Eyes Flashcards
What are the elements of the first component of the eye exam, testing visual acuity?
Snellen eye chart
Near vision*
*for those older than 40 or having difficulty reading
What are the six major components of the eye exam?
1) test visual acuity
2) test visual fields
3) inspect extraocular muscle function
4) inspect external eye structure
5) inspect anterior eyeball structures
6) inspect the ocular fundus
What is the element of the second component of the eye examination, testing visual fields?
Confrontation test
What are the elements of the third component of the eye exam, inspect extraocular muscle function?
Corneal light reflex (hirschberg test)
Cover-uncover test
Diagnostic position test
What are the elements of the fourth component of the eye exam, inspecting external eye structures?
General
Eyebrows
Eyelids and lashes
Eyeball alignment
Conjunctiva and sclera
Lacrimal apparatus
What are the elements of the fifth component of the eye exam, inspect anterior eyeball structures?
Cornea and lens
Iris and pupil
- size, shape, and equality
- pupillary light reflex
- accommodation
What are the elements of the sixth component of the eye exam, inspect the ocular fundus?
Optic disc - colour, shape, margins, cup-disc ratio
Retinal vessels - number, colour, artery-vein(a-v) ratio, calibre, arteriovenous crossings, tortuosity, pulsations
General background - colour, integrity
Macula - 2 dd from optic disc, 1 dd in diamter, grey
Inspect the external ocular structures
Facial expression - should be relaxed and symmetrical
Note eyebrows. That they are symmetric bilaterally, move symmetrically with facial expressions and have no lesions or scaling
Look at eyelids. Upper lid should cover uppermost part of iris. Note palpebral fissures shape is symmetrical and horizontally aligned.Lids should approximate when closed. Eye lashes should be evenly distributed and curve outward. There should be no lesions, swelling or discharge
Look at the eyeballs. Inspect their alignment in sockets, that they are not sunken nor protruding.
Inspect conjunctiva and sclera by having patient look up and using your thumbs to gently slide down lower lids. Eye should be moist and glossy. The conjunctiva transparent and the vessels visible through it. Sclera should be China white. There should be no swelling or lesions
Examine lacrimal apparatus by having patient look down while you use your thumb to slide upper eyelid along bony orbital to expose under the eye lid. No redness or swelling should be seen. Then using index fingers, gently depress nasoga rival duct, not excessive tearing or response other than slight eversion of lower lid.
Test visual acuity
Administer Snellen at 20ft. Occlude one eye at a time with opaque card. Indicate last line able to be read and if one or two letters were missed, record line score/20
Administer near vision test if indicated by age over 40 or increased difficulty reading
Inspect extraocular muscle function
Test parallel alignment of eyes using corneal light reflex by shining a light from 30 cm away with pt looking straight ahead. Light should appear in same spot in both eyes
Perform cover-uncover test. While covered, uncovered eye should be able to maintain gaze. When uncovered, “covered” eye should have steady, fixed gaze
Perform diagnostic positions test. Test six Cardinal positions of gaze, returning to center each time. Parallel tracking with no lid lag or nystagmus expected
Inspect anterior eyeball structures
Cornea and lens inspected with pen light. Shine light from side to inspect surface. No opacities or cloudiness expected on corneal surface, anterior chamber or lens behind pupil
Inspect iris, which should be flat, round and evenly coloured.
Inspect pupils by testing accommodation - have patient look at a distant object/point then at your pen/finger 7-8cm from their nose. Then test pupillary light reflex, measuring pupil size before and after shining a light at it. PERRLA d+c expected
