Eye Exam Basics Flashcards
What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?
- Hx
- Visual acuity
- pupillary examination***
- visual fields by confrontation
- extraocular movements
- external inspection
- -lid and surrounding tissues
- -conjunctiva and sclera
- Anterior Structures
- -cornea, pupil, and iris
- -anterior chamber depth
- -lens clarity
- tonometry
- fundus examination
- -view-disc-macula-vessels
Distance Visual Acuity testing
- position 20 ft from chart (unless its a 10ft char)
- may use glasses
- test OD, OS, OU
- must ID 1/2 the figures
Near visual acuity testing
- 14-16inches from face
- test OD, OS, OU
*Be aware of their age, ask them if they have dbl vision, what they do for work.
Amblyopia
- aka
- what is it?
- what is it caused by?
- tx
- lazzzzyyy eeeeyyyyeeeee
- the eye has never had an opportunity to learn to see
- caused by refractive amblyopia, strabismic amblyopia, deprivation
Tx:
- lenses
- training
- patches
- surgery
Pupillary Examination
- use pen light
- -direct and consensual
- -PERRLA
why might the pupil be messed up?
- head or neck trauma
- whole in the eye (pupil points to hole)
- coughing (watch for lung carcinomas) (pancoast**)
What do we watch for when testing accommodation and convergence?
pupillary constriction (not related to light)
Synchia, what is this?
- pupil can adhere to the front of the lens (posterior synchia) or to the corneal endothelium (anterior snychia)
- may cause secondary glaucoma
Leukocoria: how does this present?
-white pupil during red reflex w/ camera flash
must rule out cataract or retinoblastoma to dx this.
- fatal in children if not caught
What are some types of pupillary abnormalitis?
- Horners Syndrome (ptosis, constriction of pupil, decreased sweating)
- Argyll- Robertson pupil (no rxn to light but constriction w/ accomodation).
^^^PANCE!!!!!^^^
-dilated fixed pupils (drugs/ neuro trauma/scopolamine patch)
What to look for in a patients eyebrows?
- quantity
- distribution
- scaliness of underlying skin
Ptosis
-may be caused from?
- trauma
- age
- nerve damage
Look at eyelids for?
- edema
- color (redness)
- lesions
- condition and direction
- ptosis
- ectropian
- entropian
- periorbital edema
- retraction of the upper eyelid and exophthalmos
Lumps and Swelling in and around the eyes may be caused from?
- pincuecula
- stye
- chalazion
- xanthelasma
- basal cell carcinoma
- dacrocystitis
- enlargment of the lacrimal gland
What are tears made of? What is their function? Too much tears vocab term? Too little tears vocab term?
-oil, water, and mucus
Function: 1st line of defense against infection
Too much- epiphora
too little- dry eye
What happens when you dont have enough basal tears?
If you don’t have enough of the basal tears your secondary tears get kicked in producing excessive watering in the eyes, the underlying problem is dry eye!
What are some secondary causes of dry eye?
- age
- medication
- systemic disease
What may cause the following cranial nerves to be no longer intact?
- III
- IV
- VI
CN III Palsy- think brain; aneurysm, brain tumor
CN IV- think trauma
CN VI-think diabetes
**PANCE!
Strabismus
- what is it?
- how to diagnose it
- misalignment of the two eyes d/t multiple causes
ex. EOM weakness
-corneal light reflex
cover test
what is an Exotropic and Esotropic eye
Hypertrophia?
Exophoria?
exotropic- lateral gaze with one
esotropic- medial gaze with one eye
Hypertrophia- vertical (up/down) gaze in one eye
Exophoria- normal, goes into its rest position and pops back with cover uncover test
Strabismus
- temporary or permanent vision loss?
- at what age is strabismus no longer cureable?
- permanent
- 16-18years
What are the EOM?
What cranial nerves control them and what is their function?
Lateral Rectus - CN VI Motor
Superior Oblique- CN IV Motor
Superior rectus, medial rectus, inferior rectus, inferior olique- CN III Mixed
When we test ocular motility of the EOM what are we inspecting for?
- normal conjugate or parallel movements of the eye (Deviation)
- abnormal movement (nystagmus)
- lid lag
Amblyopia
- is this correctable?
- what is the cause?
- treatment?
-loss of visual acuity not correctable by glasses
- brain selects the better image and suppresses the blurred or conflicting image, cortical suppression of sensory input interrupts the normal development of vision
- may be caused by strabismus, refractive error, ocular disease, idiopathic
- development problem in the brain
- chemical or physical patch done ages 3-18
Confrontation Visual Fields
-how to perform this exam
-ask cover one eye, from 2 ft away teset 8 fields
Possible causes of an abnormal visual field
glaucoma DM HTN MN Hyperthyroidism Pituitary adenoma Stroke
Visual field defects:
What tumor might cause bi-temporal field loss?
