Eyes Flashcards by B -

EXTERNAL ANATOMY

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The eye is the sensory organ of vision
A)true
B)false

True

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More than half the neocortex is involved with processing visual information.
A)true
B)false

True

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the eye is well protected by the bony orbital cavity, surrounded with a cushion of fat.
A)true
B)false

True

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The eyelids are like two movable shades that further protect the eye from injury, strong light, and dust. The upper eyelid is the larger and more mobile one.
A)true
B)false

True

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The _________are short hairs in double or triple rows that curve outward from the lid margins, filtering out dust and dirt.
A)eyelashes
B)eyelids

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The __________ is the elliptical open space between the eyelids (Fig. 14-l). When closed, the lid margins approximate completely. When open, the upper lid covers part of the iris.
A)palpebral fissure
B)eyelashes

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The ___________ is just at the limbus, the border between the cornea and sclera.
A)lower lid margin
B)upper lid margin
C)both a and b

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The________ is the corner of the eye, the angle where the lids meet. At the inner canthus, the caruncle is a small, fleshy mass containing sebaceous glands.
A)eyelashes come together
B)canthus

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The canthus is the corner of the eye, the angle where the lids meet. At the inner canthus, the__________ is a small, fleshy mass containing sebaceous glands.
A)caruncle
B)canthus

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Within the upper lid, tarsal plates are strips of connective tissue that give it
A)shape
B)color
C)both a and b

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The tarsal plates contain the__________ glands, modified sebaceous glands that secrete an oily lubricating material onto the lids. This stops the tears from overflowing and helps form an airtight seal when the lids are closed
A)lacrimal
B)meibomian

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The exposed part of the eye has a transparent protective covering, the__________. The________—- is a thin mucous membrane folded like an envelope between the eyelids and the eyeball.
A)cornea
B)rentia
C)conjunctiva

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The ___________ lines the lids and is clear, with many small blood vessels. It forms a deep recess and then folds back over the eye.
A)palpebral conjunctiva
B)cornea
C)cataracts

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The ________ overlays the eyeball, with the white sclera showing through.
A)bulbar conjunctiva
B)sclera
C)both a and b

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At the limbus, the conjunctiva merges with the_______-.
A)rentia
B)cornea
C)iris

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The cornea covers and protects the
A)iris
B)pupil
C)both a and b

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The lacrimal apparatus provides constant irrigation to keep the conjunctiva and cornea moist and lubricated. The ____________, in the upper outer corner over the eye, secretes tears. The tears wash across the eye and are drawn up evenly as the lid blinks.
A)lacrimal gland
B)cornea gland
C)canthus gland

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The _____________ provides constant irrigation to keep the conjunctiva and cornea moist and lubricated. The lacrimal gland, in the upper outer corner over the eye, secretes tears. The tears wash across the eye and are drawn up evenly as the lid blinks
A)lacrimal apparatus
B)cornea apparatus

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The tears drain into the_______, visible on the upper and lower lids at the inner canthus. The tears then drain into the nasolacrimal sac, through the one-half-inch-long nasolacrimal duct, and empty into the inferior meatus inside the nose. A tiny fold of mucous membrane prevents air from being forced up the nasolacrimal duct when the nose is blown.
A)puncta
B)cornea
C)sinus

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Six muscles attach the eyeball to its orbit and serve to direct the eye to points of the person’s interest. These extraocular muscles give the eye both straight and rotary movement. The four straight, or rectus, muscles are the superior, inferior, lateral, and medial rectus muscles. The two slanting, or oblique, muscles are the superior and inferior muscles.
A)true
B)false

True

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Each muscle is coordinated, or yoked, with one in the other eye. This ensures that when the two eyes move, their axes always remain parallel (called conjugate movement). Parallel axes are important because the human brain can tolerate seeing only one image.
A)true
B)false

True

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Each muscle is coordinated, or yoked, with one in the other eye. This ensures that when the two eyes move, their axes always remain parallel called
A)conjugate movement
B)ocular movement

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Movement of the ___________ is stimulated by three cranial nerves. Cranial nerve VI, the abducens nerve, innervates the lateral rectus muscle (which abducts the eye); cranial nerve IV, the trochlear nerve, innervates the superior oblique muscle; and cranial nerve III, the oculomotor nerve, innervates all the rest-the superior, inferior, and medial rectus and the inferior oblique muscles.
A)intraocular muscles
B)extraocular muscles

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Movement of the extraocular muscles (Fig. 14-4, B) is stimulated by three cranial nerves. They are A)Cranial nerve VI, cranial nerve IV, cranial nerve III, B)cranial nerve 6, cranial nerve 3, cranial nerve 5

Cranial nerve VI, A) the abducens nerve, innervates the lateral rectus muscle (which abducts the eye); B)the trochlear nerve, innervates the superior oblique muscle; C), the oculomotor nerve, innervates all the rest-the superior, inferior, and medial rectus and the inferior oblique muscles D)all the above

); cranial nerve IV, A)the trochlear nerve, innervates the superior oblique muscle; B)the oculomotor nerve, innervates all the rest-the superior, inferior, and medial rectus and the inferior oblique muscles C)both a and b

cranial nerve III, A), the abducens nerve, innervates the lateral rectus muscle (which abducts the eye); inferior oblique muscles B)the oculomotor nerve, innervates all the rest-the superior, inferior, and medial rectus and the inferior oblique muscles C) both a and b

Note that the superior oblique muscle is located on the superior aspect of the eyeball, but when it contracts, it enables the person to look A)upward and inward B)downward and inward. C)both a and b

INTERNAL ANATOMY

The eye is a sphere composed of three concentric coats: A) (l) the outer fibrous sclera, (2) the middle vascular choroid, and (3) the inner nervous retina B)false only has 2 real concentric coats

Inside the retina is the transparent A)vitreous body B)aqueous body

The only parts accessible to examination are the A)sclera anteriorly B) retina through the ophthalmoscope C)both a and b

The outer layer of the internal anatomy of the eye is A)sclera B)rentia

The___________ is a tough, protective, white covering. It is continuous anteriorly with the smooth, transparent cornea, which covers the iris and pupil. A)sclera B)rentia

The_______is part of the refracting media of the eye, bending incoming light rays so that they will be focused on the inner retina. A)sclera B)cornea

The________ is very sensitive to touch; contact with a wisp of cotton stimulates a blink in both eyes, called the corneal reflex. The trigeminal nerve (cranial nerve V) carries the afferent sensation into the brain, and the facial nerve (cranial nerve VII) carries the efferent message that stimulates the blink. A)cornea B)rentia

The trigeminal nerve (cranial nerve V) A)carries the afferent sensation into the brain, B) carries the efferent message that stimulates the blink.

the facial nerve (cranial nerve VII) A)carries the efferent message that stimulates the blink. B)carries the afferent message that stimulates the blink.

The middle layer of the internal anatomy A) choroid B) rentia

. The___________ has dark pigmentation to prevent light from reflecting internally and is heavily vascularized to deliver blood to the retina. Anteriorly, the_________ is continuous with the ciliary body and the iris. A)choroid B)rentia C)sclera

The muscles of the _________ control the thickness of the lens. A)ciliary body B)iris

The________ functions as a diaphragm, varying the opening at its center, the pupil. This controls the amount of light admitted into the retina. The muscle fibers of the______ contract the pupil in bright light and to accommodate for near vision; they dilate the pupil in dim light and accommodate for far vision. The color of the______ varies from person to person. A)choroid B)iris

The muscle fibers of the iris contract the pupil A)in bright light and to accommodate for near vision; B) in dim light and accommodate for far vision.

The muscle fibers of the iris,they dilate the pupil A)in bright light and to accommodate for near vision; B)in dim light and accommodate for far vision.

The_______ is round and regular. Its size is determined by a balance between the parasympathetic and sympathetic chains of the autonomic nervous system. Stimulation of the parasympathetic branch, through cranial nerve lll, causes constriction of the________. Stimulation of the sympathetic branch dilates the_________ and elevates the eyelid. As mentioned earlier, the_________ size also reacts to the amount of ambient light and to accommodation, or focusing an object on the retina. A)pupil B)iris

Stimulation of the parasympathetic branch, through cranial nerve lll, A) causes constriction of the pupil. B)Stimulation of the sympathetic branch dilates the pupil and elevates the eyelid.

cranial nerve lll, Stimulation of the sympathetic branch A) causes constriction of the pupil. B)dilates the pupil and elevates the eyelid.

``` The ________ is a biconvex disc located just posterior to the pupil. The transparent_______ serves as a refracting medium, keeping a viewed object in continual focus on the retina. Its thickness is controlled by the ciliary body; the______ bulges for focusing on near objects and flattens for far objects. A)lens B)pupil C)iris D)rentia ```

Its thickness is controlled by the ciliary body; the lens bulges for focusing A)on near objects B)flattens for far objects.

Its thickness is controlled by the ciliary body; the lens flattens for A)far objects. B)near objects. C)both and b

The anterior chamber is posterior to the cornea and in front of the iris and lens. A)true B)false

True

The posterior chamber lies behind the iris to the sides of the lens. A)true B)false

True

These contain the clear, watery aqueous humor that is produced continually by the ciliary body. The continuous flow of fluid serves to deliver nutrients to the surrounding tissues and to drain metabolic wastes. Intraocular pressure is determined by a balance between the amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber. A)anterior chamber B)posterior chamber C)both a and b

Intraocular pressure is determined by a balance between the amount of aqueous produced and resistance to its outflow at the angle of the A)anterior chamber. B)posterior chamber. C)both a and b

The internal anatomy of the inner layer of the eye A)retina B)choroid C)sclera

The_______ is the visual receptive layer of the eye in which light waves are changed into nerve impulses. The_______ surrounds the soft, gelatinous vitreous humor. The______ structures viewed through the ophthalmoscope are the optic disc, the_______ vessels, the general background, and the macula A)choroid B)retina C)sclera

``` The __________ is the area in which fibers from the retina converge to form the optic nerve. Located toward the nasal side of the retina, it has these characteristics: a color that varies from creamy yellow-orange to pink; a round or oval shape; margins that are distinct and sharply demarcated, especially on the temporal side; and a physiologic cup, the smaller circular area inside the disc where the blood vessels exit and enter. A)optic disc"blind spot" B)cornea C) creamy choroid D)all the above ```

The __________ normally include a paired artery and vein extending to each quadrant, growing progressively smaller in caliber as they reach the periphery. The arteries appear brighter red and narrower than the veins, and the arteries have a thin sliver of light on them (the arterial light reflex). The general background of the fundus varies in color, depending on the person's skin color. A)retinal vessels B)sclera vessels C)choroid vessels

The general background of the fundus varies in color, depending on the person's skin color. A)true B)false

True

VISUAL PATHWAYS AND VISUAL FIELDS

Objects reflect light. The light rays are refracted through the transparent media (cornea, aqueous humor, lens, and vitreous body) and strike the retina. A)true B)false

True

``` The _______transforms the light stimulus into nerve impulses that are conducted through the optic nerve and the optic tract to the visual cortex of the occipital lobe. A)retina B)sclera C)choroid D)all the above ```

The image formed on the retina is upside down and reversed from its actual appearance in the outside world. A)true B)false

True

The image formed on the retina is upside down and reversed from its actual appearance in the outside world.That is, an object in the upper temporal visual field of the right eye reflects its image onto the lower nasal area of the retina. A)true B)false

True

All retinal fibers collect to form the optic nerve, but they maintain this same spatial arrangement, with nasal fibers running medially and temporal fibers running laterally. A)true B)false

True

nasal fibers running A)medially B)laterally.

temporal fibers running A)medially B)laterally.

``` At the __________, nasal fibers (from both temporal visual fields) cross over. The left optic tract now has fibers from the left half of each retina, and the right optic tract contains fibers only from the right. Thus the right side of the brain looks at the left side of the world. A)optic brain B)optic chiasm C)optic disk D)all the above ```

VISUAL REFLEXES

The ____________ is the normal constriction of the pupils when bright light shines on the retina. It is a subcortical reflex arc (i.e., a person has no conscious control over it); the sensory afferent link is cranial nerve II (the optic nerve), and the motor efferent path is cranial III (the oculomotor nerve) A)Pupillary Light Reflex B)retinal light reflex

When one eye is exposed to bright light, a direct light reflex occurs (constriction of that pupil) as well as a consensual light reflex (simultaneous constriction of the other pupil). This happens because the optic nerve carries the sensory afferent message in and then synapses with both sides of the brain. A)true B)false

True

a direct light reflex occurs (constriction of that pupil) as well as a consensual light reflex (simultaneous constriction of the other pupil). A)true B)false

True

For example, consider the light reflex in a person who is blind in one eye. Stimulation of the normal eye produces both a direct and a consensual light reflex. Stimulation of the blind eye causes no response because the sensory afferent in cranial nerve II is destroyed. A)true B)false

True

This is a reflex direction of the eye toward an object attracting a person's attention. The image is fixed in the center of the visual field, the fovea centralis. This consists of very rapid ocular movements to put the target back on the fovea and somewhat slower (smooth pursuit) movements to track the target and keep its image on the fovea. These ocular movements are impaired by drugs, alcohol, fatigue, and inattention A)fixation B)accommodation C)both a and b

This is adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of the ciliary muscles. Although the lens cannot be observed directly, the components of____________ that can be observed are convergence (motion toward) of the axes of the eyeballs and pupillary constriction A)fixation B)accommodation

DEVELOPMENTAL COMPETENCE | Infants and Children

At birth, eye function is limited, but it matures fully during the early years. Peripheral vision is intact in the newborn infant. A)true B)false

True

The macula, the area of keenest vision, is absent at birth but is developing by 4 months and is mature by 8 months. Eye movements may be poorly coordinated at birth. A)true B)false

True

By 3 to 4 months of age, the infant establishes binocularity and can fixate on a single image with both eyes simultaneously. A)true B)false

