Exam of eye lecture Flashcards
emmetropia
light rays enter the eye fall directly on the retina. Normal vision
Myopia
light rays fall in front of retina-nearsightedness
Hyperopia
light rays fall behind the retina-farsightedness
astigamtism
irregular shaped cornea-varying refraction
What cornerstones of physical exam are used on eye exam?
inspection
VERY GENTLE palpation
What is the vital sign of the eye exam?
Visual acuity
Where does the Visual acuity belong in the SOAP note?
eye exam section of the O part of the notes
What are the mc complaints of the eye pt?
loss of vision
pain in the eye
Visual distortion or aberrations
What might be indicated by acute painless visual loss?
Vitreous hemorrhage Retinal detachment Retinal artery occlusion Retinal vein occlusion exudative macular degeneration ischemic optic neuropathy CVA
Vitreous hemorrhage: symptoms, assoc dz, PE
spider webs clouding vision
DM, sickle cell
Decreased red reflex, clouding
Retinal detachment: symptoms, assoc d/o, PE
flashes of light, curtain covering
severe myopia, post surgery, trauma
difficult to visual with scope, VF or VA loss
Retinal artery occlusion: symptoms, cause, PE
Monocular visual loss sudden and nearly complete
Embolic occlusion (TIA)
VA limited to hand motion or light perception only, Cherry red spot
Retinal vein occlusion: symptoms, assoc dz, PE
Loss of vision
HTN
retinal hemorrhages, veins tortuous
Exudative macular degeneration: r/f, symptoms, PE
age > 60
slow progressive VF loss, metamorphosia
retinal hemorrhage possible
Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE
HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.
What might be indicated by acute PAINLESS visual loss?
Vitreous hemorrhage Retinal detachment Retinal artery occlusion Retinal vein occlusion exudative macular degeneration ischemic optic neuropathy CVA
Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE
HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.
Acute PAINFUL vision loss DDX:
Corneal ulcer
Uveitis
Acute angle closure glaucoma
Endopthalmitis
Corneal ulcer: r/f, PE
Hx of trauma, contact lens wearer
Little or no signs on inspection w/ slit lamp might see abrasion
Uveitis: signs, r/f, assoc. dz, PE
Inflammation of uveal tract
hx of photophobia
assoc: sarcoidosis, TB, IBD, psoriasis
small pupil, sluggish/non-reactive to light, circular reddening around the cornea, diminished red reflex,
Acute angle closure glaucoma: R/f, signs, assoc manifestations, PE:
older individuals, farsighted
hx of blurry vision, halos around lights, pain
Marked increase in IOP-H/A, N/V
Unilateral red eye, mid position pupil non-reactive, vision dec due to corneal edema,
Endopthalmitis: m/c cause, PE
post surgical complication
decreased vision, redness, corneal edema, mucopurulent d/c, decreased red reflex
Chronic progressive PAINLESS visual loss DDX
Refractive error cataract Open angle glaucoma Atrophic macular degeneration Brain tumor
open angle glaucoma is mc in who?
pt’s with family hx of glaucoma, nearsighted pt’s, african americans
Atrophic macular degeneration: r/f, PE
pts >60yo and fam hx.
Drusen in fundus, retinal scar or atrophic area in central macula
Causes of Binocular diplopia:
III nerve palsy IV nerve palsy VI nerve palsy uncompensated strabismus thyroid dz Myesthenia graves Blow out fracture.q
PE findings of III nerve palsy
gazing lateral and slightly downward. Pt unable to gaze medially or down.
What will a pt with IV nerve palsy complain of?
difficulty with reading or going down stairs
What will be seen on a pt with VI nerve palsy?
esotropia-eye at rest gazes inward instead of neutral)
Addies pupil
Large pupil very sluggish or no reaction to light, accommodation although slowed is present
anisocoria related to 3rd nerve paralysis
no reaction to light or accomodation
argyll-robertson pupil
small often irregular pupils that do not react to light but do to accomodation
Horner’s syndrome
pupil is small but reacts to light and accommodations, ptosis is present on affected side and loss of sweating on the affected side of forehead.
Marcus Gunn pupil:
monocular blindness, light directed at affected eye shows no pupillary reaction but swing light to other eye and affected eye constricts
swing light back to affected eye and pupil dilates.
EOM: 3rd nerve palsy
Paralysis of medial gaze, upward and downward game on affected side (CN aren’t crossed so deficits are on side of lesion).
Also-dilated pupil that does not react to light or accommodation and ptosis
EOM: 6th nerve palsy
paralysis or lateral gaze on affected side
EOM: 4th nerve palsy
affected eye cannot look down when turned inward (reading/walking down stairs)
