Examination of the Eye Flashcards
Sudden loss of vision
retinal detachment vitreous hemorrhage central retinal artery occlusion CVA trauma
gradual loss of vision
aging cataracts glaucoma HIV AI disease diabetes macular degeneration neoplasm
hyperopia
farsightedness, diff. seeing near objects
myopia
nearsightedness- diff. seeing distant objects
presbyopia
aging vision - progressive difficulty seeing near objects
- lens is less pliable due to aging
diplopia
double vision
heterophoria
failure of the visual axes to remain parallel
- either esophoria or exophoria
- use the cover test to evaluate. the good eye will be reflected directly in the pupil, the bad eye will not be focused on the light.
esophoria vs. exophoria
esophoria: one eye deviates inward
exophoria: one eye deviates outward
cover test
have patient look right at you. cover the good eye, the eye won’t move. when you cover bad eye, and remove it, the bad eye will swing out
look at surface structures of the eye
slide #10
limbus = border b/w scler and iris
medial canthus = middle corner
lateral canthus = lateral corner
lacrimal gland
produce tears located in upper lateral eyelid
puncta
absorbs the tears, they go down the nasolacrimal duct, and are dropped into the nose
want to find the optic disc
stay away from fovea and macula: will cause the patient pain. optic disc is where the blood and vessels enter the eye
the examination of the eye
Visual Acuity Color blindness Visual field testing External examination Conjunctiva and sclera Cornea, lens and pupil Extra-ocular movement The ophthalmoscopic examination
tests for near and far vision
- far vision: snellen eye chart 20 feet away
- near vision: hand held card,
recording visual acuity
20/20 normal vision (you can see everything at 20 feet that normal people can)
20/100 what a normal visual (what people can normally see at 100 feet, you can only see at 20 feet)
should always check with and without corrective lenses. how do you document?
oculus dexter (right) O.D. oculus sinister (left) O.S. oculus uterque (both eyes) O.U.
Ishihara color blindness test
dots with different colors
- tests for “red blindness”
visual field testing by confrontation
- doctor’s cover her eye, patient covers the eye across from hers. bring fingers in from 4 dxns. n/s/e/west
homonymous hemianopsia
- homonymous hemianopsia: have lost half of visual field on same side
bitemporal hemianopsia
have lost vision on opposite sides - lost on right side of right eye and left side of left eye
quadrantic defects
lost visual field from 1/4 of the eye
exopthalamos
protrusion of the eyes - can see the whites of their eyes. (normally the eyelids should cover the top portion of the iris, and be just below the iris)
- this is happening b/c eye is being pushed forward.
palpebral fissure
opening of the eye
blepharitis
inflamed lid margins
entropion vs ectropion
entropion: eyelid turned in
ectropion: eyelid turned out
conjunctiva… what are the two types?
clear mucus membrane which covers the eye
- bulbar conjunctiva: covers the anterior eye
- palpebral conjunctiva- lines the eyelids
jaundice
will see sclera has turned yellow before skin has
“icterus”
osteogenesis imiperfecta
- problem with calcium metabolism: will see blue sclera
- its blue b/c calcium gives the white color in the sclera.
anisocoria
unequal pupils (greater than 0.5 mm)
when looking at anterior chamber what do you use?
look at iris with oblique lighting - gives better perspective of anterior chamber.
- slit lamp used to look at anterior chamber
direct reaction
constriction of the same pupil
consensual reaction
constriction of the opposite pupil
accommodation
change in pupil and lens for near and far objects
- can see the pupil change looking close and far distance (far distance, pupil opens up wide, close distance, pupil constricts)
convergence
eyes look inward to focus on a near object
PERRLA
pupils equal, round, react to light, accommodation.
nystagmus
fine rhythmic oscillations of the eyes at the extreme lateral gaze
6 cardinal dxns. of gaze
shows if all extraocc. eye muscles are working (see slide)
first landmbark you need to look at is?
the optic disc. located 25 degree angle toward the nose. don’t shine light at the macula or fovea, or strait back. blood vessels can be seen entering optic disc
how to use opthalmoscope
- Darken the room.
- Turn the lens disc to 0 diopter.
- Hold the ophthalmoscope in your right hand to examine the right eye and vice versa.
- Brace the scope against your eye and about 15-20 degrees lateral to the patient.
- Shine the light into the pupil and find the red reflex.
- Place your thumb of your other hand on the patient’s eyebrow, keeping the light focused on the red reflex, move in with the scope maintaining the 10-20 degree angle.
how to examine the optic disc and retina
- Locate the optic disc. It is medial.
- Bring the optic disc into sharp focus with the lens diopter adjustment.
- Identify the following:
a. Clarity of the disc margin
b. Color of the disc
c. Central physiologic cup
A small whitish depression within the optic disc.
- once find cup and disc, look inward, and lastly go to the macula (last, because it is so sensitive to light)
blind sport
the optic disc
bitemporal hemianopsia… think about…..
think about pituitary tumor pushing on optic chiasm
pinguecula
small nodule on the bulbar conjunctiva, does not cross the limbus over the cornea
pterygium
thickening of the bulbar conjunctiva which grows accross the cornea
sty
infection at the margin of the eyelid
chalazion
- painless nodule involving the Meibomian gland
- nodule that is seen underneath the lower eyelid
- may need to be surgically removed
xanthelasma
flat yellow plaques, found under the eye. associated with hyperlipidemias, no treatment. inestigate lipids and cholesterol.
- seen on the eyelids
ptosisd
drooping of eye
horner’s syndrom
ptosis, miosis and anhydrosis - lack of sympathetic innervation
bells palsy
CN VII lesion, causes drooping of eye
graves disease
see exopthalamos due to hyperthyroidism
conjunctivitis
infection or inflammation of the conjunctiva. discomfort and discharge are seen. vessels go from eyelid towards the pupil.
subconjunctival hemorrhage
blood leaks between the sclera and conjunctiva. see blood under the conjunctiva. painless, sharply demarcated, resolves on its own. does not cross into cornea.
see a sunburst of vessels coming out from eye
- corneal injury or infection
- acute iritis
- glaucoma
- ** this is occular emergency
- inflammation of the radiating vessels around the limbus, very painful, vision affected
hyphema
blood in anterior chamber due to trauma, seen in iris
papilledema
when looking at fundoscopic exam - disc is swollen with blurred margins and physiologic cup not visible = increased intracranial pressure
gaucomatous cupping
increased intraocc. pressure causes increased disc cupping. the physiologic cup is enlarged occupying more than half of the discs diameter. the bowl is enlarged.
A-V nicking
arterial walls become thickened and lose transparency, atherosclerotic changes. the vv. appear to taper as the artery crosses.
*** indicates hypertensive changes
cotton wool patches, coper or silver wiring, A-V nicking
indicative of hypertensive retinopathy
