eyes Flashcards
external anatomy of the eye
the bony orbital cavity surrounded by cushion of fat that protects the eye
external anatomy of the eye - palpebral fissure
Palpebral fissure:
◦ Elliptical open space between eyelids
external anatomy of the eye - corneal limbus
Lower lid margin, at limbus, borders between
cornea and sclera
external anatomy of the eye - canthus
◦ Canthus: corner of eye, angle where lids meet
◦ Inner canthus: caruncle is small fleshy mass
containing sebaceous glands
anatomy of the external eye - tarsal plate
◦ contain meibomian glands, which are modified sebaceous glands that secrete an oily lubricating material onto lids
anatomy of the external eye - conjunctiva
- transparent protective covering of the eye
anatomy of the external eye - cornea
covers and protects the iris and pupil
anatomy of the external eye - lacrimal apparatus
provides irrigation to the eye
extraocular muscles
- Give eye both straight and rotary movement
- Each muscle is coordinated, or yoked, with one in other eye ensuring that when two eyes
move, their axes always remain parallel, called
conjugate movement - Four straight, or rectus, muscles are superior,
inferior, lateral, and medial rectus muscles - Two slanting, or oblique, muscles are
superior and inferior muscles
how many extraocular muscles are there (exam)
Six muscles attach eyeball to its orbit and direct eye to points of a person’s
interest
why are parallel axis important for the extraocular muscles (exam)
Parallel axes are important because
human brain has a binocular, single image visual system
what is movement of the extraocular muscles stimulated by (exam)
◦ Cranial nerve VI: abducens nerve, innervates lateral rectus muscle, which abducts eye
◦ Cranial nerve IV: trochlear nerve, innervates superior oblique muscle
◦ Cranial nerve III: oculomotor nerve, innervates all the rest: the superior, inferior, and medial rectus and the inferior oblique muscles
internal anatomy of the eye
Eye: a sphere of three concentric coats
Outer fibrous sclera
Middle vascular choroid
Inner nervous retina
Inside the retina is a transparent vitreous body.
The only parts accessible for examination are the sclera anteriorly and the retina through the ophthalmoscope.
sclera
Sclera: tough, protective, white covering
◦ Continuous anteriorly with smooth, transparent cornea, which covers iris and pupil
cornea
Cornea: part of the refracting media of eye, bending incoming light rays so that they will be focused on
inner retina
◦ Corneal reflex—contact with a wisp of cotton stimulates a blink in both eyes
◦ Trigeminal nerve, cranial nerve V, carries afferent sensation into brain.
◦ Facial nerve, cranial nerve VII, carries efferent message that stimulates blink.
the middle layer - choroid
has dark pigmentation to prevent light
from reflecting internally and is heavily
vascularized to deliver blood to retina
the middle layer - iris
Iris: functions as a diaphragm, varying opening
at its center, the pupil
◦ Muscle fibers of iris contract pupil in bright light and to accommodate for near vision
◦ Dilate pupil when light is dim and for far vision
the middle layer - pupil
Pupil: round and regular; size determined by
the balance between parasympathetic and
sympathetic chains of the autonomic nervous
system
Stimulation of the parasympathetic branch, through cranial nerve III causes constriction of the pupil
Stimulation of the sympathetic branch dilates the pupil and elevates the eyelid
Pupil size also reacts to the amount of ambient light and accommodation or focusing an object on the retina
internal anatomy - lens
Lens: biconvex disc located just posterior
to the pupil
middle layer - transparent
Transparent; it serves as a refracting
medium, keeping a viewed object in
focus on the retina
Anterior and posterior chambers contain
clear, watery aqueous humor produced
continually by the ciliary body
- Continuous flow of fluid serves to deliver nutrients to surrounding tissues and to drain
metabolic wastes
Intraocular pressure determined by
balance between the amount of aqueous
produced and resistance to outflow
inner layer - retina
Retina: the visual receptive layer of eye where light waves change into nerve impulses
◦ Retinal structures viewed through
ophthalmoscope are optic disc, retinal vessels,
general background, and macula
inner layer - optic disc
Optic disc: area in which fibers from retina converge to form optic nerve
- Located toward nasal side of retina, it has
characteristics specific to color, shape and
margins
inner layer - retinal vessels
Retinal vessels: normally include a paired artery and vein extending to each quadrant
inner layer - macula
Macula: located on temporal side of fundus
◦ Slightly darker pigmented region surrounding fovea centralis, area of sharpest and keenest vision
