Ophthalmic pt Services and Education 8% Flashcards
*What are the 2 main causes of color deficiency?
Inherited (passed by the mother to male child)
Aquired(due to ON or Ret disease)
*Eye lid turns inward causing eyelashes to rub against K
Entropion
An inflammatory and bacterial condition of the lid and lid margin
Blepharitis
Blepharitis is treated with
Mild Abx and steroid oint, lid hygiene, lid scrub, and baby shampoo scrubs, warm compresses. Chronic condition (don’t sure it’s just manage it)
Hordeolum and chalazion are mostly cause by what
Staph aureus
Infection or inflammation of the sebaceous gland at base of lashes
Hordeolum
*Infection or inflammation of deep meibomian glands within the eyelids-develops into a hard mass
Chalazion
*Pt has high blood cholesterol causing cholesterol deposits to form around the eyes
Xanthalasma
A failure of the levator muscle
Ptosis
What are the types of ptosis?
Congenital or aquired
*Pt can’t close eyelids all the way. Caused by Bell’s Palsy and other causes
Lagophthalmos
Upper eyelid skin has become very thin and droopy. Causes overhanging of normally positioned eyelid
Dermatochalasis
Can happen in the lid margin. Most frequent site to find this. Will typically not grow lashes.
(BCC) Basil Cell Cancer(CA)
Opacification in the crystalline lens. Can form in any layer of the lens.
Cataracts
What are some causes of cataracts?
Trauma, congenital, due to use of certain medications like steroids, or age related.
Cataract formed in the nucleus
White mature
*Cataracts: opacification just below the capsular bag. Tend to happen due to steroid use.
PSC (posterior subcapsular cat)
Cataracts: frequently grows in spokes. Can cause increasing lenticular astigmatism if more dense in one meridian than another.
Cortical cataracts
What are the 3 primary types of GLC?
OAG, pupillary block, secondary glaucoma
*What is the most common type of glaucoma
Open angle
GLC: Fluid flows fine in the eye but when tries to escape through trabecular meshwork it doesn’t flow out well. Fluid flow is decreased due to narrowed opening on the TM.
OAG
Glc: angle structures are narrowed. Aqueous flow has difficulty circulating. Iris bows forward obstructing outflow through the TM
Pupillary block
Glc: also known as narrow angle glc
Pupillary block
Glc: eye is crowded because pt hyperopic and has a small eye or perhaps has a dense CAT that has crowded out the eye.
Pupillary block (narrow angle)
Glc: TM is blocked by red blood cells, scarring/sunechiae, debri, pigment, hyphema
Secondary Glc
A comparison of the size of the cup(white circle in the middle) compared to the disc(size of the whole optic nerve)
Cup to disc ratio
C/D
(Ex. If cup is 20% size of disc you would say it is .2 cup to disc ratio)
The larger the number the sicker the ON is.
What normal range of C/D?
Suspicious range?
Glaucoma?
.1-.4
.5-.7
.8 and above
2nd most common form of GLC
Narrow angle (NAG or closed angle glc)
*Glc that presents through sudden attacks of pain caused by increase iop. Treated with LPI,
Narrow angle
Procedure that puts a hole in the iris with a laser creating an overflow channel.
LPI
(Laser peripheral iridotomy)
Glc: can be apparent when a child has very large eyes, one eye larger than the other, causes blue tinted sclera
Congenital
Pain, Constant tearing, photophobia, and blepharospasms are sign and symptoms of…
Congenital glc
Glc: Abnormal blood vessel growth in the iris. Very difficult glc to treat.
Neovascular glc (rubiosis)
*Vitreous detached from the retina.
PVD(floaters)
What are the worries with PVD?
That it’s gonna pull a hole in the retina which can progress into a RD.
New onset of floaters or flashing lights needs….
Prompt ret exam within 24 hours
90% of AMD is _______
10% of AMD is _______
Dry(no leaky blood vessel)
Wet(has leaky blood vessels)
Blood is toxic to_____. When they are expose to blood they ____
Retinal photo receptors
Die
Profound vision loss, geographic atrophy, and scarring of the macula are symptoms of what AMD?
Wet AMD
Which AMD is characterized by Pt tending to have a gradual decrease in va
Dry AMD
Yellow spots on retinal that are signs of dry AMD
Drusen
Central VF test given to pt to monitor and see if any change in retina between appointments for AMD pts
Amsler
Distortion in smaller grid, present with wet AMD. Can also be missing areas or double lines.
Metamorphopsia
Membrane that grows over the macula. Can cause distorted vision and decreased va. Treated with membrane peel when va dropped to 20/50 or worse.
