many conditions that can be hereditary and run in families: Glaucoma, AMD, DM, Strabismus

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25
Q

Medications, Allergies, Vitamins and Supplements

A

Ask the patients about medications that they take

Ask the patient about allergies to medications

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26
Q

Visual Acuity Exam

A

This is the portion of the exam where we find out how well the patient can see

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27
Q

Visual Acuity

A

The ability to discern fine detail
20/20 is considered normal. The numerator is what you the patient can see something, and the denominator is what a normal person (who does not need correction) can see something

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28
Q

Snellen Acuity Test

A

A measurement of visual acuity by testing the ability to read characters at a standard distance on a special target called the Snellen Chart

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29
Q

Snellen Chart

A

A printed visual acuity chart consisting of Snellen Optotypes: specially formed letter arranged in rows of decreasing letter size

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30
Q

Projector

A

Another way to use the Snellen chart, in stead of printed letters on the wall, is to have them projected onto the wall using a series of mirrors. This allows us to shrink the exam room from 20 feet to 5 feet.

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31
Q

Pinhole Occluder

A

The handheld device that completely covers one eye and allows the other to view a chart through a tiny central opening
The implication is that there is a refractive error that can be corrected.
Typically performed when VA is 20/40 or worse

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32
Q

Near Visual Acuity

A

The measurement of the ability to see clearly at a normal reading distance (14-16 inches).
Can also be recorded in Jaeger notation, which has a Snellen equivalent.

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33
Q

Following Visual Acuity Testing

A

After performing Visual Acuity, you can then perform:
1) Lensometry
2) Refractometry
3) Keratometry

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34
Q

Alignment and Motility Examination

A

Eye alignment is essential for fusion, and proper vision.
Patients are tested for properties:
1) Eye movement
2) Eye alignment
3) Fusional ability

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35
Q

Fusion

A

The blending by the brain of the separate images received by the 2 eyes into a single image

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36
Q

Diplopia

A

Double vision
Can be caused by an eye alignment disorder

37
Q

Suppression

A

The brain’s mechanism to avoid double vision by ignoring the image from 1 eye
This ability is lost after childhood

38
Q

Stereopsis

A

3D visual perception

39
Q

6 Cardinal Positions of Gaze

A

The 6 point to which a patient’s eyes are directed, to test the major function if each EOM
Positions:
1) Right and up
2) Right
3) Right and down
4) Left and up
5) Left
6) Left and down

40
Q

Muscle Balance

A

The term that describes the alignment of the EOMs
Assessing ocular alignment involves several procedures including the Cover test, Alternative Cover test, and more

41
Q

Strabismus

A

A misalignment of the eyes that may cause vision disturbances, occurring when the EOMs do not work together

42
Q

Cover-Uncover Test

A

A test performed by alternating covering and uncovering each eye to determine if a patient’s eyes are misaligned
This test reveals Tropias

43
Q

Alternate Cover Test

A

A test performed by placing an occluder over one eye and then moving it slowly over to the other eye to detect a tendency for the eyes to deviate while under the occluder
This test is used to detect Phorias
Also called Cross Cover Test

44
Q

Prism and Alternative Test

A

A test that measures the quantity of the ocular misalignment using prisms and an occluder

45
Q

Ancillary Testing

A

Additional testing that can be performed during an examination

46
Q

Worth 4 Dot Test

A

A test for determining whether a patient has suppression, diplopia, or fusion

47
Q

Titmus Stereopsis Test

A

A test for determining whether the patient has fine depth perception in terms of binocular cooperation

48
Q

Pupillary Examination

A

Important to conduct as it can reveal iris muscle or nerve damage
Must be done prior to dilation!
4 procedures:
1) Measuring pupil size in dim light
2) Speed of pupil constriction
3) Pupil response to near fixation
4) Swinging Light Test

49
Q

Swinging-Light Test

A

A test used to define normal binocular pupillary response to a light stimulus; the direct and consensual pupillary reaction

50
Q

Direct and Consensual Pupillary Reaction

A

The response of pupils when light is shone in one eye: that eye constricts (direct reaction) and the other eye also constricts (consensual reaction)

51
Q

Afferent Pupillary Defect

A

A pupil with normal iris function that fails to constrict normally with direct light stimulation but reacts strongly consensually, or when the fellow eye is stimulated
Also called Marcus Gunn Pupil
Typically an indicator of damage to the optic nerve

52
Q

Visual Field Examination

A

This measures the expanse and sensitivity of the vision surrounding the direct line of sight; IE Periperhal vision
Damage to peripheral vision is common with disease in the retina, optic nerve, or structures along the visual pathway to the brain.
Loss of peripheral vision is typically not noticed until it is significant

53
Q

Intracranial

A

The cavity within the skull that houses the brain

54
Q

Confrontational Visual Field Test

A

A test comparing the gross boundaries of the patient’s visual field with that of the examiner; assumes a normal field of vision for the examiner

55
Q

Amsler Grid Test

A

A test for determining the presence and location of defects in the central portion of the visual field (20 degrees- 10 degrees in all directions)

