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EENT > Eye conditions and evaluation > Flashcards

Eye conditions and evaluation Flashcards

1
Q

A confluence of blood vessels

A

arcade

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2
Q

What type of fluid is in the posterior chamber of the eye?

A

Vitreous Humor

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3
Q

fluid in the eye, found between the cornea and the lens

A

Aqueous Humor

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4
Q

progressive, drain is clogged and slowed but still flowing

A

Open Angle Glaucoma

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5
Q

What is the flow of aqueous humor

A

Ciliary body=> posterior chamber=> pupil=> anterior chamber=> trabeculae=> scleral venous sinus (canal of Schlemm)=> vein

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6
Q

there is a structural failure of the iris. The iris is collapsed forward and stops the flow. what is this?

A

closed angle glaucoma

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7
Q

Visual input from rods and cones, contrast (acuity), accommodation, light reflex

A

CN II Optic nerve (S)

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8
Q

Innervation for: Superior, inferior and medial rectus, and inferior oblique, levator palpebrae superioris, constrictor (sphincter) pupilae, ciliary m. (for accommodation)

A

CN III Oculomotor (M)

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9
Q

Provides sensory from cornea, conjunctiva, sclera, lacrimal gland, eye lids, iris (dilation)

A

CN V Trigeminal V1, V2 (B)

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10
Q

Innervates Lateral rectus Mm

A

CN VI Abducens (M)

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11
Q

Orbicularis oculi innervation

A

CN VII Facial (M)

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12
Q

This provides the fine tuning for light to hit the right spot

A

Lens

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13
Q

Broad refraction of light to direct to the lens

A

Cornea

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14
Q

Name the 4 most common vision problems

A

Myopia
Hyperopia
Presbyopia
Astigmatism

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15
Q

Inflammation of the eyelid, and lid margin
Occurs at Meibomian gland (eyelashes)
Most often occurs in people with allergies, rosacea, seborrheic dermatitis, oily skin, dandruff, or dry eyes

A

Blepharitis

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16
Q

Blepharitis can lead to what 4 things

A

Excess tears, flaking, crusting, redness

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17
Q

If untreated can lead to an erosion of the eye lashes.
Eye lashes contribute to the overall health of the eye which leads to issues spreading tear film and other dryness issues of your eye

A

Complications of Blepharitis

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18
Q

Blepharitis treatment options are?

A

Gently clean lids & lashes with warm water & baby shampoo
Antibiotics when needing to clear up infection
Corticosteroid eyedrops with severe inflammation

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19
Q

Lower eyelid turns outward, and doesn’t completely touch/cover the eye
* mostly in elderly, due to lax lid muscles * can also occur secondary to scars on or near lid, or due to facial nerve palsy

A

Ectropion

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20
Q

Ectropion Treatment?

A

If mild, artificial tears or lubricating ointment will work
If worse, surgery to reposition lower eyelid

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21
Q

Eyelid (usually the lower eyelid) and eyelashes turn inward towards eye, causing the lashes to rub against cornea and conjunctiva

A

Entropion

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22
Q

Entropion treatment is?

A

Soothing eyedrops/artificial tears
Tape applied to lid to pull it down towards cheek underneath
Surgery to tighten up the lid

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23
Q

-Painful, tender, red, pus‐filled infection of the glands
(Zeis, Moll, meibomian) at the base of the eyelashes
-Often secondary to blepharitis
-Looks like a pimple or boil pointing on lid margin
-Only ever at the eye lid margins because they are from meiboian glands that makes oil for your eye lash.

A

Stye (Acute Hordeolum*)

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24
Q

Stye Treatment?

A

Don’t squeeze the stye

As soon as a stye begins to form, apply clean, warm washcloth compress several times a day until stye comes to a head and opens

Once the stye opens, wash eyelid thoroughly to prevent bacteria from spreading

Recurrence may require antibiotic tablets or ointment

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25
Q

Swellings in the eyelid caused by blockage of one of the glands (e.g., meibomian gland) that lubricate the eye

A

Chalazion

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26
Q

Chalazion treatment?

