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Ophtho 2 > Eye Exam Basics > Flashcards

Eye Exam Basics Flashcards

1
Q

What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?

A
  • 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
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2
Q

Distance Visual Acuity testing

A
  • position 20 ft from chart (unless its a 10ft char)
  • may use glasses
  • test OD, OS, OU
  • must ID 1/2 the figures
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3
Q

Near visual acuity testing

A
  • 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.

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4
Q

Amblyopia

  • aka
  • what is it?
  • what is it caused by?
  • tx
A
  • 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
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5
Q

Pupillary Examination

A
  • use pen light
  • -direct and consensual
  • -PERRLA
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6
Q

why might the pupil be messed up?

A
  • head or neck trauma
  • whole in the eye (pupil points to hole)
  • coughing (watch for lung carcinomas) (pancoast**)
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7
Q

What do we watch for when testing accommodation and convergence?

A

pupillary constriction (not related to light)

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8
Q

Synchia, what is this?

A
  • pupil can adhere to the front of the lens (posterior synchia) or to the corneal endothelium (anterior snychia)
  • may cause secondary glaucoma
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9
Q

Leukocoria: how does this present?

A

-white pupil during red reflex w/ camera flash

must rule out cataract or retinoblastoma to dx this.

  • fatal in children if not caught
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10
Q

What are some types of pupillary abnormalitis?

A
  • 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)

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11
Q

What to look for in a patients eyebrows?

A
  • quantity
  • distribution
  • scaliness of underlying skin
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12
Q

Ptosis

-may be caused from?

A
  • trauma
  • age
  • nerve damage
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13
Q

Look at eyelids for?

A
  • edema
  • color (redness)
  • lesions
  • condition and direction
  • ptosis
  • ectropian
  • entropian
  • periorbital edema
  • retraction of the upper eyelid and exophthalmos
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14
Q

Lumps and Swelling in and around the eyes may be caused from?

A
  • pincuecula
  • stye
  • chalazion
  • xanthelasma
  • basal cell carcinoma
  • dacrocystitis
  • enlargment of the lacrimal gland
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15
Q

What are tears made of? What is their function? Too much tears vocab term? Too little tears vocab term?

A

-oil, water, and mucus

Function: 1st line of defense against infection

Too much- epiphora
too little- dry eye

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16
Q

What happens when you dont have enough basal tears?

A

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!

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17
Q

What are some secondary causes of dry eye?

A
  • age
  • medication
  • systemic disease
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18
Q

What may cause the following cranial nerves to be no longer intact?

  • III
  • IV
  • VI
A

CN III Palsy- think brain; aneurysm, brain tumor

CN IV- think trauma

CN VI-think diabetes
**PANCE!

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19
Q

Strabismus

  • what is it?
  • how to diagnose it
A
  • misalignment of the two eyes d/t multiple causes
    ex. EOM weakness

-corneal light reflex
cover test

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20
Q

what is an Exotropic and Esotropic eye
Hypertrophia?
Exophoria?

A

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

21
Q

Strabismus

  • temporary or permanent vision loss?
  • at what age is strabismus no longer cureable?
A
  • permanent

- 16-18years

22
Q

What are the EOM?

What cranial nerves control them and what is their function?

A

Lateral Rectus - CN VI Motor
Superior Oblique- CN IV Motor

Superior rectus, medial rectus, inferior rectus, inferior olique- CN III Mixed

23
Q

When we test ocular motility of the EOM what are we inspecting for?

A
  • normal conjugate or parallel movements of the eye (Deviation)
  • abnormal movement (nystagmus)
  • lid lag
24
Q

Amblyopia

  • is this correctable?
  • what is the cause?
  • treatment?
A

-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
25
Q

Confrontation Visual Fields

-how to perform this exam

A

-ask cover one eye, from 2 ft away teset 8 fields

26
Q

Possible causes of an abnormal visual field

A 
glaucoma 
DM
HTN
MN
Hyperthyroidism
Pituitary adenoma
Stroke
27
Q

Visual field defects:

What tumor might cause bi-temporal field loss?

A

-pituitary adenoma

28
Q

What does a slit lamp examine?

A
  • 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
29
Q

What does a herpetic ulcer look like under woods lamp?

A

dendritic

30
Q

When inspecting the conjunctiva, episclera, and sclera what are some things you will be looking for?

A
  • Color: pale, yellow, red, injection, blanched
  • Edema- chemosis (edema of the conjunctiva), cycts, hemorrhages
  • Growths- Neoplasms, pinguecula, Pteryguim
31
Q

Keys to Iritis Dx

A

-red around the limbus and very painful when the pupil dilates/constricts

32
Q

IN trauma what happens with pupil?

A

pupil points to the trauma

33
Q

Anesthetic drops

  • types
  • uses
  • SE
A
  • 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
34
Q

What is normal intraocular pressure?

A

10-22 - Benner

12-20- RMC

35
Q

Classes of Pupil Dilation

A
  • Cholinergic- blocking (Parasympathetic; sphinctor)

- Adrenergic- stimulating (sympathetic; dilator)

36
Q

Cholinergic blocking drugs

  • action
  • example med, how long effects, SE
A

-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
37
Q

Adrenergic Stimulating Drugs

  • action
  • example med, how long effects, SE
A

-dilates the pupil, by stimulating the sympathetic response (dilation)

-Phenylephrine 2% or 10%
Dilates in 30mins
SE: acute hypertension or MI (10%)

38
Q

What to observe in ophthalmioscopy

A
  • 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

39
Q

Optic Neuritis

  • cause
  • symptoms
A

-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)
40
Q

Abnormalities of the optic disc

A
  • optic atrophy
  • papilledema

young fertile females, overweight pseudotumor cerebri

41
Q

Arteries and veins/ arterioles and veinuoles/ capillary beds: characteristics during fundoscopic exam

A
  • 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

42
Q

What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?

A
  • -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!!!

43
Q

Branch Retinal Artery Occlusion (BRAO)

  • what is this?
  • Tx
A
  • sector of retina is opacified and vision is partially lost
  • most often d/t embolus
  • treat as CRAO
44
Q

What would you find on ophthalmic exam of someone with Central Retinal Vein Occlusion?

A

Findings:

-disc swelling, venous engorgement, cotton wool spots, diffuse retinal hemorrhage

45
Q

List Urgent Eye Situations

A
  • 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
46
Q

Semi- Urgent Eye SItuations

A
  • 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
47
Q

perforating injury will appear this way.

what to avoid with perforating injury

A
  • teardrop shaped pupil and flat anterir chamber

- avoid digital palpation of the globe

48
Q

Chemical burns

  • what type is the worst?
  • first line of action for tx
A
  • Alkaline is worse than acidic

- irrigation before and during transport

Ophtho 2 (7 decks)

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