Eye Exam

Question 1

Why would you test acuity with a pinhole? When would you do this?

Answer 1

to eliminate most refractive error. do this if patient’s snellen acuity is less than 20/40.

Question 2

How far away do we test near vision? far vision?

Answer 2

near vision: 14 inches

far vision: 20 feet

Question 3

What should you look for in terms of ocular alignment? What are the relevant terms?

Answer 3

light reflex position relative to the pupil. It should be in the middle. strabismus is ocular misalignment. It may be inward (esotropia), outward (exotropia), upward, or downward.

Question 4

What is pseudostrabismus?

Answer 4

false appearance of strabismus caused by broad nasal distance in kids without fully developed facial structure.

Question 5

What should I look for in the lid inspection?

Answer 5

scleral show (bug eyes).  May be seen in Graves disease.  
ectropion

Question 6

What is ectropion?

Answer 6

lid laxity related to age. may include exposed conjunctiva.

Question 7

What are some features of a sub-conjunctival hemorrhage?

Answer 7

clear area around the limbus (area just around the iris). You don’t see blood vessels, just splotchy blood patches. resolves spontaneously.

Question 8

What is gonococcal conjuctivitis?

Answer 8

this is an EMERGENCY that can cause peroration of the cornea. look for a hyper acute course with severe mucopurulence. positive ciliary flush (little red lines around the iris) may suggest corneal involvment.

Question 9

What are the lenses of the eye? Which one does most of the work?

Answer 9

cornea and the lens (intraocular crystalline lens). Cornea does 2/3 of focusing pwr.

Question 10

What would you see with a pseudomonas infection of the eye?

Answer 10

loss of corneal clarity with potential ulcer Important)
multiple light reflections off cornea- cornea isn’t smooth!
(purulent discharge)
(vascular dilation that extends to limubs)

Question 11

How do you check anterior chamber depth? What is one pathological finding you might see?

Answer 11

shine a light from temporal side of head across the eye, parallel to the iris. (think of the anatomy) look at nasal aspect of iris. if 2/3 or more is in shadow, it indicates a shallow chamber and maybe narrow angle glaucoma aka angle closure glaucoma

Question 12

What should I know about angle closure glaucoma?

Answer 12

This is an OCULAR EMERGENCY
may present with nausea, severe eye pain, decreased vision. ofen seen as redness with ciliary flush. May see corneal edema (multiple reflections: cornea not smooth). you may also see a mid-dilatated unreactive pupil.

Question 13

What should I always check following trauma to the eye?

Answer 13

check for lacrimal drainage. canaliculus drains tears- make sure it is still intact.

Question 14

What is iritis?

Answer 14

inflammation of the iris.
may see photophobia, pain with accomodation
may see ciliary flush, pupillary irregularity, unequal shape or reactivity. may be due to any number of conditions, including HSV, HZV, and sarcoid.
halo around the cornea

Question 15

What are some causes of abnormal red reflex?

Answer 15

any obstruction of path of light off the fundus

cataract, retinal tumor, retinal detachment. keukocoria is white pupil on red reflex exam.

Question 16

What is the word for paralysis of accomodation?

Answer 16

cycloplegia

Question 17

What are some mydriatic agents?

Answer 17

symapthomimetics like phenylephrine (alpha-1 adrenergic agonist)
parasympathetic antagonists (lots).  We used topicamide

Question 18

What is the macula?

Answer 18

darker area temporal and inferior to the disc

used for fine detail vision

Question 19

What is the significance of the cup/disc ratio? What is a normal ratio?

Answer 19

cup is a lighter area of the optic disc without many axons. increased cup/disc rations suggests atrophy of the optic nerve- common in glaucoma.
normal ratio is

Question 20

How do you identify an optic nerve atrophy?

Answer 20

swelling first, then pale ischemic disc appearance

Question 21

What are some features of optic nerve swelling that can be used for identification on the fundoscopic exam?

Answer 21

cotton wool spots: areas of nerve fiber infarcts.

peripapillary hemorrhages, vein dilation, fine capillaries obscured.

Question 22

What are causes of optic nerve swelling?

Answer 22

decreased axoplasmic flow due to raised CSF pressure (papilledema)
acute infarction or injury of optic nerve (acute optic neuropathy)

Question 23

What are causes of optic nerve atrophy?

Answer 23

glaucoma, arterial occlusion, optic nerve tumor

Question 24

What are some features of diabetic retinopathy?

Answer 24

microaneurysms- vascular wall weakness due to pericyte loss
exudates
hemorhagges
cotton wool spots (nerve fiber layer infarcts)
neovascularization
macular edema- most common cause of vision loss.
fibrosis and retinal detachment