Module 1 - Basic Eye Exam Flashcards
What do you mean by oculus?
Eye
What do you mean by dextro?
Right
What do you mean by sinister?
Left
What is oculus dexter?
Right eye
What is oculus sinister?
Left eye
What is oculus uterque?
Both eyes
What step in the eye examination is the measurement of the smallest object a person can identify at a given distance?
Visual acuity
What is the unit of measurement used in the Philippines in measuring the visual acuity?
Metric system (meters)
What is the unit of measurement used in the Other countries in measuring the visual acuity?
English system (feet)
What is measured as a fraction?
Distance visual acuity
What does the first and second number of the visual acuity mean?
First number (numerator): distance of patient from the eye chart Second number (denominator): distance at which the letter can be read by a person with normal vision
What are the 5 charts used in testing visual acuity?
Number acuity Snellen chart HOTV chart Picture chart Illiterate E chart
What are the procedures in testing distance visual acuity?
Position patient at 6 meters
Use a well lit chart
Start with right eye first (occlude the other eye)
Ask patient to read smallest line he can distinguish
If VA is 6/12 or worse, repeat test using a pinhole
Test the left eye similarly
Record VA for each eye
What should be used if VA is 6/12 or worse?
Pinhole
If the patient cannot see the largest letter, what should be done?
Bring patient closer (record new distance as the numerator eg. 3/60 for a patient at 3 mm from chart)
In testing distance VA, if patient still unable to see largest letter at 1 meter what should be done?
Do counting fingers (eg CF at 1 ft)
In testing distance VA, if patient unable to count fingers, what should be done?
Determine if he can detect movement of your hand (eg HM 2 ft)
In testing distance VA, if patient cannot detect movement what should be done?
Detect presence and direction of light
- LP - light perception
- LP with direction - light direction with localization of light
- NLP - no light perception (totally blind)
What is a quick method to assess best corrected vision?
Pinhole vision
What is expected by looking through a pinhole?
The refractive errors of the peripheral cornea and crystalline lens of the eyes are significantly reduced or eliminated
In pinhole test, visual acuity simulates that with proper eyeglasses in place. True or false?
True
Pinhole test is not done as part of the visual acuity test. True or false?
False
What are the 2 indications of doing near vision testing?
Near vision complaints
Difficulty testing for distance (ex. Bedridden patients)
What are the 8 steps in performing an eye examination?
Measure and record visual acuity Examine the external eye Examine the cornea Assess the pupillary reflexes Evaluate ocular motility Measure ocular pressure Evaluate visual fields by confrontation Examine the fundus using a direct ophthalmoscope
What chart is used for near vision testing?
Rosenbaum pocket vision chart
What is the usual distance of near vision testing?
13-15 inches in front of the patient
What do you call the measurement recorded in near vision testing?
Jaeger equivalent
What are the 6 structures that needs to be inspected in the external eye?
Lids Eyelashes Surrounding tissues Cornea Anterior chamber Iris
What is used for the upper eyelid when everting the lids?
Cotton bud
What tests elicit the corneal light reflex?
Hirschberg test
What is the indication of Hirschberg test?
Strabismus testing
For uncooperative child, the Hirschberg test tests what?
Only test of alignment
What are the 3 techniques for Hirschberg test?
Hold penlight or light source in front of patient
Ask patient to fixate at something in the distance
Note position of corneal light reflex on each eye
How would you interpret normal corneal light reflex?
Reflex slightly nasal to the center of cornea
How would you interpret esodeviation corneal light reflex?
On deviated eye, reflex displaced temporally
How would you interpret exodeviation corneal light reflex?
On deviated eye, reflex displaced medially
What are the procedures in testing pupillary reaction?
Use a penlight
Dimly lit room; subject looking at the distance
Inspect pupil size and shape
Test for direct pupillary reaction and consensual pupillary reaction
What is expected in direct pupillary reaction?
Constriction of pupil when tested eye is exposed to bright light
What is expected with consensual pupillary reaction?
Constriction of pupil of the opposite eye when tested eye is exposed to bright light
What is the indication of swinging penlight test?
Anisocoria (unequal pupils)
What is anisocoria?
Unequal pupils
What are the techniques for checking right eye response in swinging penlight test?
Shine light on right eye and check right pupil reflex
Shine light on left eye and check right pupil reflex
What are the techniques for checking left eye response in swinging penlight test?
Shine light on left eye and check left pupil reflex
Shine light on right eye and check left pupil reflex
What are the 2 normal response for swinging penlight test?
Direct light reflex
Consensual light reflex
What normal response of the swinging penlight test does the pupil constricts to direct light?
Direct light reflex
What normal response of the swinging penlight test does the pupil constricts to light shining on opposite pupil?
Consensual light reflex
What 2 structures are affected in afferent lesion when eliciting swinging penlight test?