◦ Receives and transduces light from center of visual field
visual pathways and visual fields
Light rays are refracted through transparent media, the cornea, aqueous humor, lens, and vitreous body, striking the retina
◦ Retina transforms light stimulus into nerve impulses conducted to visual cortex
◦ Image formed on retina is upside down and reversed
◦ All retinal fibers collect to form optic nerve but maintain same spatial arrangement
◦ At optic chiasm, fibers from both visual fields cross over
◦ Left optic tract now has fibers from left half of each retina, and right optic tract contains fibers only from right; thus, right side of brain looks at left side of the world
pupillary light reflex (exam)
Pupillary light reflex: normal constriction of pupils when bright light shines on retina
◦ Subcortical reflex arc with no conscious control
fixation of the eyes (exam)
Fixation: a reflex direction of eye toward an object attracting a person’s attention
◦ Image fixed in center of visual field, the fovea centralis
what is accommodation (exam)
the ability for adaptation of the eye for near vision
accommodation of the eye (exam)
◦ Accomplished by increasing curvature of lens through movement of ciliary muscles
◦ Although lens cannot be observed directly, the following components of accommodation can be observed:
◦ Convergence (motion toward) of the axes of the eyeballs
◦ Pupillary constriction
developmental competence: aging in adults
- Changes in eye structure loss of
elasticity, fat & muscle tissue atrophy
&decreased tear production - Visual acuity may diminish gradually
after age 50 and more so after age 70
Floaters appear from accumulation of
debris
what is presbyopia
Presbyopia
◦ Lens loses elasticity, becoming rigid and
glasslike, which decreases the ability to
change shape to accommodate for near
vision by age 40 to 45
what are the four most common causes of decreased visual functioning in older adults
cataract formation
diabetic retinopathy (DR)
glaucoma
Age-related macular degeneration (AMD)
cataract formation
lens opacity, resulting from a clumping of proteins in the lens
diabetic retinopathy (DR)
oxidative damage and inflammation of the retina leading to blindness
glaucoma
increased intraocular pressure leading to optic nerve compression
age-related macular degeneration (AMD)
degeneration of the cells in the macula of the retina leading to a loss of central vision
how genetics affects developmental competence of the eyes in aging adults
Culturally based variability present in color of iris and retinal pigmentation
- By age 80, most individuals in the US have cataracts or have had cataract surgery
◦ Family history & environment are risk factors
Glaucoma incidence increases with age.
◦ Black Americans 40 years & older are at highest risk, followed by Hispanic/Latinos & Whites (NIH, 2021)
what is age-related macular degeneration seen in
- Increase seen in White Americans over the
age of 75 (NIH,2021) - Diet & smoking are modifiable risk factors
how is visual impairment seen
- Not being able to see letters on the eye
chart at line 20/40 or below (NIH, 2021) - Due to uncorrected refractive error
- Most common eye problems in children
uncorrected refractive errors
(nearsightedness, farsightedness &
astigmatism)- Visual screening is crucial to detect
strabismus (“cross-eye”) & amblyopia
(“lazy eye”)
- Visual screening is crucial to detect
subjective complaints regarding vision
- Vision difficulty: decreased acuity, blurring, blind spots
- Pain
- Strabismus, diplopia
- Redness, swelling
- Watering, discharge
- History of ocular problems
- Glaucoma
- Use of glasses or contact lenses
- Patient-centered care
some vision difficulty questions to ask
Any difficulty seeing or any blurring? Blind spots?
Come on suddenly or slowly? One eye or both?
Constant, or does it come and go?
Do objects appear out of focus or clouding of
objects?
Do spots move in front of your eyes? One or
many? In one or both eyes?
Any halos, rainbows, rings around objects?
Any blind spot? Does it move as you shift your
gaze? Any loss of peripheral vision?
Any night blindness?
some questions to ask about the eye pain
Any eye pain? Please describe.
Come on suddenly?
Quality: burning or itching? Or sharp, stabbing
pain; pain with bright light?
A foreign body sensation? Or deep aching? Or
a headache in the brow area?
pain questions for strabismus, diplopia
Any history of crossed eyes?
Now or in the past?
Does this occur with eye fatigue?
Ever see double?
Constant, or does it come and go?
In one eye or both?
pain questions for redness, swelling
Any redness or swelling in the eyes?
Any infections?
Now or in the past?
When do these occur?
In a particular time of year?
questions to ask about watering or discharge of the eyes
◦ Any watering or excessive tearing?