56
Q

Intraocular Pressure Measurement

A

Intraocular eye pressure is maintained through an inflow and outflow of aqueous fluid within the anterior chamber.
Elevations of IOP can result in damage to the optic nerve
Elevated IOP is often not something that is noticed by the patient unless it has occurred suddenly)

57
Q

Tonometry

A

The measurement of IOP by means of a tonometer
To be done on all patients (unless indicated otherwise)

58
Q

Applanation

A

A form of tonometry that in which the force required to flatten a small area of the central cornea is measured and extrapolated into IOP
Expressed in mm Hg
Normal IOP is between 10 and 21 mm Hg

59
Q

Indentation

A

A form of tonometry in which the amount of corneal indentation produced by a fixed weight is measured

60
Q

Fluorescein

A

A dye solution that is used in applanation tonometry, as well as intravenously with fluorescein angiography

61
Q

Goldmann Applanation Tonometer

A

A tonometer that is attached to a biomicroscope (slit lamp) that measures IOP by determining how much force is necessary to flatten the central cornea

62
Q

Tono-Pen

A

A portable, electronic tonometer used to measure IOP

63
Q

Perkins Tonometer

A

A handheld applanation tonometer

64
Q

iCare Tonometer

A

A hand held applanation tonometer that is particularly useful for nervous and younger patients

65
Q

Mackary-Marg Tonometer

A

An electronic tonometer that measures IOP using an annular ring to flatten the cornea

66
Q

Pneumatonometer

A

An instrument that uses compressed air and a piston-like wand to applanate the surface of the eye ball and measure IOP

67
Q

Schiotz Tonometer

A

An indentation contact tonometer that uses weights and a table of measurements based on the weight used to determine IOP
Indentation tonometry assumes normal scleral rigidity

68
Q

Scleral Rigidity

A

The resistance to stretching of the white fibrous outer layer of the eye

69
Q

Pachymetry

A

The measurement of corneal thickness by use of a pachymeter, which measures the distance between the corneal epithelium and the endothelium
Needed for DX’s of keratoconus, glaucoma, irregular astigmatism, and corneal edema

70
Q

External Examination

A

The purpose is to provide assessment of adnexa, external globe, and anterior chamber

71
Q

Palpation

A

Medical examination through touch

72
Q

Anterior Chamber Evaluation

A

During this, we evaluate the angle depth for narrow angles to see if the patient is safe to dilate

73
Q

Flashlight Test

A

A simple test for estimating the depth of the anterior chamber and the chamber angle

74
Q

Biomicroscopy

A

Also called the slit lamp exam, and consists of a magnified viewing with a light source. This can be used to view everything about the eye

75
Q

Gonioscopy

A

A method of viewing the anterior chamber angle through a special contact lens that is placed on anesthetized eye

76
Q

Goldmann Goniolens

A

A mirrored contact lens used in gonioscopy, and reflects an image of the anterior chamber angle and is used in conjunction with the slit lamp

77
Q

Koeppe Lens

A

A high-plus contact lens used in gonioscopy to examine angle structures directly with a handheld light source and microscope

78
Q

Ophthalmoscopy

A

An instrument used for examining (directly or indirectly) the vitreous and fundus.
This is done exclusively by the Ophthalmologist

79
Q

Direct Ophthalmoscope

A

A handheld instrument with a light and mirror system that provides a 15-fold magnified, monocular view of a narrow field of the ocular fundus

80
Q

Indirect Ophthalmoscope

A

An instrument with a light and mirror system that provides a binocular and wide view of the ocular fundus. This is worn on the physician’s head and is used in conjuncture with some condensing lenses that the physician will hold a distance away from the patient’s head
The view with this is INVERTED, stereoscopic and virtual
Most commonly used

81
Q

Additional Testing

A

Additional testing may be indicate based on patient history and current symptoms

82
Q

Color Testing

A

Issues with perceiving color is typically an inherited condition, but can also be an issue related to the optic nerve or retina

83
Q

Pseudoisochromatic Color Plates

A

A book of plates that display patterns of colored and gray dots to evaluate color vision

84
Q

Farnsworth-Munsell D-15 Test

A

A test that can identify color vision deficits by asking a patient to arrange 15 pastel-colored chips of similar brightness but subtle different hues in a related color sequence
Also called 15-hue test

85
Q

Schirmer Tear Test

A

A test that uses a strip of filter paper to measure the patient’s tear output and helps confirm a dry eye diagnosis. The strip is placed in the outer lower fornix and a timer is set for 5 minutes. The strip is then measured as to how far the wetness (in mm) has spread down the strip.

86
Q

Phenol Red Thread Tear Test

A

A test that aides in the diagnosis of dry eyes and uses cotton threads treated with pH indicator to measure the patient’s tear production

87
Q

Exophthalmometry

A

The measurement of the prominence of the eyeball in relation to the bony orbital rim surrounding it
Performed with evaluation of the Thyroid eye disease and orital tumors

88
Q

Exophthalmometer

A

An instrument that measures the prominence of the eyeball in relation to the bony orbit surrounding it

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