Midterm Exam Flashcards
How do you check the direct/consensual pupil reflex?
direct: shine light into eye for 2sec (5-6cm)
consensual: shine light into 1 eye while looking at the other for 2sec (5-6cm)
How do you check for an APD?
shine light into one eye for 3sec, rapidly move to other eye for 3sec and repeat
What is the clinical significance of an APD?
asymmetry in the afferent pathway
What is anisocoria? and when is it normal vs. abnormal?
Different pupil sizes. Normal = within 1mm (illumination level shouldn’t change amount)
Abnormal = more than 1mm
What is the pathway for the sympathetic pupil response?
mydriasis/dilation (iris dilator)
and anisocoria will be greater in dim illumination
What is the pathway for the parasympathetic pupil response?
miosis/pupil constriction (iris sphincter) and anisocoria will be greater in light illumination
What are the 3 ways to control amount of illumination?
height, width, and intensity of beam
What are the 2 most common illumination techniques?
wide beam and direct
How do you grade the bulbar conjunctiva?
0-4: 0=normal, 1=trace, 2=mild, 3=moderate, 4=severe
Which vessels are moveable with eyelid friction?
conjunctival vessels
what is the layer of vessels deep to the conjunctival vessels?
episcleral (do not move)
What is considered a ptosis?
if the palpebral fissure differs by more than 0.5mm
what is the normal position of the upper lid margin?
2mm below the upper limbus
what is the normal position of the lower lid margin?
about 1mm above the lower limbus
What is Munson’s sign?
a V-shaped dent of the lower lid produced by the conic cornea in downgaze (keratoconus)
What are the 3 most common TED lid signs?
Dalrymple’s sign, Von Graefe’s sign, and Stellwag’s sign
What is Dalrymple’s sign?
abnormally widened palpebral fissures, “pseudoptosis” (surprised look)
What is Von Graefe’s sign?
lid lag in down gaze, lag of upper eyelid in following the globe when patient looks down (sclera is continuously seen)
What is Stellwag’s sign?
infrequent or incomplete blinking
What is Gifford’s sign?
difficulty in everting upper lid
What is Vigouroux sign?
eyelid fullness or swelling (upper and/or lower)
What is Mobius sign?
poor convergence
What is Boston’s sign?
“jerky” lid lag
What is the best light source to evaluate pupils with?
transilluminator (direct, BIO, and slit lamp may also be used)