Eyes Flashcards
LR6-SO4-R3
Lateral rectus 6
Superior oblique 4
Remainder 3
blurred vision, loss of vision, floaters, flashing lights are
important questions to ask for changes in vision
diplopia
double vision
what can cause flashing lights?
Retinal detachment
How many feet from the snellen chart is the patient
6 feet
what are the steps for snellen eye chart?
- cover one eye
- ask the patient to read the smallest line possible
- identify the smallest line of print where the pt can read more than half the letters
- test the other eye
indicate if the pt is using correctino or not
what does the top number indicate (of visual acuity)
how far the pt is from the chart
what chart tests for near vision
rosenbaum handheld eye chart
identifies need for bifocals or reading glasses in >45 yo
how far do you hold the rosenbaum chart from the pt
14 inches
how to test for visual field?
confrontation visual field testing: static finger wiggle test
what tests for color blindness
pseudoisochromatic color plates
esotropia
one eye inward
what do you exam the eye for?
position and alignment
exotropia
one eye outward (lateral)
hypertropia
one eye goes upward
hypotropia
one eye goes downward
what to inspect the eyebrow for
- fullness
- hair distribution
- scaliness of underlying
what do you inspect eyelids for
- width of palpebral fissures
- edema
- color
- lesions
- condition/direction
- adequacy of eyelid closure
what do you inspect lacrimal appartatus for
- regions of swelling
- excessive tearing or dryness
what do you inspect the conjunctiva/sclera
- color
- vascular pattern
- nodule/swelling chemosis
what do you inspect the cornea/lens for?
- Opacities with oblique lighting
- opacities in the lens through the pupil
what do you inspect iris for?
- shine a light from the temporal side to look for a cresent shaped shadow on the medial side of the iris (sign of acute narrow angle glaucoma)
- pupil size
- diameter
- light reaction
- near reaction
small pupil is less than
3mm
large pupil is greater than
5mm
simple anisocoria is a difference in pupillary diameter of
> 0.4mm without a known pathologic cause
when is anisocoria benign
equal difference in dim/bright light with a brisk light reaction
pupillary constriction in the same eye
direct reaction
pupillary constriction in the opposite eye
consenual reaction
what is near reaction testing
hold your finger 10cm from the pt’s eye and have them look at a point behind you
watch for pupillary constriction w/ near effort and convergence of eye
how to do light reflection in the corneas
- stand 2 feet directly in front of the pt and shine light into the pts eyes and ask to look at
- light should be visible/symmetric
a fine rhythmic oscillation of the eye
nystagmus
pause during upward and lateral gaze assessment to detect
what system mediates pupillary constriction to light and near reaction
parasympathetic pathway
what system regulates pupillary dilation
sympathetic pathways
how to test for lid lag
- ask the pt to follow your finger as you move it from up to down midline
what does lid lag indicate
hyperthyroidism
how to test for EOM
- ask the pt to follow your finger in an H
- convergence
what is the first thing you look for in the ophthalmoscope?
red reflex (orange glow in the pupil)
what are the 6 steps of examining the optic disc and retina
- locate the optic disc
- bring the optic disc into focus
- inspect the optic disc
- inspect for papilledema
- inspect the retina-arteries, veins, fovea, macula
rotate the focus wheel counterclockwise for
nearsighted patient (to the red)
Rotate the focusing wheel clockwise for
farsighted (green)
what is a normal color of the disc
yellowish orange to creamy pink
what is a normal color of the cup
yellowish white
what is a normal diameter of the physiologic cup
less than half the diameter of the disc
what is the normal cup:disc ratio
1:3
optic nerve head swelling associated with increased intraCRANIAL pressure
papilledema
blurring of the disc margin, swelling of the optic disc, physiologic cup bulge or invisible is a sign of
papilledema
what does papilledma signal?
serious disorder in the brain such as meningitis, subarachnoid hemorrhage, trauma, mass lesion
what characteristics are the arteries on opthalmic exam
- light red
- smaller
- bright light reflex
what are characteristics of veins on opthalmascope
- dark red
- larger
- absent or dull on light reflex
how many arteries/veins are in visible in the eye
5
what is eye protrusion
proptosis or exophthalmos
what does bilateral proptosis indicate
graves disease (autoimmune hypterthyroidism)
what does unilateral proptosis indicate
- infection
- trauma
- bleeding
- orbital tumor
- granulomatous disorders: granulosis
what further evaluation should you get done for proptosis
CT or MRI if proptosis exceeds normal
what does mucopurulent fluid from the puncta suggest?