A

Small ones often go away on their own
Can speed up process by applying warm water
compress 2‐4x/day for 5‐20 minutes
If large, or it fails to go away or it becomes infected, MD may prescribe antibiotics or corticosteroid eyedrops
Surgical drainage is done as last resort

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27
Q

Slightly raised, yellowish, well‐circumscribed plaques on the nasal portion of one or both eyelids
May accompany lipid disorders (hyperlipidemia, hypercholesterolemia, and others), as well as diabetes and obesity

A

Xanthelasmas

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28
Q

xanthelasma treatment?

A

None required unless, for cosmetic reasons, the patient would like them removed surgically

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29
Q

Slow‐growing,fleshy, non‐cancerous bumps that are pink or skin‐ colored
* Can be removed surgically if unsightly

A

Papillomas

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30
Q

Fluid‐filled
* Many variations (inclusion cysts, sweat gland cysts, etc.)
* Almost always non‐cancerous
*Should be removed if they grow, disturb vision, or are located where they are subject to recurring injury, bleeding or irritation
*Often indistinguishable from chalazion or stye

A

Cysts

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31
Q

Drooping of the upper eyelid‐ unilateral or bilateral
* May partially block vision
* Causes: weakness of the levator palpebrae superioris muscle due to: congenital (familial), normal aging, stroke, diabetes mellitus, injury, damage to the oculomotor nerve, sympathetics to eye (Horner’s), myasthenia gravis
* Treatment depends on cause
Caused by ACH receptors

A

Ptosis

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32
Q

inward growth of eye lashes; can produce chronic lid edema

A

Trichiasis

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33
Q

Roundworm infection that can cause chronic lid edema (Not usually seen in early or “light” infection)

A

Trichinosis

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34
Q

Forward bulging of the eyeball(s)
* Most common cause is hyperthyroidism (Grave’s
disease)
* Other causes: inflammation of tissue behind eyeball due to infection, orbital cellulitis, tumor behind eyeball, aneurysm
* Eye feels dry, gritty due to air exposure
* Lid lag sign: when patient looks down after looking up, lid is slow to move down

A

Exophthalmos

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35
Q

Inflammation of the conjunctiva – the transparent membrane that covers the white of the eye and lines the inside of the eyelids
‐ A.K.A. “pinkeye”
‐ Causes redness, irritation, gritty feeling in eye, and discharge

A

conjunctivitis

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36
Q

Most commonly due to bacterial infection ‐ highly contagious, transmitted hand‐to‐eye, or by washcloth,
towel
‐ produces yellow or green discharge that can cause eyelids to stick together
‐ Can also be caused by viral infection ‐ also highly contagious, producing watery discharge ‐ often with sore throat, tonsillar lymphadenopathy
-Can also be caused by allergies

A

conjunctivitis causes

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37
Q

Conjunctivitis treatments?

A

clean eyelids, face with warm water
* use washcloth soaked in warm water as a compress to relieve
discomfort
* antibiotic eyedrops or ointment
* launder washcloths, towels pillowcase each day; don’t share these items with others; keep hands away from eyes

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38
Q

Leakage of blood into space between conjunctiva and sclera
* Alarming bright red patch in eye – like a “puddle of blood”
* Rarely serious
* Very common
-See opthamoligist if there is pain with it

A

subconjunctival hemorrhage

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39
Q

Causes pain, redness, sensitivity to light
* Can blur vision
* May not see it without special dye (fluorescein) and slit lamp magnification (ophthalmologist)
* Can become infected

A

Corneal Abrasions, Cuts, and Ulcers

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40
Q

Can be difficult to see without fluorescein dye and slit‐lamp

magnification with blue light

Removal by irrigation is attempted first

Careful removal by sterile swab or hypodermic needle is attempted
next

Antibiotics are given to prevent infection

as a chiropractor you do not touch it. Do not remove it, if it is a small fleck of something they can attempt to wash their eye out themselves or send them out. Cover it and send them if it is large enough.