True

``` Most neonates (80%) are born farsighted; this gradually decreases after 7 to 8 years of age. A)true B)false ```

True

In structure, the eyeball reaches adult size by 8 years. A)true B)flase

True

At birth, the iris shows little pigment and the pupils are small. The lens is nearly spherical at birth, growing flatter throughout life. Its consistency changes from that of soft plastic at birth to rigid glass in old age. A)true B)false

True

Developmental Competence | The Aging Adult

Changes in eye structure contribute greatly to the distinct facial changes of the aging person. A)true B)false

True

The skin loses its elasticity, causing wrinkling and drooping; fat tissues and muscles atrophy; and the external eye structures appear as on p. 306. A)true B)false

True

Lacrimal glands involute, causing decreased tear production and a feeling of dryness and burning. A)true B)false

True

Pupil size decreases. The lens loses elasticity, becoming hard and glasslike. This glasslike quality decreases the lens's ability to change shape to accommodate for near vision; this condition is termed presbyopia. A) true B) false

True

By 40 years of age, 50% of people have presbyopia. A)true B)false

True

By 70 years of age, the normally transparent fibers of the lens begin to thicken and yellow; this is the beginning of a senile cataract. A)true B)false

True

Inside the globe, floaters appear in the vitreous as a result of debris that accumulates because the vitreous is not renewed as continuously as the aqueous humor. A)true B)false

True

Visual acuity may diminish gradually after 50 years of age, and even more so after 70 years. A)true B)false

True

Near vision is commonly affected because of the decreased power of accommodation in the lens (presbyopia). A)true B)false

True

In the early 40s, a person may have blurred vision and difficulty reading. A)true B)false

True

Also, the aging person needs more light to see because of a decreased adaptation to darkness, and this condition may affect the function of night driving. A)true B)flase

True

In older adults, the most common causes of decreased visual functioning are:

Cataract formation, or lens opacity, resulting from a clumping of proteins in the lens. Some cataract formation should be expected by age 70 years. Studies indicate that 46% of people ages 75 to 85 years have cataracts. A)true B)false

True

2. Glaucoma, or increased intraocular pressure. The incidence increases with age to 7.2% at ages 75 to 85 years, affecting men at higher rates than women. Chronic open angle glaucoma is the most common type; it involves a gradual loss of peripheral vision. A)true B)flase

True

3. Macular degeneration, or the breakdown of cells in the macula of the retina. Loss of central vision, the area of clearest vision, is the most common cause of blindness. It affects 28% of those ages 75 to 85 years, with women affected more often than men.With this, the person is unable to read fine print, sew, or do fine work and may have difficulty distinguishing faces. Depending on how much the lifestyle is oriented around activities requiring close work, loss of central vision may cause great distress. Peripheral vision is not affected, so the person can manage self-care and will not become completely disabled. A)true B)false

True

CULTURE AND GENETICS

Racial differences are evident in the palpebral fissures. A)true B)false

True

Persons of Asian origin are often identified by their characteristic eyes, A)true B)false

True

whereas the presence of narrowed palpebral fissures in non-Asian individuals may be diagnostic of a serious congenital anomaly, Down syndrome A)true B)false

True

Culturally based variability exists in the color of the iris and in retinal pigmentation, with darker irides having darker retinas behind them. A)true B) false

True

Individuals with light retinas generally have better night vision but can have pain in an environment that has too much light A)true B)flase

True

Primary open-angle glaucoma affects Blacks three to six times more often than whites and is six times more likely to cause blindness in Blacks than in whites.Reasons for this are not known. A)true B)flase

True

The percent of adults 18 years of age and older reporting visual limitations and trouble seeing with glasses in 2006 was the highest, 16.7%, among American Indians and Alaska natives; African Americans I 0.4%; and whites 9.5%. Poverty is also an extenuating factor in this problem; 26.4% of the population living within poverty levels report this. A)true B)false

True

In whites older than 40 years, the leading cause of blindness is age-related macular degeneration (54%), followed by cataracts (9%)." In Blacks older than 40 years, cataracts and open-angle glaucoma together cause 60% of blindness. In Hispanics older than 40 years, the leading cause of blindness is open-angle glaucoma. A)true B)false

True

In Blacks older than 40 years, cataracts and open-angle glaucoma together cause 60% of blindness. A)true B)false

True

In Hispanics older than 40 years, the leading cause of blindness is open-angle glaucoma. A)true B)false

True

SUBJECTIVE DATA

1. Vision difficulty (decreased acuity, blurring, blind spots) 2. Pain 3. Strabismus, diplopia 4. Redness, swelling 5. Watering, discharge 6. History of ocular problems 7. Glaucoma 8. Use of glasses or contact lenses 9. Self-care behaviors Are all what data A)objective data B)subjective data

Do spots move in front of your eyes? One or many? In one or both eyes? A)Floaters are common with myopia or after middle age due to condensed Yitreous fibers. Usually not significant, but acute onset of floaters ("shade" or "cobwebs") occurs with retinal detachment B)Halos around lights occur with acute narrow-angle glaucoma.

Any halos/rainbows around objects? Or rings around lights? A)Halos around lights occur with acute narrow-angle glaucoma. B)Scotoma, a blind spot surrounded by an area of normal or decreased Yision, occurs with glaucoma, with optic nerve disorders.

Any blind spot? Does it move as you shift your gaze? Any loss of peripheral vision? A)Scotoma, a blind spot surrounded by an area of normal or decreased Yision, occurs with glaucoma, with optic nerve disorders. B)Night blindness occurs with optic atrophy, glaucoma, or vitamin A deficiency.

Any night blindness? A)Night blindness occurs with optic atrophy, glaucoma, or vitamin A deficiency. B)Halos around lights occur with acute narrow-angle glaucoma.

Any eye pain? Please describe. • Come on suddenly? A)Sudden onset of eye symptoms (pain, floaters, blind spot, loss of peripheral vision) is an emergency. Refer immediately. B)Quality is valuable in diagnosis. Photophobia is the inability to tolerate

Quality-a burning or itching? Or sharp, stabbing pain? Pain with bright light? A)Quality is valuable in diagnosis. Photophobia is the inability to tolerate B)Note: Some common eye diseases cause no pain (e.g., cataract, glaucoma).

A foreign body sensation? Or deep aching? Or headache in brow area? A)Note: Some common eye diseases cause no pain (e.g., cataract, glaucoma). B)none

Strabismus, diplopia. Any history of crossed eyes? Now or in the past? Does this occur with eye fatigue? A)Strabismus is a deviation in the axis of the eye B)Ever see double? Constant, or does it come and go? In one eye or both?

Ever see double? Constant, or does it come and go? In one eye or both? A)Diplopia is the perception of two images of a single object. B)infections

Redness, swelling. Any redness or swelling in the eyes? A)infections may be present B)normal signss

Watering, discharge. Any watering or excessive tearing? A)Lacrimation (tearing) and epiphora (excessive tearing) are due to irritants or obstruction in drainage of tears. B)hygiene

Any discharge? Any matter in the eyes? Is it hard to open your eyes in the morning? What color is the discharge? A)Purulent discharge is thick and yellow. Crusts form at night. B)none

How do you remove matter from your eyes? A)Assess hygiene practices and knowledge of crosscontamination. B)no contamination

Past history of ocular problems. Any history of injury or surgery to eye? Or any history of allergies? A)Allergens cause irritation of conjunctiva or cornea (e.g., makeup, contact lens solution). B)none

Glaucoma. Ever been tested for glaucoma? Results? A)Glaucoma is characterized by increased intraocular pressure. B)If you wear contact lenses, are there any problems such as pain, photophobia, watering, or swelling?

If you wear contact lenses, are there any problems such as pain, photophobia, watering, or swelling? A)assess irritation,allergic reaction and infection B)don't assess

Any environmental conditions at home or at work that may affect your eyes? For example, flying sparks, metal bits, smoke, dust, chemical fumes? If so, do you wear goggles to protect your eyes? A)Work-related eye disease (e.g., an auto mechanic with a foreign body from metal working or radiation damage from welding). B)none

Last vision test? Ever tested for color vision? A)Self-care behaviors for eyes and vision. B)What medications are you taking? Systemic or topical? Do you take any medication specifically for the eyes?

What medications are you taking? Systemic or topical? Do you take any medication specifically for the eyes? A)Some medications affect the eyes (e.g., prednisone may cause cataracts or increased intraocular pressure). B)A constant spatial layout eases navigation through the home.

Do you maintain your living environment the same? A)A constant spatial layout eases navigation through the home. B)none

Additional History for Infants and Children

Any vaginal infections in the mother at time of delivery? A)Genital herpes and gonorrhea vaginitis have ocular sequelae for the newborn. B)The parent is most often the one to detect vision problems.

Considering age of child, which developmental milestones of vision have you (parent) noted? A)The parent is most often the one to detect vision problems. B)none

``` Are you (parent) aware of safety measures to protect child's eyes from trauma? Do you inspect toys? Have you taught the child safe care of sharp objects and how to carry and how to use them? A)assess safety prevention B)none ```

Additional History for the Aging Adult

Have you noticed any visual difficulty with climbing stairs or driving? Any problem with night vision? A)Any loss of depth perception or central vision. B)none

When was the last time you were tested for glaucoma? Any acning pain around eyes? Any loss of peripheral vision? • If you have glaucoma, how do you manage your eyedrops? A)Compliance may be a problem if symptoms are absent. Assess ability to administer eyedrops. B)Decreased tear production may occur with aging.

Is there a history of cataracts? Any loss or progressive blurring of vision? A)assessing eyes B)none

Do your eyes ever feel dry? Burning? What do you do for this? A)Decreased tear production may occur with aging. B)Macular degeneration causes a loss in central vision acuity.

Any decrease in usual activities, such as reading or sewing? A)Macular degeneration causes a loss in central vision acuity. B)none

OBJECTIVE DATA

Position the person standing for vision screening; then sitting up with the head at your eye level. A)true B)false

Snellen Eye Chart

The _______ is the most commonly used and accurate measure of visual acuity. It has lines of letters arranged in decreasing size. A)Snellen alphabet chart B)kardex

Place the _________ in a well-lit spot at eye level. Position the person on a mark exactly 20 feet from the chart. Hand over an opaque card with which to shield one eye at a time during the test; inadvertent peeking may result A)Eye chart B)Snellen alphabet chart C)both a and b

``` Abnormal finding during a Snellen Eye Chart reading would be? A)hesitancy B) squinting, leaning forward C)misreading letters D)all the above ```

Indicate whether the person missed any letters or if corrective lenses were worn-for example, "Right 20/30- 1, with glasses." That is, the right eye scored 20/30, missing one letter. A)Snellen Eye Chart B)correct

Normal visual acuity is 20/20. Contrary to some people's impression, the numeric fraction is not a percentage of normal vision. Instead, the top number (numerator) indicates the distance the person is standing from the chart, and the denominator gives the distance at which a normal eye could have read that particular line. Thus ''20/30" means, "You can read at 20 feet what the normal eye can see from 30 feet away." A)true B) false

True

the top number (numerator) indicates the A)distance the person is standing from the chart, B) distance at which a normal eye could have read that particular line

the denominator gives the A)distance at which a normal eye could have read that particular line. B) distance the person is standing from the chart,

''20/30" means, "You can read at 20 feet what the normal eye can see from 30 feet away." A)true B)false

True

The larger the denominator, the poorer the vision. If vision is poorer than 20/30, refer to an ophthalmologist or optometrist. Impaired vision may be due to refractive error, opacity in the media (cornea, lens, vitreous), or disorder in the retina or optic pathway. A)true B)false

True

The larger the denominator, the poorer the vision. If vision is poorer than 20/30,the nurse knows that the patient will eventually have to see a A)ophthalmologist B)optometrist C)both a and b

Impaired vision may be due to which of the following? A)refractive error, opacity in the media (cornea, lens, vitreous) B)disorder in the retina or optic pathway C)both a and b

If the person is unable to see even the largest letters, shorten the distance to the chart until it is seen and record that distance (e.g.," 10/200"). If visual acuity is even lower, assess whether the person can count your fingers when they are spread in front of the eyes or distinguish light perception from your penlight. A)true B)false

True

If visual acuity is even lower, the nurse should A)assess whether the patient can count your fingers when they are spread in front of the eyes or distinguish light perception from your penlight B)None

Near Vision

For people older than 40 years or for those who report increasing difficulty reading, test near vision with a handheld vision screener with various sizes of print (e.g., a Jaeger card). Hold the card in good light about 35 cm (14 inches) from the eye-this distance equals the print size on the 20-foot chart. Test each eye separately, with glasses on. A normal result is "14/14" in each eye, read without hesitancy and without moving the card closer or farther away. When no vision screening card is available, ask the person to read from a magazine or newspaper. A)true B)false

True

Presbyopia, the decrease in power of accommodation with aging, is suggested when the person moves the card farther away A) true B)false

True

The nurse is testing an older adult for near vision the nurse knows when the patient moves the card farther away. Which of the following would be suggested A)cataracts B)presbyopia C)glaucoma

Confrontation Test

This is a gross measure of peripheral vision. It compares the person's peripheral vision with your own, assuming yours is normal. 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 the 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 a pencil or your flicking finger as a target midline between you and slowly advance it in from the periphery in several directions A)Confrontation Test B)accommodation test

Ask the person to say "now" as the target is first seen; this should be just as you see the object also. (This works with all but the temporal visual field, with which you would need a 6-foot arm to avoid being seen initially! With the temporal direction, start the object somewhat behind the person.) Estimate the 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 temporally, 70 degrees down, and 60 degrees nasally A)true B)false

True

``` the temporal visual field, with which you would need a 6-foot arm to avoid being seen initially! With the temporal direction the nurse would start the object A)somewhat behind the person B)in front of the person C)both a and b D)at the angle of the nasal ```

If the person is unable to see the object as the examiner does, the test suggests peripheral field loss. In an older adult, this screens for glaucoma. Refer to a specialist for more precise testing. A)glaucoma vision test B)Confrontation Test

If the person is unable to see the object as the examiner does, the test suggests peripheral field loss. A)Confrontation Test B)accommodation test

. In an older adult, this screens for glaucoma. A)accommodation test B)Confrontation Test

Acutely diminished visual fields occur with diseases of the retina and stroke. A)true B)false

True

Range of peripheral vision | Confrontation Test

Normal results of the Confrontation Test is, select all that apply A)50 degrees superiorly B)90 degrees Temporally anterior posterior of axis of the eye C)70 degrees inferiorly D)60 degrees nasally

A B C D

INSPECT EXTRAOCULAR MUSCLE FUNCTION

Corneal Light Reflex (The Hirschberg Test)

Assess the parallel alignment of the 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 the light on the corneas; it should be in exactly the same spot on each eye. See the bright white dots for symmetry of the corneal light reflex. This test is called? A)The Hirschberg Test B)Corneal Light Reflex C)both a and b

Asymmetry of the light reflex indicates deviation in alignment from eye muscle weakness or paralysis. If you see this, perform the cover test A)true B)flase

True

Perform cover test after the The Hirschberg Test) if the patient A)Asymmetry of the light reflex indicates deviation in alignment from eye muscle weakness or paralysis B)none

Cover Test

This test detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. Ask the person to stare straight ahead at your nose even though the gaze may be interrupted. With an opaque card, cover one eye. As it is covered, note the uncovered eye. A normal response is a steady fixed gaze A)The Hirschberg Test B)Cover test

``` If the eye jumps to fixate on the designated point, doing the cover test then A)it was out of alignment before B)it was out of pupillary reflex C)it show sluggish perla D)all the above ```

During the cover test the macular image has been suppressed on the covered eye. If muscle weakness exists, the covered eye will A) drift into a relaxed position. B)remain open on to fixation

Now uncover the eye and observe it for movement. It should stare straight ahead (Fig. 14-13, B). If it jumps to re-establish fixation, eye muscle weakness exists. Repeat with the other eye. A)negative cover test B)positive cover test

A ___________ is a mild weakness noted only when fusion is blocked. A)Phoria B)Tropia

________ is more severe-a constant malalignment of the eyes A)Phoria B)Tropia

Diagnostic Positions Test

Leading the eyes through the six cardinal positions of gaze will elicit any muscle weakness during movement (Fig. 14-14). Ask the person to hold the head steady and to follow the movement of your finger, pen, or penlight only with the eyes. Hold the target back about 12 inches so the person can focus on it comfortably, and move it to each of the six positions, hold it momentarily, then back to center. Progress clockwise. A normal response is parallel tracking of the object with both eyes. A)cover test B)Diagnostic Positions Test

``` Eye movement is not parallel. Failure to follow in a certain direction indicates weakness of an extraocular muscle (EOM) or dysfunction of cranial nerve innervating it. A)negative cover test B)negative Diagnostic Positions Test C)positive cover test D)positive Diagnostic Positions Test ```

In addition to parallel movement, note any nystagmus-a fine, oscillating movement best seen around the iris. Mild nystagmus at an extreme lateral gaze is normal; nystagmus at any other position is not. A)true B)flase

