Chapter 9: Eyes Flashcards
Physical exam components
Measure visual acuity -near vision, distant vision, peripheral vision
Inspect the eyebrows -hair texture, size, extension to temporal canthus
Inspect the orbital area -edema, redundant tissues or edema, lesions
Inspect the eyelids -ability to open and close completely, eyelash position, pitosis, the fasciculations or tremors, flakiness, redness, swelling
Palpate the eyelids for nodules
Inspect the orbits
Pull down the lower lids and inspect the palpebral conjuctivae, bulbar conjunctiva, and sclera -color, discharge, lacrimal gland punctum, pterygium
Inspect the external eyes -corneal clarity, corneal sensitivity, corneal arcus, color of iris, PERRLA, afferent pupillary defect, nystagmus
Palpate the lacrimal gland in the superior temporal orbital rim
Evaluate muscle balance and movement of eyes -corneal light reflex, cover-uncover test, six cardinal fields of gauze
Opthalmoscopic exam -lens, clarity, red reflex, retinal color and lesions, characteristics of blood vessels, disc characteristics, macular characteristics, depth of anterior chamber
HPI
Allergies, secretions, pain, vision, changes, recent injury, foreign bodies, swelling, infections, eye, surgery, recent illness, or similar symptoms in the household, redeye, medication’s
Vision problems -ptosis, double vision, involvement of one or both eyes, corrective lenses, near/distant vision, central/peripheral vision, transient/sustained vision
Color vision, cataracts, vision changes (halos, floaters, diplopia), loss of vision, trauma
PMH
Eye surgery
Chronic illnesses that can affect vision -allergic disease, ASCVD, diabetes mellitus, glaucoma, inflammatory, bowel, disease, thyroid dysfunction, auto immune disease, HIV
Medications
FMH
Allergies affecting the eye
Nearsightedness, farsightedness, strabismus, or amblyopia
Color blindness, retinal detachment, retinitis pigmentosa,
Glaucoma, macular degeneration, diabetes, hypertension, other conditions, retinoblastoma
PMH/SMH
Date of last eye examination
Corrective lenses
Corrective surgery
Employment exposure -use of protective devices
Recreational activities
History of cigarette smoking -risk factor for cataract glaucoma, macular degeneration, thyroid eye disease
History for infants and children
Prematurity
Maternal history of infection
Congenital abnormalities
White area in pupil
Tearing, discharge, erythema
Young child behaviors -rubbing of eyes, tilting head, short, attention, span
School age children - poor school performance, poor focusing
History for preg patients
Disorders that cause ocular complications
Use of topical eye medication
History for older adults
Visual acuity, excessive, tearing, dry eyes, nocturnal eye pain, depth perception difficulties
Physical exam -visual testing
Test each eye individually
Test with and without corrective lenses
Snellen chart -if vision less than 20/20 conduct pinhole test
Near vision -use Rosenbaum pocket, screener, test each eye individually
Color vision -rarely tested and routine physical examination
Peripheral vision -estimate with confrontation test, accurate measurement requires instrumentation
physical exam -external structures
Systematic manner -appendages to inward
Surrounding structures -inspect eyebrows for size extension, and texture. Expect orbital/Periorbital area for edema, puffiness, and redundant tissue below orbit
Eyelid inspection -close eyes for fasciculations and tremors, ability to close, completely/open widely observe, margins for flakiness, redness, and swelling, look at eyelashes and eyelash crusting, note eye opening/ptosis, ectropion/entropion
Conjuctiva inspection -usually transparent and free of erythema, inspect by pulling down, lower lid, hemorrhage, pterygium
Cornea -examine clarity of cornea by shining light onto it. Cornea is normally avascular; blood vessels should not be present. Inspect for corneal arcus (acrus senilis) composed of lipids deposited in periphery of the cornea
Iris and pupil -inspect Iris for pattern, color, shape. Test for direct/consensual light response. Test pupils for accommodation -the pupils should constrict when focused on near object. Estimate pupil size and compare for equality.
Lens- inspect for transparency/clarity
Sclera -examine to ensure that it is white. Inspect for senile hyaline plaque
Lacrimal apparatus -inspect lacrimal gland. Palpate, lower orbital rim near inner canthus
Eyelid palpation -palpate for nodules, palpate the eye itself through closed lids -digital palpation tonometry, pain
Physical examination: extraocular eye muscles
CNS III, IV, VI
Text eye-movement using sex cardinal fields of gaze. Nystagmus, lid lag, convergence, strabismus
Use corneal light reflects to test, extraocular, muscles balance. If imbalanced perform cover-uncover test.
Physical examination: opthalmoscopic
Visualize red reflex -opacities appear as black densities
Inspect interior eye -optic disc, arteries, veins, retina
Examine fundus, vascular supply, does margins, macula
Look for unexpected findings, such as: myelinated nerve fibers, papilledema, guacamatous cupping, drusen bodies, cotton wool spots, hemorrhages
Physical examination: infants
Inspection: symmetry, size, red reflects, lead, swelling position, epicanthal folds, eye spacing, sclera, conjuctiva, pupil, Iris
Test, cranial, nerves, two, three, four, six -visual acuity (developmentally appropriate), extraocular movements, corneal light reflex, red reflex
Physical exam: children
External structure inspection
Visual acuity via LEA, HOTV, observing activity it’s
Peripheral vision tested in cooperative child
Cranial nerve test, same for adult
Fundoscopy requires patience
Physical exam: pregnant patients
Retinal examination helps differentiate between chronic hypertension and pregnancy induced hypertension -vascular tortuosity, angiosclerosis, hemorrhage, and exudates. PIH changes: segmental anterior narrowing with a wet, blistering appearance indicative of edema
Cycolpegic and mydriatic agents should be avoided unless retinal disease is suspected
