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ICM > Eye Exam > Flashcards

Eye Exam Flashcards

1
Q

Describe hypermetropia/hyperopia

A

Focuses behind (posterior to) retina because eyeball is too short

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2
Q

Describe myopia

A

Focuses in front of (anterior to) retina because eyeball is too long

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3
Q

What can cause a light path to be obstructed?

A

Cataracts

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4
Q

What is the mechanism behind blind spots caused by things like a pituitary tumor?

A

There is a malfunction somewhere along the visual pathway (from the retina to occipital lobe)

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5
Q

What can spots in the eye be described as?

A

Retinal debris floating in vitreous humor

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6
Q

What can spots in the eye be caused by?

A

Retinopathy

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7
Q

What can flashing lights be described as?

A

Retinopathy, particularly pulling away of retina from choroid, as seen in retinal detachment

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8
Q

Describe double vision

A

Image focuses on a different area of retina on each eye

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9
Q

What causes ocular malalignment

A

Weak or abnormally attached extraocular muscles

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10
Q

What can cause a refractive (lens) abnormality?

A

Cataracts

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11
Q

What can cause double vision?

A

Ocular malalignment or refractive (lens) abnormalities

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12
Q

What is visual acuity testing a measurement of and what does it test?

A

Central vision, CN II (optic nerve)

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13
Q

How far away do you position the patient from the Snellen chart when doing visual acuity testing?

A

20 feet

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14
Q

You record the visual acuity designated by which line when doing this testing?

A

The smallest line in which the patient can identify all of the letters

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15
Q

How can you reduce the chance of recall influencing visual acuity testing when testing the second eye?

A

Asking the patient to read the line in the opposite direction

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16
Q

What is OD?

A

Visual acuity in the right eye

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17
Q

What is OS?

A

Visual acuity in the left eye

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18
Q

What is OU?

A

Visual acuity with both eyes open

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19
Q

How else should you measure near vision?

A

Testing each eye separating using a handheld card like the Rosenbaum Pocket Vision screener, held about 14 in from the eyes

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20
Q

How do you generally estimate peripheral vision?

A

Confrontation test, though it can be accurately measured with sophisticated instruments

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21
Q

What are some things that could produce confrontation abnormalities when testing peripheral vision?

A

Stroke, retinal detachment, optic neuropathy, pituitary tumor compression at the optic chiasm, and central retinal vascular occulsion

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22
Q

What is red testing particularly helpful in determining?

A

Subtle optic nerve disease, even when visual acuity remains nearly normal

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23
Q

What does an afferent pupillary defect often coexist with?

A

A red defect

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24
Q

How would you carry out an examination of the external structures of the eye?

A

Start with the appendages (like the eyebrows and surrounding tissues) and moving inward

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25
Q

A patient with hypothyroidism may have which features in regards to their eyebrows?

A

Coarse eyebrows that don’t extend beyond the temporal canthus

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26
Q

What may periorbital edema may be indicative of?

A

Thyroid eye disease, allergies, or (especially in youth), the presence of renal disease (nephrotic syndrome)

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27
Q

What is xanthelasma?

A

An elevated plaque of cholesterol deposited in macrophages, most commonly in the nasal portion of the upper or lower lid, observed as flat to slightly raised oval, irregularly shaped, yellow tinted lesions on the periorbital tissues

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28
Q

The presence of fasciculations or tremors of the eyelids when lightly closed may be a sign of what?

A

Hyperthyroidism

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29
Q

When would you say ptosis is present?

A

If one superior eyelid covers more of the iris than the other or extends over the pupil

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30
Q

Where is the average lower lid position?

A

At the lower limbus

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31
Q

Describe lagophthalmos and what it causes an increased risk of.

A

Lagophthalmos is when the closed lids do not completely cover the globe, so the cornea may become dried, increasing risk of infection.

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32
Q

What are some common causes of lagophthalmos?

A

Thyroid eye disease, seventh nerve palsy (Bell palsy), and overaggressive ptosis or blepharoplasty surgical repair

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33
Q

What is ectropion?

