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Jess Head & Neck > Examination of the eye > Flashcards

Examination of the eye Flashcards

1
Q

How should examination of the external eye be structured?

ELCSCALVRNOB
external lid can sag causing a lazy vision RNOB

A

From front-back

  1. external eye
  2. lid
  3. conjunctiva
  4. sclera/episclera
  5. cornea
  6. anterior chamber
  7. lens
  8. vitreous
  9. retina
  10. nerve
  11. orbit
  12. brain
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2
Q

Name six things you would examine an eyelid for

A

Ptosis, entropion (turning in), ectropion (turning out), masses, edema, erythema

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3
Q

What is the function of the punctae? How might they be examined?

A

The two lacrimal puncta are in the medial portion of each eyelid and collect the tears produced by the lacrimal glands. They can be examined for patency

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4
Q

What should soft tissue around the eye be examined for?

A

Swelling, erythema and any skin disorders

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5
Q

How should the skin overlying the nasolacrimal duct be examined?

A

Palpated for masses

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6
Q

Name six things that would be looked for when examining the conjunctiva

A

Signs of inflammation, follicles (round collections of lymphocytes), chemosis (swelling), papillae (bumps), unusual pigmentation or hemorrhages

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7
Q

How should the tarsal conjunctiva be visualized?

A

By everting the lid (lines the eyelids)

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8
Q

What should the sclera be examined for?

A

Thinning, deep injection of vessels and discoloration (should be white)

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9
Q

How should the cornea appear normally and what should it be checked for and with what tools?

A

Clear and without cloudiness or opacities, surface can be checked for ulceration or abrasion with fluorescein eye drops and a cobalt blue filter

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10
Q

What should NOT be seen in the anterior chamber? Provide the clinical terms for both abnormalities

A

Blood - Hyphema

WBCs - Hypopyon

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11
Q

What is the clinical term for inequality in pupillary size and what might it be an indication of?

A

Anisocoria - may indicate neurological disease (like horner’s or 3rd nerve palsy)

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12
Q

Which drugs can cause mydriasis and miosis?

A

Miosis/Pupillary constriction: parasympathomimetic/cholinergic drugs

Mydriasis/Pupillary dilation: sympathomimetic drugs or dilating drops

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13
Q

How should the pupils appear normally on examination?

A
  1. Equal in size
  2. Round
  3. Reactive to light and accommodation (direct and consensual)
  4. No relative afferent pupillary defect RAPD
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14
Q

What is the iris evaluated for?

A

Nodules (i.e neurofibromatosis) and abnormal vascularity

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15
Q

If a patient is experiencing diplopia, what details should you specify?

A

Whether it’s monocular (single eye) or binocular (both eyes)

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16
Q

If the eye is red, what should you ask about?

A

Discharge, trauma and photophobia

17
Q

What specific details about someone’s past medical history should you attain during an eye examination?

A

Previous ophthalmic history (including surgery) and contact lens wear

18
Q

What four visual functions should you check “around the eye”? Which nerve is responsible for which?

A
  1. Visual acuity - optic
  2. Colour vision - optic
  3. Field of vision - optic
  4. Pupil reactions
19
Q

Describe the field of vision someone would experience if there was a lesion to the R optic nerve directly after the chiasm

A

Left Homonymous hemianopia

Why?
Left nasal fibres which crossed over in the chiasma are damaged, meaning loss of L temporal vision

R optic temporal fibres (which didn’t cross over) are damaged, meaning loss of R nasal vision

20
Q

Describe the field of vision someone would experience if there was a lesion to the R optic nerve at its optic radiations

A

Left Homonymous hemianopia with macular sparing

Why? Lecture

21
Q

Describe the field of vision someone would experience if there was a lesion to the optic chiasma

A

Bitemporal hemianopia

Why?
Damage to the L and R nasal fibres means loss of temporal sided vision on both eyes

22
Q

How would you assess a patient’s field of vision?

A
  1. Both eyes open, patient looking at bridge of examiner’s nose - ask if any part appears missing
  2. Patient covers each eye in turn, examiner keeps opposite eye open and position the target equidistant between examiner and patient
    - move from unseen to seen (peripheral - central)
  3. Map out the physiological blind spot
23
Q

How should a healthy eye react to light exposure and why?

A

Constriction

24
Q

What happens in relative afferent pupillary defect RAPD?

A

The pupils respond differently to light stimuli shone in one eye at a time due to unilateral or asymmetrical retina and/or optic nerve disease

25
Q

When is RAPD seen maximally?

A

With the lights low

26
Q

Describe the pathology of RAPD

A

Lecture

27
Q

What is proptosis and how should you examine for it?

A

Eyes PROtruding (PROptosis) from the orbit, observe patient from above looking down over brow

28
Q

Name five potential causes for proptosis

A
  1. Infection (orbital cellulitis)
  2. Inflammation (thyroid eye - severe hypothyroidism)
  3. Tumours
  4. Vascular abnormalities
  5. Bony abnormalities
29
Q

Which optic nerves are responsible for the extraocular eye muscles (one more time)

A

CN III, IV and VI

30
Q

How should the setting ideally be when using a direct ophthalmoscope?

A

Darkened room and dilated pupils

31
Q

What is the benefit of using the red free (green) filter in a direct ophthalmoscope?

A

Makes blood and blood vessels black; useful for seeing hemorrhages or new vessels

32
Q

What is the benefit of using the cobalt blue filter in a direct ophthalmoscope?

A

Makes fluorescein drops glow green to find corneal epithelial defects

33
Q

What is a slit beam useful for examining in a direct ophthalmoscope?

A

Anterior chamber/cornea

34
Q

What is the range of an intraocular pressure measurement?

A

10-22

35
Q

Differentiate between preseptal vs orbital cellulitis

A

Proptosis
PS - absent
O - present

Ocular motility
PS - normal
O - painful and restricted

Color vision/Visual acuity/RAPD
PS - normal
O - reduced in severe cases

Jess Head & Neck (13 decks)

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