A

foreign body in cornea

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41
Q

Central, diseased part of cornea is cut out & replaced with a cornea from a donor (a person who has recently died)
* Usually takes several months to a year for new cornea to completely heal and for vision to be clear

A

corneal transplant

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42
Q

inflammation of the sclera
* Uncommon. Most commonly affects people 30‐60 years of age
* Sometimes occurs with autoimmune disorders (such as rheumatoid arthritis) or with inflammatory bowel disease

A

Scleritis

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43
Q

a mild inflammation of the episclera, a transparent layer that sits between the conjunctiva and the sclera
* Usually affects young adults

A

Episcleritis

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44
Q

what is different between the symptoms of scleritis and episcleritis?

A

Scleritis may cause aching pain, blurred vision
Episcleritis is rarely harmful

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45
Q

Blocked nasolacrimal duct
Can be congenital or acquired following infection, deviated septum, nasal polyps and swelling, fracture of facial or nose bones

A

dacryostenosis

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46
Q

Infection of the lacrimal sac
* Usually secondary to dacryostenosis
* Causes pain, redness, swelling, tearing, conjunctivitis, blepharitis, fever
* Treatment: frequent application of hot compresses and antibiotics

A

dacryocystitis

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47
Q

what are the 3 layers that lubricate the eye aka the “disgusting sandwich”

A

Outer oil layer (meibomian glands) * Middle water layer (lacrimal glands) * Inner mucus layer ‐ helps spread tears evenly

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48
Q

keratoconjunctivitis sicca is also known as?

A

Dry Eye

49
Q

result when the tear film breaks down, and parts of cornea dry out
* Symptoms:
* Burning, scratching, stinging, irritated eyes, often with redness * Eye fatigue
* Discomfort while wearing contact lenses * Mucus in or around eyes

A

Dry Eye

50
Q

What are dry eye treatments?

A

Tear replacement * Artificial tears–eye drops that mimic the natural tear film, or as an ointment (ask the pharmacist for recommendations)
* Tear conservation= Tiny punctal plugs inserted into the tear drainage ducts Avoid: smoke, direct wind, AC
* Use a humidifier during winter
* Try to blink more often, and rest the eyes
* Lubricating eye ointment at bedtime
* Anti‐inflammatory medications

51
Q

Both of these are benign neoplasms of the conjunctiva

A

Pinguecula
Pterygium

52
Q

A raised yellowish white mass on the bulbar conjunctiva
‐ Adjacent to the cornea at 3‐ and/or 9‐o’clock position
‐ Risk factors are ultraviolet light exposure, dry eyes, and dust
exposure

A

Pinguecula

53
Q

Fleshy, triangular growth of bulbar conjunctiva onto cornea at 3 &/or 9‐o’clock
* Found more in hot, dry climates‐ has the same risk factors as pinguecula
* Some evidence suggests that this is a pinguecula that has progressed
* May spread across and distort cornea, causing astigmatism and blurring
* surgical removal is necessary in these circumstances

A

Pterygium

54
Q

perfect vision depends on what?

A
  1. Perfect eyeball length ‐ cornea to retina
  2. Cornea bends the light coming into eye
  3. Lens adjusts the focus of the light
55
Q

-eyeball being too long from front to back
-nearsightedness
-Objects in the distance are blurred, but near objects are seen clearly
-Starts during elementary school years, progressively worsens until late 20’s

A

myopia

56
Q

Eyeball is shorter than normal
farsightedness

A

Hyperopia

57
Q

age related condition often referred to as farsightedness, but different from hyperopia

A

presbyopia

58
Q

Treatments of myopia?

