Eyes Assessment Flashcards
Subjective Data
Health History Questions
VPPSDRWHGGSMV
Vision difficulty (decreased acuity, blurring, blind spots) Pain Photophobia- inability to tolerate light Strabismus- crossed eyes Diplopia- double vision Redness, swelling Watering, discharge History of ocular problems Glaucoma Glasses or contact lenses Self-care behaviours Medications Vision loss
Additional Health History Questions
Infants and children
VDRS
Aging Adults
MGCDD
Fresh born humans Vaginal infection during delivery Developmental milestones (4 months babys can track big objects, 5 for small, its normal for babies eyes to cross and wander) Routine vision testing Safety measures
Old foggies Movement and visual difficulty Glaucoma testing Cataracts Dryness of eyes Decreased activities
Physical Exam
6 parts
- Central Visual Acuity
- Snellen Eye Chart
- Near Vision test - Visual Fields
- Confrontation test (covering an eye and going 60 degrees nasally, 50 degrees superiorly, 90 degrees temporally from anteroposterior axis of eye and 70 degrees inferiorly) - Extraocular Muscle function
- Corneal Light Reflex (Hirschberg’s Test) (parallel alignment)
- Cover-uncover test (deviated alignment)
- Diagnostic positions test (6 cardinal positions of gaze) - External Ocular structures( General movement, eyebrows, eyelids and lashes, eyeballs, conjunctiva and sclera, upper lid eversion (not part of normal exam), lacrimal apparatus (tear duct)
- Anterior Eye ball structures (cornea and lens, iris and pupil (using PERRLA)
- Ocular fundus (internal structure) (use opthalmoscope)
Central Visual Acuity
2 tests
- test
- myopia - test
- presbyopia
- hyperopia
Snellen Eye chart
- 20 feet/ 10 adjusted
- one eye at a time
- keep visual aids on
- Record smallest line read (20/20 normal result)
- numerator = distance pt is from chart
- denominator = distance a normal eye could have read that line (bigger the denominator the worse the vision)
- myopia - near vision
Near vision
- > 40 years old/ difficulty reading
- use jaeger card, 14 inches from eye
- 14/14 normal result
- Presbyopia- decreased ability of the lens to accommodate for near vision
- Hyperopia- far vision
Visual Fields
What is the test
what are the normal values
Confrontation test
- peripheral vision
- compares it to your own
- eye level with pt 60 cm away
- cover eye, say now when you see finger
Normal findings: Upward 50° Temporal 90° Downward 70° Nasal 60°
Extraocular muscle function
3 tests
What are the normal findings
Corneal Light Reflex (Hirschberg’s Test)
- Assesses parallel alignment of the eyes
- Normal findings: light reflection should be at exactly the same spot on each eye
Cover-Uncover Test
- Detects small degree of deviated alignment
- Normal findings: A steady fixed gaze (covered eye should remain staring straight, if drifting occurs there is some eye muscle weakness)
Diagnostic Positions Test
- Leads eyes through 6 cardinal positions of gaze
- Reveals any muscle weakness during movement
- Normal findings: parallel tracking of the object with both eyes
External Ocular structures
GEEECUL
General
-Ability to move about the room, no squinting
Eyebrows
-Present bilaterally, symmetrical movement, no scaling/lesions
Eyelids & lashes
-Overlap the superior part of the iris, approximate completely when closed, lashes evenly distributed
Eyeballs
-Normal alignment, not protruding or sunken
Conjunctiva & sclera
-Conjunctiva clear, sclera china white, no lesions or discharge
Upper lid eversion
-Not part of the normal exam
Lacrimal apparatus
-Swelling, redness, tenderness, discharge from puncta
Anterior eyeball structures
2 parts
2nd part
- Pupillary light reflex
- Accommodation
- PERRLA
Cornea & lens
- Shine oblique light
- Smoothness, clarity, no opacities (cloudiness)
Iris & pupil
Iris- flat, round regular shape & even coloration
Pupils
-Size, shape & equality
-Pupillary light reflex
Always advance light from the SIDE to test this
