Eye Exam Flashcards
What is the PE question?
Any problems with your vision?
What are you testing for a measurement of central vision?
CN 2
What is the chart called that we use to test people’s vision?
Snellen Chart
How far do patient’s stand from the Snellen Chart?
20 feet (6 meters)
3 requirements for the Snellen Chart Test
- Make sure the chart is well lit
- Test each eye individually
- Always test vision without glasses first
What do we determine and record in the Snellen Test?
The smallest line in which the patient can identify all of the letters and then record the visual acuity designated by that line
What does the numerator and denominator mean in Visual Acuity?
- Numerator - distance of pt from chart
2. Denominator - distance at which the average eye can read the line
What does 20/200 vision mean? (visual acuity)
Patient can read at 20 feet what the average person can read at 200 feet
What is considered legal blindness?
Vision that cannot be correctable from 20/200
How do we reduce memory recall during the Snellen Test?
Use one eye to read from right to left, the other eye from left to right
Why do we perform a pinhole test?
To check for refractive error; it allows light to enter only the central portion of the lens
Should we test near vision? If so, how?
Yes; each eye separate with the Rosenbaum Pocket Vision Screener (handheld card)
How far does the pt hold the Rosenbaum?
14 inches from the eyes
How do we test peripheral vision?
Confrontation test
Is color vision often tested?
No
What is red testing helpful for?
Determining subtle optic nerve disease
What often coexists with a red defect?
Afferent pupillary defect
Once we assess vision, what do we begin with?
Appendages in a systematic manner and move inward (posteriorly)
What do we inspect the eyebrows for?
Size, extension, and texture of the hair
How would the eyebrows present in hypothyroidism?
Coarse or do not extend beyond the temporal canthus
What do we inspect the orbital and periorbital area for?
Edema, puffiness, or redundant tissue below the orbit
What is Xanthelasma?
Elevated plaque of cholesterol deposited in macrophages
Where is Xanthelasma most commonly seen?
Nasal portion of upper ow lower lid
What do we inspect the eyelids for?
Their ability to close completely and open widely
When the eye is open, what should we see?
Superior eyelid should cover a portion of the iris but not the pupil itself
What is Ptosis?
If one superior eyelid covers more of the iris than the other or extends over the pupil
Ptosis can indicate what?
- Congenital or acquired weakness of the levator muscle
2. Paresis of a branch of the 3rd CN
What is the average lower lid position?
Lower limbus
What do we observe for on the eyelid margin?
Flakiness, redness, or swelling
Why do we ask the patients to close their eyes?
To note whether or not the eyelids meet completely
What is Lagophthalmos?
Closed lids do not completely cover the globe
What could happen due to Lagophthalmos?
Cornea may become dried and be at increased risk of infection
What are 4 causes of Lagophthalmos?
- Thyroid eye disease
- 7th CN palsy (Bells Palsy)
- Overaggressive ptosis
- Blepharoplasty surgical repair
Should we note whether the lids evert or invert?
Yes
What is Ectropion? What could result?
When the lower lid is turned away; excessive tearing
What is Entropion?
Lid turned inward toward globe
What could the lid’s eyelashes cause in Entropion?
Corneal and conjunctival irritation
What does the patient often report in Entropion?
Foreign body sensation
What could cause a lump on the eyelid?
Inflammation of the follicle of an eyelash
What is the eyelid bump called? What is it generally caused by?
Hordeolum/stye; staphylococcal infection
What does an Internal Hodeolum involve?
Meibomian glands
Conjunctiva are usually what?
Translucent and free of erythema
Do we inspect the palpebral conjunctiva? How?
Yes; have the pt look upward as we draw the lower lid downward to inspect for translucency and vascular pattern
What do we inspect the upper tarsal conjunctiva?
Only when there is a suggestion that a foreign body may be present
What do we observe the conjunctiva for?
Erythema or exudate
What can indicate an allergic or infectios conjunctivitis?
Erythematous or cobblestone appearance
What indicates a subconjunctival hemorrhage?
Bright red blood in a sharply define area
What is a Pterygium?
Abnormal growth of conjunctiva that extends over the cornea from the limbus
When is a Pterygium more commonly seen?
In people heavily expose to ultraviolet light
How do we exam “flatness” of the anterior chamber?
Shining a light tangentially on it
What is Corneal Sensitivity controlled by?
CN 5
What is a Corneal Arcus?
Lipid deposits in the periphery of the cornea
What is another name for Corneal Arcus?
Arcus Senilis
Do we note the subtle clear area between the limbus and arcus?
Yes
When is Arcus commonly seen?
Many individuals older then 60 years
What would Arcus Senilis indicate if it was present before age 40?
Lipid disorder
Why should the sclera be examined?
Primarily to ensure that it is white
What would be indicated if the sclera was yellow or green?
Liver or a hemolytic disease
What appears as dark, slate, and gray in the eye?
Senile Hyaline Plaque
Do we inspect the lacrimal gland and palpate the lower orbital rim near the inner canthus?
Yes
How should the Puncta be seen as?
Slight elevations with a central depression on both the upper and lower lid marginas nasally
What do we do if the temporal aspect of the upper lid feels full?
Evert the lid and inspect the gland
Should the iris pattern be clearly visible?