A

Corrective lenses (don’t cure, reverse, or slow progression of refractive errors, but they improve vision)
* Bates exercises
* Orthokeratology (“Ortho‐K”)
* Refractive surgery

59
Q
  • Uses eye focusing exercises to attempt correction * Minimal correction of .25 ‐.75 diopters at most
    what is this?
A

Bates Method

60
Q

Short‐term corneal re‐shaping using contacts worn at night
Especially helpful for sports, and when dusty conditions make normal contacts difficult to wear
Wear contacts each night; effects last for a day or two

A

Ortho-K aka
Orthokeratology

61
Q

-A tiny knife makes multiple cuts into cornea, radiating like spokes of a wheel
-The worse the nearsightedness, the more cuts are needed

A

Radial Keratotomy

62
Q

Potential complications of Radial Keratotomy treatment?

A

Fluctuating vision for first few months
* Unpredictable healing
*Weakened cornea more prone to rupture if hit directly * Difficulty fitting and wearing contact lenses if needed * Glare or haze around lights

63
Q

Cornea is sliced from the side; laser beam then reshapes the tissue of the inner layer of the cornea

Complications include infection, loss of sharpness of vision

Cannot be used in patients with thin corneas

A

LASIK

64
Q

What eye shape has a greater risk of closed angle glaucoma?

A

Hyperopia

65
Q

Blurred or distorted vision due to irregularities in shape of cornea or lens
* may see lines (vertical, horizontal or diagonal) out of focus
May occur with nearsightedness or farsightedness
* Tends to remain stable throughout life

A

astigmatism

66
Q

Greek for “old sight”
* Caused by age‐related stiffening of the lens → loss of lens’s ability to change shape through accommodation
-starts in 40’s, usually affects everyone
-Earliest sign is need to hold reading material at arm’s length

A

Presbyopia

67
Q

Treatment for presbyopia?

A

For people who had perfect vision or were far‐sighted when they were younger:
* Reading glasses
For nearsighted people:
* Bifocals or trifocals (or progressive lenses) Take glasses off when reading or doing close‐up work * Can’t read very well when wearing contacts

68
Q

an bigger cup in the cup to disc ratio can be an early sign of?

A

possible sign of increased pressure aka glaucoma

69
Q

This appears to be a mole or darkened spot on the retina and is a normal variant

A

Crescent

70
Q

Gradual clouding of the normally transparent lens, usually due to aging
* Proteins in the lens begin to clump together

A

cataracts

71
Q

What are these?
Certain medications(especially corticosteroids)
* DiabetesMellitus
* Alcoholism
* Smoking
* Long‐term exposuretosun
* Deficiency of anti‐oxidants in the diet

A

Factors that can facilitate or precipitate cataracts

72
Q

What are the symptoms of cataracts?

A
  • Decreased vision, blurred vision, dimmed vision
  • Decreased night vision
  • Glare, especially facing headlights at night
  • Decreased color vision
73
Q

What will cataracts look like during an ophthalmoscopic exam?

A

decreased red reflex, or gaps in it
direct inspection, you see a cloudy whiteness when you look through the pupil

74
Q

What steps would you perform to evaluate cataracts?

A

-Evaluate visual acuity with Snellen Eye Chart
* Use ophthalmoscope to check for whiteness in pupil area and/or interrupted red reflex
* Eye doctor will make final diagnosis

75
Q

What is the treatment for cataracts?

A

Surgical extraction is only effective cure: lens is removed, replaced with a plastic lens implant

Doctor may recommend cataract removal earlier if patient has diabetes mellitus or retinal detachment (because cataract interferes with exam of fundus)

76
Q

high frequency ultrasound waves are used to emulsify lens so it can be vacuumed out

A

Phacoemulsification

77
Q

Deterioration of the blood vessels of the retina in people with diabetes mellitus.
Can progress to advanced stage without symptoms

A

diabetic retinopathy

78
Q

How can chiropractors screen for diabetic retinopathy?

A

Check visual acuity and central visual fields

79
Q

What are the two forms of diabetic retinopathy? Which is better to have?