◦ Any discharge? Any matter in the eyes? Is it hard to open your eyes in the morning? What color is the discharge?
◦ How do you remove matter from eyes?
questions to ask about past history of vision problems
Any history of injury or surgery to eye? Any history of allergies?
questions to ask about glaucoma
◦ Have you ever been tested for glaucoma?
What were the results?
◦ Do you have any family history of
glaucoma?
questions to ask about use of glasses or contacts (Exam?)
◦ Do you wear glasses or contact lenses?
How do they work for you?
◦ Last time your prescription was checked?
Was it changed?
◦ If you wear contact lenses, are there any
problems such as pain, photophobia,
watering, or swelling?
◦ How do you care for contacts? How long do
you wear them? How do you clean them?
Do you remove them for certain activities?
questions for the eyes regarding patient-centered care
- Last vision test? Ever tested for color?
- Any environmental conditions at home or at work that may affect your eyes? If so, do you wear goggles to protect your eyes?
- What medications are you taking? Systemic or topical? Any specifically for eyes?
- Do you smoke?
- If you have experienced a vision loss, how do you cope? Do you have books with large print, books on audio tape, braille?
- Do you maintain living environment the same?
- Do you sometimes fear complete loss of vision?
additional history questions to ask of aging adults
Have you noticed any visual difficulty with
climbing stairs or driving? Any problem with
night vision?
When was last time tested for glaucoma?
◦ Any aching pain around eyes? Any loss of
peripheral vision?
◦ If you have glaucoma, how do you
manage your eyedrops?
Is there history of cataracts? Any loss or
progressive blurring of vision?
Do your eyes ever feel dry or burning? What
do you do for this?
Any decrease in usual activities, such as
reading or sewing?
preparation for obtaining objective data for the eye
position the person standing for the vision screening; then sitting up with their head at your eye level
equipment needed to collect objective data of the eye
- Snellen eye chart
- Handheld visual screener
- Opaque card or occluder
- Penlight
- Ophthalmoscope
- Applicator stick (occasionally)
how to test central visual acuity (exam)
Snellen alphabet chart is most used and accurate measure of visual acuity
◦ It has lines of letters arranged in decreasing size
◦ Place chart in a well-lit spot at eye level; position the person exactly 20 feet
from chart; hand the person an opaque card with which to shield one eye at
a time during test
◦ If the person wears glasses or contact lenses, leave them on; remove only
reading glasses
◦ Ask the person to read through chart to smallest line of letters possible;
encourage trying next smallest line also
what to do if they person can not see the letter chart when doing an eye exam (exam)
If the person is unable to see even largest letters, shorten distance to
chart until the person sees it, and record that distance (e.g., 10/20)
If visual acuity even lower, assess whether the person can count your fingers
when they are spread in front of eyes or distinguish light perception from your
penlight
how to test near vision
For those who report increasing
difficulty reading
Test near vision with handheld vision
screener with various sizes of print (e.g.,
a Jaeger card)
* Hold card in good light about 35 cm (14 inches) from the eye; this distance equals print size on 20-foot chart
* Test each eye separately, with glasses on
* Normal result is “14/14” in each eye, read
without hesitancy and without moving card
closer or farther away
* When no vision screening card is available, ask the person to read from a magazine or
newspaper
what is the confrontation test
a gross measure of the peripheral vision; it compares the person’s peripheral vision with that of yours
how to do the confrontation eye test
◦ Position yourself at eye level with the
person about 2 feet away
◦ Direct the person to cover one eye with
an opaque card and with other eye to
look straight at you
◦ Cover your own eye opposite to the
person’s covered one; you are testing
the uncovered eye
◦ Hold pencil or your finger as target
midline between you and the person,
and slowly advance it in from periphery
in several directions
*Ask the person to say “now” as a
target is first seen; this should be just
as you see the object also
*Estimate angle between the
anteroposterior axis of the eye and
the peripheral axis where the object
is first seen
* Normal results are about 50
degrees upward, 90 degrees
temporal, 70 degrees down, and
60 degrees nasal
*Sensitivity can be increased by
combining a wiggling finger with a
moving red target
what is the corneal light reflex also known as
the Hirschberg test
how to assess the corneal light reflex
- Assess parallel alignment of eye axes by shining a light toward the person’s eyes
