Module 1 eye examination

Question 1

screening recommendations >65

Answer 1

every 1-2 years

Question 2

screening recommendations for diabetics

Answer 2

T1DM: 3-5 years after dx and annually
T2DM: at time of Dx and annually
Pregnancy: screening before conception, early in 1st trimester, and 1 year PP

Question 3

high risk populations for glaucoma

Answer 3

older adults
family hx
African american > 50
Hispanics > 65

Question 4

Erectile dysfunction Rx can cause

Answer 4

cyanopsia: blue-tinted vision

Question 5

important family hx

Answer 5

glaucoma
color blindess
cataracts
macular degeneration
corneal dystrophy
retinoblastoma
RA
DM
HTN
CAD
renal disease
autoimmune disorders

Question 6

ocular vital signs
- assess basic health and function

Answer 6

visual acuity
pupil responses
intraocular pressure
visual fields
extraocular movements

Question 7

visual acuity

Answer 7

spatial resolving power of the eyes
- primary functional measure

Question 8

Alternatives to Snellen

Answer 8

20/200 Snellen E
- held directly in front of pt and then moved back until no longer able to identify
Finger counting
- any number of fingers held at increasing distances from pt until pt can no long count the fingers
Waving
- asked to identify waving hand in from of eyes
Perceive light
- light shined into a pt eye in a darkened room

Question 9

Near vision screen

Answer 9

Rosenbaum near card: 14 inches away

Question 10

Near vision recorded on

Answer 10

Jaeger scale

Question 11

Near vision and aging

Answer 11

difficulties begin around age 42-43
- dec. flexibility of the human lens: presbyopia

Question 12

Anisocoria

Answer 12

any variance in the size of pupils between eyes

Question 13

Hippus

Answer 13

Light shown in pupil
- after constriction there is a slight fluctuation in diameter

Question 14

swinging flash light test

Answer 14

verify pupil responses
- focus straight ahead at distant object
- light in one eye until constriction then swung quickly to opposite eye
- NML: equal signal and consensual constriction

Question 15

Relative afferent pupillary defect/ Marcus-Gunn pupil

Answer 15

swinging flash light test
- normal constriction in both eyes upon shining light in first pupil, when light sung to second pupil the pupils paradoxically dilate
- disruption of the afferent signal from damaged nerve

Question 16

normal intraocular pressure

Answer 16

10-20 mmHg

Question 17

methods to test intraocular pressure

Answer 17

air-puff tonometer
tono-pen
Goldmann applanation tonometry (gold standard)

Question 18

estimating intraocular pressure with palpation

Answer 18

eyes should feel like a grape and by roughly symmetric
Abnormal:
- rock hard
- firm, painful eye, w/ inflammation and cloudy cornea
-> acute rise in intraocular pressure

Question 19

ocular alignment exam

Answer 19

Test for presence of strabismus
- Hirschberg test
- cover-uncover
- alternate cover

Question 20

Hirschberg

Answer 20

pt looking in primary gaze
- shine light directly in pt eyes, reflection of light off cornea seen: light reflex
- If reflection deviated medially or laterally indicates exotropia (lateral) or esotropia (medial)

Question 21

nine dx positions of gaze

Answer 21

straight
right
upper right
lower right
left
upper left
lower left
up
down

Question 22

Cranial nerve III (oculomotor) palsy signs

Answer 22

down and out position of eye
- unable to adduct the eye or move it up or down
completer or partial ptosis
possible non-responsive pupil

Question 23

nonresponsive pupil suggestive of

Answer 23

a compression lesion

Question 24

Cranial nerve IV (trochlear) palsy signs

Answer 24

dec. ability to look down in the adducted position
- head tilt away from affected side is often present

Question 25

Cranial nerve VI (abducens) palsy signs

Answer 25

unable to abduct the eye
- head turn away from the affected side