Retina
Optic nerve
What 2 structures are affected in efferent lesion when eliciting swinging penlight test?
CN III
Pupillary muscle
Afferent lesion in swinging penlight test is known?
Marcus Gunn Pupil
What happens when there is efferent lesion when eliciting swinging penlight test?
Affected eye loses consensual and direct light reflex
Unaffected eye maintains consensual and direct reflex
What happens when there is afferent lesion when eliciting swinging penlight test?
Intact consensual light reflex
Paradoxical pupil dilation to direct light
What condition occurs on moving light from opposite to affected eye?
Marcus Gunn Pupil
What innervates the lateral rectus?
CN VI
What innervates the superior oblique?
CN IV
What innervates other eye muscles?
CN III
What is the action of superior muscles (SO, SR)?
Elevates the eye
What is the action of the inferior muscles (IO, IR)?
Depress the eye
What is the action of oblique eye muscle?
Abduct the eye
What is the action of the lateral rectus?
Abducts the eye
What is the action of all other recti muscles?
Adducts the eye
What eye muscle intorts?
Superior muscles
What extorts the eye muscles?
Inferior muscles
What are the cardinal fields of gaze?
Right and up Right Right and down Left and up Left Left and down
What is the pressure of the eyeball in mmHg?
Intraocular pressure
Intraocular pressure is determined by
Outflow of aqueous humor from eye
What is the normal IOP range?
10-20 mmHg
What tool is the gold standard of IOP?
Goldmann Applanation Tonometer
What are the 3 other means of measuring IOP?
Palpation tonometry - using the index finger
Schiotz tonometer
Electronic tonometers
What is the entire area seem when your gaze is fixed in one direction (central visual and the side [peripheral] visual fields)?
Visual field
What tests help detect eye diseases or nervous system problem that limit your ability to see objects clearly in the entire visual field or a part of it?
Confrontation field tests - visual field test
What test is a simple screening method that allows estimation of a patient’s visual field?
Confrontation test
What will you do if there are variations in the confrontation test?
Count how many fingers
Identify if fingers are moving or not
What are the procedure for confrontation test?
Patient faces MD
Eye is tested one eye at a time (usually right first)
MD also closes his/her eye that is directly opposite the patient’s closed eye
Patient focuses on the MD’s nose
ME moves his/her finger from periphery towards the center
Patient indicates when he/she sees MD’s finger
Testing done on all quadrants
What ancillary test tests central vision?
Amsler Grid test
What type of diseases does the Amsler Grid test detects?
Macular diseases
What are the procedures in using the Amsler Grid test?
Tested one eye at a time
Patient indicates area that is not seen or is distorted
What staining is used to detect dendritic ulcer (HSV)?
Fluorescein dye staining
What ancillary test checks the patient’s ability to distinguish color?
Color vision test
Is color vision test not part of a routine eye examination?
It is part of the routine eye examination
What are the indications of color vision test?
Color blindness
Screen applicants for job in fields where color perception is essential, such as the military pr electronics
What is done in ophthalmoscopy as this aids in examining the fundus?
Dilation
Is dilation in ophthalmoscopy routinely done?
It is not routinely done
What is the usual dilating drops?
Tropicamide
Phenylephrine
Dilation in ophthalmoscopy is not achieved in what 3 conditions?
Shallow anterior chamber
Patients undergoing neurologic observation
Patients who underwent cataract surgery
What are the 5 landmarks in direct ophthalmoscopy?
Red reflex Optic disc Retinal blood vessels Retinal background Macula
Describe the red reflex
Reflected light from the fundus
Red to red orange
Evenly colored
Dull color or absent
The dullness or absence of red reflex are due to what 2 conditions?
Media opacities (including vitreous) Retinal disease
What is the shape of the optic disc?
Slightly oval in vertical meridian
What is the approximated diameter of the optic disc?
1 mm
What condition can be assumed if the optic disc is tilted?
Myopia
What is the color of the optic disc?
Pink in color
What is the color of the optic disc if there is optic atrophy?
Pallor
What is the physiologic cup?
Central depression
Central depression measures how many?
0.2 to 0.4
What condition can be assumed of there are large cups?
Glaucoma
What is the normal cup-disc ratio?
0.2 to 0.4
What condition can be assumed if there is large cup-disc ratio?
Glaucoma
Where does the central retinal artery starts?
Optic disc
Central retinal artery branches into what 4 divisions which supplies the 4 quadrants?
Superotemporal branch
Inferotemporal branch
Superonasal branch
Inferonasal branch
True or false. Similar arrangement of retinal vein that collects at the optic disc
True
What is the normal artery-vein (AV) ratio?
2:3
What should be taken note of in retinal circulation?
Arteriovenous crossings
What are the 3 factors contributing to red orange color?
Retinal pigment
Choroidal pigment
Blood
What are the 3 lesions to watch out of in retinal background?
Exudates
Hemorrhages
Scars
