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Clinical Assessment > Eyes and Visual Pathways > Flashcards

Eyes and Visual Pathways Flashcards

1
Q

What is in the eyes ROS when there is a positive response?

A
  • sudden or gradual onset or pattern of change, type of change
  • Associated symptoms: discharge/tearing, pain, redness, photophobia
  • H/O prior eye issues
  • Date and result of last eye exam
  • Medications
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2
Q

Components of an Eye Exam

A

Visual Acuity
External
Internal

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3
Q

What is included in the visual acuity component of an eye exam?

A

Central/distant (CN II): Snellen or Rosenbaum

Peripheral: Visual fields (CN II)

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4
Q

What is included in the external component of an eye exam?

A
  • Brows, lids, lashes, orbit, gaze (EOMs, nystagmus)

- Conjunctiva & sclera, cornea & lens, pupils

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5
Q

Nystagmus

A
  • fine rhythmic oscillation of the eyes

- normal during extreme lateral gaze

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6
Q

What is included in the internal component of the eye exam?

A

retina

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7
Q

Horizontal Visual Field Defect

A

Occlusion of branch of central retinal artery

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8
Q

Monocular Visual Field Defect

A

Also called blind right eye

-lesion of the optic nerve

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9
Q

Bitemporal hemianopsia Visual Field Defect

A
  • lesion at the optic chiasm and may involve only fibers crossing over to the opposite side
  • visual loss involves the temporal half of each field
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10
Q

Homonymous hemianopsia Visual Field Defect

A
  • same part of visual field is affected in both eyes
  • lesion at optic tract
  • multiple types
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11
Q

What are you looking for on the brows?

A

quantity, distribution, scales

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12
Q

What are you looking for on the lids?

A
  • Palpebral conjunctiva
  • Edema, color, position, lesions
  • Orbicularis occuli closure
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13
Q

Dacryocystitis

A
  • inflammation of the lacrimal sac
  • swelling between the lower eyelid and nose
  • acute: painful, red, tender
  • chronic: obstruction of the nasolacrimal duct
  • tearing is prominent and pressure on sac produces regurgitation of material
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14
Q

Ptosis

A
  • drooping of the upper lid

- caused by myasthenia gravis, damage to CN III, damage to SNS supply (Horner’s disease), congenital

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15
Q

Exophthalmos

A

-protrusion of the eyeball triggered by autoreactive T lymphocytes

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16
Q

Entropion

A
  • inward turning of the lid margin
  • lower lashes irritate the conjunctiva and lower cornea
  • common in elderly
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17
Q

Ectropion

A
  • lower lid turned outward, exposing palpebral conjunctiva
  • eye no longer drains well and tearing occurs
  • common in elderly
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18
Q

Sty

A

Painful, tender, red infection in a gland at the margin of the eyelid

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19
Q

Chalazion

A

subacute nontender, usually painless nodule involving a blocked meibomian gland

  • usually points inside the lid rather than on the lid margin
  • not painful
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20
Q

Xanthelasma

A

slightly raised yellowish, well-circumscribed plaques that appear along the nasal portions of one or both eyelids
-may accompany lipid disorder

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21
Q

Retraction

A
  • wide eyed stare suggests retracted eyelids

- symptom of hyperthyroidism

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22
Q

What are you looking for in the lashes?

A

Presence/absence of lashes, crusting and irritation combination with sty/chalzion

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23
Q

Blepharitis

A

swelling or inflammation of the eyelids, usually where the eyelash hair follicles are located

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24
Q

Abnormalities of EOM

A
  • Imbalance muscle tone- congenital or CN disorder (lesions, trauma, MS, syphilis)
  • Nystagmus (normal = extreme lateral gaze)
  • Lid lag
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25
Q

What are the three layers of the eye?

A
  • Fibrous (outer): sclera & cornea
  • Vascular (middle): choroid, ciliary body & iris
  • Inner: retina, optic & non-visual parts
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26
Q

What is bulbar fascia?

A

covers anterior part of cornea

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27
Q

How do you assess the conjunctiva and sclera?

A
  • For: Color, injection, hemorrhage, foreign bodies
  • Spread lids: sclera & bulbar conjunctiva
  • Lid eversion (PRN): for palpebral conjunctiva
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28
Q

What ROS should you do if sclera is yellow?

A

GI ROS

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29
Q

What does blue sclera refer to?

A

Osteogenesis imperfecta, a congenital bone condition causing extremely fragile bones

30
Q

What are you looking for when examining the cornea?

A

-Arcus, scar, pinguecula/pterygium, Kayser-fleischer ring (Wilson’s dz), shadows

31
Q

Corneal arcus

A
  • thin grayish whiet arc or circle not quite at the edge of the cornea
  • accompanies normal aging
  • usually benign
  • in young people, suggests possible hyperlipoproteinemia
32
Q

pinguecula

A
  • harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris
  • appears frequently with aging, 1st on nasal and then on temporal side
33
Q

pterygium

A
  • triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side
  • reddening may occur
  • may interfere with vision as it encroaches on pupil
34
Q

Kayser-Fleischer ring

A
  • golden to red brown ring, sometimes shading to green or blue
  • from copper deposition in periphery of the cornea found in Wilson’s dz
  • due to mutation in gene on chromosome 13
35
Q

Corneal Scar

A
  • superficial grayish white opacity in the cornea
  • secondary to an injury or inflammation
  • variable size and shape
  • do not confuse with cataracts, which can only be seen through pupil
36
Q

Cataracts

A

-opacities of the lenses visible through the pupil

37
Q

Assessment of Pupils (CN II & III)

