Exam 2: Eyes Flashcards
In elderly, the inward turning of the lid margin
Entropion
Drooping of the upper lid. Could be caused from MG, damage to CNIII, dammage to the sympathetis nerve supply (horner syndrome), or cogential.
Ptosis
Lid retraction with the visualization of the rim of sclera. Cause from Grave’s Dx
Exopthalmus
yellowish triangular nodule in the bulbar conjunctiva. Common in aging
Pinguecula
Localized ocular inflammation of the episcleral vessels. Seen in RA, Sjoren, herpes zoster
Episcleritis
painful, red, tender outer margin of the eyelid. Caused from staph, also known as stye
hordeolum
a subacute nontender, painless nodule caused by a blocked meibomian gland. May become acutely inflammed, but unlike a stye, usually points inside the lid rather than on the lid margin
chalzion
slightly raised, yellow, well-circumsized cholesterol-filled plaques along nasal portions of the eyelids. Half of pts with this have hyperlipidemia. Can also be caused from primary biliary cirhhosis
Xanthelasma
chronic inflammation of the eyelids at the base of the hair folicile with crusting/scaling of the lashes
blepharitis
a thin, grayish-white arc or cirlce at the edge of the cornea: seen with aging, common in AA; usually benign
corneal arcus
opacity of the lens, visible through th pupil that sauses the absence of red reflex. Risk factors: older age, smoking, diabetes, corticosteriod use.
cataracts
Normal: major vessels, slightly darker fovea
Darker macula
Fovea slightly discernable
No light reflex
Choridal vessels
Darker skinned person vessels may be darker
- color: yellowish orange to creamy pink
- cup is located centrally or somewhat temporally. It may be conspicuous or absent. diameter is usually less than half of the disc
Cotton-wool patches: Soft, irregular border exudates-white or grayish (smaller than disc)-HTN, DM, HIV
Proliferative retinopathy with neovascularization: new preretinal vessels arising on the disc, extending across the disc margins. Visual aquity is normal, but risk for visual loss is high. Photocoagulation reduces the risk by >50%.
Diabetic retinopathy
physiologic cupping: cup is a small white depression in the optic disc, the entry point for the retinal vessels. Although sometimes absent, the cup is usally visible either centrally or towards the temporal sideof the disc. grayish spots are often seen at its base.
Rings and cresents: seen around the optic disc. These are developmental variations that appear as either white sclera, black retinal pigment, or both. Not part of the disc itself, but should not be included in the estimate of the disc diameter. Normal finding
Medullated (or myelinated) nerve fibers: a much less common, but dramatic finding. Appearing as irregular white patches with feathered margins, they obscure the disc edge and retinal vessels. They have NO PATHOLOGICAL SIGNIFICANCE.
Farsightedness: difficulty seeing upclose
Hyperopia
Associated with age-related visual changes that cause difficulty with reading. Caused by loss of elasticity of the lens.
Presbyopia
Seen with lesions in the brainstem or cerebullum, and/or with weakness or paralysis of oneor more extraocular muscles. Palsy of CN III or VI. Pattern of III, VI, III when extraocular movements.
images appear side by side of object not in focus
Horizontal diplopia
if only in one eye: suggests problem with cornea or lens.
Seen with lesions in the brainstem or cerebullum, and/or with weakness or paralysis of oneor more extraocular muscles. Palsy of CN III or IV. Pattern of III, III, IV when assessing extraocular movements.
images appear on top of each other
Vertical diplopia
if only in one eye: suggests problem with cornea or lens.
What does the static finger wiggle test evaluate, what should we consider if positive, and how is it performed?
peripheral vision
(visual fields by confrontation)
enlarged blind spot consider: affecting optic nerve (glaucoma), opti neuritis, papilleedema
Method: stand in front/facing of pt, cover matching eyes, instruct to look at nose while present 1-5 fingers to each quadrant of vision
What does the kinetic red target test evaluate?
peripheral vision
(visual fields by confrontation)
enlarged blind spot consider: affecting optic nerve (glaucoma), opti neuritis, papilleedema
Papilledema: pink, hyperemic optic disk with vessels very numerous, curving over the disc border, with no visibility of the physiologic cup. (swelling of the optic disk and anterior bulding of the cup. caused by increased ICP with intracranial mass, legion, or hemorrhage (SAH), menigitis
intermittent convergence: one eye turning in towards nose. what test can be used to diagnose?
esotropia
cover-uncover test
If the patient is myoptic, which way do we rotate the lens of the ophthalmascope to assess the optic disc?
counter clockwise to the minus diopter
If the pt is hyperoptic, which way do we rotate the lens of the ophthalmascope to assess the optic disc?
clockwise to the positive diopters
On ophthalmologic exam, you assess the following. You understand this ti mean…?
Left homonymous hemianopsia (right optic radiation)
- visual loss in both eyes
- involves half of each field
What does the cover-uncover test help identify?
Dyconjugate gaze
