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Methods Block 3 > Dilation > Flashcards

Dilation Flashcards

1
Q

purpose of dilation

A
  • improve visualization of the fundus

- improve visualization increases detection rate of abnormalities

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2
Q

Is dilation required for a thorough evaluation of ocular structures?

A

-according to the AOA it is

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3
Q

who should be dilated?

A

ALL patients

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4
Q

How often should you get a comprehensive eye exam?

A

18-39 should be at least every 2 years

65 and older, every year IN THE ABSENCE OF OCULAR CONDITION

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5
Q

when else should you dilate?

A
  • patients with previous ocular pathology
  • patients with high risk of intraocular disease
  • patients that come in with certain chief complaints
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6
Q

if people are sensitive to dilation drops, what are they sensitive to?

A

-the preservative

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7
Q

when you see someone with_______, you should not dilate

A
  • narrow anterior chamber angle

- iris-fixed intraocular lens

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8
Q

why is history important before dilation?

A
  • guides the DFE

- aids in what you are looking for during ophthalmoscopy

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9
Q

Why should you do VA?

A
  • before any procedure for legal reasons

- detect refractive error, problems with retina, optic nerve, etc

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10
Q

Do all disorders affect VA?

A

-nope

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11
Q

pupil reflexes

A
  • screen for abnormalities prior to dilation
  • determine if vision loss is macular or optic nerve related
  • VERY important when people have APD and decreased acuity in one eye
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12
Q

normal range of IOP

A

8-23 mmHg

average: 15.5

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13
Q

when is a difference in pressure between two eyes considered significant?

A

-difference more than 2 mm Hg

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14
Q

what time of day are pressures higher?

A

-morning

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15
Q

Diurnal variations of what are considered normal?

A

3-4 mm Hg

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16
Q

What patients will see a elevation of IOP after dilation?

A

-open angle glaucoma

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17
Q

how do pressures change in age?

A

-increase

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18
Q

What are the three ways you check IOP?

A
  • digital palpation
  • non contact tonometry
  • goldman
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19
Q

advantages of digital palpation

A
  • simple
  • inexpensive
  • no instrument
  • good when external tonometrty is not possible
  • when patients are unable to do other methods
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20
Q

Disadvantages of digital palpation

A
  • least accurate

- you should avoid in eyes with trauma or in post op conditions

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21
Q

what fingers do you use for digital palpation?

A

-two pointer finers

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22
Q

soft IOP

A

less than 6-8

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23
Q

Hard IOP

A

greater than 30

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24
Q

using other body parts, what does the eye feel like?

A
  • nose is normal
  • chin is hard
  • cheek is soft
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25
Q

should you record time for digital palpation?

A

-hell yea

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26
Q

NCT

A
  • cornea is applanated by air pulse
  • IOP mesured without direct contact between eye and instrument
  • useful when there are infections
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27
Q

advantages of NCT

A
  • quick
  • no anesthetic
  • can be delegated to tech
  • no epithelial damage
  • measure through contact lenses
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28
Q

disadvantagegs of NCT

A
  • cost
  • large instrument
  • less portable
  • must be factory callibrated
  • multiple readings necessary
  • most patients hate it
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29
Q

applanated

A

-force it takes to flatten the cornea

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30
Q

a narrow anterior chamber angle increases risk of?

A

angle closure glaucoma

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31
Q

shadow test book definition

A

-anterior chamber depth estimated with oblique penlight illumination across the surface of the iris

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32
Q

three ways to evaluate anterior cahmber depth

A
  • shadow test
  • slit lamp
  • gonioscopy
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33
Q

shadow testttttt

A
  • GROSS ESTIMATION
  • used only when slit lamp is not available
  • light is presented from temporal side
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34
Q

what level of brightness should you do shadow test?

A

FULL ILLUMINATION

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35
Q

grade 1

A

-less than 1/3 iris is illuminated

36
Q

grade 2

A

-1/3-2/3 illuminated

37
Q

grade 3

A

2/3 illuminated

38
Q

grade 4

A

fully illuminated

39
Q

what should you warn patients with narrow anterior chamber angles about?

A
  • signs and symptoms of angle-closure glaucoma

- could have increases of IOP after dilation

40
Q

who is more at risk of narrow angle glaucoma?

