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Physical Assessment > Eye > Flashcards

Eye Flashcards

1
Q

Concerning symptoms

A

Change in vision
Diplopia
Eye pain
Photophobia

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2
Q

Health hx

A

Gradual loss of vision:

  • cataracts
  • glaucoma
  • optic nerve compression
  • macular degeneration
  • IOP
  • cortical blindness
  • presbyopia
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3
Q

Heath hx

A

Sudden loss of vision:

  • amaurosis fugax
  • migraine headaches
  • retinal detachment
  • vitreous hemorrhage
  • central retinal artery occlusion
  • uveitis
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4
Q

subjective data: eyes

A
  • 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
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5
Q

Hx for infants and children

A
  • vaginal infections in mom
  • developmental milestones of vision
  • routine vision testing at school?
  • parents aware of safety measure
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6
Q

hx for older adult

A
  • 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
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7
Q

Eye exam

A 
visual acuity
visual fields
conjunctiva and sclera
cornea, lens, and pupils
extraocular movements
Fundi:
-optic disc and cup
-retina
-retinal vessels
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8
Q

Visual Acuity (CN II )

A

CNII - optic nerve
-Snellen chart
one at a time, then both eyes

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9
Q

Visual Acuity/Refraction

A

Emmetropia
Myopia
Hyperopia
Astigmatism

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10
Q

Emmetropia

A

normal, light focuses on retina

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11
Q

Myopia

A

nearsightedness, focus in front of instead of on retina

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12
Q

Hyperopia

A

farsighted, nearby objects are blurry

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13
Q

astigmatism

A

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.

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14
Q

Eye lids, lashes, conjunctiva, sclera, iris and cornea

A

inspect

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15
Q

Eye lids: ptosis

A 
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
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16
Q

Eye lids: xanthelasma

A

fat pad, may be familiar

50% have high cholesterol

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17
Q

eye lids: dacrocystitis

A

inflamed, cellulitis of lacrimal sac

acute or chronic

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18
Q

Retracted lid

A

mild exophthalmia

Grave’s disease

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19
Q

Periorbital edema

A

edema accumulates in loosely attached tissues around eye

  • Allergies
  • Myxedema
  • nephrotic syndrome
  • localized reaction
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20
Q

stye

A

painful inflammation of hair follicle, Eye lid margins

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21
Q

chalazion

A

painless, meibomian gland inflammation, eye lid margins:

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22
Q

Blepharitis

A

clogged meibomian glands

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23
Q

Ectropion

A

lid falls out, protrusion of lid margin

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24
Q

Entropion

A

margin turns in, painful r/t lashes irritating eye

25
Q

Conjunctivitis

A 
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
26
Q

Subconjunctival hemorrhage

A

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

27
Q

Conjunctivitis differential

A

bacterial - purulent, goopy
viral - red, inflammed vessels
allergic - general erythema

28
Q

Acute Iritis

A 
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
29
Q

Glaucoma

A 
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)
30
Q

Pinguecula

A

(opacity of cornea and lens)

-benign, will not impair vision

31
Q

Pytergium

A

(opacity of cornea and lens)
overgrowth of cornea tissue
benign but may grow to cover pupil
removed by laser

32
Q

Cataract

A

opacity of lens

33
Q

Cornea arcus

A

deposited lipids
common in elderly
hyperlipoproteinemia*

34
Q

Corneal Light reflex

A

Abnormal

esotropia: strabismus, eye turned inward (dysconjugate gaze)
exotropia: eye turned outward
- related to DD or CN abnormalities

35
Q

Pupils

A 
normal = 3-5 mm
miosis = <2mm
mydriasis = >5mm, fight or flight, death, brainstem injury, coma
36
Q

anisocoria

A

unequal pupils, usually benign

37
Q

Pupillary response to light

A

room dark, pupils dilated
shine pen light, look for constriction (direct response)
shine pen light, look for constriction in other eye (consensual response)

38
Q

No direct constriction of one but has consensual

A

Topical mydriatics
acute angle glaucoma
argyll Robertson pupil

39
Q

neither pupil constricts with light in either

A

death
bilateral blindness
brainstem level coma

40
Q

Unilateral blindnress

A

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

41
Q

Honers syndrome

A

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)

42
Q

Extraocular movements (CN III, CN IV, VI)

A

CN III - oculomotor
CN IV - trochlear
CN VI - abducens

43
Q

CN III palsy

A

movement in lateral and inferonasal only

44
Q

loss of inferonasal movement

A

CN IV palsy

superior oblique defect

45
Q

loss of lateral movement

A

CN VI palsy

lateral rectus defect

46
Q

LR6SO4

A

Lateral Rectus - CN VI
Superior oblique - CN IV
ALL others CN III

47
Q

Disconjugate Gaze
esotropia
exotropia

A

strabismus

developmental disorder or CN abn.

48
Q

Testing for Accommodation

A

pupils follow and move inward as object comes close to nose

49
Q

Tonic Pupils (Adies pupil)

A

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

50
Q

Argyll Robertson Pupils

A

small, irregular pupils that accommodate but do not react to light
seen in central nervous system syphillis

51
Q

Visual fields

A

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

52
Q

Fundus

A

sharpness or clarity of disc outline
color of disc
size of central physiologic cup if present
comparative symmetry

53
Q

Arteriovenous crossing

A

AV nicking or concealment
AV crossing - tapering
AV crossing - banking

54
Q

Abnormalities of fundus

A

Cotton wool patches - damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.

55
Q

Red spots in fundi

A

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.
56
Q

fovea centralis

A

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

57
Q

yellow spots in fundi

A

macular degeneration

58
Q

Papilledema

A

color pink
disc swollen with margins blurred
elarged cup
papilledema occurs with raised IOP, intracranial mass, lesions, hemorrhage or meningitis

Physical Assessment (5 decks)

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