- obstructed nasolacrimal duct
- canaliculitis
how to evaulate for upper eyelid foreign body
everting the eyelid
what is anormal response to the swinging flashlight test
each illuminated eye constricrts and the opposite eye constricts consensually
what is an abnormal response to swinging flashing test
RAPD- relative afferent pupillary defect marcus gunn pupil
left side optic nerve damage, light is shown into the left eye, both pupils partially dialte
marcus gunn pupil (RAPD- relative afferent pupillary defect)
what test evaluates for slight or latent muscle imbalance associated with esotropia or exotropia
cover-uncover test
nearsightedness, difficulty with distance vision
myopia
farsightedness, difficulty with near vision
hyperopia
visual changes due to aging causing focusing problems
presbyopia
imperfection of the cornea or lens causing distortion while looking at near and far objects
astigmatism
focal point of the light rays are in front of the retina
myopia
focal point of the rays are behind the retina
hyperopia
what is the pattern of redness of conjunctivits
redness maximal peripherally
what pain is associated with conjunctivitis
mild discomfort
is vision affected in conjunctivitis
not
what kind of discharge is see in conjunctivitis
watery, mucoid, mucopurulent
is the pupil or cornea affected in conjunctivitis
pupil is not affected, cornea is clear
leakage of blood outside the vessels with a sharply demarcated red area and no pain
subconjunctival hemorrhage
is vision affected in subconjunctival hemorrhage
no
is there dischage, damage to the pupil or cornea in subconjunctival hemorrhage
no to all 3
ciliary injection or diffusely red and moderate-severe pain
corneal injury/infection
what has decreased vision, watery/purulent discharge and epithelial defect or opacity
corneal injury or infection
is the pupil affected in corneal injury or infection
no
ciliary injection or diffusely red with moderate, deep/aching pain, photophobia and decreased vision ?
acute iritis
is the pupil and cornea affected in acute iritis
pupil is small and irregular, cornea is clear or SLIGHTLY clouded
what is associated with systemic infections like herpes zoster, tb, autimmune disease
acute iritis
ciliary injection or diffusley red with severe, aching deep pain; severe photophobia a,d decreased vision
acute angle glaucoma
is there discharge associated with acute angle closure glaucoma
no
how is the pupil and cornea affected in acute angle closure glaucoma
dilate/fixed puil and steamy or cloudy cornea
what is a red eye emergency
acute angle closure glaucoma
occlusion of a central retinal artery and ischemia of the optic nerve can cause what visual field defect
horizontal defect (can only see the top of the affected eye and the whole unaffected eye)
lesion of the right eye or right optic nerve can cause what type of visual field defect
blind right eye (monocular blindness) (can only see out of the unaffected eye)
lesion of the optic chiasm (like a pituitary tumor) can cause what visual field defect
bitemporal hemianopsia (can only see medially on both eyes)
lesion of the right optic tract and complete lesion of R optic radiation can cause what visual field defect
left homonymous hemianopsia (can only see the R temporal and L nasal)
partial lesions of the right optic radiation can cause what visual field defect
homonymous left superior quadrant defect (upper left quadrant of both eyes blocked)
“pie in the sky”
pie in the sky defect
homonymous left superior quadrant defect
* partial lesion of R optic radiation
drooping of the upper lid
ptosis
- myasthenia gravia
- damage to CN 3
- aging (senile ptsosis)
- congenitral
- horner syndrome
are causes of what in the eyelid
ptosis
sympathetic nerve supply injury is aka
horner syndrome
lower lid margins turn outward exposing palpebral conjunctiva
ectropion
inward turing of the lid margin and eyelashes irritate the conjuntiva and lower cornea
entropion
harmless, yellowish triangular nodule in the bulbar conjunctiva on either side of the iris
pinguecula
associated with aging
localized ocular inflammation of the episcleral vessels
episcleritis, usually benign
infection at the margin of the eyelid from obstructed meibomian gland, eyelash follicle, or tear gland that is painful, red and tender
stye (hordeolum)
common cause of styes (hordeolum)
staph. aureus
raised, yellow, cholesterol filled plaques along the nasal portion of one or both eyelids
xanthelasma
what diseases commonly have xanthelasma
hyperlipidemia or pbc
inflammation of the eylids at the base of the hair follicles
blepharitis
what organism causes blepharitis
s. aureus
if scaling is present in blepharitis, what should you consisder
seborrhea
subacute, nontender nodule cause by a blocked meibomian gland, typically points inside the lid
chalazion
types of corneal arcus
- acucus senilis
- arcus juvenilis
thin, grayish white arc near the edge of the cornea
corneal arcus (opacity of the cornea)
benign lipid deposition in both eye related to aging causing corneal arcus
arucus senilis
corneal arcus due to a lpid metabolism disorder and is strongly associarted with CAD
arcus jevenilis
what should you check if you suspect arcuss juvenilis
serum lipid levels
what eye abnormality is associated with wilsons disease
kayser-fleischer ring
gold to red brown ring in the periphery of the cornea
what is a superficial grayish white opacity in the cornea resulting from an old injury or inflammation
corneal scar
surfer’s eye is aka ——? what causes it
pterygium
long exposure to UV light, eye irritation from weather elements
what is a triangular thickening of the bulbar conjunctiva that grows across the cornea