True

The nurse notes, nystagmus-a fine, oscillating movement best seen around the iris, but it is a Mild nystagmus at an extreme lateral gaze is A)normal; nystagmus at any other position is not. B)not normal report it to the MD

A patient has nystagmus at medial border is that normal. A)no the nurse needs to report it to the physician B)yes perfectly normal for a patient

Nystagmus occurs with disease of the semicircular canals in the ears, a paretic eye muscle, multiple sclerosis, or brain lesions. A)true B)false

True

``` Nystagmus occurs with disease of the?select all that apply A) semicircular canals in the ears B) a paretic eye muscle C)multiple sclerosis D)brain lesions. ```

A B C D

Rapid involuntary movements of the eye is called. A)nystagmus B)glaucoma

Finally, note that lhe upper eyelid continues to overlap the superior part of the iris, even during downward movement. You should not see a white rim of sclera between the lid and the iris. If noted, this is termed "lid lag." A)true B)false

True

Finally, note that the upper eyelid continues to overlap the superior part of the iris, even during downward movement. A)normal finding B)abnormal finding "

The nurse notice a white rim of sclera between the lid and the iris of a patient.The nurse knows that this is termed is called A)lid lag. B)sclera lag

Lid lag occurs with A)hypothyroidism B)hyperthyroidism C)both a and b

INSPECT EXTERNAL OCULAR STRUCTURES

Begin with the most external points, and logically work your way inward A)true B)false

True

General

a relaxed expression accompanies adequate vision. A)true B)false

True

Squinting or craning forward A)abnormal finding B)normal finding

Eyebrows

Look for symmetry between the two eyes. Normally the eyebrows are present bilaterally, move symmetrically as the facial expression changes, and have no scaling or lesions A)true B)false

True

Unequal or absent movement with nerve damage. A)abnormal finding with the eyebrows B)normal finding with the eyebrows

Scaling with seborrhea. A)abnormal finding with the eyebrows B)abnormal finding with the eye lashes

Eyelids and lashes

The upper lids normally overlap the superior part of the iris and approximate completely with the lower lids when closed. The skin is intact without redness, swelling, discharge, or lesions A)normal finding of eyelids and lashes B)normal findings of eyebrows

Lid lag with hyperthyroidism. Incomplete closure creates risk for corneal damage. A)abnormal finding of eyelids and lashes B)abnormal finding of eyebrows

The palpebral fissures are horizontal in non-Asians, A)true B)false

True

whereas Asians normally have an upward slant. A)true B)false

True

Ptosis, drooping of upper lid. A)abnormal finding of the eyelids and lashes B)normal finding

Periorbital edema, lesions A)abnormal finding of the eyelids and lashes B)normal finding

Note that the eyelashes are evenly distributed along the lid margins and curve outward. A)true B)false

True

A condition, typically a consequence of advanced age in which the eyelid is turned outward away from the eyeball? A)ectropion B)lentropion

A condition in which the eyelid is rolled inward against the eyeball typically caused by muscle spasm or by inflammation or scaring of the conjunctiva and resulting in irritation of the eye by the lashes A)ectropion B)entropion

Eyeballs

The eyeballs are aligned normally in their sockets with no protrusion or sunken appearance. A)true B)false

True

``` What race, normally may have a slight protrusion of the eyeball beyond the supraorbital ridge. A)Asian Americans B)Hispanic American C)Caucasian American D)African American ```

Exophthalmos A)(protruding eyes) B) (sunken eyes)

enophthalmos A)(protruding eyes) B)(sunken eyes)

Conjunctiva and Sclera

Ask the person to look up. Using your thumbs, slide the lower lids down along the bony orbital rim. Take care not to push against the eyeball. Inspect the exposed area (Fig. 14-16). The eyeball looks moist and glossy. Numerous small blood vessels normally show through the transparent conjunctiva. Otherwise, the conjunctivae are clear and show the normal color of the structure below pink over the lower lids and white over the sclera. Note any color change, swelling, or lesions. A)checking the conjunctiva B)checking the sclera

General reddening (see Table 14-6, Vascular Disorders). Cyanosis of the lower lids. Pallor near the outer canthus of the lower lid may indicate anemia {the inner canthus normally contains less pigment). A)abnormal finding of the conjunctiva B)abnormal finding of the sclera

The________ is china white, although African Americans occasionally have a gray-blue or "muddy" color to the sclera. Also in dark-skinned people, you normally may see small brown macules (like freckles) on the________, which should not be confused with foreign bodies or petechiae. Last, African Americans may have yellowish fatty deposits beneath the lids away from the cornea. Do not confuse these yellow spots with the overall scleral yellowing that accompanies jaundice. A)conjunctiva B)sclera

What race, occasionally have a gray-blue or "muddy" color to the sclera. Also in _____________, you normally may see small brown macules (like freckles) on the sclera, which should not be confused with foreign bodies or petechiae. Last, _____________ may have yellowish fatty deposits beneath the lids away from the cornea. Do not confuse these yellow spots with the overall scleral yellowing that accompanies jaundice. The nurse knows this is normal for what race. A)Asian Americans B)African American C)Caucasian American

is an even yellowing of the sclera extending up to the cornea, indicating jaundice. The nurse knows that this could be do to which of the following A)Scleral icterus B)jaundic

Tenderness, foreign body, discharge, or lesions. A)abnormal findings of the sclera B)abnormal findings of the conjunctiva

Eversion of the Upper Lid

This maneuver is not part of the normal examination, but it is useful when you must inspect the conjunctiva of the upper lid, as with eye pain or suspicion of a foreign body. Most people are apprehensive of any eye manipulation. Enhance their cooperation by using a calm and gentle, yet deliberate, approach A) eversion of the upper eyelid B) inversion of the upper eyelid

1. Ask the person to keep both eyes open and look down. This relaxes the eyelid, whereas closing it would tense the orbicularis muscle. 2. Slide the upper lid up along tl1e bony orbit to lift up the eyelashes. 3. Grasp the lashes benveen your thumb and forefinger and gently pull down and outward. 4. With your other hand, place the tip of an applicator stick on the upper lid above the level of the internal tarsal plates 5. Gently push down with the stick as you lift the lashes up. This uses the edge of the tarsal plate as a fulcrum and flips the lid inside out. Take special care not to push in on tl1e eyeball. 6. Secure the everted position by holding the lashes against the bony orbital rim 7.Inspect for any color change, swelling, lesion, or foreign body. 8. To return to normal position, gently pull the lashes out\vard as the person looks up. A)steps to inversion of the upper eyelid B)steps to eversion of the upper eyelid

Lacrimal Apparatus

Ask the person to look down. With your thumbs, slide the outer part of the upper lid up along the bony orbit to expose under the lid. Inspect for any redness or swelling. The nurse is inspecting? A)Lacrimal Apparatus B)upper eyelids

The nurse knows that Swelling of the lacrimal gland may show as a A)visible bulge in the outer part of the upper lid B) visible bulge in the inner part of the lower lid.

Normally the puncta drain the tears in to the lacrimal sac. Presence of excessive tearing may indicate blockage of the nasolacrimal duct. Check this by pressing the index finger against the sac, just inside the lower orbital rim, not against the side of the nose (Fig. 14-18). Pressure will slightly evert the lower lid, but there should be no other response to pressure. A)true B)false

True

Normally the puncta drain the tears in to the A)lacrimal sac B)sclera C)both a and b

Normally the puncta drain the tears in to the lacrimal sac. Presence of excessive tearing may indicate blockage of the A)nasolacrimal duct. B)lacrimaltemperal duct

Normally the puncta drain the tears in to the lacrimal sac. Presence of excessive tearing may indicate blockage of the nasolacrimal duct. So the nurses would? A)Check this by pressing the index finger against the sac, just inside the lower orbital rim, not against the side of the nose. Pressure will slightly evert the lower lid, but there should be no other response to pressure. B)false

Puncta red, swollen, tender to pressure. Watch for any regurgitation of fluid out of the puncta, which confirms duct blockage. A)abnormal fringing of lacrimal apparatus B)abnormal finding of the sclera

A small distinct point opening into the tear duct A)sclera B)Puncta C)both a and b

INSPECT ANTERIOR EYEBALL STRUCTURES

Cornea and Lens

Shine a light from the side across the cornea, and check for smoothness and clarity. This oblique view highlights any abnormal irregularities in the corneal surface. There should be no opacities (cloudiness) in the cornea, the anterior chamber, or the lens behind the pupil. Do not confuse an arcus senilis with an opacity. The arcus senilis is a normal finding in aging persons. A)true B)false

True

The arcus senilis is a normal finding in A)young adult B)aging persons

``` an opaque ring, gray to white in color, that surrounds the periphery of the cornea. It is caused by deposits of cholesterol in the cornea or hyaline degeneration and occurs primarily in older persons. A)arcus senilis B)glaucoma C) cataracts D)all the above ```

A corneal abrasion causes A)irregular ridges in reflected light, producing a shattered look to light rays B)hemorrhageing

Iris and Pupil

The iris normally appears flat, with a round regular shape and even coloration. A)true B)false

True

Note the size, shape, and equality of the pupils. Normally the pupils appear round, regular, and of equal size in both eyes. In the adult, resting size is from 3 to 5 mm. A)true B)false

True

A small number of people (5%) normally have pupils of two different sizes, which is termed A)anisocoria B)bilateral puplipus C)both a and b

Normally the pupils appear round, regular, and of equal size in both eyes. In the adult, resting size is from A)4 to 6mm B)3 to 5 mm C)2 to 4 mm

Irregular shape. Although they may be normal, all unequal-size pupils call for a consideration of central nervous system injury. A)abnormal findings of pupil B)normal findings of pupils

To test the pupillary light reflex, the nurse should A)darken the room and ask the person to gaze into the distance. (This dilates the pupils.) Advance a light in from the side* and note the response. B)brighten the room and wear sun glasses to test the pupils

Normally you will see what action doing a pupillary light reflex A)constriction of the same-sided pupil (a direct light reflex) B)simultaneous constriction of the other pupil (a consensual light reflex). C)Both a and b

Dilated pupils. Dilated and fixed pupils. Constricted pupils. Unequal or no response to light. A)abnormal finding of pupillary light reflex B)normal finding of pupillary light reflex

Always In the acute care setting, gauge the pupil size in millimeters, both before and after the light reflex. Recording the pupil size in millimeters is more accurate when many nurses and physicians care for the same person or when small changes may be significant signs of increasing intracranial pressure. Normally, the resting size is 3, 4, or 5 mm and decreases equally in response to light. A)true B)false

True

Normally, the resting size is 3, 4, or 5 mm and decreases equally in response to light. A)true B)false

True

Always advance the light in from the side to test the light reflex. If you advance from the front, the pupils will constrict to accommodate for near vision. Thus you do not know what the pure response to the light would have been. A)true B)false

True

A normal response is recorded as: This indicates that both pupils measure 3 mm in the resting state and that both constrict to 1 mm in response to light. A graduated scale printed on a handheld vision screener or taped onto a tongue blade facilitates your measurement A)true B)false

True

Test for______________ by asking the person to focus on a distant object. This process dilates the pupils. Then have the person shift the gaze to a near object, such as your finger held about 7 to 8 cm (3 inches) from the Abnormal Findings person's nose. A normal response includes (1) pupillary constriction and (2)convergence of the axes of the eyes. A)accommodation B)pupillary

Absence of constriction or covergence. Asymmetric response. Is an? A)abnormal finding in the test of accommodation B)normal finding

Far vision the pupils will? A)dilate B)pupils constrict

Near vision the pupils will A)constrict B)dilate

Record the normal response to all these maneuvers as A)PERRLA. B)accommodation C)both a and b

Record the normal response to all these maneuvers as PERRLA, or A)Pupils Equal, Round, React to Light, and Accommodation B)none

INSPECT THE OCULAR FUNDUS with an ophthalmoscope

The _____________ enlarges your view of the eye so that you can inspect the media {anterior chamber, lens, vitreous) and the ocular fundus (the internal surface of the retina). It accomplishes this by directing a beam of light through the pupil to illuminate the inner structures. Thus using the ophthalmoscope is like peering through a keyhole (the pupil) into an interesting room beyond. A)ophthalmoscope B)otoscope

The ophthalmoscope should function as an appendage of your own eye. This takes some practice. Practice holding the instrument and focusing at objects around the room before you approach a "real" person. Hold the ophthalmoscope right up to your eye, braced firmly against the cheek and brow. Extend your index finger onto the lens selector dial so that you can refocus as needed during the procedure without taking your head away from the ophthalmoscope to look. Now look about the room, moving your head and the instrument together as one unit. Keep both your eyes open; just view the field through the ophthalmoscope A)true B) false

True

The unit of strength of each lens is the diopter.The black numbers indicate a positive diopter; They focus on objects nearer in space to the ophthalmoscope. The red numbers show a negative diopter and arc for focusing on objects farther away. A)true B)false

True

The black numbers indicate a positive diopter; They focus on objects nearer in space to the ophthalmoscope. A)true B)false

True

The red numbers show a negative diopter and arc for focusing on objects farther away. A)true B)false

True

To examine a person, darken the room to help dilate the pupils. (Dilating eyedrops are not needed during a screening examination. When indicated, they dilate the pupils for a wider look at the fundus background and macular area. Eyedrops are used only when glaucoma can be completely ruled out, because dilating the pupils in the presence of glaucoma can precipitate an acute episode.) A)true B)false

True

To examine a person,with an ophthalmoscope the nurse A) darken the room to help dilate the pupils. B) brighten the room

Dilating eyedrops are not needed during a screening examination. When indicated, they dilate the pupils for a wider look at the fundus background and macular area. Eyedrops are used only when glaucoma can be completely ruled out, because dilating the pupils in the presence of glaucoma can precipitate an acute episode.) A)true B)false

True

Eyedrops are used only when glaucoma can be completely ruled out, because dilating the pupils in the presence of glaucoma can precipitate an acute episode.) A)true B)false

True

Remove your eyeglasses and those of the other person; they obstruct close movement and you can compensate for their correction by using the diopter setting. A)true B)false

True

Contact lenses may be left in; they pose no problem as long as they are clean. A)during an ophthalmoscope B)false

If the pupils are small, use the smaller white light. A)true B)false

True

The light must have maximum brightness; replace old or dim batteries. A)true B)false

True

Tell the person, "Please keep looking at that light switch (or mark) on the wall across the room, even though my head will get in the way." Staring at a distant fixed object A)helps to dilate the pupils and to hold the retinal structures still. B)helps the nurse concentrate on the external ear

Match sides with the person. That is, hold the ophthalmoscope in your right hand up to your right eye to view the person's right eye. You must do this to avoid bumping noses during the procedure. Place your free hand on the person's shoulder or forehead (Fig. 14-21, A). This helps orient you in space, because once you have the ophthalmoscope in position, you only have a very narrow range of vision. Also, your thumb can anchor the upper lid and help prevent blinking. A)true B)false

True

What can the nurse do to avoid bumping heads with the patient. A)That is, hold the ophthalmoscope in your right hand up to your right eye to view the person's right eye. You must do this to avoid bumping noses during the procedure. Place your free hand on the person's shoulder or forehead (Fig. 14-21, A). This helps orient you in space, because once you have the ophthalmoscope in position, you only have a very narrow range of vision. Also, your thumb can anchor the upper lid and help prevent blinking. B)none

Begin about 25 cm (10 inches) away from the person at an angle about 15 degrees lateral to the person's Line of vision. Note the red glow filling the person's pupil. This is the red reflex, caused by the reflection of your ophthalmoscope light off the inner retina. Keep sight of the red reflex, and steadily move closer to the eye. If you lose the red reflex, the light has wandered off the pupil and onto the iris or sclera. Adjust your angle to find it again. A)true B)false

True

What is the red reflex? A)Note the red glow filling the person's pupil. This is the red reflex, caused by the reflection of your ophthalmoscope light off the inner retina. Keep sight of the red reflex, and steadily move closer to the eye. If you lose the red reflex, the light has wandered off the pupil and onto the iris or sclera. Adjust your angle to find it again. B)false

The nurse looks for the red reflex by holding the ophthalmoscope A)Begin about 25 cm (10 inches) away from the person at an angle about 15 degrees lateral to the person's Line of vision. B)false

As you advance, adjust the lens to +6 and note any opacities in the media. These appear as dark shadows or black dots interrupting the red reflex. Normally, none are present. Progress toward the person until your foreheads almost touch. A)true B)false

True

Cataracts appear as opaque black areas against the red reflex A)true B)false

True

Against red reflex cataracts looks like, A)appear as opaque black areas B)appear as opaque yellow areas

Adjust the diopter setting to bring the ocular fundus into sharp focus. If you and the person have normal vision, this should be at 0. Moving the diopters compensates for nearsightedness or farsightedness. Use the red lenses for nearsighted eyes and the black for farsighted eyes A)true B)false

True

. If you and the person have normal vision, this should be at 0. A)true B)false

True

Moving the diopters compensates for nearsightedness or farsightedness. A)true B)false

True

Use the red lenses for A)nearsighted eyes B)farsighted eyes

Use the black lens for A)nearsighted eyes B)farsighted eyes

The person's eye and your eye are normal. The 0 diopter (clear glass) will focus sharply on the retina. A)normal eye B)abnormal eye

In myopia, the globe is longer than normal and light rays focus in front of the retina Compensate for myopia in yourself or the other person by using a negative diopter (red number or concave lens). This corrects the focal point onto the retina. A)nearsighted B)farsighted

In hyperopia, the globe is shorter than normal. Light rays would focus behind the retina (if they could pass through) Compensate for hyperopia by using a positive diopter (black number or convex lens). This bends the light rays so the focal point is on the retina A)nearsighted B) farsighted

Nearsightedness A)myopia B)hyperopia

Hyperopia A)nearsightedness B)farsightedness

Moving in on the 15-degree lateral line should bring your view just to the optic disc. If the disc is not in sight, track a blood vessel as it grows larger and it will lead you to the disc. Systematically inspect the structures in the ocular fundus: (I) optic disc, (2) retinal vessels, (3) general background, and (4) macula A)true B)false

True

Systematically inspect the structures in the ocular fundus: (I) optic disc, (2) retinal vessels, (3) general background, and (4) macula A)true B)false

True

Moving in on the IS-degree lateral line should bring your view just to the optic disc. If the disc is not in sight, the nurse should A) track a blood vessel as it grows larger and it will lead you to the disc. B) terminate

Optic Disc

The most prominent landmark is the optic disc, located on the nasal side of the retina. Explore these characteristics: I. Color -Creamy yellow-orange to pink. 2. Shape -Round or oval. 3. Margins Distinct and sharply demarcated, although the nasal edge may be slightly fuzzy. 4. Cup-disc ratio---Distinctness varies When visible, physiologic cup is a brighter yellow-white than rest of the disc. Its width is not more than one-half the disc diameter A)optic disc B)fundus

True A

Pallor. Hyperemia. Irregular shape. Blurred margins. Cup extending to the disc border A)abnormal findings of the optic disc B)abnormal finding of the fundus

Two normal variations may ring around the disc margins. A scleral crescent is a gray-white, new-moon shape. It occurs when pigment is absent in the choroid layer and you are looking directly at the sclera. A pigment crescent is black; it is due to accumulation of pigment in the choroid. A)true B)false

True

A ____________ is a gray-white, new-moon shape. It occurs when pigment is absent in the choroid layer and you are looking directly at the sclera. A)scleral crescent B)pigment crescent

A ____________ is black; it is due to accumulation of pigment in the choroid. A)scleral crescent B)pigment crescent

The diameter of the disc, or DD, is a standard of measure for other fundus structures. To describe a finding, note its clock-face position as well as its relationship to the disc in size and distance (e.g., " ... macula at 3:00, 2 DD from the disc") A)true B)false

True

Retinal Vessels

This is the only place in the body where you can view blood vessels directly. Many systemic diseases that affect the vascular system show signs in the retinal vessels. A)true B)false

True

This is the only place in the body where you can view blood vessels directly. A)retinal vessels B)cardiac vessels