A

Non-proliferative (less serious)
Proliferative

80
Q

-Blood vessels are narrow, blocked, deteriorating, sometimes
hemorrhaging
* Blood flow and oxygen to retina is reduced
* Tiny yellow exudates form on retina

A

non-proliferative diabetic retinopathy

81
Q

-Fragile new vessels form and grow over retina
* Blood leaks into vitreous humor
* Scar tissue may be generated pulling on retina, increasing risk of retinal detachment

A

Proliferative diabetic retinopathy

82
Q

What hormone increases vascularization in the eye?

A

VEGF
Vascular Endothelal Growth Factor

83
Q

How do you treat diabetic retinopathy

A

Focus on controlling diabetes
* Control blood pressure if elevated
* Laser surgery (photocoagulation)
* Secure retina to back of eye
* Cryotherapy (freezing)
-Anti-VEGF shots

84
Q

-Partial or complete loss of vision in one eye caused by conditions that affect normal visual development
-most common cause of monocular blindness (impaired vision in one eye)

A

Amblyopia

85
Q

What are the two causes of amblyopia?

A

Strabismus
Anisometropia

86
Q

-(crossed eyes or wall‐eye) due to weaker muscles in one eye ‐ AKA lazy eye

A

Strabismus

87
Q

occurs when the eyes have an unequal refractive power (for example, one eye is 20/20, the other is 20/40)

A

Anisometropia

88
Q

What is the difference in amblyopia and ansiometropia?

A

Amblyopia- what the brain does with the info, turns the signal down
Ansiometropia- the eye has an issue

89
Q

How do you evaluate for strabismus?

A
  1. Check for asymmetry of visual acuity
    (Left eye vs. Right eye)
    = anisometropia
  2. Check eye alignment- pen light & pupil refraction
  3. Do the Cover/Uncover Test
90
Q

How do you treat strabismus?

A
  1. Eyeglasses
  2. Patching
  3. Surgical correction
91
Q

_______________ eye is what you see when you look at the patient
___________ is the loss of vision caused by untreated strabismus or
anisometropia ‐ and refers to what the patient sees

A

Strabismus/lazy eye;
Amblyopia

92
Q

Increased INTRACRANIAL pressure can push optic disc out, blur margins
* Almost always bilateral
* Refer for MRI or CT to start determining cause
*Can lead to vision loss if
left untreated

A

Papilledema

93
Q

-A light‐colored ring seen at the periphery of the cornea due to lipid
infiltration
* A normal finding in older patients, but should be evaluated in young people

A

Corneal Arcus
A.K.A. Arcus Senilis

94
Q

unequal pupil size

A

anisocoria

95
Q

what makes up Horner’s syndrome?

A

Horner’s= ptosis, anhidrosis, miosis

96
Q

Continuously produced by the ciliary body
* Circulates between posterior and anterior chambers
* Nourishes the lens and cornea
* Maintains appropriate pressure within the eyeball
* Drains into angle in front of iris, through a trabecular meshwork (reticulum) and then through Canal of Schlemm

A

aqueous humor

97
Q

60‐90% of cases of glaucoma
* Angle in anterior chamber is open, *drainage of aqueous humor through
trabecular meshwork is obstructed
Gets worse over time, but with few or no symptoms * may notice blind spots, ↓ peripheral vision, ↓ night vision

A

open angle glaucoma

98
Q

How do you evaluate for open angle glaucoma?

A

gentle palpation of closed eye may reveal rigidity
* Eye doctor conducts routine eye exam and checks pressure
* Measures eye pressure (normal pressure: < 20 mm Hg)
* Ophthalmoscopy reveals cup:disc ratio > .5
*Exam reveals loss of peripheral vision

99
Q

Treatment options for open angle glaucoma?

A

-Topical medications
* Oral medications
* Surgery: laser trabeculoplasty
* Trabeculectomy may be required

100
Q

Acute, or Narrow‐Angle glaucoma
* Develops quickly, as drainage angle suddenly becomes blocked
* Eyeball quickly hardens
* Pressure causes eye pain, blurred vision, rainbow halos around lights, headache, nausea, vomiting
* An emergency! Refer to opthalmologist

A

Closed angle glaucoma

101
Q

How do you treat closed angle galucoma?

