Eye exam Flashcards
Iris/Pupil
1) what should the room be
2) how do you test the iris
3) what do you put on the SOAP?
Darken the room
shine light into each eye and check for constriction (consensual and direct)
PERRLA
what happens if people can’t close their eyes all the way?
risk for corneal abrasions
Proptosis/exophthalmos?
hyperthyroidism sometimes caused by graves disease
Increased intracranial pressure indicates what?
what do you see?
papilledema
optic nerve swelling
Pustules on the periorbital area?
acne, insect bites, other stuff.
Erythema on the eyelids/eyelashes?
blepharitis?
contact dermatitis/allergies from makeup
swelling, scaling, reddening, crusting of the eyelid
Cover, Uncover test?
what is this causing?
what are the two things to know about this?
cover one eye, look at the uncovered eye and see if it moves to the center –> indicates one is subtly off.
strabismus
Esotropia –> eye turns in.. when you cover it moves more outward.
Exotropia –> eye turns out
Dacrocystitis
infection in the tear duct
super common in infants
EOMI?
nystagmus, horizontal vs vertical?
extra ocular muscles intact
horizontal can be seen at extremities.. this can be normal
vertical is NEVER normal
how do you treat strabismus?
eyepatch.
Corneal abrasion, how do we treat this?
they can be super painful. we take a fluorescein stain and a blue light to visualize the cornea
important to look for and remove foreign body
If you have a rash of the periorbital area straight lining to the hairline, what would you think?
Herpes Zoster (shingles)
Periorbital region, what is to note about examination?
1) what can cause edema?
2) what about changes in elasticity?
3) shiners?
4) what would tell you to check cholesterol levels?
Edema –> allergies, hyperthyroidism, hypothyroidism, trauma.
Change in elasticity –> lipoatrophy (fat changes), lipohypertrophy –> both of these coming from
allergic shiner
Xanthelasma –> lipid deposits.
what is a brown birthmark called on the eye? what are they more likely to have?
Nevus of Ota. what is it?
Oculodermal melanocytosis. Glaucoma
discoloration of sclera AND periorbital tissue. it’s a birthmark!
Blepharitis?
scales. Collarettes along the eye lashes.
patient can lose their eyelashes and have a red lid.
you spend time removing the crusty parts with baby soap.
Cornea:
1) what happens if you see a brown tint? what could have caused it?
2) whitish scar?
3) what tests utilize the cornea?
hyphema –> blood from trauma in anterior chamber
abrasion/ulcer
testing cranial nerve V and blinking with VII
what general meds can have ocular effects?
steroids, antihistamines, antidepressants, antipsychotics, antiarrhythmics, beta blockers
if you dilate the eyes, what must you check for first before you do it?? **
what happens if you do without checking and they have this?
check for a shallow anterior chamber –> this could represent acute angle glaucoma.
dilate the eyes with this you can precipitate an ocular event which is emergent.
Entropion vs Ectropion?
lashes go in toward the eye because the lid turns inward
lashes are everted –> exposes the lower palpebral conjunctiva (lower lid margin turns outward)
both are associated with increased risk of infections
Drusen bodies?
precursor to macular degeneration
they are small yellow or white spots on the retina.. at an early age is age related macular degeneration.
Corneal light reflex?
checking the reflection of light symmetry
Conjunctiva? what should it look like?
what if you see erythema?
purulence?
pterygium? what causes this? what does it look like?
inside of upper and lower eyelid. –> should be clear
erythema –> subconjunctival hemorrhage
Purulence –> pink eye, conjunctivitis
Pterygium –> overgrowth of conjunctiva toward the pupil –> excessive exposure to sun!
Hordeolum vs Chalazion?
Hordeolum (stye) is ALONG THE LASH LINE. these are tender and painful. –> blocked meibomian gland or tear eyelash follicle or tear gland.
Chalazion –> IN THE LID.. blocked meibomian gland. NONTENDER and NONPAINFUL unless become inflamed.
when looking at the eyes, what if the red reflex is not equal on both sides?
yellow or gray instead of red?
brown?
the side that you’re not getting probably has a misalignment.
cataract, or can be normal in people with increased melanin
cataract
what is the term for”dilating the pupils”
Mydriasis
Relevant ROS for eye complaints?
neuro
cardio
endocrine
MSK
skin
gi
general
neuro: headache, motor weakness, dizziness
cardio - chest pain
endocrine - thirst, urination, hypoglycemia
msk - back pain, joint pain
skin - frequent infections, dry skin
GI - changes in bowel function
general - fever, weight change
what do you see depositing along the outside of the cornea in older adults?
when is it common?
what if its below 40?
arcus senilis
it’s a lipid deposition encircling the iris
after 60
get cholesterol level
Sclera
1) what color should it be?
2) what if you see brown or gray spots? what is increased here? what are they at higher risk for?
3) blue sclera?
4) yellow? what is the term called? what is it associated with? what complications?
white
birthmarks. increased melanin in sclera. Glaucoma
brittle bone disease
“icterus” is the term. increased bilirubin. liver disease, pancreatic cancer, GB disease.
Lacrimal Apparatus
you can get skin lesions/cancer around the Punctae there and autoimmune diseases.
Associated symptoms for eye complaints?
pain, drainage, itching/burning, vision change, blurry vision, flashing lights
What happens if you see cotton wool spots?
what else can you see with a similar pathology?
fluffy white patches on the retina from damages to nerve fibers. –> vascular disease from HTN or DM
retinal proliferation –> HTN or DM
Eyebrows, what is to note about examination?
people pluck eyebrows out for stress - trichotillomania
eyebrows are falling out
scaly skin - Seborrheic dermatitis
scarring
Glaucomatous Cupping?
you see a white circle with a pink circle outlying it. looks like you’re looking into a cup.
Conjunctivitis:
1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance
redness is mostly peripheral
mild discomfort rather than pain
not affected except for blurring due to discharge
watery, mucoid, mucopurulent
not affected
Clear
bacterial, viral, other. HIGHLY contagious
Subconjunctival hemorrhage
1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance
Leakage of blood outside of vessels, producing a sharply demarcated red area that resolves over 2 weeks.
Painless
Not affected
None
Not affected
Clear
may result from trauma, or venous pressure, but no significance really
Corneal injury / infection
1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance
diffusely red
moderate to severe, superficial pain
decreased vision
watery or purulent
not affected
changes depending on cause
abrasions, other injuries; viral and bacterial causes too
Acute Iritis
1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance
diffusely red
moderate, aching, deep pain
decreased; PHOTOPHOBIA
absent
SMALL and irregular
clear or slightly clouded
systemic infection, herpes zoster, tuberculosis, autoimmune diseases
Acute Angle Closure Glaucoma
1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance
diffusely red
SEVERE ACHING DEEP PAIN
Decreased vision
Absent
DILATED + FIXED
Steamy, cloudy
Acute increase in intraocular pressure constitutes an emergency.
