Clinical Flashcards
How is IOP measured?
Tonometry
What are the 6 steps of dealing with ocular trauma?
- History
- ALWAYS record visual acuity
- Fluroescein
- Handle suspected global ruptures with care
- X-ray/CT orbits if suspected Intra-ocular foreign body (IOFB)
- Immediate irrigation of chemical injuries
What is acuity?
The ability to differentiate between 2 points as distance increases
A patient in clinic is using the Snellen Acuity chart.
It is situated at 6m, they can read 3/5 letters on a line with 12 beside it.
What is their score?
6/6(-2)
Top line = 6 (distance in m)
Bottom line = 12 and -2 as got 2 wrong
You do the Snellen test for acuity testing 1 eye first then they other. T/F?
You test without glasses and the pinhole thing first and then repeat with glasses after. T/F?
T - test one eye at a time
F - test using glasses first and then test again with glasses off and using the pinhole
If a patient can’t read the Snellen test. What are the 3 other ways to test if a patient can see?
- Count fingers
- Hand movement - move hand from side to side and ask to tell the direction of movement
- Shine light into one eye then the other and ask to tell what direction light is coming from
How can you test to see if a patient is suffering from tunnel vision, the most common form of functional visual loss regarding visual fields?
Start with palmar surface of hand close to face - patient should be able to see just palm
Move backward
- patient should be able to see whole hand and you
- if can still only see palm = tunnel vision
What are the 5 pupil tests you would do in order?
- Bright room - assess if pupils are equal
- Dim room - assess if pupils equally dilate
- DIRECT
- shine light in one eye - if it constricts - CONSENSUAL
- shine light in one eye - look to see if opposite consensually contracts - RAPD (rapid afferent papillary defect)
- move light rapidly between the 2 eyes
- eyes should both remain constricted
- if abnormal - 1 eye will dilate when exposed to light
What advice should be given to contact lens wearers over washing their lens?
Do NOT wash in tap water - bacteria live in tap water
What are the steps when testing visual field?
- Can you see my face?
- How many hands can you see?
- Look straight towards me. Number of fingers in 4 quadrants, hand covering 1 eye at time
- Same setup. Use white cottonbud and move in from angles into field of view and ask to confirm when they can see it
- Blind spot test. Use red cottonbud and move on horizontal to test for blindspot - ask to tell when can no longer see - patient must remain looking towards you
How should you be positioned in regard to the patient during visual field assessment?
At same level
Knees almost touching
What are the 3C’s which are important to observe when looking at optic disc on fundoscopy?
Contour - is there a clear well-defined contour around the disc
Colour - pinky colour
Cup - clear central pale area
What is diagnostic of a glucoma on fundoscopy?
Large cup - almost takes up all of optic disc space
What two things are apparent in the case of swollen disc?
What condition is this suggestive of?
- No contour
- NO CUP
- More red colour
Papilloedema
What colour will fundoscopy appear in artery/vein occlusion?
Artery - pale - no blood getting to retina
Vein - red - no blood able to get away from retina
A positive RAPD test is indicative of what?
Optic nerve lesion or severe retinal disease -> >100% transmission down CN II
What is ptosis?
Droopy eyelid
Would you do fluroscien or acuity first?
Acuity always, fluroscien effects results
Patients with injected conjunctiva around the iris is suggestive of pathology where?
Deeper in the eye as opposed to superficial
If around edges -> more superficial -> sclera/conjuctiva
When looking on fundoscopy, what are thicker arteries or veins?
Veins
Why is the pinhole such a useful tool when testing visual acuity?
Corrects visual acuity caused by refractive error but NOT by pathology
- help differentiate
Snellen test should be repeated for each eye 2 times. Each one of those three times has a variable. Explain
- unaided (if don’t own glasses)
- with glasses (if applicable)
- pinhole
What is a more reliable alternative to finger counting if patient can’t read Snellen chart from 6m?
Get them to stand as close as they need to be able to read top line and record that distance/60
When a patient presents with diplopia, what must be established?
What direction the double vision is
What is the role of the Orthoptic?
Assessment of eye muscle movements
What drug used in rheumatology is associated with corneal deposits and retinopathy?
Hydroxychloroquine