-pituitary adenoma
What does a slit lamp examine?
- anterior and posterior segment of the eye
- can see optic nerve or retina
- cataracts, conjunctivitis, iritis
- glaucoma or macular degeneration
- check for foreign body
- detect eye problems that my be caused by other diseases such as diabetes, rheumatoid arthritis
Cornea & Iris opacities:
- arcus senilis (narrow opaque band around iris)
- corneal scarring
- pteryguim
- pharmacolgic
What does a herpetic ulcer look like under woods lamp?
dendritic
When inspecting the conjunctiva, episclera, and sclera what are some things you will be looking for?
- Color: pale, yellow, red, injection, blanched
- Edema- chemosis (edema of the conjunctiva), cycts, hemorrhages
- Growths- Neoplasms, pinguecula, Pteryguim
Keys to Iritis Dx
-red around the limbus and very painful when the pupil dilates/constricts
IN trauma what happens with pupil?
pupil points to the trauma
Anesthetic drops
- types
- uses
- SE
- proparacaine
- tetracaine
- benoxinate
Use: anesthatize cornea (last 10mins)
- foreign corneal body removal
- tonometry
- examine damaged corneal surface
SE:
- allergy, systemic or local
- toxic to corneal epithelium
- epithelial sluffing if over used
What is normal intraocular pressure?
10-22 - Benner
12-20- RMC
Classes of Pupil Dilation
- Cholinergic- blocking (Parasympathetic; sphinctor)
- Adrenergic- stimulating (sympathetic; dilator)
Cholinergic blocking drugs
- action
- example med, how long effects, SE
-dilate by paralyzing iris sphinctor muscles (cycloplegic) by inhibiting the parasympathetic response (constriction)
-Tropicamide: pupil dilation 30mins effects diminishes 4-5hrs SE: Rare, n/v, pallor, fainting
Adrenergic Stimulating Drugs
- action
- example med, how long effects, SE
-dilates the pupil, by stimulating the sympathetic response (dilation)
-Phenylephrine 2% or 10%
Dilates in 30mins
SE: acute hypertension or MI (10%)
What to observe in ophthalmioscopy
- red reflex
- clarity of disc outline
- color of disc
- look at rim of optic disc
- presence of normal white or pigmented rings, crescents around discs
- size and color of cup
*in normal exam both should look similar
Optic Neuritis
- cause
- symptoms
-idiopathic or associated with MS in young adult
- Sx:
- decreased visual acuity and color vision
- pain w/ ocular movement*****
- disc swelling (bulbar) or you wont see anything (retro bulbar)
Abnormalities of the optic disc
- optic atrophy
- papilledema
young fertile females, overweight pseudotumor cerebri
Arteries and veins/ arterioles and veinuoles/ capillary beds: characteristics during fundoscopic exam
- color (veins are darker)
- size- ratio (4/5, artery; vein)
- crossings- nicking/pinching
- red colored spots
Cotton wool spots- white fluffy, ischemia
hard exudates- white/yellow lipids
colloid bodies- abnormal growths of inner layer of choroid
drusen (in or around macula); - made up of lipids
What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?
- -cherry red spot
- no optic disc swelling, unless carotid artery occlusion
- months in, pale disc due to death of ganglion cells and their axons
*TRUE EMERGENCY!!!
Branch Retinal Artery Occlusion (BRAO)
- what is this?
- Tx
- sector of retina is opacified and vision is partially lost
- most often d/t embolus
- treat as CRAO
What would you find on ophthalmic exam of someone with Central Retinal Vein Occlusion?
Findings:
-disc swelling, venous engorgement, cotton wool spots, diffuse retinal hemorrhage
List Urgent Eye Situations
- penetration of globe
- conjunctival or corneal foreign body
- hyphema
- lid laceration (vertical worse than horizontal)
- traumatic optic neuropathy
- radiant energy burns (welding)
- corneal abrasion
- sudden loss of vision
- “curtains” retinal detachment
Semi- Urgent Eye SItuations
- orbital fx (urgent if muscle is trapped)
- subconjuncitval hemorrhage in blunt trauma
- refer within 1-2 days
- new/ repetitive flashes/floaters
- eye pain
- staining of cornea w/ no hx of trauma
- zoster around eye or tip of nose
- dbl vision
perforating injury will appear this way.
what to avoid with perforating injury
- teardrop shaped pupil and flat anterir chamber
- avoid digital palpation of the globe
Chemical burns
- what type is the worst?
- first line of action for tx
- Alkaline is worse than acidic
- irrigation before and during transport