``` This is the only place in the body where you can view blood vessels directly. Many systemic diseases that affect the vascular system show signs in the A)retinal vessels B)sclera vessels C)cardiac vessels D)all the above ```

I. Number----A paired artery and vein pass to each quadrant. Vessels look straighter at the nasal side. 2. Color--- Arteries are brighter red than veins. Also, they have the arterial light reflex, with a thin stripe of light down the middle. 3. A: V ratio---The ratio comparing the artery-to-vein width is 2:3 or 4:5. 4. Caliber Arteries and veins show a regular decrease in caliber as they extend to the periphery. 5. A-V (arteriovenous)-----An artery and vein may cross paths. This is not significrossing cant if within 2 DD of disc and if no sign of interruption in blood flow is seen. There should be no indenting or displacing of vessel. 6. Tortuosity-----Mild vessel nvisting when present in both eyes is usually congenital and not significant. 7. Pulsations---- Present in veins near disc as their drainage meets the intermittent pressure of arterial systole. A)normal findings in retinal vessels B)normal findings in sclera vessels

Arteries too constricted. Veins dilated. A)abnormal findings in the retinal vessels B)abnormal findings in the sclera vessels

Focal constriction. Neovascularization (proliferation of new vessels). A)abnormal finding in the retinal vessels B)abnormal finding in the sclera vessels

Crossings more than 2 DD away from disc. A)abnormal finding of the retinal vessels B)abnormal finding of the sclera vessels

Nicking or pinching of underlying vessel. Vessel engorged peripheral to crossing,Extreme tortuosity or marked asymmetry in two eyes. Absent pulsations. A)abnormal finding of the retinal vessels B)abnormal finding of the sclera vessels

General Background of the Fundus

The color normally varies from Light red to dark brown-red, generally corresponding with the person's skin color. Your view of the fundus should be clear; no lesions should obstruct the retinal structures. A)normal finding of the fundus B) normal finding of the iris

Abnormal lesions: hemorrhages, exudates, microaneurysms A)abnormal finding of the fundus B)normal finding of the fundus

Macula

``` The______ is 1 DD in size and located 2 DD temporal to the disc A)fundus B)sclera C)iris D)macula ```

Inspect this area last in the funduscopic examination. A)macula B)sclera C)both a and b

A bright light on this area of central vision causes some watering and discomfort and pupillary constriction. Note that the normal color of the area is somewhat darker than the rest of the fundus but is even and homogeneous. Clumped pigment may occur with aging. A)macula B)fundus

Clumped pigment occurs with trauma or retinal detachment. A)abnormal finding of the macula B)abnormal finding of the fundus

Within the macula, you may note the foveal light reflex. This is a tiny white glistening dot reflecting your ophthalmoscope light. A)true B)false

True

Within the macula, you may note the A)foveal light reflex. This is a tiny white glistening dot reflecting your ophthalmoscope light. B)red reflex

Hemorrhage or exudate in the macula occurs with A)senile macular degeneration. B)fundus degeneration

DEVELOPMENTAL CARE | Infants and Children

The eye examination is often deferred at birth because of transient edema of the lids from birth trauma or from the instillation of silver nitrate at birth. The eyes should be examined within a few days and at every well-child visit thereafter. A)infant and children B)aging adult

Visual Acuity. The child's age determines the screening measures used. With a newborn, test visual reflexes and attending behaviors. Test light perception using the blink reflex; the neonate blinks in response to bright light ). Also, the pupillary light reflex shows that the pupils constrict in response to light. These reflexes indicate that the lower portion of the visual apparatus is intact. But you cannot infer that the infant can see; that requires later observation to show that the brain has received images and can interpret them. A)infant and children B)aging adult

With a newborn, test visual reflexes and attending behaviors. Test light perception using the blink reflex; the neonate blinks in response to bright light.Also, the pupillary light reflex shows that the pupils constrict in response to light. These reflexes indicate that the lower portion of the visual apparatus is intact. But you cannot infer that the infant can see; that requires later observation to show that the brain has received images and can interpret them. A)infant and children B)aging adult

Absent blinking. Absent pupillary light reflex, especially after 3 weeks, indicates blindness. Abnormal findings of A)infant and children B)aging adult

As you introduce an object to the infant's line of vision, note these attending behaviors: Birth to 2 weeks-Refusal to reopen eyes after exposure to bright light; increasing alertness to object; infant may fixate on an object. By 2 to 4 weeks- Infant can fixate on an object. By 1 month-Infant can fixate and follow a light or bright toy. By 3 to 4 months-Infant can fixate, follow, and reach for the toy. By 6 to 10 months- infant can fixate and follow the toy in aLl directions A)infant and children B)aging adult

Birth to 2 weeks-Refusal to reopen eyes after exposure to bright light; increasing alertness to object; infant may fixate on an object. A)infant and children B)aging adult

By 2 to 4 weeks- Infant can fixate on an object. A)infant and children B)aging adult

By 1 month-Infant can fixate and follow a light or bright toy. A)infant and children B)aging adult

By 3 to 4 months-Infant can fixate, follow, and reach for the toy. A)infant and children B)aging adult

By 6 to 10 months- infant can fixate and follow the toy in aLl directions A)infant and children B)aging adult

The Allen test (picture cards) screens children from 2and a half years to 2 years and 11 months of age and is even reliable with cooperative toddlers as young as 2 years. The test contains seven cards of familiar objects (birthday cake, teddy bear, tree, house, car, telephone, and horse and rider). First, show the pictures up close to the child to make sure the child can identify them. Then, present each picture at a distance of 15 feet. Results are normal if the child can name three of seven cards within three to five trials. A)infant and children B)aging adult

The ________________ screens children from 2and a half years to 2 years and 11 months of age and is even reliable with cooperative toddlers as young as 2 years. The test contains seven cards of familiar objects (birthday cake, teddy bear, tree, house, car, telephone, and horse and rider). First, show the pictures up close to the child to make sure the child can identify them. Then, present each picture at a distance of 15 feet. Results are normal if the child can name three of seven cards within three to five trials. A)infant and children B)aging adult C)Allen test (picture cards)

.The test contains seven cards of familiar objects (birthday cake, teddy bear, tree, house, car, telephone, and horse and rider). First, show the pictures up close to the child to make sure the child can identify them. Then, present each picture at a distance of 15 feet. Results are normal if the child can name three of seven cards within three to five trials. A)infant and children B)aging adult C)Allen test (picture cards)

Results are normal if the child can name three of seven cards within three to five trials. A)infant and children B)aging adult C)Allen test (picture cards)

Use a picture chart or the Snellen E chart for the preschooler from 3 to 6 years of age. The E chart shows the capital letter E in varying sizes pointing in different directions. The child points his or her fingers in the direction the "table legs" are pointing. By 7 to 8 years of age, when the child is familiar with reading letters, begin to use the standard Snellen alphabet chart. Normally a child achieves 20/20 acuity by 6 to 7 years of age A)infant and children B)aging adult

Use ____________________ for the preschooler from 3 to 6 years of age. The __________shows the capital letter E in varying sizes pointing in different directions. The child points his or her fingers in the direction the "table legs" are pointing. By 7 to 8 years of age, when the child is familiar with reading letters, begin to use the standard Snellen alphabet chart. Normally a child achieves 20/20 acuity by 6 to 7 years of age A)infant and children B)aging adult C)Snellen E chart or picture chart

By 7 to 8 years of age, when the child is familiar with reading letters, begin to use the standard _____________[. Normally a child achieves 20/20 acuity by 6 to 7 years of age A)infant and children B)Snellen alphabet chart C)Adult aging

The National Society for Prevention of Blindness states these criteria for referral: 1. Age 3 years-vision 20/50 or less in either eye. 2. Age 4 years and older- 20/40 or less in either eye. 3. Difference between two eyes is one line or more. 4. Child shows other signs of vision impairment, regardless of acuity. Screen two separate times before referral. A)true B)false

True

Visual Fields. Assess peripheral vision with the confrontation test in children older than 3 years when the preschooler is able to stay in position. As with the adult, the child should see the moving target at the same time your normal eyes do. Often a young child forgets to say "now" or "stop" as the moving object is seen. Rather, note the instant the child's eyes deviate or head shifts position to gaze at the moving object. Match this nearly automatic response with your own sighting A)true B)false

True

Assess peripheral vision with the confrontation test in children older than 3 years when the preschooler is able to stay in position. A)true B)false

True

Color Vision. Color blindness is an inherited recessive X-linked trait affecting about 8% of white males and 4% of Black males. It is rare in females (0.4%). "Color deficient" is a more accurate term, because the condition is relative and not disabling. Often, it is just a social inconvenience, although it may affect the person's ability to discern traffic lights or it may affect school performance in which color is a learning tool. A)true B)false

True

Color blindness is an inherited recessive X-linked trait affecting about 8% of white males and 4% of Black males. It is rare in_______ (0.4%). "Color deficient" is a more accurate term, because the condition is relative and not disabling. A)females B)males C)Asians

Color deficient affects what race more A)whites B)blacks

Test only boys for color vision, once between the ages of 4 and 8 years. Use Ishihara's test, a series of polychromatic cards. Each card has a pattern of dots printed against a background of many colored dots. Ask the child to identify each pattern. A boy with normal color vision can see each pattern. A color-blind person cannot see the letter against the field color. A)true B)false

True

Test only boys for color vision, once between the ages of 4 and 8 years. Use ________, a series of polychromatic cards. Each card has a pattern of dots printed against a background of many colored dots. Ask the child to identify each pattern. A boy with normal color vision can see each pattern. A color-blind person cannot see the letter against the field color. A)Ishihara's test B)Snellen E chart

``` Ishihara'sTest only boys for color vision, once between the ages of A)1 and 5 years. B)4 and 8 years. C)5months and 1year. D)10 and 15 years ```

Extraocular Muscle Function. Testing for strabismus (squint, crossed eye) is an important screening measure during early childhood. Strabismus causes disconjugate vision because one eye deviates off the fixation point. To avoid diplopia or unclear images, the brain begins to suppress data from the weak eye (a suppression scotoma). Then visual acuity in this otherwise normal eye begins to deteriorate from disuse. Early recognition and treatment are essential to restore binocular vision. Diagnosis after 6 years of age has a poor prognosis. Test malalignment by the corneal light reflex and the cover test. A)true B)false

True

Testing for strabismus (squint, crossed eye) is an important screening measure during early childhood. A)true B)false

True

Strabismus causes disconjugate vision because one eye deviates off the fixation point. To avoid diplopia or unclear images, the brain begins to suppress data from the weak eye (a suppression scotoma). Then visual acuity in this otherwise normal eye begins to deteriorate from disuse. Early recognition and treatment are essential to restore binocular vision. Diagnosis after 6 years of age has a poor prognosis. Test malalignment by the corneal light reflex and the cover test. A)true B)false