pterygium
grows from the nasal side and may interfer with vision
opacity of the lens seen through the eye is aka
cataracts
old age, smoking, DM, corticosteroid use are risk factors of what opacity in the eye
cataracts
unequal pupils due to a defect in the constriction or dilation of one pupil
anisocoria
anisocoria greater in bright light causes
larger pupil to not constrict properly
what are causes of bright light anisocoria
- blunt trauma
- open angel trauma
- impaired parasympathetic innervation to the iris (tonic pupil, CN 3 paralysis)
anisocoria greater in dim light causes
smaller pupil to not dilate properly
whats a cause of anisocoria greater in dim light
Horner syndrome (imparied PNS innervation to the iris)
tonic pupil
- pupil is dilated, regular and unilateral
- reaction to light is reduced/slowed
- near reaction is slow
*
oculomotor nerve paralysis
- pupil is dilated and fixed to light and near effort
- ptosis of the ipsilateral upper eyelid
- lateral deviation of the eye downward and outward
equal pupils and one blind eye
- light directed in seeing eye produced direct reaction in that eye and a consenual reaction in the blind eye
- light in blind eye causes no respose in either eye
pupil is constricted, unilateral, reacts briskly to light and near effort but dilates slowly in dim light
horner syndrome
what does horner’s syndrome cause in the eyelid
ipsilateral ptosis of the eyelid
what causes ipsilateral loss of sweating on the forehead in horners syndrome
- ipsilateral brainstem lesion
- neck or chest tumors affecting the ipsilateral sympathetic ganglia
- orbital trauma
- migraines
- congenital
classic triad of the horner syndrome
- miosis
- ptosis
- anhydrosis
pupils small, irregular, usually bilaterally and has normal near reaction. but does not react to light
argyll robertson pupils
what can cause argyll robertson pupils
- neurosyphilis
- diabetes (rare)
new onset dysconjugate gaze in adults
cranial nerve palsies
what causes cranial nerve palsies
- injury
- lesions
- abnormalities
- trauma
- ms
- syphilis
left cn VI paralysis
- left eye can not look to the left & deviates inward looking straight ahead
- left eye can look to the right
Left CN IV paralysis
L eye can not look down when turned inward
L CN 3 paralysis
eye is pulled outward by action of CN VI
* upward, downward, and inward movements are impaired or lost
* ptosis and pupillary dilation also present
small, whitish depresion in the optic disc that is the entry point for retinal vessels
physiologic cup
* normal less than half diameter. ofthe disc
*
rings & cresents
developmental variation
*around the disc, not part of it
*dont include in the estimate of the disc diameter
medullated nerve fibers
- white patches with feathers margins
- no pathologic significance
when is papilledema seen?
intracranial mass, lesions, hemorrhage, meningitis
optic disc abnormalities in papilledema
- pink or hyperemic disc
- disc vessels increased
- disc swollen & blurred margins
- physiologic cup not visible or bulgign
glaucomatous cupping
- elevated IOP
- seen in glaucoma
- backward depression of the disc and atrophy due to IOP
- enlarged cup w/ pale base
- depth of nerve fibers leads to tiny disc vessels
arterial wall is usually
transparent, only the column of blood is visible with normal light reflex narrow
1.
optic atrophy
- enlarged physiologic cup
- seen in optic neuritis, MS, temporal arteritis
- disc color is white
- tiny disc vessels absent
- cup may extend to the edge of the disc
HTN can cause what in regards to arteries
- focal or generalized narrowing of the lumen and light reflex
- copper wiring
- silver wiring
- AV nicking
narrowing of the artery wall in HTN is caused by
increased pressure that damages the vascular epithelium leading to:
* deposition of plasma macromolecules
* thickening of the arterial wall
copper wiring in HTN
arteries close to disc become full with increased light reflex and bright coppery luster
silver wiring in HTN
wall of narrowed artery becomes opague so there is no visible blood
AV nicking (concealment)
arterial walls lose their transparency, changes appear in the AV crossings.
vein stops abruptly on either side of the artery
Superficial retinal hemorrhages are
- small
- flame shaped red streaks in the fundi
- follow the patterns of nerve fibers that radiate from the optic disc
what diseases are superficial retinal hemorrhages common in
- severe htn
- papilledma
- retinal vein occlusion
preretinal hemorrhages are
- anterior to the retina
- blood escaping into the potential space between the retina and vitreous
- obscures underlying retinal vessels
- seen with ssudden increase in intracranial pressure
deep retinal hemorrhage are
- small red dots or blots hemorrhages
- occurs in the deeper layer of the retina
- commonly seen in diabetes
what is a hallmark of diabetic retinopathy
tiny, round red spots seen in and around the macular area
* due to minute dilations of small retinal vessels
neovascularization
formation of new blood vessels
* numerous, narrow
* may grow into the vitreous causing retinal detachment or hemorrhage
* common feature of diabetic retinopathy proliferative stage
soft exudates
- white or grayish, ovoid lesions with irregular/soft border
- moderate in size
- seen in htn, DM, HIV and other viruses
hard exudates
- creamy or yellowish, bright lesions w/ well defined hard borders
- small and round that occur in clusters/ linear/circular or start like patterns
drusen
- yellow spots that vary from tiny to small
- edges soft or hard
- concentrated between optic disc and macula
- seen in aging and macular degeneration