A
  • older patients
  • asians
  • women
41
Q

hyperopia

A

-more likely to have shallow anterior chambers and narrow angles

42
Q

signs of angle closure glaucoma

A
  • severe pain
  • blurred vision/halos
  • headache
  • nausea
  • red eye
  • dilated pupils
43
Q

is angle closure glaucoma an ocular emergency?

A

YES

44
Q

go look at summary

A

do it

45
Q

what is the purpose for dilation?

A
  • improve visualization of the fundus

- improved visualization means more detection of disease!

46
Q

mydriasis

A

dilation

47
Q

mydriatics

A

agent that induces dilation of the pupil

48
Q

why use an anesthetic before instillation of mydriatic?

A
  • decreases blinking and tearing

- reduces burning or stinging

49
Q

why do light eyes dilate faster?

A

-less pigment in the iris to sequester the drug

50
Q

what does uncontrolled diabetes have to do with dilation?

A

-uncontrolled diabetics will have smaller pupils and are slower to dilate

51
Q

increase in age does what?

A

smaller pupils

-increase in latency time to dilate

52
Q

miotic

A

-small pupil

53
Q

side effects of dilation

A
  • blurred vision for near tasks
  • photophobia
  • decreased ability to recognize low-contrast
  • glare sensitivity
  • can contribute to angle-closure
54
Q

can you drive with dilation?

A

yea

55
Q

what is under the sympathetic pathway?

A

dilator

56
Q

what is under the parasympathetic pathway?

A

sphincter

57
Q

in general, dilation has what kind of innvervation?

A

autonomic

58
Q

cholinergic drugs-agonist

A
  • parasympathomimetics
  • cause iris sphincter contraction (miosis)
  • causes ciliary body contraction(accommodation)
59
Q

what color cap do agonists have

A

green

60
Q

example of agonist cholinergic drug

A

pilocarpine

61
Q

cholinergic drugs-antagonist

A
  • anticholinergics
  • bind to and inhibit cholinergic receptors
  • pupil sphincter inhibition-mydriasis
  • ciliary body inhibition- cycloplegia
62
Q

cycloplegia

A

-inability to accommodate

63
Q

what color cap do antagonists have?

A

red

64
Q

examples of antagonists

A

-tropicamide, cyclo, atropine

65
Q

tropicamide

A

-fastest onset and shortest duration of mydriatic effects

66
Q

what is the drug of choice for routine mydriasis?

A

tropicamide

67
Q

does the concentration of tropicamide change the effects?

A

-mydriasis is the same, but cycloplegia is worse in 1%

68
Q

what is the most potent mydiatic/cyclo drug?

A

-atropine

69
Q

when do you use atropine?

A
  • when you need complete cyclo

- can last up to 7 days

70
Q

what is the drug of choice for routine cycloplegic refraction?

A

cyclopentolate

71
Q

cyclopentolate

A

-faster cycloplegia with less residual accommodation

72
Q

adrenergic drugs-direct

A
  • stimulation of dilator to cause mydriasis

- no cycloplegia effect!

73
Q

what is an example of adrenergic-direct drugs?

A

phenylephrine

74
Q

what color cap do adrenergic drugs have?

A

red

75
Q

indirect alpha adrenergic drugs

A

-release stored norepi of inhibit reuptake of norepi

76
Q

example of adrenergic-indirect drug

A

hydroxyamphetamie

77
Q

phenylephrine

A
  • dilation without cycloplegia

- combined with anticholinergics

78
Q

what is routinely used for maximum dilation?

A

2.5% phenylehrine with tropicamide

79
Q

side effects of phenylephrine

A

STINGING

80
Q

what is the preferred method for drop instillation?

A

inferior fornix delivery

81
Q

why use inferior fornix delivery?

A
  • max ocular contact time of drug
  • minimize drug loss
  • increase ocular absorption
  • decrease systemic absorption
82
Q

what should you do after you have properly instilled the drop?

A

-punctal occlusion

83
Q

what should you include in the recording of drops?

A
  • name of the drug
  • its concentration
  • how many drops for each eye
  • time
84
Q

what are alternate methods of drop instillation?

A
  • medial canthus delivery
  • spray bottle
  • pledgets
85
Q

what does pregnancy group C mean?

A

-tests have been done on animals and have seen bad results, but not done on prego humans

86
Q

should you just out like a million drops in all at once?

A
  • nah
  • no anesthetic first, wait 2-5 min, then do dilation
  • sit in dark room

Methods Block 3 (5 decks)

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