Medical Issues Ch. 12 Flashcards
History for an eye exam
history of visual acuity
any pre-existing conditions
general health status
history of the present condition
location and description of symptoms
injury mechanism
inspection techniques
periorbital area -discoloration -gross deformity globe -general appearance -eyelids -conjunctiva -sclera -iris -pupil shape and size
how do you examine inside the eye
use your fingers to retract their eyelid and shine a light in to see for foreign objects
palpation areas
orbital margin
frontal bone
nasal bones
zygomatic bones
functional assessments
vision assessment -Snellen eye chart -Rosenbaum pupillary reaction to light eye motility peripheral vision ophthalmoscope
Snellen vs. Rosenbaum
Snellen: 20 feet away
Rosenbaum: 14-16 inches
pupillary reaction to light
-PEARL
pupils equal and reactive to light
eye motility
- which nerves do they test?
- how to test
occulomotor tymphatic abducens how to test -follow an object horizontal, vertical, diagonal
peripheral vision test
bring fingers in from the sides until they can see them
two others recommendations when examining the eye
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
red flags for referral
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
refractive errors
- -cause
- types
caused by length of eye and shape or curvature of cornea
types
-myopia - hard to see distance
-hyperopia - hard to see close up
conjunctivitis
- contagious?
- other S/S
can be contagious
-viral or bacterial
other respiratory problems
conjunctivitis bacterial vs. viral
bacterial is more crusty
conjunctivitis RTP
48-72 hours after starting antibiotic eyedrops
stye
-S/S
inflammation of duct or hair follicle on the eyelid S/S -pain -swelling -redness
glaucoma
increased intraocular pressure
- build up of aqueous humor
- can lead to damage to the optic nerve
who is at risk for a glaucoma
anyone over 40 -with myopia -diabetes -hypertension AAs
eyelid laceration
-question to ask
bleed profusely
can you approximate the wound?
-harder to do over the eyelid
periorbital contusions
- DDx
- RTP
black eye
test the eye early before swelling develops
DDx
-orbital fracture
-concussion
RTP
-as soon as possible if there are not major problems
orbital fracture
-S/S
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
dislocated contact lens
evert eyelid
wash with sterile saline solution
locate lens
replace once the lens is clean or with a new one
corneal and conjunctival foreign bodies
may need to evert the upper eyelid to visualize the foreign bodies
corneal abrasions
feels with something in the eye
can lead to decreased to vision, pain, tearing
how to diagnose a corneal abrasion
fluorescein - dye
shine pen light with attachment
abrasion will be visible
will resolve within a few days to a week
corneal laceration
puncture wound to the eye
“open globe”
automatic referral
can use an eye shield
subconjunctival hemorrhage
benign
can occur from trauma (straining, high BP)
hyphema
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
detached retina
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
retinal tears
similar S/S to detached retina
immediately refer
chemical burns
flush continuously
refer
traumatic iritis
blunt trauma S/S -photophobia -sluggish pupil reaction refer
proptosis
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
ruptured globe
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