True

Extraocular Muscle Function. Testing for strabismus (squint, crossed eye) is an important screening measure during early childhood. Strabismus causes disconjugate vision because one eye deviates off the fixation point. To avoid diplopia or unclear images, the brain begins to suppress data from the weak eye (a suppression scotoma). Then visual acuity in this otherwise normal eye begins to deteriorate from disuse. The nurse knows that with this condition the: A)Test malalignment by the corneal light reflex and the cover test. B)false, no test

Untreated strabismus can lead to permanent visual damage. The resulting loss of vision from disuse is amblyopia exanopsia. A)true B)false

True

Check the corneal light reflex by shining a light toward the child's eyes. The light should be reflected at exactly the same spot in the two corneas. Some asymmetry (where one light falls off center) under 6 months of age is normal. A)true B)false

True

Perform the cover test on all children.Some examiners omit the opaque card and place a hand on the child's head. The examiner's thumb extends down and blocks vision over the eye without actually touching the eye. One can use a familiar character puppet to attract the child's attention. The normal results are the same as those listed in the adult section. A)true B)false

True

Function of the extraocular muscles during movement can be assessed during the early weeks by the child's following a brightly colored toy as a target. An older infant can sit on the parent's lap as you move the toy in all directions. After 2 years of age, direct the child's gaze through the six cardinal positions of gaze. You may stabilize the child's chin with your hand to prevent him or her from moving the entire head A)true B)false

True

Function of the extraocular muscles during movement can be assessed during the early weeks by the child's following a brightly colored A)toy as a target. B)water bottle C)hand

An older infant can sit on the parent's lap as you move the toy in all directions. A)true B)false

True

After 2 years of age, direct the child's gaze through the six cardinal positions of gaze. You may stabilize the child's chin with your hand to prevent him or her from moving the entire head. A)true B)false

True

External Eye Structures.. A neonate usually holds the eyes tightly shut. Do not attempt to pry them open; that just increases contraction of the orbicularis oculi muscle.the nurse should A) Hold the newborn supine and gently lower the head; the eyes will open. B)the eyes will open when you hold the infant at arm's length and slowly turn the infant in one direction C)both a and b

In addition to inspecting the ocular structures, this also tests the ______________________. That is, the baby's eyes will look in the same direction as the body is being turned. When the turning stops, the eyes will shift to the opposite direction after a few quick beats of nystagmus. Also termed "doll's eyes," this reflex disappears by 2 months of age A)vestibular function reflex B)none

Eyelids and Lashes. Normally the upper lids overlie the superior part of the iris. In newborns, the ___________ is common. The eyes appear to deviate down, and you see a white rim of sclera over the iris. It may show as you rapidly change the neonate from a sitting to a supine position A)setting-sun sign B)deviation eyes

The setting-sun sign also occurs with hydrocephalus as the globes protrude. A)true B)false

True

``` Blank sunken eyes accompany A)malnutrition B)dehydration C)a severe illness D)all the above ```

Many infants have an epicanthal fold, an excess skinfold extending over the inner corner of the eye, partly or totally overlapping the inner canthus. It occurs frequently in Asian children and in 20% of whites. In non-Asians, it disappears as the child grows, usually by 10 years of age. While they are present, epicanthal folds give a false appearance of maLalignment, termed pseudostrabismus (Fig. 14-30). Yet the corneal light reflex is normal A)true B)false

True

Many infants have an epicanthal fold, an excess skinfold extending over the inner corner of the eye, partly or totally overlapping the inner canthus. It occurs frequently in _____________and in 20% of whites. In non-Asians, it disappears as the child grows, usually by 10 years of age. A)blacks B)Asian children

Many infants have an epicanthal fold, an excess skinfold extending over the inner corner of the eye, partly or totally overlapping the inner canthus. While they are present, epicanthal folds give a false appearance of malalignment, termed________________. Yet the corneal light reflex is normal A)pseudostrabismus B)strabismus C)both a and b

Asian infants normally have an upward slant of the palpebral fissures. Entropion, a turning inward of the eyelid, is found normally in some Asian children. If the lashes do not abrade the corneas, it is not significant. A)true B)false

True

``` ___________infants normally have an upward slant of the palpebral fissures. Entropion, a turning inward of the eyelid, is found normally in some Asian children. If the lashes do not abrade the corneas, it is not significant. A)black B)white C)Asian D)Indian ```

An upward lateral slope together with epicanthal folds and hypertelorism (large spacing between eyes) occurs with A)Down syndrome. B)striasbuim C)both a and b

Conjunctiva and Sclera. A newborn may have a transient chemical conjunctivitis from the instillation of silver nitrate. This appears within I hour and lasts not more than 24 hours after birth. The sclera should be white and clear, although it may have a blue tint as a result of thinness at birth. The lacrimal glands are not functional at birth. A)true B)false

True

``` Conjunctiva and Sclera. A newborn may have a transient chemical conjunctivitis from the instillation of silver nitrate. This appears within _________ and lasts not more than 24 hours after birth. The sclera should be white and clear, although it may have a blue tint as a result of thinness at birth. The lacrimal glands are not functional at birth. A)1 hour B)2 hours C)3 hours D)30mins ```

Ophthalmia neonatorum (conjunctivitis of the newborn) is a purulent discharge caused by a _______? A)chemical irritant or a bacterial or viral agent from the birth canal B)false,normal finding

Iris and Pupils. The iris normally is blue or slate gray in light-skinned newborns and brown in dark-skinned infants. By 6 to 9 months, the permanent color is differentiated. Brushfield's spots, or white specks around the edge of the iris, occasionally may be normal. A)true B)false

True

Iris and Pupils. The iris normally is ___________] in light-skinned newborns and brown in dark-skinned infants. By 6 to 9 months, the permanent color is differentiated. Brushfield's spots, or white specks around the edge of the iris, occasionally may be normal. A)black B)blue or slate gray C)blue and clear

``` Iris and Pupils. The iris normally is blue or slate gray in light-skinned newborns and___________ in dark-skinned infants. By 6 to 9 months, the permanent color is differentiated. Brushfield's spots, or white specks around the edge of the iris, occasionally may be normal. A)black B)brown C)yellow D)gray ```

Brushfield's spots, or white specks around the edge of the iris, occasionally may be normal. A)infant and children B)aging adult

Absence of iris color occurs with A)albinism. B)Brushfield's spots

Absence of iris color occurs with albinism. A)true B)false

True

Brushfield's spots usually suggest A)Down syndrome B)up syndrome

A searching nystagmus is common just after birth. The pupils are small but constrict to light A)infant and children B)aging adult

Constant nystagmus, prolonged setting-sun sign, marked strabismus, and slow lateral movements suggest vision loss. Abnormal finding A)infant and children B)aging adult

The Ocular Fundus. The amount of data gathered during the funduscopic examination depends on the child's ability to hold the eyes still and on your ability to glean as much data as possible in a brief period of time. A complete funduscopic examination is difficult to perform on an infant, but at least check the red reflex when the infant fixates at the bright light for a few seconds. Note any interruption A)infant and children B)aging adult

The Ocular Fundus. A complete funduscopic examination is difficult to perform on an infant, but at least check the ________ when the infant fixates at the bright light for a few seconds. Note any interruption A)red reflex B)black reflex C)macula

An interruption in the red reflex indicates an opacity in the cornea or lens. An absent red reflex occurs with congenital cataracts or retinal disorders. A)infant and children B)aging adult

An interruption in the red reflex indicates an A)opacity in the cornea or lens. Infants B)false

An absent red reflex occurs with A)congenital cataracts B)retinal disorders. C)both a and b

Perform a funduscopic examination on an infant between 2 and 6 months of age. Position the infant (up to 18 months) lying on the table. The fundus appears pale, and the vessels are not fully developed. There is no foveal light reflection because the macula area will not be mature until l year. A)true B)false

True

Perform a funduscopic examination on an infant between the age sub A)6 and 12 months of age. B)2 and 6 months of age.

Position the infant (up to 18 months) lying on the table. The fundus appears A)pale, and the vessels are not fully developed. B)There is no foveal light reflection because the macula area will not be mature until l year. C)both a and b

There is no foveal light reflection because the macula area will not be mature until l year. A)true B)false

True

Papilledema is rare in the infant because the fontanels and open sutures will absorb any increased intracranial pressure if it occurs. A)true B)false

True

Inspect the fundus of the young child and school-age child as described in the preceding section on the adult. Allow the child to handle the equipment. Explain why you are darkening the room and that you will leave a small light on. Assure the child that the procedure will not hurt. Direct the young child to look at an appealing picture, perhaps a toy or an animal, during the examination A)true for young child and school age B)false, good for elderly adult

Developmental competence | The Aging Adult

Visual Acuity. Perform the same examination as described in the adult section. Central acuity may decrease, particularly after 70 years of age. Peripheral vision may be diminished. A)true B)false

True

``` What age to expect central acuity to diminish A)65 B)70 C)80 D)85 ```

In older adults, an increased risk of falls and fractures occurs with a distance visual acuity of 20/25 or greater. A)true B)false

True

In older adults, an increased risk of _________occurs with a distance visual acuity of 20/25 or greater. A)falls B)fractures C)both a and b

Ocular Structures. The eyebrows may show a loss of the outer one third to one half of hair because of a decrease in hair follicles. The remaining brow hair is coarse. As a result of atrophy of elastic tissues, the skin around the eyes may show wrinkles or crow's feet. The upper lid may be so elongated as to rest on the lashes, resulting in a pseudoptosis. A)infant and children B)aging adult

Ocular Structures. The eyebrows may show a loss of the outer one third to one half of hair because of a decrease in hair follicles. The remaining brow hair is coarse. As a result of atrophy of elastic tissues, the skin around the eyes may show wrinkles or ________. The upper lid may be so elongated as to rest on the lashes, resulting in a pseudoptosis. A)infant and children B)aging adult C)crow's feet

The upper lid may be so elongated as to rest on the lashes, resulting in a A)pseudoptosis. B)ptosis

The eyes may appear sunken from atrophy of the orbital fat. Also, the orbital fat may herniate, causing bulging at the lower lids and inner third of the upper lids. A)true B)false

True

Ectropion A)(lower lid dropping away) B)(lower lid turning in)

entropion A)(lower lid turning in) B)(lower lid dropping away)

Ectropion (lower lid dropping away) and entropion (lower lid turning in). A)infant and children B)aging adult

The lacrimal apparatus may decrease tear production, causing the eyes to look dry and lusterless and the person to report a burning sensation. A)infant and children B)aging adult

The ___________ may decrease tear production, causing the eyes to look dry and lusterless and the person to report a burning sensation. A)lacrimal apparatus B)nasal apparatus C)both a and b

Pingueculae commonly show on the sclera.These yellowish, elevated nodules are due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. Pingueculae appear at the 3 and 9 o'clock positions-first on the nasal side and then on the temporal side. A)true B)false

___________commonly show on the sclera.These yellowish, elevated nodules are due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. Pingueculae appear at the 3 and 9 o'clock positions-first on the nasal side and then on the temporal side. A)lacrimal spots B)Pingueculae

____________appear at the 3 and 9 o'clock positions-first on the nasal side and then on the temporal side. A)Pingueculae B)false

Distinguish pinguecula from the abnormal pterygium, also an opacity on the bulbar conjunctiva, but one that grows over the cornea. A)infant and children B)aging adult

___________, also an opacity on the bulbar conjunctiva, but one that grows over the cornea. A)Pingueculae B)pterygium

The cornea may look cloudy with age. A)true B)false

True

An ___________ is commonly seen around the cornea.This is a gray-white arc or circle around the limbus; it is due to deposition of lipid material. As more lipid accumulates, the cornea may look thickened and raised, but the arcus has no effect on vision. A)arcus senilis B)pusedostraisbum

____________are soft, raised yellow plaques occurring on the lids at the inner canthus. They commonly occur around the fifth decade of life and more frequently in women. They occur with both high and normal blood levels of cholesterol and have no pathologic significance. A)ancus senile B)Xanthelasma

Pupils are small in old age, and the pupillary light reflex may be slowed. The lens loses transparency and looks opaque. A)true aging adult B) false aging adult

Pupils are small in old age, and the pupillary light reflex may be slowed. The lens loses transparency and looks opaque. A)infant and children B)aging adult

The Ocular Fundus. Retinal structures generally have less shine. The blood vessels look paler, narrower, and attenuated. Arterioles appear paler and straighter, with a narrower light reflex. More arteriovenous crossing defects occur. A)infant and children B)aging adult

A normal development on the retinal surface is drusen, or benign degenerative hyaline deposits. They are small, round, yellow dots that are scattered haphazardly on the retina. Although they do not occur in a pattern, they are usually symmetrically placed in the two eyes. They have no effect on vision. A)drusen B)benign degenerative hyaline deposits C)both a and b

Drusen are easily confused with the abnormal finding hard exudates, which occur with a more circular or linear pattern A)true B)false

Also, drusen in the macular area occur with macular degeneration. A)true B)false

True

PROMOTING A HEAL THY LIFESTYLE: SCREENING FOR GLAUCOMA | Preventing Irreversible Blindness

glaucoma is a leading cause of blindness in the United States. A)true B)false

True

_____________is a condition that involves optic nerve damage and visual field changes. The risk of _____________ increases with age but can occur in anyone in any age-group. There is no cure, but medication, laser trabeculoplasty, and/or surgery can slow or prevent further vision loss. . A)Glaucoma B)cataract

Unfortunately, treatments do not improve sight already lost from glaucoma. Therefore early detection is critical to stopping progression of the disease A)true B)false

True

two categories: open-angle (more common) or closed-angle glaucoma A)true B)false

True

________________ glaucoma, the drainage canals of the eye gradually become clogged. The entrance to these drainage canals is clear (open) and working correctly, but the clogging occurs further inside the canals. There is a slow buildup of intraocular pressure (lOP) as fluids continue to be produced at normal rates. The process is gradual, painless, and causes no early symptoms. Vision loss begins with the peripheral vision, and this often goes unnoticed because the individual learns to compensate intuitively by turning the head. As the condition progresses, the field of peripheral vision decreases until eventually the individual cannot see anything on either side (tunnel vision A)In open-angle B)In closed angle

____________ glaucoma, the drainage canals are blocked or covered over by the outer edge of the iris when the pupil enlarges too much or too quickly. This blockage most often occurs suddenly (acute) but can develop slowly (chronic). Acute closed-angle glaucoma involves an abrupt onset of symptoms, including eye pain, headaches, nausea and/or vomiting, blurred or sudden loss of vision. and rainbow-colored halos around lights, especially at night. If left untreated, an individual can lose vision within 2 to 3 hours A)in open angle B)In closed-angle

The American Academy of Ophthalmology (AAO) recommends screening for glaucoma as part of a comprehensive eye exam starting at 29 years of-age A)true B)false

True

Subsequent screening schedules depend on individual risk factors, which include: 1 . Age over 60 years (over 40 years for African Americans) 2. African American ethnicity or heritage 3. Increased intraocular pressure (lOP) 4. Family history of glaucoma 5. Steroid use 6. History of blunt eye injury (often sports-related) 7. Hypertension 8. Decreased central corneal thickness less than 0.5 mm 9. Severe myopia (nearsightedness) 10. Diabetes A)true B)false

True

Because glaucoma does not produce symptoms in its early stages, early and ongoing comprehensive eye exams are extremely important and should include the following: 1. Visual acuity test- to assess overall vision 2. Visual field test- to identify decreased peripheral vision 3. Dilated eye examination-to examine the retina and optic nerve 4. Tonometry- to measure the pressure inside the eye 5. Pachymetry- to measure the thickness of the cornea A)true B)false

True

3. Dilated eye examination- A)to examine the retina and optic nerve B)to measure the pressure inside the eye C)to measure the thickness of the cornea

4. Tonometry- A)to measure the pressure inside the eye B) to measure the thickness of the cornea

Pachymetry- A)- to measure the pressure inside the eye B) to measure the thickness of the cornea

Extraocular Muscle Dysfunction

Pseudostrabismus has the appearance of strabismus because of epicanthic fold but is normal for a young child. A)Symmetric Corneal light Reflex B)Asymmetric Corneal light Reflex

_________is true disparity of the eye axes. This constant malalignment is also termed tropia and is likely to cause amblyopia A)Strabismus B)entropion

Esotropia- A)inward turning of the eye. B)-outward turning of the eyes.

Exotropia- A)outward turning of the eyes. B)- inward turning of the eye.

Cover Test

__________-If it jumps to fixate on designated point, it was out of alignment before (i.e., when you cover the stronger eye [Dl ), the weaker eye now tries to fixate D2]) A)Uncovered eye B)covered eye

________-mild weakness, apparent only with the cover test and less Likely to cause amblyopia than a tropia but still possible. A)Phoria B)exophoria C)euphoria

_______If this is the weaker eye, once macular image is suppressed, it will drift to relaxed position (El). As eye is uncovered-if it jumps to reestablish fixation (E2), weakness exists. A) Covered eye B) uncovered eye

Esophoria- A)nasal (inward) drift. B)temporal (outward) drift. -

Exophoria- A)-nasal (inward) drift. B)temporal (outward) drift. -

Diagnostic Positions Test If eye will not turn: Indicates paralysis in: or cranial nerve Straight nasal Medial rectus 3 Up and nasal Inferior oblique 3 Up and temporal Superior rectus 3 Straight temporal Lateral rectus 6 Down and temporal. Inferior rectus 3 Down and nasal Superior oblique. 4

True

Abnormalities in the Eyelids

Lids are swollen and puffy. Lid tissues are loosely connected so excess fluid is easily apparent. This occurs with local infections; crying; and systemic conditions such as congestive heart failure, renal failure, allergy, hypothyroidism (myxedema). A)Exophthalmos (Protruding Eyes) B)Periorbital Edema

_______--is a forward displacement of the eyeballs and widened palpebral fissures. Note "lid lag," in which the upper lid rests well above the limbus and white sclera is visible. Acquired bilateral exophthalmos is associated with thyrotoxicosis. A)Exophthalmos (Protruding Eyes) B)Periorbital Edema

