Eye Flashcards
Concerning symptoms
Change in vision
Diplopia
Eye pain
Photophobia
Health hx
Gradual loss of vision:
- cataracts
- glaucoma
- optic nerve compression
- macular degeneration
- IOP
- cortical blindness
- presbyopia
Heath hx
Sudden loss of vision:
- amaurosis fugax
- migraine headaches
- retinal detachment
- vitreous hemorrhage
- central retinal artery occlusion
- uveitis
subjective data: eyes
- glasses or contacts
- self care behavior, last vision test
- vision difficulty (dec acuity, blurring, blind spot)
- SUDDEN LOSS ALWAYS EMERGENT
- pain
- stabismus, diplopia
- redness, swelling
- watering, discharge
- past hx of ocular problems
- glaucoma
Hx for infants and children
- vaginal infections in mom
- developmental milestones of vision
- routine vision testing at school?
- parents aware of safety measure
hx for older adult
- visual difficulty with climbing stairs or driving
- last tested for glaucoma
- problem with night vision
- hx of cataracts
- loss or progressive blurring of vision
- ever feel dry? burning?
- dec in usual activities
Eye exam
visual acuity visual fields conjunctiva and sclera cornea, lens, and pupils extraocular movements Fundi: -optic disc and cup -retina -retinal vessels
Visual Acuity (CN II )
CNII - optic nerve
-Snellen chart
one at a time, then both eyes
Visual Acuity/Refraction
Emmetropia
Myopia
Hyperopia
Astigmatism
Emmetropia
normal, light focuses on retina
Myopia
nearsightedness, focus in front of instead of on retina
Hyperopia
farsighted, nearby objects are blurry
astigmatism
the front surface of the eye or the lens, inside the eye, is curved differently in one direction than the other.
A common symptom is blurry vision.
Eye lids, lashes, conjunctiva, sclera, iris and cornea
inspect
Eye lids: ptosis
drooping or falling of the upper eyelid causes: -myasthenia gravis -damage to CN III (oculomotor nerve) -congenital -muscle weakness from relaxed tissue r/t aging
Eye lids: xanthelasma
fat pad, may be familiar
50% have high cholesterol
eye lids: dacrocystitis
inflamed, cellulitis of lacrimal sac
acute or chronic
Retracted lid
mild exophthalmia
Grave’s disease
Periorbital edema
edema accumulates in loosely attached tissues around eye
- Allergies
- Myxedema
- nephrotic syndrome
- localized reaction
stye
painful inflammation of hair follicle, Eye lid margins
chalazion
painless, meibomian gland inflammation, eye lid margins:
Blepharitis
clogged meibomian glands
Ectropion
lid falls out, protrusion of lid margin
Entropion
margin turns in, painful r/t lashes irritating eye
Conjunctivitis
diffuse dilation of conjunctival vessels mild discomfort rather than pain vision not affected, except for temporary blurring due to discharge pupil and cornea not affected bacterial, viral, allergy, irritation
Subconjunctival hemorrhage
leakage of blood, homogeneous, sharply demarcated red area - lasts over 2 weeks
no discomfort
vision not affected
pupil and cornea not affected
often no cause identified, may result from trauma or sudden increase in venous pressure
Conjunctivitis differential
bacterial - purulent, goopy
viral - red, inflammed vessels
allergic - general erythema
Acute Iritis
EMERGENT, immediate referral red eyes moderate, aching, deep pain decreased vision, photophobia pupil small and irregular cornea clear or slightly cloudy associated with systemic infection - herpes zoster, TB
Glaucoma
Angle closure glaucoma -IOP Risk factors: family hx, >40, female, farsightedness (hyperopia), medications Symptoms: -headache -severe eye pain -N/V -conjunctival redness -corneal edema or cloudiness -dilated pupil that reacts poorly to light -decreased vision -halos around lights (chronic)
Pinguecula
(opacity of cornea and lens)
-benign, will not impair vision
Pytergium
(opacity of cornea and lens)
overgrowth of cornea tissue
benign but may grow to cover pupil
removed by laser
Cataract
opacity of lens
Cornea arcus
deposited lipids
common in elderly
hyperlipoproteinemia*
Corneal Light reflex
Abnormal
esotropia: strabismus, eye turned inward (dysconjugate gaze)
exotropia: eye turned outward
- related to DD or CN abnormalities
Pupils
normal = 3-5 mm miosis = <2mm mydriasis = >5mm, fight or flight, death, brainstem injury, coma
anisocoria
unequal pupils, usually benign
Pupillary response to light
room dark, pupils dilated
shine pen light, look for constriction (direct response)
shine pen light, look for constriction in other eye (consensual response)
No direct constriction of one but has consensual
Topical mydriatics
acute angle glaucoma
argyll Robertson pupil
neither pupil constricts with light in either
death
bilateral blindness
brainstem level coma
Unilateral blindnress
does not cause aniscocoria if:
-parasympathetic and sympathetic innervation to both irises is normal
light directed into seeing eye produces direct rxn in that eye and consensual response in blind eye
light directed into blind eye causes no response in either eye
Honers syndrome
the effected pupil is small (miosis)
reacts briskly to light
ptosis of lid present
anhidrosis (decreased sweating on effected side) may present
if congenital, the involved iris is usually lighter than unaffected (heterochromia)
Extraocular movements (CN III, CN IV, VI)
CN III - oculomotor
CN IV - trochlear
CN VI - abducens
CN III palsy
movement in lateral and inferonasal only
loss of inferonasal movement
CN IV palsy
superior oblique defect
loss of lateral movement
CN VI palsy
lateral rectus defect
LR6SO4
Lateral Rectus - CN VI
Superior oblique - CN IV
ALL others CN III
Disconjugate Gaze
esotropia
exotropia
strabismus
developmental disorder or CN abn.
Testing for Accommodation
pupils follow and move inward as object comes close to nose
Tonic Pupils (Adies pupil)
pupil is large, regular and usually unilateral
reaction to light severely reduced and slowed or absent
slow accommodation causes blurred vision
near rxn is slow but present
deep tendon reflexes are often decreased
usually idiopathic but can be from tumor, trauma, surgery or infection
Argyll Robertson Pupils
small, irregular pupils that accommodate but do not react to light
seen in central nervous system syphillis
Visual fields
defined as entire area seen by eye when its gaze is fixed on central point
superficially tested by comparing the pts peripheral vision with your own
technique: confrontation visual fields
Fundus
sharpness or clarity of disc outline
color of disc
size of central physiologic cup if present
comparative symmetry
Arteriovenous crossing
AV nicking or concealment
AV crossing - tapering
AV crossing - banking
Abnormalities of fundus
Cotton wool patches - damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.
Red spots in fundi
Diabetic retinopathy
- damage to the blood vessels in the tissue at the back of the eye (retina). Poorly controlled blood sugar is a risk factor.
- Early symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors. Blindness can occur.
- Mild cases may be treated with careful diabetes management. Advanced cases may require laser treatment or surgery.
fovea centralis
center of the macula and is highly concentrated with cones.
This is the areas of highest visual resolution and color vision.
May be identified by a reflection of light- located two disc diameters temporal to the disc temporal side of fundus- review and transduces light form center of visual field.
is 1 disc diameter in size and located 2 DD temporal to disc
yellow spots in fundi
macular degeneration
Papilledema
color pink
disc swollen with margins blurred
elarged cup
papilledema occurs with raised IOP, intracranial mass, lesions, hemorrhage or meningitis