Cellophane maculopathy, epiretinal membrane (ERM), or macular pucker
What are the 2 types of cerebral vascular accidents?
Ischemic stroke and hemorrhagic stroke
Stroke that happens when an emboli or blood clot cuts off oxygen to a given part of the brain. Warning is sudden temporary va loss and visual field loss (CRAO, CRAVO, BRAO, BRVO)
Ischemic
Stroke describes as bleeding in the brain
Hemorrhagic
Blood is ____to the neuro cells in the brain. So they ____ when exposed to blood.
Toxic
Die
An example of interaction between 2 organ systems(circulatory and neurologic system)
Cerebral vascular accident
*Inflammatory or immunologic disorder effecting circulatory system. Dreaded conditions because can cause permanent va loss and/or death. Can cause ON damage from reduced blood supply, diplopia, CRAO, usually occurs 60 yo +
Giant cell arteritis (temporal arteritis)
What is the protocol and tx of Giant cell arteritis?
Urgent blood testing (set rate) and/or temporal artery biopsy. Treated with corticosteroids
*Signs and symptoms of giant cell arteritis
Pain/ headache in the temple, jaw pain, scalp tenderness, decreased appetite, unexplained weight loss, and malaise(won’t feel well)
*Circulatory impairment in the vessels that supply retina, choroid, and ON. Retina has been affected by HBP, usually sees small retinal hemorrhages.
Hypertensives retinopathy
*Thought to be caused by circulatory problems in the eye in the case of ocular migraines or in the brain in the case of regular headaches. It’s an intense headache with nausea, vomiting, visual scintillations(subjective visual disturbances.ex. Whirling lights, flashing lights, temporary partial or complete loss of vision)
Migraines
Chronic disease of young adults, it’s a problem with the myelin sheath, white matter of spinal cord and brain, causing optic nerve inflammation (optic neuritis). Diagnosed by MRI, CSF exam, or watching for long patterns or symptoms.
Multiple sclerosis
*Disease of the orbit caused by thyroid eye disease or Grave’s disease. Causes eyelids and orbital tissue to swell causing eyes to have forward protrusion(proptosis). Eye muscles swell, causing proptosis which causes dryness, problems with lid and eye movements, loss of va and vf loss due to pressure on ON.
Thyroid orbitipathy
Chronic autoimmune disease. Can occur at any age. Interferes with proper nerve transmission to muscles through out the body. Causes muscle weakness causing diplopia due to muscle swelling, proptosis, trouble swallowing, trouble breathing
Myasthenia Gravis
Autoimmune disease that occurs in women>men. Affects skin, blood vessels, lungs, kidneys, eyes. Ocular symptoms: dry eyes, scleritis, corneal ulcers, retinal vasculitis, optic neuritis.
Butterfly rash common. Treated with systemic or topical corticosteroids.
Systemic Lupus Erythrematosus
Inflammation causing skin and lacrimal gland involvement including nodules and granuloma on the conjunctivita. Origin unclear, occurs more often in blacks and Hispanics. Affects the retina, ON, choroid, and can cause uveitis. Treated with corticosteroids.
Sarcoidosis
Can be inflammatory, idiopathic, or immunologic, causes dry mucous membranes through out the body. Causes dry eyes, dry mouth, KCS (photophobia, grittiness, burning, FB sensation) treated with artificial tears and punctal occlusion.
Sjogren’s Syndrome
Disease caused by HIV virus. Compromises the immune system. Sexually transmitted, needle sticks, and contact with blood or body fluid by someone that is infected. Causes Cytomegalovirus Retinitis, Kaposi’s sarcoma, and HZO.
AIDS
Disease that can be bacterial or parasitic. It is urologic and sexually transmitted. Can be transmitted from genitals to the eyes. Causes conjunctivitis (must treat pt and partners)
Chlamydia
Fungal infection, contracted by inhaling dust spores infected soil. Commonly found in Mississippi River Valley, South American. Asia, and Africa. Affects pulmonary system causing flu like symptoms. Ocular: causes choroidal and retinal scarring and subretinal hemorrhages.
Histoplasmosis
Causes by a protozoan. Can be congenital from mothers uterus or acquired. Can result in death of baby in womb. Occurs due to exposure of animal feces. Can cause swollen glands and mild fever. Ocular: can cause retinal choroiditis, uveitis, and vitritis . Can also occur in association with AIDS.
Toxoplasmosis
A highly contagious STD caused by bacterium, Treponema pallidem. Can result in blindness. Treated with PCN. Ocular: uveitis, functional defects in pupils and optic nerve.