``` A look of narrowed palpebral fissures shows with enophthalmos, in which the eyeballs are recessed. Bilateral enophthalmos is caused by loss of fat in the orbits and occurs with dehydration and chronic wasting illnesses. A)Enophthalmos (Sunken Eyes) B)Ptosis (Drooping Upper Lid) C)Upward Palpebral Slant D)Ectropion E)Entropion ```

``` ____occurs from neuromuscular weakness (e.g., myasthenia gravis with bilateral fatigue as the day progresses), oculomotor cranial nerve Ill damage, or sympathetic nerve damage (e.g., Horner's syndrome) or congenital as in this example. It is a positional defect that gives the person a sleepy appearance and impairs vision. A)Enophthalmos (Sunken Eyes) B)Ptosis (Drooping Upper Lid) C)Upward Palpebral Slant D)Ectropion E)Entropion ```

``` Although normal in many children, when combined with epicanthal folds, hypertelorism (large spacing between the eyes), and Brush field spots (light-colored areas in outer iris), indicates Down syndrome. A)Enophthalmos (Sunken Eyes) B)Ptosis (Drooping Upper Lid) C)Upward Palpebral Slant D)Ectropion E)Entropion ```

``` The lower lid is loose and rolling out, does not approximate to eyeball. Puncta cannot siphon tears effectively, so excess tearing results. The eyes feel dry and itchy because the tears do not drain correctly over the corner and toward the medial canthus. Exposed palpebral conjunctiva increases risk for inflammation. Occurs in aging as a result of atrophy of elastic and fibrous tissues but may result from trauma. A)Enophthalmos (Sunken Eyes) B)Ptosis (Drooping Upper Lid) C)Upward Palpebral Slant D)Ectropion E)Entropion ```

``` The lower lid rolls in because of spasm of lids or scar tissue contracting. Constant rubbing of lashes may irritate cornea. The person feels a "foreign body" sensation. A)Enophthalmos (Sunken Eyes) B)Ptosis (Drooping Upper Lid) C)Upward Palpebral Slant D)Ectropion E)Entropion ```

Lesions on the Eyelids

Red, scaly, greasy flakes and thickened, crusted lid margins occur with staphylococcal infection or seborrheic dermatitis of the lid edge. Symptoms include burning, itching, tearing, foreign body sensation, and some pain. A)Blepharitis (Inflammation of the Eyelids) B)Chalazion C)Hordeolum (Stye) D)Dacryocystitis (Inflammation of the Lacrimal Sac) E)Basal Cell Carcinoma

_______is a localized staphylococcal infection of the hair follicles at the lid margin. It is painful, red, and swollen- a pustule at the lid margin. Rubbing the eyes can cause crosscontamination and development of another stye. A)Blepharitis (Inflammation of the Eyelids) B)Chalazion C)Hordeolum (Stye) D)Dacryocystitis (Inflammation of the Lacrimal Sac) E)Basal Cell Carcinoma

A beady nodule protruding on the lid, chalazion is an infection or retention cyst of a meibomian gland. It is a non tender, firm, discrete swelling with freely movable skin overlying the nodule. If it becomes inflamed, it points inside and not on lid margin (in contrast with stye). A)Blepharitis (Inflammation of the Eyelids) B)Chalazion C)Hordeolum (Stye) D)Dacryocystitis (Inflammation of the Lacrimal Sac) E)Basal Cell Carcinoma

Dacryocystitis is infection and blockage of sac and duct. Pain, warmth, redness, and swelling occur below the inner canthus toward nose. Tearing is present. Pressure on sac yields purulent discharge from puncta. A)Blepharitis (Inflammation of the Eyelids) B)Chalazion C)Hordeolum (Stye) D)Dacryocystitis (Inflammation of the Lacrimal Sac) E)Basal Cell Carcinoma

___________is an infection of the lacrimal gland (not illustrated). Pain, swelling, and redness occur in the outer third of the upper lid. It occurs with mumps, measles, and infectious mononucleosis or from trauma. A)Dacryoadenitis B)Entropion

Carcinoma is rare, but it occurs most often on the lower lid and medial canthus. lt looks like a papule with an ulcerated center. Note the rolled-out pearly edges. Metastasis is rare but shOLLld be referred for removal. A)Blepharitis (Inflammation of the Eyelids) B)Chalazion C)Hordeolum (Stye) D)Dacryocystitis (Inflammation of the Lacrimal Sac) E)Basal Cell Carcinoma

Abnormalities in the Pupil

Unequal Pupil Size-________ Although this exists normally in 5% of the population, consider central nervous system disease A)Anisocoria B)B. Monocular

____________ \when light is directed to the blind eye, no response occurs in either eye. When light is directed to the normal eye, both pupils constrict (direct and consensual response to light) as long as the oculomotor nerve is intact. A)B. Monocular Blindness B)C. Dilated and Fixed Pupils-Mydriasis

C. Dilated and Fixed Pupils-____________Enlarged pupils occur with stimulation of the sympathetic nervous system, reaction to sympathomimetic drugs, use of dilating drops, acute glaucoma, or past or recent trauma. Also, they herald central nervous system injury, circulatory arrest, or deep anesthesia. A)Mydriasis B)D. Constricted and Fixed Pupils-Miosis

Constricted and Fixed Pupils-_________ occurs with the use of pilocarpine drops for glaucoma treatment, the use of narcotics, witl1 iritis, and with brain damage of pons A) Miosis B) Argyll Robertson Pupil

___________l No reaction to light, pupil does constrict with accommodation. Small and irregular bilaterally. Argyll Robertson pupil occurs with central nervous system syphilis, brain tumor, meningitis, and chronic alcoholism A) Argyll Robertson Pupi B)Tonic Pupil (Adie's Pupil)

_______ Sluggish reaction to light and accommodation. Tonic pupil is usually unilateral, a large regular pupil that does react, but sluggishly after long latent time. No pathologic significance. A)Tonic Pupil (Adie's Pupil) B)Horner's Syndrome Unilateral

__________ Unilateral, small, regular pupil does react to light and accommodation. Occurs with Horner's syndrome, a lesion of the sympathetic nerve. Also, note ptosis and absence of sweat (anhidrosis) on same side. A)Horner's Syndrome B)Cranial Nerve Ill Damage

__________ Unilateral dilated pupil with no reaction to light or accommodation, occurs with oculomotor nerve damage. May also have ptosis with eye deviating down and laterally A) Cranial Nerve Ill Damage B)none

Visual Field Loss

1. Retinal damage Macula-central blind area (e.g., diabetes): A)true B)false

True

Lesion in globe or optic nerve A)Injury here yields one blind eye, or unilateral blindness B)false

Lesion at optic chiasm (e.g., pituitary tumor)- A)injury to crossing fibers only yields a loss of nasal part of each retina and a loss of both temporal visual fields. Bitemporal (heteronymous) hemianopsia: B)false

• Increasing intraocular pressure- A)decrease in peripheral vision (e.g., glaucoma). Starts with paracentral scotoma in early stage: B)Lesion of outer uncrossed fibers at optic chiasm (e.g., aneurysm of left internal carotid artery exerts pressure on uncrossed fibers). Injury yields left nasal hemianopsia

Lesion of outer uncrossed fibers at optic chiasm (e.g., aneurysm of left internal carotid artery exerts pressure on uncrossed fibers). Injury yields left nasal hemianopsia A)true B)false

True

Retinal detachment- A)a shadow or dimi11ished vision in one quadrant or one half of visual field: B)Lesion R optic tract or R optic radiation Visual field loss in R nasal and L temporal fields Loss of same half of visual field in both eyes is homonymous hemianopsia:

Lesion R optic tract or R optic radiation Visual field loss in R nasal and L temporal fields Loss of same half of visual field in both eyes is homonymous hemianopsia: A)true B)false

True

Vascular Disorders of the External Eye

___________Infection of the conjunctiva, "pink eye," has red, beefy-looking vessels at periphery but usually clearer around iris. This is common from bacterial or viral infection, allergy, or chemical irritation. Purulent discharge accompanies bacterial infection. Preauricular lymph node is often swollen and painful, with a history of upper respiratory infection. Symptoms include itching, burning, foreign body sensatjon, and eyelids stuck together on awakening. A)Conjunctivitis B)Subconjunctival Hemorrhage

_____________ A red patch on the sclera, subconjunctival hemorrhage looks alarming but is usually not serious. The red patch has sharp edges like a spot of paint, although here it is extensive. It occurs from increased intraocular pressure from coughing, vomiting, \Veight lifting, labor during childbirth, straining at stool, or trauma. A)Subconjunctival Hemorrhage B)Iritis (Circumcorneal Redness)

____________ Deep, dull red halo around the iris and cornea. Note that redness is around iris, in contrast with conjunctivitis, in which redness is more prominent at the periphery. Pupil shape may be irregular from swelling of iris. Person also has marked photophobia, constricted pupil, blurred vision, and throbbing pain. Warrants immediate referral. A)Iritis (Circumcorneal Redness) B)Acute Glaucoma

_____________ Acute narrow-angle glaucoma shows a circumcorneal redness around the iris, with a dilated pupil. Pupil is oval, dilated; cornea looks "steamy"; and anterior chamber is shallow. Acute glaucoma occurs with sudden increase in intraocular pressure from blocked outflow from anterior chamber. The person experiences a sudden clouding of vision, sudden eye pain, and halos around lights. This requires emergency treatment to avoid permanent vision loss. A)Acute Glaucoma B)Pterygium

Abnormalities on the Cornea and Iris

_________A triangular opaque wing of bulbar conjunctiva overgrows toward the center of the cornea. It looks membranous, translucent, and yellow to white, usually invades from nasal side, and may obstruct vision as it covers pupil. Occurs usually from chronic exposure to hot, dry, sandy climate, which stimulates the growth of a pinguecula (see p. 307) into a pterygium. A)Pterygium B)Corneal Abrasion

___________ This is the most common result of a blunt eye injury, but irregular ridges usually visible only when fluorescein stain reveals yellow-green branching. Top layer of corneal epithelium removed, from scratches or poorly fitting or overworn contact lenses. Because the area is rich in nerve endings, the person feels intense pain, a foreign body sensation, and lacrimation, redness, and photophobia. A)Corneal Abrasion B)Normal Anterior Chamber (for Contrast)

______ A light directed across the eye from the temporal side illuminates the entire iris evenly because the normal iris is flat and creates no shadow. A)Normal Anterior Chamber (for Contrast) B)Shallow Anterior Chamber

____________ The iris is pushed anteriorly because of increased intraocular pressure. Because direct light is received from the temporal side, only the temporal part of iris is illuminated; the nasal side is shadowed, the "shadow sign." This may be a sign of acute angle-closure glaucoma; the iris looks bulging because aqueous humor cannot circulate. A)Shallow Anterior Chamber B)Hyphema Blood

________ Blood in anterior chamber is a serious result of herpes zoster infection. Also occurs with blunt trauma (a fist or a baseball) or spontaneous hemorrhage. Suspect scleral rupture or major intraocular trauma. Note that gravity settles blood. A)Hyphema B)Hypopyon

_______Purulent matter in anterior chamber occurs with iritis and with inflammation in the anterior chamber. A)Hypopyon B)Central Gray Opacity-Nuclear Cataract

Opacities in the Lens

___________ shows as an opaque gray surrounded by black background as it forms in the center of lens nucleus. Through the ophthalmoscope, it looks like a black center against the red reflex. It begins after age 40 years and develops slowly, gradually obstructing vision. A)Central Gray Opacity-Nuclear cataract B)Star-Shaped Opacity-Cortical Cataract

_______shows as asymmetric, radial, white spokes with black center. Through ophthalmoscope, black spokes are evident against the red reflex. This forms in outer cortex of lens, progressing faster than nuclear cataract. A)Star-Shaped Opacity-Cortical Cataract B) cataract

___________is a white or gray color of the disc as a result of partial or complete death of the optic nerve. Thjs results in decreased visual acuity, decreased color vision, and decreased contrast sensitivity. A)Papilledema (Choked Disc) . B)Optic Atrophy (Disc Pallor)

___________ Increased intracranial pressure causes venous stasis in the globe, showing redness, congestion, and elevation of the disc; blurred margins; hemorrhages; and absent venous pulsations. This is a serious sign of intracranial pressure, usually caused by a space-occupying mass (e.g., a brain tumor or hematoma). Visual acuity is not affected. A)Papilledema (Choked Disc) B)Excessive Cup-Disc Ratio

