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OPT 514 > External exam and pupils > Flashcards

External exam and pupils Flashcards

1
Q

External examination

A

GROSS OBSERVATION

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2
Q

General guidelines for external examination

A
  • BE OBSERVANT(watch mobility and speech)
  • anything strange?
  • pay special attention to Head/ face(head tilt, asymmetry) and ocular adnexa/eyes(differences, lids, grossness)
  • ASK PATIENT IN APPROPRIATE WAY AND RECORD IT
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3
Q

Eye lid and ocular adnexa

A
  • Before slit lamp, used naked eye and penlight
  • Look for large lesions
  • Eyelid position
    - palpebral aperture(distance between upper and lower lid-usually 8-11mm.
    - Ptosis(drooping)
    - retraction(eyes too open)
    - exophthalmos(eyes push out)
    - enophthalmos(eyes depressed in)
  • Eyelid movement
    - check for forced closure
    - make sure eye and upper lid move up when looking up
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4
Q

What the hell should I do if something is weird as shit?

A
  • ask the patient without implying it is abnormal
  • ask for onset and duration
  • look at old photos
  • add testing and history if needed
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5
Q

What is a pupil?

A
  • optics terms-numbers
  • physiological- regulates light and neurological processes
  • real-not a structure. a hole in the middle of the iris
  • controls retinal illumination and retinal image quality
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6
Q

Importance of pupil evaluation

A
  • quick, simple, lots of information

- tells us about neurological problems, ocular problems, systemic problems(drug use/ allergies)

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7
Q

What are the ophthalmic vital signs?

A
  • VA
  • pupil check
  • pressure
  • DR.R includes visual fields
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8
Q

how do we evaluate the pupil?

A
  • shape, position, color of iris
  • size
  • light reflexes
  • swinging flashlight test
  • near response
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9
Q

Pupil shape

A
  • normal(round and centered(5 mm))

- correctopia(displacement of the pupil)

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10
Q

Heterochromia

A

-iris color is different between eyes

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11
Q

Transillumination

A
  • see through iris

- some pigment gets rubbed off

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12
Q

Pupil size

A
  • increases size with SYMPATHETIC ACTIVATION of DILATOR MUSCLE
  • decreases size with PARASYMPATHETIC ACTIVATION of SPHINCTER MUSCLE
  • sphincter muscle is stronger so para has more control so constriction(miosis) is slightly faster than dilation.
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13
Q

Dilation

A
  • enlargement of pupil via sympathetic activation
  • enlargement of pupil via parasympathetic block
  • mydriasis
  • caused by drugs, hypothyroidism, stimuli
  • disturbance and glare are worse with larger diameter
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14
Q

Pupil size testing

A
  • measure in NORMAL LIGHT(if weird, check it in dim)
  • make sure it fluctuates constantly(hippus is normal)
  • abnormal findings can be bilateral or unilateral
  • abnormal findings can be seen in light or dark
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15
Q

NORMAL pupil size

A 
age 20- 5mm in light and 8mm in dark
age 80-2mm in light and 2.5 in dark
-aging causes a reduction in sympathetic tone
-senile miosis
-measure by largest diameter
-round to nearest 0.5mm
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16
Q

Anisocoria

A
  • significant difference in size of pupils in each eye
  • difference of 1mm or more is considered significant
  • observe in brightest possible light AND dimmest possible light
  • FAIRLY COMMON AND FINE BUT DIAGNOSE TO COVER YOUR BASES
17
Q

Afferent nerve fibers

A
  • sensory
  • eye to brain
  • leave each eye at optic nerve and they cross paths at the optic chiasm
18
Q

Efferent nerve fibers

A
  • motor
  • brain to eye
  • leave brain and go to EACH EYE
19
Q

direct and indirect responses to light

A
  • light received in one eye causes constriction in BOTH eyes.
  • direct is shine light in left and see constriction in left
  • indirect is shine light in left and see constriction in right
20
Q

Pupillary near reflex

A
  • if light response is normal, you do not need to do it.
  • pupil constricts due to accommodation, convergence, and miosis
  • is present when direct response is normal, but can be present OR absent in abnormal eye (light-near dissociation)
  • can be present in blind eyes
21
Q

Record pupillary evaluation

A
  1. Size(equal)
  2. Shape(round)
  3. Light(Reactive
22
Q

PERRL/PERRLA

A 
Pupils
Equal
Round
Reactive to
Light and 
accomodation
23
Q

-MG/-APD

A
  • no marcus-gunn pupils

- no afferent pupillary defect

24
Q

Swinging Flashlight Test

A
  • measures strength of direct response with consensual(indirect) response
  • used to assess afferent sensory defects
  • shine light 2-4 seconds in right then swing to left for 2-4 seconds 4-5 times
  • must be consistent in time between and amount of light exposure in both eyes
25
Q

Swinging Flashlight test results

A
  • pupils should stay constricted throughout the entire test

- direct/indirect responses should be equal and time between eyes should not allow dilation

26
Q

Pupillary escape

A
  • APD is present
  • pupils will BOTH dilate slightly when afferent eye is illuminated
  • binocular dilation is observed when affected eye is direct
  • binocular constriction should occur when unaffected eye receives direct light
27
Q

Ectopic pupil

A

significantly decentered pupil

28
Q

Sensor for pupillary light response

A
  • photopic system (cones)

- illumination of the fovea determines light reflex

29
Q

Pupil cycle

A
  • determined by the rapidity with which the neutral and muscular components act to constrict and dilate the pupil
  • quickens with defects
  • averaged over 30 cycles
  • recorded in milliseconds per cycle(954)
30
Q

Andie’s tonic pupil

A
  • usually females in 30-40
  • unilateral semi-dilated pupil that responds minimally or slow to light
  • problem is present in near reflex
  • suggest legion on para pathway that affects pupil sphincter
  • usually show reduced tendon reflexes in lower extremities
31
Q

Third cranial nerve palsies

A
  • aniscoria greater in bright conditions
  • involves extraocular muscles
  • pupillary fibers travel with the third cranial nerve and can be compressed by tumor or legion to result in fixed pupil.
32
Q

Pharmacological pupil

A

-neurologically dilated pupils will constrict with 1% pilocarpine, but pharmacological will not

33
Q

Horner’s Syndrome

A
  • sympathetic innervation to the eye is interrupted
  • incomplete dilation in the dark
  • miosis, ptosis, anhydrosis
  • in congenital cases, can cause heterochromia
34
Q

Amaurotic Pupil

A
  • occurs in an eye with no light perception

- effected eye does not do by direct, but it does respond indirectly

OPT 514 (6 decks)

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