A

When the lower eyelid is turned away from the eye. It may result in excessive tearing.

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34
Q

What is entropion?

A

When the lower eyelid is turned inward toward the globe. The lid’s eyelashes may cause corneal and conjunctival irritation, increasing risk of a secondary infection

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35
Q

A hordeolum or stye is generally caused by what?

A

A staphylococcal infection

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36
Q

An internal hordeolum involves what?

A

Meibomian glands

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37
Q

Describe normal conjunctivae

A

Translucent and free of erythema

38
Q

An erythematous or cobblestone appearance, especially on the tarsal conjunctiva, may indicate what?

A

An allergic or infectious conjunctivitis

39
Q

What would indicate a subconjunctival hemorrhage?

A

Bright red blood in a sharply defined area surrounded by healthy-appearing conjunctiva

40
Q

What is a pterygium?

A

An abnormal growth of conjunctiva that extends over the cornea from the limbus

41
Q

A pterygium is more common in what type of people?

A

Those heavily exposed to ultraviolet light

42
Q

Arcus senilis in a person under 40 may indicate what?

A

A lipid disorder

43
Q

What is arcus senilis?

A

A deposit of lipids in the periphery of the cornea, seen in many individuals older than 60n

44
Q

Decreased corneal sensation is often associated with?

A

Diabetes, herpes simplex and herpes zoster viral infection, and after trigeminal neuralgia surgery

45
Q

How would you examine the “flatness” of the anterior chamber?

A

By shining a light tangentially on it

46
Q

What is corneal sensitivity controlled by and how is it tested?

A

By CN V, tested by touching a wisp of cotton to the cornea

47
Q

If liver or a hemolytic disease is present, what would you expect to see when examining the sclera?

A

Pigmented sclera that appears either yellow or green

48
Q

What does senile hyaline plaque appear as?

A

A dark, slate gray pigment just anterior to the insertion of medial rectus muscle

49
Q

When would you expect to see enlarged lacrimal glands?

A

Enlarged lacrimal glands are rare, but can be seen in conditions like Sjogren syndrome, and patients may report dry eyes because the glands produce inadequate tears

50
Q

When examining the pupils, what is expected?

A

The pupils should be round, regular, and equal in size, and any irregularity should be noted

51
Q

The pupils response to light should be tested how?

A

Both directly and consensually

52
Q

What are some contributing factors for miosis?

A

Iridocyclitis, miotic eye drops (like pilocarpine), and drug abuse

53
Q

What are some contributing factors for mydriasis?

A

Mydriatic or cycloplegic drops (like atropine), midbrain lesions or hypoxia, drug abuse

54
Q

Describe Argyll Robertson pupil

A

Bilateral, miotic, irregularly shaped pupils that fail to constrict with light but retain constriction with conversion, and may or may not be equal in size

55
Q

What is a common cause of Argyll Robertson pupil?

A

Neurosyphilis

56
Q

Acute uveitis is commonly what?

A

Unilateral

57
Q

What are signs of oculomotor nerve damage?

A

Pupil dilated and fixed, eye deviated laterally and downward, ptosis

58
Q

What would you expect to see in an Adie pupil?

A

Affected pupil is dilated and reacts slowly or fails to react to light, but responds to convergence, and is often accompanied by diminished tendon reflexes

59
Q

What is Adie pupil commonly caused by?

A

Impairment of postganglionic parasympathetic innervation to sphincter pupillae muscle or ciliary malfunction

60
Q

What are common causes of anisocoria?

A

It can be congenital or caused by local eye medications, or unilateral sympathetic or parasympathetic pupillary pathway destruction

61
Q

Full movement of the eyes is controlled by what?

A

The integrated function of CNs III, IV, and VI and the six extraocular muscles

62
Q

What is sustained nystagmus?