A

Iridectomy- laser used to remove the blockage of aqueous humor flow

102
Q

Leading cause of vision loss in people > 60
* Gradual development of blurred central vision, difficulty reading, and blind spots in the central area of vision (peripheral vision is retained)

A

Macular degeneration

103
Q

what are the two types of macular degeneration?

A

Dry
Wet

104
Q

The most common type of macular degeneration
* Tissues of retina thin and cells decay, especially in macula area
* Yellow deposits (Drusen bodies) form on retina
* May affect only one eye at first
* Symptoms:
* Gradual blurring of central vision
* Difficulty reading and recognizing faces

A

Dry Macular Degeneration

105
Q

Less common macular degeneration but more severe
* Progresses faster
* Begins the same way as dry macular degeneration
* Abnormal new blood vessels grow into macula area from the choroid layer
* They leak blood and fluids, which injure the photoreceptor cells
* Distorted vision is one of the early signs * Straight lines appear wavy
* Shapes look deformed

A

Wet Macular Degeneration

106
Q

How do you diagnose macular degeneration?

A

Decreased visual acuity (Snellen chart)
* Use Amsler Grid: Blurred or wavy lines (grid lined paper)
* Color testing: Decreased color vision
* Fundoscopic exam: Drusen bodies, hemorrhage in the macula area
* Visual field exam: Central field defects
* Refer to Ophthalmologist

107
Q

What is the treatment for Dry Macular Degeneration?

A

No currently proven treatment will prevent vision loss
* Proper nutrition can slow progression

All macular degeneration patients: stop smoking; eat right; manage BP; reduce exposure to sunlight; monitor progress with regular eye exams

108
Q

What is the treatment for Wet Macular Degeneration?

A

Laser surgery
photodynamic therapy
Injections into the eye to stop vessel growth
*All macular degeneration patients: stop smoking; eat right; manage BP; reduce exposure to sunlight; monitor progress with regular eye exams

109
Q

Symptoms and Signs:
* Sensation of flashing lights
* Many “floaters” (dark or light spots, specks or lines) in field of vision
* Blurred vision
* Shadow or part of field of vision

A

Retinal Detachment

110
Q

Most cases start with a tear or hole caused by:
* Aging changes in the vitreous fluid
* Weak patches in the retina itself
* Tear allows vitreous to
leak behind retina and
further separate it from
the choroid layer

A

retinal detachment

111
Q

Primary type of RD is called :

A

Rhegmatogenous

112
Q

Most common type of RD is?

A

Rhegmatogenous

113
Q

Exudates/fluid accumulates behind retina without tear or hole, due to:
* Inflammatory disease in the posterior eye * Tumor in posterior eye
* Traction on retina due to diabetic retinopathy
-just cant find the mechanical failure causing fluid seeping

A

Secondary retinal detachment

114
Q

Vitreous cavity shrinks, causing traction on retina, producing “flashing lights”
* If traction is strong enough to create small holes or tears in retina, vitreous humor seeps under the retina, producing blurring, floaters, spots, flecks, or lines in field of vision
-Will not heal on its own, needs surgery

A

retinal detachment

115
Q

laser beam is directed at area around defect, forming a scar that holds the retina to the choroid

A

photocoagulation

116
Q

uses intense cold to freeze the area around the defect, causing a scar that holds the retina to the choroid

A

cryopexy

117
Q

For uncomplicated detachment in upper retina
1. After freezing the defect with cryopexy, surgeon injects a bubble of gas into the vitreous cavity

A

Pneumatic Retinopexy

118
Q

Most common surgery for repairing retinal detachment

A

Scleral Buckling

119
Q

Bloody or cloudy vitreous is removed
* Scleral buckle is usually inserted
* In difficult cases:
* Air, silicone or oil injected into vitreous cavity

A

Vitrectomy

EENT (2 decks)

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