- Direct the person to stare straight ahead as you hold the light about 30 cm (12 inches) away
- Note the reflection of light on the corneas; should be in exactly the same spot on each eye
what are diagnostic positions tests and how to do them
Leading patient through six cardinal positions of gaze:
◦ Follow the movement of penlight or object proceeding clockwise
◦ Assess for potential EOM muscle weakness,
nystagmus, or lid lag
the general inspection of the eyebrows
◦ Already you will have noted the person’s
ability to move around room, with vision
functioning well enough to avoid
obstacles and to respond to your
directions
◦ Also note facial expression; relaxed
expression accompanies adequate
vision
Eyebrows
◦ Look for symmetry between the two eyes
◦ Normally eyebrows are present
bilaterally, move symmetrically as
expression changes, and have no
scaling or lesions
the general inspection of the eyelids and lashes
◦ Upper lids normally overlap superior part of iris, and approximate
completely with lower lids when closed
◦ Note that eyelashes are evenly distributed along lid margins and curve
outward
the general inspection of the eyeballs
◦ Eyeballs are aligned normally in their sockets with no protrusion or sunken appearance
◦ Blacks normally may have slight protrusion of eyeball beyond supraorbital ridge
how to check the eyes for conjunctiva, and to check the sclera
Ask the person to look up; using thumbs,
slide lower lids down along orbital rim,
being careful not to push against eyeball
◦ Inspect exposed area; eyeball should look
moist and glossy
◦ Numerous small blood vessels normally
show through transparent conjunctiva
- Otherwise, conjunctivae clear and show
normal color of structure below; pink over
lower lids and white over sclera
- Note any color change, swelling, or
lesions
- Be aware of ethnic variations
how to inspect the lacrimal apparatus
Ask the person to look down; with thumbs, slide outer part of upper lid up along bony orbit to expose under lid; inspect for any redness or swelling
◦ Normally puncta drain tears into lacrimal sac
◦ Presence of excessive tearing may indicate blockage of nasolacrimal duct
Check by pressing index finger against sac, just inside lower orbital rim, not against side of the nose
◦ Pressure will slightly evert lower lid, but there should be no other response to pressure
how to check the function of the cornea and lens of the eye
Shine light from side across cornea, and check for smoothness and clarity
◦ Oblique view highlights any abnormal irregularities in corneal surface
There should be no opacities (cloudiness) in cornea, anterior chamber, or lens behind the pupil
◦ Do not confuse an arcus senilis with an opacity; arcus senilis is normal finding in aging persons
how to check the function of the iris
Iris normally appears flat, with round
regular shape and even coloration
◦ Note size, shape, and equality of pupils;
normally pupils appear round, regular,
and of equal size in both eyes
how to check the function of the pupils (pupillary light reflex) (Exam)
◦ Darken room and ask person to gaze
into distance; this dilates pupils; advance
a light in from side and note response
◦ Normally you will see constriction of
same-sided pupil (a direct light reflex)
and simultaneous constriction of the
other pupil (a consensual light reflex)
◦ In acute care setting, pupil size is
measured in millimeters before and after
the light reflex
how to test for accommodation of the iris and pupil (exam)
Test for accommodation by asking the
person to focus on a distant object
◦ This dilates pupils; then have the person shift gaze to near object, such as your finger held about 7 to 8 cm (3 inches) from nose
Normal response includes
◦ pupillary constriction
◦ convergence of axes of eyes
- Record normal response to all these
maneuvers as PERRLA, or Pupils Equal,
Round, React to Light, and Accommodation
what does the ophthalmoscope do
it enlarges the view of the eye so that you can better see it
what do lenses do
they control the focus of the unit with the unit of strength measurement known as the diopeter
order in which to inspect the eye with the opthalmoscope
- inspect media (anterior chamber, lens,
vitreous) and the ocular fundus (internal surface of retina)
what do parts of the diopter mean
- Black numbers indicate positive
diopter; they focus on nearer objects - Red numbers show negative diopter
and focus on objects farther away
how to do ocular fundus examination
To examine a person
◦ Darken room to help dilate pupils; dilating
eyedrops are not needed during a screening examination
◦ Select large round aperture with white light
for routine examination
◦ If pupils are small, use smaller white light
◦ Ask a person to please keep looking at
mark on wall across room
◦ Staring at distant fixed object helps to
dilate pupils and to hold retinal structures
still
steps to examining the ocular fundus on a person
To examine a person
◦ Begin about 25 cm (10 inches) away from a
