H&P Ophtho Exam Flashcards
What do you start with ALWAYS?
Visual Acuity Exam
- Snellen Eye Chart
Examination of the External Structures
Inspection
- Protrusion of the eyes - hyperthyroidism or retrobulbar tumor
- Strabismus
- Lids- *ptosis, entropion, ectropion, styes, chalazion *
- Lashes/brows: presence/sparcity - indicates thyroid disease
- Puncta: abnl lacrimal damage, matter - *lacrimal duct obstruction, conjunctivitis *
Palpate
- orbits and lacrimal glands - tenderness
Inspection of anterior structures
- Conjunctiva - color, vascular pattern, nodules, swelling, opacities, abraisions, foreign bodies, pterygium
- Palpebral - pull down lid, use light source
- Bulbar: evert lid
- Sclera - jaundice (icterus)
- Cornea - Arcus
- Pupils: size, shape, symmetry
- anisocoria is benign if <0.5mm difference and reacts normally to light
Cardinal Fields of Gaze
Symmetry of movement
Nystagmus - one or two beats at the extreme of peripheral vision are normal
Lid lag - suspect thyroid disease
LR6 SO4 AO3
Pupillary Reflexes
- Direct
- Consensual
- Accomodation
- Also: inspect iris with tangential light
- should see crescentric shadow or bowing of iris indicative of glaucoma
Conjugate Gaze
Light reflex
- hold light ~2 ft directly in front of pt
- reflection should be symmetric and just nasal to the midline of the pupil
- *assymmetry of corneal reflections indicates deviation from normal ocular alignment *
Cover/uncover
- weak eye will re-centralize after uncovering
- *subtle muscle imbalance or weakness *
Peripheral vision by confrontation
- bilateral exam in temporal quadrants is adequate for screening
- if abnl perform unilateral testing in all four quadrants
- hemianopsia and quadratic defects
- *most deficits occur in temporal fields *
- temporal defect indicates nasal defect in other eye
Posterior Structure Exam by Fundoscopy
Lens: clarity - normally clear
Red Reflex
Optic disc/cup dimensions and borders: normal ratio is 1:2 (cup should not exceed half the diameter of the disc). Blurry margins or increased ratio indicates papilledema.
Retina: inspect arteries and veins in 4 directions, retinal exudates and hemorrhages - assess for AV nicking or inverion
Fovea and Macula - assess for macular degeneration
Vitreous +10-12 diopters - assess for vitreous floaters, cataracts, or anterior chamber pathology
Cranial Nerves in Ophthomolgy
Viscular acuity, fields, fundi - CNII
Pupillary reaction - CN II, III
Extraocular movements - CN III, IV, VI
Corneal reflex - CN V
History: Acute Causes of Vision Loss
retinal detachment
vitreous hemorrhage
central retinal artery occlusion
History: Gradual Vision Loss (Degenerative)
myopia - near-sighted
hyperopia - far-sighted
presbyopia - aged eye
hyperglycemia? can lead to retinopathy/damage retinal vessels
slow central vision loss
cataract
macular degeneration
slow peripheral vision loss
advanced open angle glaucoma
one-sided vision loss
hemianopsia or quadrantic defects
flashing lights or new vitreous floaters
retinal detachment
causes of diplopia
central causes: brainstem or cerebellum (+/- nystagmus)
peripheral causes: weakness or paralysis of CN III or VI (horizontal) or CN III or IV (vertical)
Diplopia in one eye with the other closed suggests pathology of the cornea or lens