A
  • Size (3-5mm), shape, symmetry (Miosis, mydriasis, Anisocoria)
  • pupillary reaction
38
Q

Miosis

A

constriction of pupils

39
Q

Mydriasis

A

dilation of pupils

40
Q

anisocoria

A
  • pupils not the same size
  • benign if normal pupillary reaction
  • Tonic Pupil (Adie’s Pupil), CN III paralysis, Horner’s, Argyll Robertson
41
Q

Tonic Pupil (Adie’s Pupil)

A
  • impaired PSNS to iris
  • pupil is U/L, large, regular
  • reaction to light severely reduced and slowed, or absent
  • near reaction is slow, but present
  • deep tendon reflexes decreased
  • slow accommodation = blurry vision
42
Q

Oculomotor Nerve (CN III) Paralysis

A

-dilated pupil is fixed to light and near effect
-ptosis of upper eyelid
lateral deviation

43
Q

Horner’s Syndrome

A
  • affected pupil is small, but reacts briskly to light and near effort
  • ptosis is present, with possibly loss of sweating in forehead
  • when congenital Horner’s: iris is lighter in color than its fellow
44
Q

Argyll Robertson Pupils

A
  • small, irregular pupils
  • accomodate but do not react to light
  • seen in CNS syphillis
45
Q

Parts of the fundus

A
  • Optic disc
  • Macula lutea
  • Fovea
  • Blood vessels
46
Q

Normal Optic Disc

A
  • Yellow-orange to creamy pink
  • Well defined margins
  • Physiologic cup (Usually ½ size of disc; may or may not be visible)
47
Q

papilledema

A
  • Pink, hyperemic
  • optic disc appears swollen & blurred margins
  • Physiologic cup is not seen
  • may have history of trauma, pain in back of eyes
48
Q

What is important to look for in the blood vessels of the fundus?

A
  • AV crossing, AV nicking, tapering
  • Copper wiring, silver wiring
  • Hemorrhages (deep, superficial & preretinal)
  • Neovascularization
  • Microaneurysms
49
Q

AV nicking

A

-vein appears to stop abruptly on either side of the artery

50
Q

AV crossing

A
  • vein crossing beneath the artery

- can be seen right up to the column of blood on either side

51
Q

Tapering

A

the vein appears to taper down on either side of the artery

52
Q

Cooper Wiring

A
  • arteries become full and somewhat tortuous

- develop an increased light reflex with bright coppery luster

53
Q

Silver Wiring

A

-portion of narrowed artery develops such an opaque wall that no blood is visible within it

54
Q

Deep Retinal Hemorrhaging

A
  • small, rounded, slightly irregular red spots that are sometimes called dot or blot hemorrhages
  • occur in deeper layer of retina than flame shaped hemorrhages
  • commonly caused by diabetes
55
Q

Superficial Retinal Hemorrhaging

A
  • small linear flame-shapped red streaks in the fundi
  • shaped by superficial bundles of nerve fibers that radiate from the optic disc
  • see in hypertension, papilledema, occlusion of the retinal vein
56
Q

Preretinal Hemorrhaging

A
  • develops when blood escapes into potential space between retina and vitreous
  • larger than retinal hemorrhages
  • obscures any underlying retinal vessels
  • red cells settle when patient is erect
57
Q

Neovascularization

A
  • formation of new blood vessels
  • they are more numerous, more tortuous, and narrower than other blood vessels in the area
  • common in diabetics
  • may obstruct vision
58
Q

Microaneurysms

A
  • tiny, round, red spots seen in and around macular area
  • minute dilations of very small retinal vessels
  • associated with diabetes
59
Q

When looking at the fundus with the opthalmoscope, what are you looking for?

A
  • “cotton wool” patch (soft exudates)
  • hard exudates
  • Drusen
  • Macular Degeneration (wet and dry)
60
Q

Cotton-Wool Patches

A
  • white or grayish cotton like patches
  • moderate in size but usually smaller than disc
  • result from infarcted nerve fibers
  • associated with HTN, DM
61
Q

Hard Exudates

A
  • creamy or yellowish bright lesions with well defined “hard” boxers
  • small and round and occur in clusters or circular/linear/star-shaped patterns
  • caused by HTN, DM
62
Q

Drusen

A
  • yellowish round spots that vary from tiny to small
  • edges may be soft or hard and are haphazardly distributed
  • appear in normal aging, but accompany other conditions (i.e. age-related macular degeneration)
  • seen through peripheral fields
63
Q

Macular Degeneration

A
  • cause of poor central vision in older adults
  • Wet (Exudative):neovascular macular degeneration; common in diabetics
  • Dry (atrophic): more common and less severe
64
Q

Examples of Age-Related Changes in the Eyes

A
  • VA: glare sensitivity, presbyopia, macular degeneration
  • Lids: entropion
  • Growths: xanthalasma, pingecula & pterygium
  • Cornea/lens: arcus, cataracts, glaucoma
  • Precancerous/cancerous skin changes
65
Q

What are the four types for anisocoria?

A

Tonic, CN III paralysis, Horner’s, Argyll Robertson

66
Q

What are hard and soft exudates associated with?

A

HTN and diabetes

67
Q

In younger people what is a corneal arcus associated with?

A

hyperlipoproteinemia

68
Q

Risk Factors of Cataracts

A

-risk factors: old age, smoking, diabetes, corticosteroid use

69
Q

What does hypertension, papilledema, occlusion of the retinal vein have in common?

A

seen in superficial retinal hemorrhaging

70
Q

What type of macular degeneration is associated with diabetics?

A

Wet or Exudative

71
Q

Fortifications

A

zig-zag arcs of light in vision

Clinical Assessment (11 decks)

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