____________ With primary open-angle glaucoma, the increased intraocular pressure decreases blood supply to retinal structures. The physiologic cup enlarges to more than half of the ruse diameter, vessels appear to plunge over edge of cup, and the vessels are displaced nasally. This is asymptomatic, although the person may have decreased vision or visual field defects in the late stages of glaucoma. A)Excessive Cup-Disc Ratio B)Arteriovenous Crossing (Nicking)

Abnormalities in Retinal Vessels and Background

Inset shows arteriovenous crossing with interruption of blood flow. When vein is occluded, it dilates distal to crossing. This person also has disc edema and hard exudates in a macular star pattern that occur with acutely elevated (malignant) hypertension. With hypertension, the arteriole wall thickens and becomes opaque so that no blood is seen inside it (silverwire arteries). A)Narrowed (Attenuated) Arteries B)Arteriovenous Crossing (Nicking)

This is a generalized decrease in arteriole diameter. The light reflex also narrows. It occurs with severe hypertension (shown above on the right) and with occlusion of the central retinal artery and retinitis pigmentosa. A)Narrowed (Attenuated) Arteries B)Diabetic Retinopathy

Diabetic Retinopathy

___________are round punctate red dots that are localized dilations of a small vessel. Their edges are smooth and discrete. The vessel itself is too small to view with the ophthalmoscope; only the isolated red dots are seen. This occurs with diabetes. A)Microaneurysms B)lntraretinal Hemorrhages C)Exudates

________ Dot-shaped hemorrhages are deep intraretinal hemorrhages that look splattered on. They may be distinguished from microaneurysms by the blurred irregular edges. Flame-shaped hemorrhages are superficial retinal hemorrhages that look linear and spindle shaped. They occur with hypertension. A)Microaneurysms B)lntraretinal Hemorrhages C)Exudates

_______Soft exudates or "cotton wool" areas look like fluffy graywhite cumulus clouds. They are arteriolar microinfarctions that envelop and obscure the vessels. They occur with diabetes, hypertension, subacute bacterial endocarditis, lupus, and papilledema of any cause. Hard exudates are numerous small yellow-white spots, having distinct edges and a smooth, solidlooking surface. They often form a circular pattern, clustered around a venous microinfarction. They also may form a linear or star pattern. (This is in contrast with drusen, which have a scattered haphazard location A)Microaneurysms B)lntraretinal Hemorrhages C)Exudates

Summary Checklist: Eye Exam

``` 1. Test visual acuity Snellen eye chart Near vision (those older than 40 years or those having difficulty reading) 2. Test visual fields-confrontation test 3. Inspect extraocular muscle function Corneal Light reflex (Hirschberg test) Cover test Diagnostic positions test 4. Inspect external eye structures General Eyebrows Eyelids and lashes Eyeball alignment Conjunctiva and sclera Lacrimal apparatus 5. Inspect anterior eyeball structures Cornea and lens Iris and pupil Size, shape, and equality Pupillary light reflex Accommodation ```

Continue to next flash card

6. Inspect the ocular fundus Optic disc (color, shape, margins, cup-disc ratio) Retinal vessels (number, color, artery-vein [A: V] ratio, caliber, arteriovenous crossings, tortuosity, pulsations) General background (color, integrity) Macula

TURE

EXTRA INFORMATION

Is the normal constriction of the pupils when bright light shines on the retina. A)pupillary light reflex B)fixation

This is a reflex direction of the eye toward an object attracting a person attention, the image is fixed in the center of the visual field,fovea centrials A)fixation B)accommodation

``` Fixation can be impaired by?select all that apply? A)drugs B)alcohol C)fatigue D) inattention ```

A B C D

This is adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of the ciliary muscles? A)accommodation B)fixation C)pupillary reflex

The macula area is the keenest vision is absent in what age group A)at brith B)older adult

``` Older adult most common cause of decrease visual function is A)cataract B)glaucoma C)macular degeneration D)all the above ```

Macula develops by A)4months B)6months

Macula matures A)8months B)12months

Light retinas have better vision at A)day B)night C)both a and b

Open angle glaucoma affects what culture group the most A)whites B)blacks C)Hispanics

A patient is experiencing halos around lots this could be do to ? A)acute narrow angle glaucoma B)open angle glaucoma

A blind spot surrounded by an area of normal or decreased vision, occurs with glaucoma with optic nerve disorders A)Scotoma B)strabismus

Occurs with optic atrophy,vitamin A deficiency , and glaucoma A)night vision blindness B)glaucoma

Excessive tearing A)epiphora B)lacrimnation

Tearing A) lacrimnation B)crying

Prednisone can cause A)cataract B)increase intraocular pressure C)both a and b

Indicates distance the person is standing away from the chart A)numerator B)denominator

Gives the distance at which a normal eye could have read that particular line A)dominator B)nominator

Hold the card in a good light about 35cm from the eye this distance equals the print size on the 20 foot chart A)near vision test B)red reflex

In the near vision test, decrease power of accommodation with aging with revel the patient A)moving the card further away, presbyopia B)false

This is a gross measure of the peripheral vision,position yourself at eye level with person about 2 feet away A)confrontation test B)accommodation test

Corneal light reflex is also called A)hirschberg test B)false, no other name

Assess the parallel alignment of the eye axes by shining a light toward the persons eyes, asymmetries of the light reflex indicates deviation in alignment from the eye muscle weakness or paralysis A)hirschberg test B)corneal light reflex test C)both a and b

To test the two eyes parallel. Ask the patient to stare at an object while you cover the eye. A)cover test B)none

Is a mild weakness noted only when fusion is blocked A)Phoria B)tropia

Is more serve a constant malignant of the eye A)Phoria B)tropia

Leading eyes the 6 cardinal positions of gaze will elicit any muscle weakness during movement,ask the person to hold the head steady and to follow the movement of your hand. A)diagnostic positions test B)corneal light reflex

Failure to follow in a cretins direction indicates weakness of a extraocular muscle or dysfunction of cranial nerve intervating it A)diagnostic position test B)red reflex

Occurs with disease of the semicircular canals in the ears a paretic eye muscle, multiple sclerosis or brain lesions A)nystagmus B)lid lag

Is an even yellow of the sclera extending up to the cornea, indicating jaundice A)scleral icterus B)none

To check the cornea and lens the nurse shines the light A)in front B) at side

What is a normal finding in an aging person A)arcus senilis B)light reflex

Darken the room ask person to gaze you are checking A)pupillary light reflex B)none

What cause the red reflex A)cornea B)rentia C)sclera

Optic disc is A)creamy yellow orange to pink B)pale white

Retinal vessels A:V is A)2:3 or4:5 B)1:2 or 2:3

The blink reflex on a neonate is done by the nurse A)using a bright light B)spinning the infant

What test is done on children from 2 and a half to 2 and 11 months of age and is even reliable with cooperative toddlers as young as 2 years A)Allen test (picture card) B)Snellen E chart

What test for preschoolers from 3-6 of age, the chart shows a E in varying sizes pointing in different direction A)Snellen E chart B) Allen E chart

Normal age child reaches 20/20 A)6-7 B)12-16 C)2-5

The eyes appear to deviate down and you see a white rim of sclera over the iris. It may show as you rapidly change the neonate from sitting to a supine position A) setting sun sign B)pusedostraisbum

Also occurs with hydrocephalus as the globes protrude A) setting sun sign B)pusedostraisbum

Is a purulent discharge caused by a chemical irritant or a bacterial or viral agent from the brith canal A)opthalma neonatorum B)brushfeild

Brushfeild spots usually suggests A)down syndrome B)tachycardia

are small white or grayish/brown spots on the periphery of the iris in the human eye due to aggregation of connective tissue, a normal iris element A)Brushfield spots B)none

Fundicscopic examination on infants is done A)2-6months B)7-12months

Commonly shown on the sclera, these yellowish elevated nodules are due to a thickness of the bulbur conjunctiva from exposed to sun wind and dust A)pingueculae B)arcus senilis

Is commonly seen around the cornea this is a gray white area or circle around the limbus it is due to deposition of the lipid material A)arcus senilis B)xanthelasma

Are soft raised yellow plaques Occurring On the lids at the inner canthus, commonly around the fifth decade of life and more frequent in women A)xanthelasma B)druses

Mild weakness apparent only with the cover test and less likely to cause amblyopia than a tropia but still possible A)Phoria B)exophoria

Lids swollen and puffy A)perobital edema B)none

Occurs from neuromuscular weakness, oculomotor cranial nerve 3 damage, sympathetic nerve damage or congenital A)ectropion B)ptosis

The lower lid is loose and rolling out does not approximate to eyeball A)ectropion B)entropion

The lower lid rolls in because of spasm of lids or scar tissue contractility A)ectropion B)entropion

When light is directed to the blind eye,no response occurs either eye A)monocular blindness B)miosis

Occur with stimulation of the sympathetic NS, reaction to the sympathetic drugs, use of dilating drops,acute glaucoma or past recent trauma A)mydriasis B)miosis

Occurs with the use of pilocarpine drops for glaucoma treatment, the use of narcotics with iristis and with brain damage of the pons A)mydriasis B)miosis

Pupil No reaction to light, pupil does constrict with accommodation. Small and irregular bilaterally. ________ pupil occurs with central nervous system syphilis, brain tumor, meningitis, and chronic alcoholism. A) Argyll Robertson B)mydriasis

Sluggish reaction to light and accommodation. _________ is usually unilateral, a large regular pupil that does react, but sluggishly after long latent time. No pathologic significance. A)Tonic Pupil (Adie's Pupil) B)horneners syndrome

Unilateral, small, regular pupil does react to light and accommodation. Occurs with ____________, a lesion of the sympathetic nerve. Also, note ptosis and absence of sweat (anhidrosis) on same side. A)Horner's Syndrome B)miosis

_________ is infection and blockage of sac and duct. Pain, warmth, redness, and swelling occur below the inner canthus toward nose. Tearing is present. Pressure on sac yields purulent discharge from puncta. A)dacryocystitis B)Dacryoadenitis

_________Infection of the conjunctiva, "pink eye," has red, beefy-looking vessels at periphery but usually clearer around iris. This is common from bacterial or viral infection, allergy, or chemical irritation. Purulent discharge accompanies bacterial infection. Preauricular lymph node is often swollen and painful, with a history of upper respiratory infection. Symptoms include itching, burning, foreign body sensatjon, and eyelids stuck together on awakening. A)Conjunctivitis B)Subconjunctival Hemorrhage

A red patch on the sclera, __________ looks alarming but is usually not serious. The red patch has sharp edges like a spot of paint, although here it is extensive. It occurs from increased intraocular pressure from coughing, vomiting, Weight lifting, labor during childbirth, straining at stool, or trauma A)subconjunctival hemorrhage B)iritis

____________ narrow-angle glaucoma shows a circumcorneal redness around the iris, with a dilated pupil. Pupil is oval, dilated; cornea looks "steamy"; and anterior chamber is shallow. _________- occurs with sudden increase in intraocular pressure from blocked outflow from anterior chamber. The person experiences a sudden clouding of vision, sudden eye pain, and halos around lights. This requires emergency treatment to avoid permanent vision loss. A)Acute Glaucoma B)none

Deep dull red halo around the iris and cornea A)iritis B)pterygium

Purulent matter in anterior chamber occurs with iritis and with inflammation in the anterior chamber. A)Hypopyon B)cataract

_________ Increased intracranial pressure causes venous stasis in the globe, showing redness, congestion, and elevation of the disc; blurred margins; hemorrhages; and absent venous pulsations. This is a serious sign of intracranial pressure, usually caused by a space-occupying mass (e.g., a brain tumor or hematoma). Visual acuity is not affected. A)Papilledema (Choked Disc) B)glaucoma

______ With primary open-angle glaucoma, the increased intraocular pressure decreases blood supply to retinal structures. The physiologic cup enlarges to more than half of the ruse diameter, vessels appear to plunge over edge of cup, and the vessels are displaced nasally. This is asymptomatic, although the person may have decreased vision or visual field defects in the late stages of glaucoma. A)Excessive Cup-Disc Ratio B)cataract

Soft _______ or "cotton wool" areas look like fluffy graywhite cumulus clouds. They are arteriolar microinfarctions that envelop and obscure the vessels. They occur with diabetes, hypertension, subacute bacterial endocarditis, lupus, and papilledema of any cause. Hard exudates are numerous small yellow-white spots, having distinct edges and a smooth, solidlooking surface. They often form a circular pattern, clustered around a venous microinfarction. They also may form a linear or star pattern. (This is in contrast with drusen, which have a scattered haphazard location A)Exudates B)none

Pupil does not react to light;does constrict with accommodation A)argylle Robertson pupil B)astigmatism

Refractive error of vision due to differences in curvature in refractive surfaces of the eye (cornea and lens) A)astigmatism B)exudates

Triangular opaque tissue on the nasal side of the conjunctiva that grows toward the center of the cornea A)pterygium B)presbyopia

Decrease in power of accommodation that occurs with aging A)presbyopia B)myopia

Impaired or dim vision without obvious defect or change in the eye. A)amblyopia B)none

The extraocular muscles consist of four _______ muscles and two slanting or ______muslces. A)superior;inferior B)rectus;oblique C)reticular;diagonal

``` A slight protrusion of the eyeballs may be when examining individuals who come from which ethnic/cultural group. A)Asian B) African Americans C)Hispanic D)American Indian ```

The location in the brain where optic nerve fibers from the temporal fields of vision cross over is identified as the A)optic chiasm B)optic disc

Which of the following group of individuals need to be tested on the presence of color blindness A)black males between the ages of 10-15 B)white males between the ages of 4-8

Which of the following statements is true in regard to the results obtained from use of the Snellen chart A)the samller the denominator , the poorer the vision B)the larger the denominator, the poorer the vision

The lens of the eye functions as a A)refracting medium B)mediator of light

When inspecting the eyeballs of an African American individual, which of the following might the examiner expect to observe. A)a slight yellow discoloration of the sclera B)small brown macules on the sclera

``` The normal color of the optic disc is A)red B)creamy pink C)creamy yellow orange to pink D)creamy red to yellow orange ```

Which of the following is an expected response on the cover test A)the covered eye maintains its position when uncovered B)the eye jumps

Which of the following is associated with Horner syndrome A)- unilaterally small regular pupil that reacts to light And accommodation B)bilateral miosis

Decreased vision in the elderly may be due to which of the following conditions A)macular degeneration B)presbyopia

The lens in an older adult loses elasticity and becomes hard and glasslike, this decreases the lens ability to change shape to accommodate for near vision called A)presbyopia B)glaucoma

``` Decreased vision in the elderly may be due to which of the following conditions? A)cataracts B)glaucoma C)macular degeneration D)all the above ```

Eyelashes filter out dust and dirt A)true B)false

True

A small fleshy mass contains sebeaous gland is located at the inner canthus A)caruncle B)canthus

Adjustment of the eye for near vision, accomplish by ciliary muscle movement A)accommodation test B)near vison

Central vision test use the A)Snellen chart B)confrontation

For thoes over 40, who have difficulty reading the nurse would test A)near vision B)none

Diagnostic positions test is also known as the A)six cardinal positions of gaze B)none

Picture charts or Snellen chart for child A)true B)false

Vision Felids by testing with the A)confrontation B)accommodation

Eye movement for infant mature by A)2-5months B)3-4months C)6-8months

A stripe connective tissue, gives shape to the upper lid is and contain the meniombium glands A)tarsal plate B)none

The _____, a thin mucus membrane is a transparent protective covering of the exposed part of the eye A)conjunctiva B)retina

