Medical Issues Ch. 12

Question 1

History for an eye exam

Answer 1

history of visual acuity
any pre-existing conditions
general health status

Question 2

history of the present condition

Answer 2

location and description of symptoms

injury mechanism

Question 3

inspection techniques

Answer 3

periorbital area
-discoloration
-gross deformity
globe
-general appearance
-eyelids
-conjunctiva
-sclera
-iris
-pupil shape and size

Question 4

how do you examine inside the eye

Answer 4

use your fingers to retract their eyelid and shine a light in to see for foreign objects

Question 5

palpation areas

Answer 5

orbital margin
frontal bone
nasal bones
zygomatic bones

Question 6

functional assessments

Answer 6

vision assessment
-Snellen eye chart
-Rosenbaum
pupillary reaction to light
eye motility
peripheral vision
ophthalmoscope

Question 7

Snellen vs. Rosenbaum

Answer 7

Snellen: 20 feet away
Rosenbaum: 14-16 inches

Question 8

pupillary reaction to light

-PEARL

Answer 8

pupils equal and reactive to light

Question 9

eye motility

• which nerves do they test?
• how to test

Answer 9

occulomotor
tymphatic
abducens
how to test
-follow an object horizontal, vertical, diagonal

Question 10

peripheral vision test

Answer 10

bring fingers in from the sides until they can see them

Question 11

two others recommendations when examining the eye

Answer 11

examine eye ASAP, as swelling will get in the way if too much time is wasted
do not place external pressure on the eye or surrounding structures if there is a high suspicion of trauma that was severe enough to rupture the eyeball

Question 12

red flags for referral

Answer 12

blurred vision
diplopia - double
foreign object protruding into the eye
restricted eye movement
distorted pupil
hyphema
unilateral pupil dilation or constriction
large lacerations of the eyelids
lacerations that involve the margins of the eyelids
persistent floaters

Question 13

refractive errors

• -cause
• types

Answer 13

caused by length of eye and shape or curvature of cornea
types
-myopia - hard to see distance
-hyperopia - hard to see close up

Question 14

conjunctivitis

• contagious?
• other S/S

Answer 14

can be contagious
-viral or bacterial
other respiratory problems

Question 15

conjunctivitis bacterial vs. viral

Answer 15

bacterial is more crusty

Question 16

conjunctivitis RTP

Answer 16

48-72 hours after starting antibiotic eyedrops

Question 17

stye

-S/S

Answer 17

inflammation of duct or hair follicle on the eyelid
S/S
-pain
-swelling
-redness

Question 18

glaucoma

Answer 18

increased intraocular pressure

• build up of aqueous humor
• can lead to damage to the optic nerve

Question 19

who is at risk for a glaucoma

Answer 19

anyone over 40
-with myopia
-diabetes
-hypertension
AAs

Question 20

eyelid laceration

-question to ask

Answer 20

bleed profusely
can you approximate the wound?
-harder to do over the eyelid

Question 21

periorbital contusions

• DDx
• RTP

Answer 21

black eye
test the eye early before swelling develops
DDx
-orbital fracture
-concussion
RTP
-as soon as possible if there are not major problems

Question 22

orbital fracture

-S/S

Answer 22

blow to the eye or the bones around the eye
blowout fracture
-fracture to the walls or floor of the orbit
S/S
-pain with eye movement
-possible inability to look up if bottom is fractured
-pain when blowing nose
-diplopia
refer

Question 23

dislocated contact lens

Answer 23

evert eyelid
wash with sterile saline solution
locate lens
replace once the lens is clean or with a new one

Question 24

corneal and conjunctival foreign bodies

Answer 24

may need to evert the upper eyelid to visualize the foreign bodies

Question 25

corneal abrasions

Answer 25

feels with something in the eye

can lead to decreased to vision, pain, tearing

Question 26

how to diagnose a corneal abrasion

Answer 26

fluorescein - dye
shine pen light with attachment
abrasion will be visible
will resolve within a few days to a week

Question 27

corneal laceration

Answer 27

puncture wound to the eye
“open globe”
automatic referral
can use an eye shield

Question 28

subconjunctival hemorrhage

Answer 28

benign

can occur from trauma (straining, high BP)

Question 29

hyphema

Answer 29

bleeding in the anterior chamber of the eye
not benign
shows up over the iris and pupil
S/S
pain, blurred vision
911
-keep them upright
Tx
-bedrest in an elevated position
resolve in about a week
will require eye protection

Question 30

detached retina

Answer 30

high chance of disrupting optic nerve
S/S
-"curtain" over their field of vision
-floaters
-blurred vision
can be caused by a severe jarring force
immediate referral

Question 31

retinal tears

Answer 31

similar S/S to detached retina

immediately refer

Question 32

chemical burns

Answer 32

flush continuously

refer

Question 33

traumatic iritis

Answer 33

blunt trauma
S/S
-photophobia
-sluggish pupil reaction
refer

Question 34

proptosis

Answer 34

direct trauma
bulging of the eye caused by swelling
swelling can damage the optic nerve
S/S
-bulging
-decreased motility
-diplopia
-can't close eyelids fully
-pain
-nausea
immediate referral

Question 35

ruptured globe

Answer 35

blunt trauma directly to the glove
rupture of the cornea or the sclera resulting in the inner contents spilling out
S/S
-pain
-eyeball may look out of place
-marked edema
-hyphema possibly
shield and refer