person at angle of 15 degrees to the person’s
line of vision
◦ Observe for presence of red reflex and
steadily move closer to eye
◦ If you lose red reflex, adjust angle to find it again
◦ As you advance, adjust lens to #6 and note
any opacities in media; these appear as dark
shadows or black dots interrupting red reflex;
normally, none is present
◦ Progress toward the person until foreheads
almost touch
how to adjust the diopter for ocular fundus examinations
◦ Adjust diopter to bring ocular fundus into sharp focus; if you and a person
have normal vision, this should be at 0
◦ Moving diopters compensates for near- or farsightedness
◦ Use red lenses for nearsighted eyes
◦ Use black lenses for farsighted eyes
◦ Moving in on 15-degree lateral line should bring your view just to optic disc
◦ If disc is not in sight, track a blood vessel as it grows larger and it will lead
to disc
what structures should you systematically inspect in the ocular fundus
optic disc
retinal vessels
general background
macula
what to inspect on the optic disc
Most prominent landmark is optic disc,
located on nasal side of retina; explore
these characteristics:
◦ Color: creamy yellow-orange to pink
◦ Shape: round or oval
◦ Margins: distinct and sharply demarcated,
although nasal edge may be slightly fuzzy
◦ Cup-disc ratio: distinctness varies; when
visible, physiologic cup is brighter yellow white than rest of disc; width not more than
one half disc diameter
the two normal variations of the optic disc
scleral crescent
pigment crescent
slceral crescent
gray-white new moon shape occurs when pigment absent in choroid layer
looking directly at sclera
pigment crescent
black due to accumulation
of pigment in choroid
what diameter should you look for of the optic disc when inspecting it and how should you describe it
Diameter of disc (DD) is standard measure
for other fundus structures.
- To describe finding, note its clock-face
position and relationship to disc in size and
distance (e.g., at 5:00, 3 DD from disc)
what are the retinal vessels and what is important about them
Only place in body where you can view
blood vessels directly
◦ Many systemic diseases that affect vascular system show signs in retinal
vessels
when following a paired artery and vein out to the periphery in the four quadrants what should be noted
◦ Number: paired artery and vein pass to
each quadrant; vessels look straighter at
nasal side
◦ Color: arteries brighter red than veins; also
have arterial light reflex, with thin stripe of
light down middle
◦ A:V ratio: ratio comparing artery-to-vein
width is 2:3 or 4:5
◦ Caliber: arteries and veins show a regular
decrease in caliber as they extend to
periphery
retinal vessel - A-V arteriovenous crossing
artery and vein may cross paths; not significant if within 2 DD of disc and if no sign of interruption in blood flow is seen; should be
no indenting or displacing of vessel
retinal vessel - tortuosity
mild vessel twisting when present in both eyes is usually congenital and not significant
retinal vessel - what are pulsations
present in veins near disc as their drainage meets intermittent pressure of arterial
systole; often hard to see
background of the fundus
◦ Color normally varies from light red to dark
brown-red; view of fundus should be clear; no
lesions should obstruct retinal structures
macula
◦ 1 DD in size, located 2 DD temporal to disc
◦ Inspect last in funduscopic examination;
bright light causes some watering, discomfort,
and pupillary constriction
* Normal color somewhat darker than rest of fundus but even and homogeneous
* Clumped pigment may occur with aging
what is eversion of the upper lid and when is it used
Used when one suspects foreign body
or eye pain
- Procedure may cause apprehension;
therefore, use a deliberate approach.
◦ Multi-step procedure using applicator
stick
- Inspect for color change, swelling,
lesion, or evidence of foreign body
the aging adult in visual acuity
◦ Perform same examination as described
in adult section
◦ Central acuity may decrease, particularly
after 70 years of age; peripheral vision
may be diminished
ocular structures in aging adults
◦ Eyebrows may show loss of outer one
third to one half of hair because of
decrease in hair follicles; remaining brow
hair is coarse
◦ As a result of atrophy of elastic tissues,
skin around eyes may show wrinkles or
crow’s feet; upper lid may be so
elongated as to rest on lashes, resulting
in pseudoptosis
◦ Eyes may appear sunken from atrophy of orbital fat; orbital fat
may herniate, causing bulging at lower lids and inner third of
upper lids
◦ Lacrimal apparatus may decrease tear production, causing
eyes to look dry and lusterless and the person to report a
burning sensation
◦ Pingueculae commonly show on the sclera
developmental competence of the aging adult and the eyes - ocular structures
Ocular structures
◦ Cornea may look cloudy with age
◦ Arcus senilis is commonly seen around the
cornea.
