External Eye Quiz Flashcards
Structural abnormalities of the external eye
- Blood shot eyes
- Puffy eyes
- Drooping/retracted eye lids
- Unequal pupils
- irregular shaped pupils
- Growths on lids or eyeball
Functional abnormalities of the external eye
- Red (bloodshot)
- Itching
- Burning/painful eyes
- Near/far/peripheral vision difficulties
- Blurry/double vision
- Blind spots
- Vitreous floaters
Baseline functional test of the eyes.
Snellen (Sloan) eye charts
What do the Snellen (Sloan) eye charts test for?
Visual acuity at a distance
Distance used for the Snellen (Sloan) eye charts
20 ft (10 ft), respectively
Snellen eye chart procedure.
Have patient stand at 20 ft (10 ft for Sloan) and cover one eye. Read the letters/numbers/symbols on each line until they can no longer read it accurately. Record the fraction on the line
Normal findings from the Snellen eye chart procedure
20/20
T/F Having a finding of 20/40 on a Snellen eye chart indicates superior vision
FALSE.
Indicates vision problem (What you can see at 20 ft most people can at 40 ft)
Means the eye has far sight, but poor near sight
Hyperopia
Means the eye has near sight, but poor far sight
Myopia
Condition associated with age (>40) where the lens loses its elasticity and causes diminished near sight but continued far sight.
Presbyopia
Common complaint in people >50. Patients describe cobwebs, spots, smudges, etc. in their field of vision
Vitreous floaters
T/F If a patient comes in and complains of what appears to be vitreous floaters that she has had for over 10 years, your first action should be to call 911 and she may have undiagnosed Retinoblastoma multiform aneuryosa
FALSE.
-Only if new vitreous floaters or flashes of light appear should they see an ophthalmologist or optometrist immediately.
Chart used to test near vision
Rosenbaum chart
How to test for near vision
Give the patient a Rosenbaum chart and ask them to read at 14 inches away with one eye closed.
Normal value for the Rosenbaum chart
20/20 (Just like Snellen/Sloan)
How to assess the peripheral vision of the eye.
Have patient cover one eye and look straight at you.
- Wiggle fingers starting from the back of the head, outside the field of vision on the top, bottom, and both sides of the eye.
- Repeat for other side.
Causes of visual field deficits of peripheral vision
- Abnormalities of the anterior segment of the eye (scratching, scaring, edema of the cornea, cataracts on the lens, pus/blood in the aqueous or vitreous humor)
- Chronic glaucoma (progressive tunnel vision)
- Retinal detachments
- Neural lesions of the visual pathway
Nerves of the extraocular muscles
C.N. III, IV, and VI
C.N. III, IV, and VI can be clinically assessed by the having the patient follow your finger through the _______________ with their eyes only
Cardinal planes of gaze
Extraocular muscle innervation memory aid
(SO4 RL6) / (3)
Tests that check symmetrical alignment of the eyes and therefor binocular fixation.
Corneal light reflection
Cover-Uncover test
T/F If there is strabismus or a refractive difference between the eyes, the brain will enhance the poorer image which leads to perfect vision
FALSE.
Brain will suppress the poorer image which leads to amblyopia and monocular vision
The upper eyelid is slow to react as the eye looks down exposing the sclera between the lid margin and iris. It suggests hyperthyroidism (early exopthalmos), 7th C.N. damage, or unilateral tumor behind the eye
Lid retraction
Congenital or acquired weakness of the levator muscle or paresis of a branch of C.N. III causing the upper eyelid to droop compared to the opposite eye lid
Lid ptosis
Inflammation of the eyelash follicles and Meibomian glands resulting in red, swollen, crusty lid margins. May be associated with allergies, seborrheic dermatitis, and psoriasis
Blephaitis
Bacterial infection of a gland in an eyelash follicle causing a well circumscribed red, swollen tender pustule
Sty(e) (hordeolum)
Hard, painless papule on the eyelid due to an obstruction of a Meibowmian (oil) gland, Just like a sebaceous cyst elsewhere on the body
Chalazion
The loss of orbicularis oculi muscles muscle tone with aging causing the lower lid to turn outward interfering with proper tear drainage. May also result from Bells Palsy
Ectropion
Inversion of the lower lid due to scar tissue formation on the inner surface of the lid. Eyelashes will irritate the conjunctiva and cornea then
Entropion
Inflammation of the tear sac secondary to chronic obstruction or narrowing of the nasolacrimal duct. Painful swollen nodule develops between the nose and eye with accompanying tearing and discharge. Usually occurs in infants
Dacryocystitis
Dacryocystitis occurs secondary to this. Known as an obstruction of the nasolacrimal duct
Dacryostenosis
A self-limiting bacterial or viral infection causing red, burning, itchy eyes with a discharge that tends to stick the eyelids together overnight.
Contagious conjunctivitis
T/F With contagious conjunctivitis, pain is severe, vision is reduced, and the blood vessels dilate in the area on top of the cornea
FALSE.
