Eyes And Ears Flashcards
Movement of extraocular muscles is stimulated by what three cranial nerves
Abducens (VI) abducts the eye, moving laterally toward temple
Trochlear (IV) downward and inward toward the nose
Oculomotor (III) all other nerves, superior, inferior, medial recuts, inferior oblique
Left optic tract has fibres only from the
Left half of each retina
Right optic tract contains fibres only from the
Right half
Right side of the brain looks at the
Left side of the world
OA eye considerations
Decreased tear production = dryness and burning
-Dec elasticity of skin
-muscle atrophy
-pupil size decrease, lens loose elasticity
Presbyopia
Lens ability to change shape and accommodate is decreased
-around 40 YOA
Macular degeneration
Break down of cells in macula of retina
-loss of central vision, most common cause of blindness
-AMD (age related macular degeneration)
Cataract formation
Lens opacity
-clumping of proteins in the lens
Glaucoma
Increased intraocular pressure, damaged optic nerve
Snellen eye chart
Has lines of letters arranged in decreasing size
Confrontation test
Measures peripheral vision
Cover uncover test
Detects small depress of deviated alignment
-normal response should be a steady fixed gaze
Anisocoria
Unequal pupil size
-CNS disease
Monocular blindness
No response in eyes to light being shone
Miosis
Constricted and fixed pupil
-use of narcotics, drops for glaucoma or pons damage
Mydriasis
Dilated and fixed pupils
Argyll Robertson pupil
Pupils have no reaction to light but do constrict with accommodation
-CNS syphilis, brain tumour, miningits, alcolhis,
Tonic pupil, aides pupil
Sluggish reaction to light and accommodation
-no pathological significance
Tonic pupil, aides pupil
Sluggish reaction to light and accommodation
-no pathological significance
Cranial nerve III damage (oculomotor)
Unilateral pupil dilation with no reaction to light or accommodation
-eye diabetes downward
Horners syndrome
Lesion of sympathize nerve, unilateral, small regular pupil that does not react to light and accommodation
Conductive hearing loss
Mechanical dysfunction of the external or middle ear
Sensorineural hearing loss
Signifies pathology of inner ear, cranial nerve VIII or auditory areas of cerebral cortex
Mixed loss
Is a combination of conductive and sensorineural types in the same ear
Women who are pregnant—> eye considerations
-eyes can be more dry
Newhorns and infants eyes
Should be able to blink, follow objects with eyes
OA and eyes
Drooping eyelids, change in curvature, eyes sit deeper, conjunctiva is thinner and may appear yellow
Acute assessments of the eye
Change in vision (loss), or double vision, blurring
Rapid assessment of the eye
-foreign bodies
-lacerations
-hyphema
-test extraocular movements
Flashing lights vs floaters
Floaters - see my eyelashes, or ameoba (NORMAL)
Flashing lights- NOT NORMAL
History needed for health history of infants and children
-vaginal infection during delivery
-developmental milestone
-routine vision testing
Infants and children’s consideration (ONE THING)
Children are unsure of vision or hearing problems and don’t mention them, so routine tests area valuable
T/f in dark skinnned people the sclera is often yellow
False, tiny brown patches or greyish blue
Visual field to confrontation
-need to be close and at the same level
Stage one: is any bit of my face missing
Stage two: covering each eye
Stage three: covering one eye, moving white target and reporting when they can see it
Stage four: blind spot
Almost in the centre the ___ is where the first ossicle is attached
Umbo
Pars flaccida versus the pars tensa
Flaccida- small slack superior section of the membrane
Tensa- remainder of the membrane, thicker and tauter
What allows for equalization of air pressure on each side of the tympanic membrane
Eustachian tube
The six muscles of the eye are innervated by
Cranial nerves III and IV and VI
Three layers of eye
Sclera - protective layer, contains: cornea, iris and pupil
Choroid- vascular layer containing collars body, iris
Retina- visual receptive layer, ligh waves are changed into nerve impulses
Pupillary light reflex
Normal constriction of pupils when bright light shines on the retina
Fixation
Reflex direction of the eye toward an object attracting a persons attention
Accommodation
Adjustment of the eye for near vision, using ciliary muscle movement
Eye function at birth
Limited eye function
-peripheral vision is intact
-macula absent
-eye movement poorly coordinated
The eyeball reaches adult size by
Age 8 years
Eye functions with again
-decreased tear production
-pupil size decreases = presbyopia
-senile cataract
-diminished visual acuity
Three most common causes of decreased visual functioning in older adults
-cataracts
-glaucoma diabetic retinopathy
-macular degeneration
Testing subjective data of the eye
-vision difficulty
-eye pain
-diploia
-redness or swelling
-watering or discharge
-ocular problems
-glaucoma
To obtain objective data first test
Central visual acuity
-Shellen or other eye chart
-if over 40 test near vision
Asses visual fields by using the
Confrontation test
Asses extraocular msucle function by
Assessing the corneal light reflex
-hirschberg test
-cover uncover test
-diagnostic position test
Observe optic disc
Color, shape, margins, and cup to disc ratio
Asses the retinal vessels
Number, color, calibre, arteriovenous crossings, artery vein ratio, tortusity and pulsations
Hearing involves
Auditory system at the peripheral level, brain stem and cerebral cortex
The ear transmit sound and converts
It’s vibrations into electrical impulses which are analyzed by the brain
Conductive hearing loss
Mechanical dysfunction of the external or middle ear
-increased amplitude can cause person to hear
Example of conductive hearing loss
Cerumen buildup and otosclerosis
Sensorineural or perceptive hearing loss
Pathological condition of cranial verve VIII
Presbycusis
Age related gradual determination of the nerve may be the cause
Mixed hearing loss
Conductive and sensorineural
Vertigo occurs from
Inflammation of semicircular canals
Infants hearing
Eustachian tube is short, wide and more horizontal
-pathogens can migrate to middle ear from Nasopharynx
In adults younger than 40 what is a common cause of conductive heating loss
Ostosclerosis
In older adults hearing acuity may be decreased because of
Coarse and stiff cilia lining the ear, impacted cerumen and nerve degeneration
Cover uncover test
Test for lazy eye
-one eye drifts off and there will be movement
-cover one eye, check for movement in the other
Corneal light reflex
Screening in younger
-baby look ahead
-penlight shine in eyes to the side
There should be a “anime” glimmer in eyes
Pupillary light reflex and accommodation
Shine light on eye to see constriction
-don’t see response = maybe not dark enough
PERRLA
Pupils equal round reactive light accommodation
Cardinal position
Eyes trace all six positions
-checking extraocular muscular function as well as III, VI and IV CN
Assessment of retinal vessels
Arteries: brighter, thinner, shine with light reflect
Vein: dimmer, bigger, do not shine
-come in pairs, but should not cross
what are we assessing in fundus
Background color
Assessing ear-> always check the __ first!
Healthy ear first
-bc children wont let you assess again if it’s extremely painful
Adults vs kids positioning of ear
Adults - up and back
Kids- straight down
-due to change in shape, and euschian tube (easier to get ear infection)
Normal tympanic membrane looks
Grey, shine, translucent
Strabismus
Weakness of extraocular muscles
Symptoms of xerostomia
Dry mouth
-decreased taste, lubrication
-hard to swallow
-erosion of hard enamel
Rhinitis
Nostril swelling
Rhinitis
Nostril swelling