Yes
Do we note any irregularities in the shape of the pupil?
Yes
What should we expect when looking at the pupils?
Round, regular, and equal in size
We test the pupils for response to light in what 2 ways?
- Directly
2. Consensually
How do we evaluate the health of the optic nerve?
Look for afferent pupillary defect by performing the swing flashlight test
What is Marcus-Gunn Pupil?
Pupil continuing to dilate rather than constrict in the swinging flashlight test
Do we test for accommodation as well for pupillary constriction?
Yes (bring finger close to nose)
Miosis 3 contributing factors
- Iridocyclitis
- Miotic eye drops (pilocarpine)
- Drug abuse
Mydriasis 3 contributing factos
- Mydriatic or cycloplegic drops (atropine)
- Midbrain (reflex arcs) lesions or hypoxia
- Druge abuse
Argyll Robertson Pupil
Retain constriction with convergence
Anisocoria 3 things
- Congenital (20% of healthy people have minor or noticeable difference in pupil size, but reflexes normal)
- Eye medications (constrictors of dilators)
- Unilateral sympathetic or parasympathetic pupillary pathway destruction
Iritis Constrictive Response
Acute uveitis commonly unilateral
Oculomotor Nerve Damage 3 things
- Pupil dilated and fixed
- Eye deviated laterally and downward
- Ptosis
Adie Pupil 3 things
- Affected pupil dilated and reacts slowly or fails to react to light
- Responds to convergence
- Diminished tendon reflexes
What is Adie Pupil caused by?
Impairment of the postganglionic parasympathetic innervation to sphincter
How do we help assess the extraocular muscles?
Hold the patients chin to prevent movement of the head
What is Nystagmus?
Involuntary, rhythmic movements of the eyes
How do we define Jerking Nystagmus?
Rapid movement phase; characterized by fast movements in one direction
What is Lid Lag?
Exposure of the sclera above the iris when patient is asked to follow your finger
What is associated with Lid Lag?
Graves Disease - thyroid eye disease
How do we test subtle balance of extraocular muscles?
Corneal light reflex
What is Heterotropia? (ocular malalignements)
Manifest of parallelism of the visual axes of the eye
What is Heterphoria?
Occult of lack of parallelism of the visual axes of the eyes
When do we perform a Cover-Uncover Test?
When we find an imbalance with the corneal reflex test
Do we refer to ophthalmologist for ocular malalignments?
Yes
When does inspection of the interior eye do?
Permits visualization of the optic disc, arteries, veins, and retina
How do we achieve adequate pupillary dilation?
Dimming the lights
Do we sometimes use medications that cause mydriasis?
Yes
Do we check for adequate anterior chamber depth?
Yes
Do we examine the patients R eye with our R eye and vice versa for the ophthalmoscope?
Yes
How do we hold the ophthalmoscope?
In the hand that corresponds to the examining eye
If the patient is myopic, how do we use the ophthalmoscope?
Minus (red) lense
If the patient is hyperopic (lacks a lens), we use what with the ophtalmoscope?
Plus lens
What is a “blind spot”?
A part of the retina that cannot respond to light stimulation (optic disk)
What is the optic disk?
Where retina converges to optic nerve because there are no photoreceptors (rods and cones) in this part of the retina
How do the blood vessels on the disc divide in to?
Superior and inferior branches
What can be seen and noted on the disc?
Venous pulsation
How should the disc margin be?
Sharp and well defined
Does the color vary on the disc?
Yes; it’s darker in individuals whose skin is dark
What is the fundus?
The retina
What is the Macula also called?
Fovea centralis
Is the macula the site of central vision? Where is it located?
Yes; 2 disc diameters temporal to the optic disc
Could it be impossible to examine when the pupil is not dialted?
Yes
How do we bring the macula into our field of vision?
Ask the pt to look directly into the ophthalmoscope
Do blood vessels enter the fovea? How does it appear?
No; lighter dot surrounded by an avascular area
Myelinated Retinal Nerve Fibers
Absence of pigment, feathery margins, and full visual fields help distinguish this benign condition from chorioretinitis
Papilledema
Loss of definition of optic disc
General signs of Retinopathy?
- Reduced visual activity
2. Visual field defect
3 things with white spots on Retinal Exam
- Cotton wool spots (CWS)
- Hard exudates (HE)
- Drusen
3 things with red spots on the Retinal Exam
- Hemorrhages
2. Microaneurysms
Do hemorrhages in the retina vary in color and shape? Why?
Yes; depends on cause and location
Where does Flame-Shaped Hemorrhages occur? How does blood spread?
Nerve fiber layers; spreads parallel to nerve fibers
Where do Round Hemorrhages occur? How might they appear?
Deeper layers and may appear as a dark color
Are Microaneurysms (MA) hemorrhages?
No; can be confused with round hemorrhages
Do we follow the blood vessels distally as far as we can in each of the 4 quadrants?
Yes
What do we especially note in the blood vessels? Why?
Sites of crossing; characteristics may change when HTN is present
What 5 things are expected characteristics found on ophthalmologic exam in a patient with HTN?
- Narrowing of vessels
- Increased vascular tortuosity
- Copper wiring (diffuse red-brown reflex)
- Arteriovenous nicking
- Retinal hemorrhages