Pain is minimal, vision is unaffected, and vessels are dilated from the peripheral up to the tissue surrounding the cornea (not going to the cornea)
Have the same signs and symptoms of contagious conjunctivitis, but to a lesser extent
Allergic or chemical conjunctivitis
Yellow elastic fibers form a plaque on either side of the cornea resulting from chronic irritation (sunny, dusty, windy conditions)
Pinguecula
What part of the eye can develop a pinguecula?
Bulbar conjunctiva
Sunny, dusty, windy conditions may stimulate the growth of a pinguecula forming a vascular membrane that may extend over the cornea, known as a __________
Pterygium
Microtraumas like coughing, sneezing, or straining may cause a conjunctiva vessel to break trapping blood between the clear mucous membrane and sclera of the eye
Subconjunctival hemorrhage
What can cause a yellow sclera?
- Fatty deposition in the sclera from aging
- Jaundice
- Antimalarial drugs
What can cause a blue sclera?
Osteogenesis imperfecta
What can cause a brown sclera?
Patches of melanin are common in people with dark complexions
Extremely painful, vision problems, and projection of conjunctival vessels out from the limbus. Blinking aggravates this
Corneal abrasion
A grayish band along part of the edge of the limbus initially. Eventually encircles the entire cornea. Not significant in people over 60. Clinically significant in people under 40.
Corneal arcus/ring
What would a corneal arcus/ring indicate in someone under 40?
Hyperlipidemia
A golden brown band around the limbus of the cornea associated with the genetic condition that causes the body to accumulate copper and produce neurological symptoms.
Kayser-Fleischer ring
Kayser-Fleischer rings are associated with what condition?
Wilson’s Disease
Inflammation of the iris due to trauma, secondary to another disease or idiopathic in nature.
Iritis
T/F Patients with iritis will report a red, teary, sluggish pupile with significant pain and decreased visual acuity
True
How should the pupils be described as if normal?
Pupil should be: Equal Round Reactive to Light Accomodation (PERRLA)
Normal direct light reflex test findings
Pupil should constrict briskly to a light directed at it from an angle lateral to the patients line of gaze
What would an abnormal finding of the direct light reflex test indicate?
Problem along neural pathway from sensory receptor (via C.N. II) to the brain center and back through C.N. III to the circular muscles of the eye
T/F The contralateral pupil should not constrict when the direct light reflex test is being run on the opposite pupil
FALSE.
The contralateral pupil should constrict (Consensual(Indirect) light reflex) albeit in a less dramatic fashion
Test to determine if the eyes are tracking on an object moved from a distant to a near point. Should constrict and converge as the object moves closer (or dilate and diverge if an object is far away)
Accommodation (near point) reflex
Unilateral condition where the pupil inequality is >2 mm, but is reactive to all reflexes and has no companion symptoms
Physiologic (congenital) anisocoria
Inequality of pupil size which may be congenital or associated with head trauma or diseases of the nervous system
Anisocoria
A fixed, dilated pupil with poor response to the pupillary reflexes. Most cases are idiopathic
Adie’s tonic pupil
Failure of the iris to close during fetal development resulting in a keyhole shaped pupil
Coloboma
An irregular shaped pupil due to adhesion of part of the iris to the cornea in front of it or the lends behind it. Blocks the flow of aqueous fluid and may lead to an eye condition and potential blindness in the effected eye
Synechia
What are some causes of Synechia? What eye condition (besides blindness) can Synechia rapidly lead to?
Causes = secondary to trauma, surgery, cataracts, glaucoma, iritis or other eye infections
Leads to developing Acute glaucoma
A CNS defect resulting from syphilis where the pupil has a decreased or absent response to the light reflexes yet the pupil responds to accommodation
Argyll Robertson pupil
Due to an interruption of of SNS to the eye miosis and mild ptosis. OFten associated with damage to the cervical sympathetic trunk medistinal tumors, bronchogenic or metastatic cancer.
Horner syndrome
What do miosis and ptosis mean?
Miosis = constricted pupil
Ptosis = sagged upper eye lid
Common in people with a shallow anterior chamber. Canal of Schlemm becomes blocked causing aqueous fluid to build up rapidly in the eye producing sudden severe eye pain, blurred vision, seeing colored lights around bright objects, corneal edema, conjunctival and perilimbal injection (redness) and a fixed dilated pupil.
Acute glaucoma
If the pressure in the eye from acute glaucoma is not reduced in _______, it will cause ________
2-5 days
Blindness
Most common form of glaucoma
Chronic glaucoma
How would you differentiate chronic glaucoma from acute glaucoma
Chronic glaucoma has an insidous onset and have none of the abrupt, dramatic signs and symptoms of acute glaucoma.
How would determine if a patient has a corneal abrasion or iritis and NOT conjunctivitis?
CA/I = reported injury to the eye, conjunctival AND perilimbal injection, affected vision, constricted pupil, and significant ocular pain. Usually unilateral
C= injection radiating from the periphery, but not touching the cornea, clear vision, burning/itching is mild. Both eyes are affected.
How would you determine if a patient has acute glaucoma and NOT conjunctivitis?
AG = sudden, unexpected, escalating eye pain and/or altered vision in one eye, corneal edema, perilimbal and conjunctival injection
C= injection radiating from the periphery, but not touching the cornea, clear vision, burning/itching is mild. Both eyes are affected.