Controls the thickness of the lens A)ciliary body's B)sclera

Eyeball reaches adult size children by age A)8y/o B)16y/o

Macula matures at age A)8months B)11months

Inspect the_______ last because it may cause watering, discomfort and pupil constriction. A)macula B)sclera C)both a and b

Iris adjust pupil size to adjust amount of light in the eye A)true B)flase

True

_______ help maintain the shape of the eye and help maintain the instraocular pressure A)Vitreous humor B)aqueous humor

Is produced by cells covering the ciliary body , the liquid flows from the posterior chamber to the anterior chamber through the pupil, drainage occurs through the canal of schlemm. A)aqueous humor B)vitreous humor

Over production or under production of ________ humor leads to increase instraocular pressure as seen in glaucoma A)aqueous humor B)vitreous humor

Distance vision test and central vision test are done by the A)Snellen chart B)none

Yellow or green sclera may indicate A)liver (jaundice) B)none

Optic disc is A)1.5mm B)2 mm

A man is being assessed following a motor vehicle accident. His right eye is swollen shut and very painful. Why does this require further assessment? Select all that apply. Select all that apply: A)Blunt-force trauma often results in fracture of the orbit B)He could have optiatrophy C)High-velocity injuries are typically penetrating D)This could be a sign of strabismus

A C

When using hand gel to clean the hands, what must the nurse do before touching a patient's eyes? Choose one of the following A)Assess visual acuity B)Wash the hands again with soap and water C)Assess for color blindness D)Make sure the hands are completely dry

The term for an involuntary rhythmic wobbling of the eyes is __________. A)Nystagmus B)glands

``` Which of the following eye abnormalities would the nurse observe for during assessment of the external eyes? Select all that apply. Select all that apply: A)Osteogenesis imperfecta B)Miosis C)Anisocoria D)Iris nevus E)Exophthalmos ```

A D E

``` What do retinal abnormalities include? Choose one of the following A)Horner's syndrome B)Argyll Robertson syndrome C)Mydriasis D)Age-related macular degeneration ```

The optic chiasm is part of the neural pathway of the eye. Choose one of the following A)True B)False

When assessing a patient with signs of infection in one eye, the nurse should always examine the infected eye first. Choose one of the following A)True B)False

Why is it important to ask the patient if he or she is experiencing discharge or drainage from the eyes? Choose one of the following A)Discharge is associated with inflammation or infection B)Discharge is associated with presbyopia C)Discharge is associated with glaucoma D)Discharge is associated with a detached retina

``` A woman who is 5 months pregnant is being assessed at a routine visit. She has increased pigmentation around the eyes. This is known as what? Choose one of the following A)Conjunctivitis B)Pink eye C)Hyphema D)Chloasma ```

``` The thin mucous membrane that lines the inner eyelid and covers the sclera is known as what? Choose one of the following A)Lacrimal apparatus B)Limbus C)Eyelid D)Conjunctiva ```

The border between the cornea and the sclera is the A)limbus B)sclera

``` A 2-month-old infant is being examined at the pediatrician's office. The mother said she noticed the baby was not making tears in the left eye. What does this finding suggest? Choose one of the following A)Blepharitis B)Amblyopia C)Vision loss D)A blocked lacrimal apparatus ```

``` A comprehensive physical examination of the eye includes tests for which of the following? Select all that apply. Select all that apply: A)The external eye B)Eye muscle function C)Internal ocular structures D)External ocular structures E)Visual acuity ```

A B C D E

``` What part of the eye receives and transmits visual stimuli to the brain for processing? Choose one of the following A)Optic disc B)Vitreous chamber C)Posterior chamber D)Retina ```

Failure to obtain an accurate and complete history can lead to loss of sight. Choose one of the following A)True B)False

``` What muscles control the eye movement and hold the eye in place in the socket? Choose one of the following A)Trochlear B)Oculomotor C)Extraocular D)Abducens ```

When assessing visual acuity with a Snellen chart, the patient should stand 30 feet from the chart. Choose one of the following A)True B)False

``` During adolescence, what vision change is common? Choose one of the following A)Amblyopia B)Presbyopia C)Nearsightedness D)Color blindness ```

The ________ are loose mobile folds of skin that cover the eye, protect it from foreign bodies, regulate light entrance, and distribute tears. A)eyelids B)retina

``` Equipment used for objective data collection involving the eyes includes which of the following? Select all that apply. Select all that apply: A)Protective mask B)Occlusive covers C)Penlight D)Snellen chart E)Ophthalmoscope ```

B C D E

(stye) red, painful pustule that is a localized infection of hair follicle at eyelid margin A)Hordeolum B)Myopia

"nearsighted", refractive error in which near vision is better than far vision A)myopia B)hyperopia

innervates the lateral rectus muscle (abducts eye) A)cranial nerve 6 abducens B)cranial nerve 4 trochler

innervates the superior oblique muscle A)Cranial nerve IV - trochlear nerve B) cranial nerve 3

This is round and regular. Size is determined by parasympathetic and sympathetic chains of the ANS. Stimulation of PS through cranial nerve III causes______ to constrict. Stimulation of Sym. dilates the _______ and elevates the eyelid A)pupil B)lens

The most commonly used and accurate measure of visual acuity. Consists of letters arranged in decreasing size A)Snellen Eye Chart B)cover test

Patient stands 20 feet from chart and covers eyes one at a time. Patient reads the smallest line they can. If they wear glasses or contacts allow them to continue wearing them. Result is recorded using a numeric fraction at the end of the last successful line read. Should indicate whether any letters were missed and if corrective lenses were worn. (Right 20/30 -1, with glasses) or (The right eye scored 20/30, missing one letter. Pt. wearing glasses) A)Process of testing visual acuity B)cover test

is used to test visual fields (peripheral vision) You position yourself at eye level about 2 feet away. Have the patient cover one eye with an opaque card. And look straight at you with the other eye. Hold a pencil or your finger as a target midline between you and the other person and slowly advance it in from the periphery in several directions (upward, downward, temporally, and nasally). Ask the person to say now when the object is first seen A)confrontation test B)cover test

patient holds card 14 inches from the eye and reads the chart - with glasses on. This test is for patients with poor eye sight. Test results should read "14/14" (Jaeger card is used) A)near vision test B)cover test

- looking for pupil reaction -client looks at object across the room (pupil should dialate) -client shifts focus to close object (pupil should constrict) *normal response is 1)pupillary constriction. 2) convergence of the axes of the eyes A)accommodation test B)cover test

the thin mucous membrane that specifically lines the lids and is clear with many small blood vessels A)palpebral conjunctiva B)nor

a thin mucous membrane that overlayes the eyeball, with the white sclera showing through. A)bulbar conjunctivea B) plate

continuous anteriorly with the sclera, which covers the iris and the pupil. it is part of the refracting media of the eye, bending incoming light rays so they will be focused on the inner retina. this is very sensitive to touch, contact with anything will stimulate a blink in both eyes A)cornea B)retina

a biconvex disc located just posterior to the pupil. serves as a refracting medium keeping a viewed object in continual focus on the retina A)lens B)pupil

posterior to the cornea and in front of the iris and lens. contains aqueous humor that is produced continually by the ciliary body. A)anterior chamber B)posterior chamber

the area in which fibers from the retina converge to form the optic nerve A)optic disc B)optic nerve

the area of the retina which has the sharpest and keenest vision. A)fovea centralis B)pupil

a slightly darker pigmented region surrounding the fovea centralis. this receives and transduces light from the center of the visual field. A)macula B)cornea

cloudiness of the cornea and lens A)opacties B)none

the anterior chamber, lens, and vitreous of the eye which can be viewed by the ophthalmoscope A)media B)none

the internal surface of the retina that can be seen by the ophthalmoscope. A)ocular fundus B)macula

the unit of strength of each lens in the ophthalmoscope. positive, black numbers indicate objects nearer in space to the ophthalmoscope, and the red, negative numbers are for focusing on objects farther away. A)diopter B)none

a gray-white new moon shape around the disc margins which occurs when pigment is absent in the choroid layer and you are looking directly at the sclera A)scleral crescent B)pigment crescent

black around the disc margins because of accumulation of pigment in the choroid. A)scleral crescent B)pigment crescent

an excess skinfold extending over the inner corner of the eye. A)epicanthal fold B)cornea

the appearance of malalignment due to the presence of epicanthal folds. A)pseudostrabismus B)none

a normal development in aging adults which consists of benign degenerative hyaline deposits. these small, round, yellow dots are scattered haphazardly on the retina. A)drusen B)cornea

a simple screening test for strabismus, is performed by shining a light and noting the reflection of the light on the eye of the person. A)Hischberg test B)none

recorded as a fraction. the numerator is the distance from the chart and the denominator represents the last line read correctly A)visual acuity B)cornea

The transparent protective covering of the eye A)conjunctiva B)cornea

The extraocular muscles are innervated by... A) cranial nerve 3,4,6 B)cranial nerve 3,5,6

stimulation of the parasympathetic branch through CN III A)constricts the pupil B)dilates the pupil

stimulation of the sympathetic branch through CN III A)dilates the pupil B)constricts the pupil

What is the area of sharpest and keenest vision? A)fovea centralis B)macula

What does it mean when the normally transparent fibers of the lens begin to thicken and yellow? A)This is the beginning of a senile cataract B)none

lens opacity resulting from a clumping of proteins in the lens A)cataract B)glaucoma

Most common type of glaucoma A)chronic open angle glaucoma; it involves a gradual loss of peripheral vision B)cornea

formation of floaters is common with A)retinal detachment B)cornea

Halos around light usually occur with A)acute narrow-angle glaucoma B)cataract

a blind spot surrounded by an area of normal or decreased vision A)Scotoma B)cornea

- use for far vision -keep glasses or contact on -numerator= distance from chart -denominator= distance the normal eye can read from -the larger the den. the poorer the vision A)Snellen eye chart B)cover test

A patient scoring less than ____ on the Snellen eye chart would need to be referred to an opthalmologist or optometrist A)20/30 B)20/20

used for people older than 40 yrs of age or who report difficulty reading -test with a handheld vision screener with various sizes of print - hold card about 35 cm or 14 inches from eye A)To test for near vision B)cover test

A normal result in the near vision test A)14/14 B)20/20

- tests for muscle function of the eye -assess the parallel alignment of the eye axes by shining a light toward the person's eyes -Hold the light 12 inches away A)Corneal Light Reflex (the Hirschberg Test) B)pupillary light reflex

- detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. ask the person to stare straight ahead at your nose. A)Cover Test B)cornea

Have client look straight ahead and foucs on pen light, move pen forward and the eye should corss A)Convergence test B)cover test

if a white rim of sclera between the lid and the iris is visible A)What is lid lag? B)macula

Incomplete closure of the lids creates A)risk for corneal damage B)none

Pallor near the outer canthus of the lower lid may indicate... A)anemia B)jaundice

an even yellowing of the sclera extending up to the cornea, indicating jaundice A)Scleral icterus B)pallor

What is a normal finding in an aging person when assessing the cornea and lens? A)Arcus senilis B)none

A normal finding when assessing the iris and pupil A)PERRLA B)accommodation

In the eyes vein are _____ than arteries A)small B)larger

In older adults, an increased risk of falls and fractures occurs with a distance visual acuity of _____ or greater. A)20/25 B)20/20

this commonly shows on the sclera in old age; they are yellowish, elevated nodules due to thickening of the bulbar conjunctiva from prolonged exposure to sun,wind, due. Usually appear at 3 & 9 o'clock position A)Pingueculae B)cornea

Pinguecula can be confused with the abnormal ________ A)pterygium B)syte

an opacity on the bulbar conjunctiva but one that grows over the cornea A)Pterygium B)none

Drusen is easily confused with what abnormal finding? A)hard exudates B)soft exudates

What is the different between drusen and hard exudates? A)Hard exudates occur in a more circular or either linear pattern B)no difference

lids are swollen and puffy occurs with: crying, congestive heart failure, renal failure, allergy, hypothyroidism A)Periorbital edema B)edema

no reaction to light A)Argyll Robertson Pupil B)Tonic

sluggish reaction to light and accomodation A)Tonic Pupil (Adie's pupil) B)horners syndrome

unilateral small, regular pupil does react to light and accomodatoin A)Horner's Syndrome B)none

Common disease among whites A) macular degeneration followed by cataract B) glaucoma

Covers and protects the iris and pupil A)cornea B)macula

Is the area of the retina visible through the ophthalmoscope A)ocular fundus B)macula

Is the area in which fibers from the retina coverage to form the optic nerve A)optic disc B)macula

Is the area of sharpest vision A)macula B)race

Position the person on a mark exactly 20 feet from the chart. If the person wears glasses or contact lenses, leave them on. Shield one eye at a time during the test. Ask the person to read through the chart to the smallest line of letters possible. A)Snellen Eye Chart B)cover test

To test the pupillar y light reflex, darken the room and ask the person to gaze into the distance. (This dilates the pupils.) Advance a light in from theside,~and note the response.Normally, you will sec (I) constriction of the same-sided pupil (a direct light reflex) and (2) simultaneous constric- tion of the other pupil (a couse/ISual light reflex). A)true B)false

Test for accommodation by ask- ing the person to focus on a distant object. This process dilates the pupils. Then have the person shift the gaze to a ncar object, such as your finger held about 7 to 8 em (3 inches) from the nose. A normal response includes ( I) pupillary constriction and(2)conver- gence of the axes of the eyes. A)true B)false

Untreated strabismus can lead to per- manent visual damage, called amblyopia exanopsia A)true B)false

True

are soft, raised, yel- low plaques occurring on the lids of the inner canthus (see Table 7-1). These commonly occur around the fifth decade of life and are more frequent in women. A)Xanthelasma B)chaziom

or benign degenerative hyaline deposits. They are small, round, yellow dots that are scattered haphazardly on the retina. A)drusen B)sclera

Infection of the conjunctiva shows red,beefy-looking vessels at the periphery, but looks clearer around the iris. This is common, due to bacterial or viral infection, allergy, or chemical irritant. Often accompanies an upper respiratory infection. Purulent discharge accompanies bacterial infection. A)conjunctivitis B)hordeloum

Black diopter is near is space A)true B)false

True

Red diopter is farther away in space A)true B)false

True

A clouding of the lens of the eye. A)cataract B)pinguence

________commonly show on the sclera. These yellowish, elevated nodules are due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. Pingueculae appear at the 3 and 9 o'clock positions-first on the nasal side and then on the temporal side. A)Pingueculae B)strabismus

Strabismus, you would perform what test A)hischberg B)entropion

Asian eyes you would find with which of the following A)entropia B)conjunctiva

High-velocity injuries are typically penetrating. Blunt-force trauma often results in fracture of the orbit. A)true B)false

Optiatrophy is atrophy of the optic nerve. A)true B)false

Strabismus is the medical term for cross-eyed. A)true B)false

``` what cranial nerves would the nurse check to see if the patient is dead? A)cranial nerves 3 and 5 B)cranial nerves 5 and 7 C)cranial nerves 8 and 11 D)all the above ```

B cranial nerve 5 and 7 the nurse will check

``` what cranial nerves would the nurse check to see if the patient is dead? A)cranial nerves 3 and 5 B)cranial nerves 5 and 7 C)cranial nerves 8 and 11 D)all the above ```

B cranial nerve 5 and 7 the nurse will check

Asymmetry in the corneal light reflex after 6 months is A)abnormal and must be referred. B)normal

STRUCTURE AND FUNCTION