eyes

Question 1

A soft yellow spot or plaque that usually occurs in groups around the eyelids.

Answer 1

xanthelasma

Question 2

Bleeding onto or into the conjuctiva of the eye.

Answer 2

Subconjunctival hemmorhage

Question 3

Swelling of the optic disc caused by increased intracranial pressure.

Answer 3

Severe Papilledema

Question 4

A dull looking grey or white ring that surrounds the edges of the cornea. Caused by deposits of fat or by breakdown of tissue.

Answer 4

arcus senilis

Question 5

Swelling in the surface to the eye due to allergy or infection.

Answer 5

acute purulent conjuntivitis

Question 6

Disruption in the corneal epithelium and stroma cause by bacterial infection, viral infection or injury.

Answer 6

corneal ulcer

Question 7

A disorder of blood vessels in the retina of the eye. This occurs most frequently when diabetes is poorly controlled. Repeated bleeding may lead to complete or partial blindness.

Answer 7

Diabetic retinopathy (proliferative)

Question 8

Answer 8

normal fundus - black person

Question 9

Answer 9

normal fundus - light skinned person

Question 10

Test for distance vision

Answer 10

Snellen eye chart at 20 feet

glasses off first one eye then the next

forward the first time, backwards the next

“read the smallest line you’re able to”

Documented as a fraction (20/25 means can read at 20 feet what most people can read at 25 feet)

Question 11

What cranial nerve is assessed with visual testing?

Answer 11

II - optic nerve

Question 12

Test for near vision

Answer 12

Use a near-vision screener card (Rosenbaum) at 35 cm

Test each eye separately

Read smallest line

Record visual acuity from that line

Question 13

Estimation of peripheral vision

Answer 13

Confrontation test Examiner is 1 m away at eye level.

Patient covers right eye, examiner covers left eye.

Look at each other.

Move your wiggling fingers from the side and have patient say when they are seen.

Should be about the same time.

Test nasal, temporal, superior and inferior fields.

Question 14

Equipment for an eye exam

Answer 14

Snellen chart

Rosenbaum chart

penlight

cotton wisp

opthalmascope

eye cover

Question 15

What nine factors do you examine in the eyelids?

Answer 15

1. closed eyelids for fasciculations (–> hyperthyroidism)
2. ability to open eyelids wide and close
3. eyelid margins for flakiness, redness and swelling
4. look for eyelashes to curve away
5. upper eyelid position with the eyes open
6. inversion or eversion
7. sty or crusting (?infection)
8. eyelids meet completely when closed?
9. palpate for nodules

Question 16

Corneal examination - two assessments

Answer 16

1. clarity
2. sensitivity (Q tip)

Question 17

An eye that feels firm and resists palpation

Answer 17

may indicate glaucoma or a retrobulbar tumor

Question 18

When should you examine the upper conjunctiva?

Answer 18

If a foreign body is suspected

Question 19

Normal conjunctiva

Answer 19

clear

no erythema, exudates or hemorrhage

Question 20

Iris and pupil - 5 characteristics to assess

Answer 20

1. inspect iris - should be clearly visible, color of iris
2. pupil’s size and shape
3. pupil’s response to light (should constrict spontaneously)
4. swinging flashlight test
5. accommodation

Question 21

Swinging flashlight test

Answer 21

Shine the light in one eye and then rapidly swing it to the other eye.

If the second eye to be tested continues to dilate rather than constrict, an afferent pupillary defect (RAPD) is present, which suggests optic nerve disease.

Question 22

Testing for accommodation

Answer 22

After looking at a distant object, then focusing on an object 10 cm from the nose, the pupils should constrict.

Question 23

Yellow or green sclera

Answer 23

?liver disease

Question 24

Examination of the extraocular muscles

Answer 24

1. watch finger through six cardinal fields
2. follow finger vertically from ceiling to floor (looking for eyelid movement)
3. corneal light reflex
4. if corneal light reflex is imbalanced, perform cover-uncover test

Question 25

Corneal light reflex

Answer 25

With the patient looking at a nearby object, shine a light on the nasal bridge. The eyes should converge and reflect the light simultaneously.

Question 26

Cover-uncover test

Answer 26

Perform if corneal light reflex is imbalanced. Patient stares at a fixed point nearby, cover one eye and observe the uncovered eye. The remove the cover and observe that eye as it focuses on the object. Note any eye movements.

Question 27

Opthalmic exam - structures to visualize

Answer 27

red reflex (30 cm away)

fundus (yellow or pink)

retina vessels (note pulsations and abnormalities where cross)

optic disc (yellow to creamy pink, 1.5 mm with sharp margin)

macula (lighter dot surrounded by avascular area, about 2 DD temporal to optic disc)

Question 28

What 3 vision fields are tested?

Answer 28

Distance

near

peripheral

Question 29

Eye exam - order of assessment

Answer 29

Visual testing

Inspect surrounding structures (eyebrows, orbital area)

Eyelids (9 factors)

Palpate eye

Conjunctiva

Cornea Iris/pupil

Lens

Sclera

Lacrimal apparatus

Extraocular muscles

Opthalmic exam

Question 30

anisocoria

Answer 30

one pupil larger than the other

Question 31

pupil will NOT constrict to light but will constrict with accommodation

Answer 31

Argyll Robertson pupil

(hallmark of tertiary syphillis)

Question 32

no (or sluggish) pupillary response to light

(both direct and consensual)

Answer 32

Adie’s (Tonic) Pupil

common in 3rd/4th decade

generally benign

Question 33

miosis

Answer 33

pupillary constriction

Question 34

Horner’s Syndrome

Answer 34

1. ptosis
2. miosis
3. anhidrosis (decreased sweating)

Due to loss of sympathetic innervation

Question 35

Relative Afferent Pupillary Defect

(RAFD, Marcus Gunn Pupil)

Answer 35

damage to optic nerve or severe retinal disease will not constrict with swinging flashlight test but will constrict with if light shone in other eye (consensual)