◦ Gray-white arc or circle around limbus due
to deposition of lipid material
◦ As more lipids accumulate, cornea may
look thickened and raised, but arcus has
no effect on vision
◦ Xanthelasma: soft, raised yellow plaques
occurring on lids at inner canthus
◦ They commonly occur around fifth decade
of life and more frequently in women,
occur with both high and normal levels of
cholesterol, and have no pathologic
significance
how may the pupils and lens be with old age
◦ Pupils small in old age; pupillary light
reflex may be slowed
◦ Lens loses transparency and looks
opaque
how may the ocular fundus be with old age
◦ Retinal structures generally have less
shine; blood vessels look paler, narrower,
and attenuated; arterioles appear paler
and straighter, with a narrower light reflex
◦ Drusen, or benign degenerative hyaline
deposits, are normal development on
retinal surface
◦ Often symmetrically placed in eyes with
no effect on vision
what is strabismus with asymmetric corneal light reflexes
◦ Esotropia—inward turning of the eye
◦ Exotropia—outward turning of the eye
cover test contains
a uncovered eye and a covered eye
the diagnostic positions test contains
paralysis that indicates the cranial nerve dysfunction
some abnormal eyelid findings
Periorbital edema
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes)
Ptosis (drooping upper lid)
Upward palpebral slant
Ectropion (eversion)
Entropion (inversion)
some abnormal lesion findings on the eyelids
Blepharitis (inflammation of the
eyelids)
Chalazion
Hordeolum (stye)
Dacryocystitis (inflammation of
the lacrimal sac)
Basal cell carcinoma
some common pupil abnormalities
Unequal pupil size—Anisocoria
Monocular blindness
Constricted and fixed pupils—Miosis
Dilated and fixed pupils—Mydriasis
Argyll Robertson pupil
Tonic pupil (Adie’s pupil)
Cranial nerve III damage
Horner’s syndrome
some abnormal findings in visual field loss - retinal damage
◦ Macula central blind area (e.g.,
Diabetes)
◦ Localized damage (Blind spot –
scotoma)
◦ Increasing intraocular pressure
(Glaucoma)
◦ Retinal detachment (shadow or
diminished vision)
Lesion in the globe or optic nerve
◦ One blind eye or unilateral blindness
Lesion at optic chiasm
◦ Pituitary tumor
Lesion of outer uncrossed fibers at the optic chiasm
◦ Aneurysm
Lesion R optic tract or R optic radiation
depending on the nature of the damage what may happen
differences in visual field losses may occur
abnormal findings - red eye vascular disorders
Conjunctivitis
Allergic conjunctivitis
Iritis (circumcorneal redness)
Primary angle-closure glaucoma (PACG)
Subconjunctival hemorrhage
Herpes simplex virus (HSV)
abnormal findings - cornea and iris
Pterygium
Corneal abrasion
Normal anterior chamber
(for contrast)
Shallow anterior chamber
Hyphema
Hypopyon
abnormal findings - opacity in the lens
- central gray opacity-nucleus cataract
- a star shaped opacity - cortical cataract
abnormal findings - optic disc abnormalities
◦ Optic atrophy (disc pallor)
◦ Papilledema (choked disc)
◦ Excessive cup-disc ratio
abnormal findings - retinal vessels and the background
◦ Arteriovenous crossing (Nicking)
◦ Narrowed (attenuated) arteries
◦ Diabetic retinopathy (DR)
◦ Moderate nonproliferative
◦ Severe nonproliferative
◦ Proliferative
summary checklist for eye examinations
Test visual acuity
◦ Snellen eye chart
Test visual fields
◦ Confrontation test
Inspect the EOM function
◦ Corneal light reflex, cover test, diagnostic
positions test
Inspect external eye structures
Inspect anterior eyeball structures
Inspect ocular fundus
◦ Optic disc, retinal vessels, general
background, and macula
pupil size also reacts to what? (exam)
Pupil size also reacts to the amount of ambient light and accommodation or focusing an object on the retina
what do the numbers of a eye prescription mean
- the top number is how close you are to the chart
- the bottom number is the distance at which a person with normal eyesight would be able to see the same thing (the higher this number the worse it is)
20/20 compared to 20/40
if you see 20/20 you would be seeing the same thing that someone who is 20/40 sees at a different distance
what is PERRLA
are pupils equal, round, reacting to light, and accomodation