A

Involuntary rhythmic movement of the eyes that can occur in a horizontal, vertical, rotary, or mixed pattern

63
Q

Describe jerking nystagmus

A

Characterized by faster movements in one direction and defined by its rapid movement phase

64
Q

What is lid lag?

A

The exposure of the sclera above the iris when the patient is asked to follow your finger as you direct the eye in a smooth movement from ceiling to floor

65
Q

Lid lag may indicate what?

A

Thyroid eye disease (Grave’s disease)

66
Q

What are some types of ocular malalignments?

A

Heterotropia and heterophoria

67
Q

What is heterotropia?

A

Strabismus/Squint - a manifest lack of parallelism of the visual axes of the eyes

68
Q

What is esotropia?

A

A type of heterotropia where the affected eye turns in, toward the nose

69
Q

What is exotropia?

A

A type of heterotropia where the affected eye turns out, toward the temple

70
Q

What is hypertropia?

A

A type of heterotropia where the affected eye turns up, toward the forehead

71
Q

What is hypotropia?

A

A type of heterotropia where the affected eye turns down, toward the chin

72
Q

What is heterphoria?

A

An occult lack of parallelism of the visual axes of the eyes, prevented by binocular vision

73
Q

What is the corneal light reflex used for?

A

To test the subtle balance of the extraocular muscles

74
Q

What does inspection of the interior of the eye permit?

A

Visualization of the optic disc, arteries, veins, and retina

75
Q

How would you examine a patient’s right eye using an ophthalmoscope?

A

Examine a patient’s right eye with your right eye and their left eye with your left while holding the ophthalmoscope in the hand that corresponds to the examining eye

76
Q

If your patient is myopic, what type of lens will you need to use in the ophthalmoscope?

A

A minus (red) lens

77
Q

If your patient is hyperopic, what type of lens will you need to use in the ophthalmoscope?

A

A plus lens

78
Q

Why is the optic disc considered a blind spot?

A

It is where the retina converges to the optic nerve and there are no photoreceptors in this part of the eye, so it can’t respond to light stimulation

79
Q

How do the blood vessels of the optic disc divide?

A

Into superior and inferior branches, then into nasal and temporal branches

80
Q

When examining the optic disc, what should you expect?

A

The disc margin should be shark and well defined, especially in the temporal region, and it is generally yellow to creamy pink, depending on race

81
Q

What is the macula and where can you find it?

A

The macula, or fovea centralis, is the site of central vision and is located approximately 2 disc diameters temporal to the optic disc

82
Q

Will you always be able to see the macula when examining a non-dilated eye?

A

No, it may be impossible to examine when the pupil isn’t dilated because shining a light on it induces strong pupillary constriction

83
Q

What would you ask a patient to do in order to bring the macula into your field of vision?

A

To look directly at the light of the ophthalmoscope

84
Q

How should the macula appear upon examination?

A

As a lighter dot surrounded by an avascular area, as no blood vessels enter it

85
Q

What would you expect to see with papilledema?

A

Loss of definition of an optic disc margin

86
Q

How would you distinguish myelinated retinal fibers from chorioretinitis?

A

An absence of pigment, feathery margins, and full visual fields help distinguish this benign condition from chorioretinitis

87
Q

What are some general signs of retinopathy?

A

Reduced visual acuity, visual field defect, white and/or red spots in the retinal exam, and disturbances of blood vessels

88
Q

What kind of spots might you seen in a retinal exam that are indicative of retinopathy?

A

White spots, including cotton wool spots, hard exudates, and drusen, or Red spots, including hemorrhages and microaneurysms

89
Q

Describe flame-shaped hemorrhages

A

Occur in the nerve fiber layers and the blood spreads parallel to the nerve fiber, and typically appears bright red

90
Q

Describe round hemorrhages

A

Tend to occur in deeper layers and may appear as a dark red color

91
Q

What types of disturbances of blood vessels are considered general signs of retinopathy?

A

Increased light reflex, generalized narrowing, crossing changes, arteriolar straightening, tortuosity, neovascularization

ICM (8 decks)

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