-Accommodation
-PERRLA- Pupils Equal, Round, React to Light, & Accommodation
Ocular fundus (internal structure)
Opthalmoscope
What does it do
how does it do it
what controls the focus,
what is a dioptre
what is a positive form and a negative
What is the red reflex
Optic disc
-CSMC
Disc Diameter
Retinal Vessels
-NCACATP
General Background
Macula
- size
- location
- Foveal light reflex
- Enlarges your view of the eye
- Directs a beam of light through pupil
- Contain a set of lens that control focus
- Dioptre- unit of strength of each lens
- Positive dioptres (black) focus on near objects
- Negative dioptres (red) focus on far objects
Red reflex
-Red glow of the retina from the ophthalmoscope light
Optic disc
- Colour
- Shape
- Margins
- Cup-disc ratio (no more then half the disc diameter) (cup is small circle within the disc that vessels enter and exit)
Disc Diameter (DD)- is a standard measure for other structures in fundus. To describe a finding, note its clock-face position, and the distance from the disc in DD E.g., “ at 3:00 position, 2 DD from the disc”
Retinal Vessels
- Number
- Colour
- A:V ratio
- Calibre
- AV crossing
- Tortuosity
- Pulsations
General Background
- Colour- light red to dark brown (corresponds to skin colour)
- Clear view, no lesions
Macula
- Size: 1 DD
- Location: 2 DD temporal to disc
- Foveal light reflex- tiny white glistening dot from the ophthalmoscope’s light
Developmental considerations
Infants and children
- blink reflex
- Snellen
- lacrimal gland
- strabismus
Blink reflex- neonates blink in response to bright light
Snellen E chart for ages 3-6 years
Lacrimal glands not fully functional at birth
Strabismus- misalignment of the eyes
Developmental considerations
Older Adults
- dry eyes
- arcus senilis
- drusen
- presbyopia
- macular degeneration (AMD)
- Cataract formation
- Glaucoma
Dry eyes- due to decreased tear production
Arcus Senilis- grey-white arc around the iris d/t lipid disposition
Drusen- yellow deposits on the retina
Presbyopia- decreased ability of the lens to accommodate for near vision
Macular Degeneration
Breakdown in the cells of the macula in the retina
Central vision loss (the area of clearest vision) is the most common cause of blindness
AMD= Age-related macular degeneration
Cataract Formation
Lens opacity from clumping of proteins in the lens
Glaucoma
Increased intraocular pressure
Peripheral vision loss (2nd most common cause of blindness)
Open-angle vs. closed-angle
Glaucoma
- close angled
- open angled
*Angle= space between the iris & cornea, Fluid= aqueous humor
Glaucoma- increased intraocular pressure
Closed-angled: angle is narrowed
- Causes sudden increased pressure
- Blurred vision, photophobia, nausea, halos, pain
- EMERGENCY!
Open-angled: angle is open, but fluid is slow to drain
- Progresses at slower rate
- Slow peripheral vision loss
- Virtually no symptoms
Glaucoma
- close angled
- open angled
*Angle= space between the iris & cornea, Fluid= aqueous humor
Glaucoma- increased intraocular pressure
Closed-angled: angle is narrowed
- Causes sudden increased pressure
- Blurred vision, photophobia, nausea, halos, pain
- EMERGENCY!
Open-angled: angle is open, but fluid is slow to drain
- Progresses at slower rate
- Slow peripheral vision loss
- Virtually no symptoms
Glaucoma Risk factors
AAFIFSDHESDU
Age >60 years African descent Female Increased intraocular pressure (21 mm Hg) Family history of glaucoma Steroid use Decreased central corneal thickness HTN Eye injury Severe myopia Diabetes Use of certain medications
Abnormal findings and what are their causes
Preorbital edema
ptosis
conjunctivitis
Periorbital edema- Eyelids are swollen & puffy
-Causes: local infections, crying, fluid overload
Ptosis- Drooping upper eyelid
-Causes: neuromuscular weakness or damage
Conjunctivitis- Infection of the conjunctiva (“pink eye”)
-Causes: bacterial or viral infection, allergy, chemical irritation