Syphilus
Cancer that spreads throughout the body in the lymphatic system. Choroid is primary site due to its vascularity. Breast cancer commonly metastasis to the choroid. May respond to chemo or radiation.
Metastatic Carcinoma
Any abnormality of the blood. Ex: sickle cell anemia, leukemia, Tay Sachs disease. Can affect ON, optic disc, retinal blood vessels. Regular eye exam required.
Blood Dyscrasiasis
Condition can cause headaches, VF defects, pupillary abnormalities, papilledema. Dx confirmed with MRI or CT scan with contrast dye.
Cerebral neoplasm(Brain Tumor)
Safety glasses break into ______ instead of _______ _______
Crumbles
Sharp shards
Safety glasses frames are designed to retain the lenses under _________ _______. They have to be ________ resistant and may have_______ shields to protect from______
High impact
Flame
Side
Projectiles
*Lens used for industrial setting and has more impact resistant requirements.
Safety lenses
*Lens for street wear. Used in eyeglasses, sunglasses, and non corrective eye wear. Is shatterproof not equivalent to impact resistant.
Impact resistant lenses
Basic impact lens tested with…..
1” steel ball dropped from 50”
Lens must not crack chip or break
High impact lens tested with…
High velocity 1/4” steel ball traveling at 150’ per sec. Has a plus mark on the lens. Lens must not crack chip or break
Lens that are better than glass, especially for welding. More impact resistant than glass but scratch easy.
Plastic hard resin lenses.
*The most impact resistant lenses. Very light weight(half the weight of glass lenses). Prone to scratches without scratch resistant coating.
Polycarbonate lenses
Lens that is oven heated, then cooled to harden the lens.
Heat treated impact resistant lenses
With heated impact resistant lenses industrial use must be no thinner than _____ and general wear must be no thinner than ____ at optical center and _____at edge
3mm
2mm
1mm
What can be used to identify a heated impact resistant lens?
Polariscope
_________treated lenses are more impact resistant than heat treated lenses.
Chemically
Lens is placed in a hot solution of potassium salt for 14 hours. Sodium ions are replaced by potassium ions. While cooling the potassium ions place the surface in a state of compression giving the lens it’s impact resistance.
Chemically treated lenses
What are the 2 types of eye dressings used in ophthalmology?
Pressure patch and patch & shield
Which patch keeps the eye closed and immobile?
Pressure patch
Which patch keeps the eye protected from bumps and prevents rubbing if the eye?
Patch and shield
When taping patches tape is…..
Angles away from the nose and the nasal folds.
How many patches are used for a pressure patch?
2
Describe how to do a pressure patch.
Fold one patch over, make wet or add ointment and place in closed eye, place a second patch over top, then tape angled away from nose and nasal folds.
What is definition of legally blind?
VA 20/200 or less or VF of 20 degrees or less in better eye.
Define low vision
20/70 or less in better eye
What does CPR stand for ?
Cardio Pulmonary Resuscitation
“CAB”
Compressions
(push hard and fast on center of pts chest)
Airway
(tilt head back and lift chin to open airway)
Breathing
(Give mouth to mouth rescue breaths)
In CPR, compress the chest of an adult_____ inches allowing for complete recoil of chest between compressions
11/2-2 inches
In CPR..compress the chest at a rate of ____chest compressions per minute
100
In CPR…._______________ AHA said you should push as long as you can. Interruptions in compression ____________which leads to brain death.
Don’t stop pushing.
Stops blood flow to the brain
What does hands only CPR?
Means you don’t do mouth to mouth
Hands only CPR is best used when
Someone suddenly collapses
*Which CPR technique should be used for drowning victim, infants and children, and people who collapse due to breathing problems?
Full CPR
(Chest compressions and breathing)
What artery is the stethoscope placed over to check BP?
Brachial
First heartbeat heard in checking BP is recorded as the ______. The last point at which you hear the heart beat is the ______
Systolic pressure
Diastolic pressure
What are 2 places to check pulse
Brachial at wrist or carotid artery
For HR count x _____seconds and multiple by _______
10
6
*Eye muscle that allows you to squeeze eyelids closed.
Orbicularis oculi muscle
(Know which nerve controls)
What are 3 external eye muscles?
Frontalis, orbicularis oculi, levator palpebral superioris
Muscle that helps you raise and lower your eyebrow
Frontalis
Muscle that elevates the eyelid
Levator
Circular muscle around the eye that lets you squeeze eye closed
Orbicularis oculi
Tears are produced by the
Lacrimal gland
Tears are pumped out through the
Lower punctum and nasal lacrimal duct
*Every time you blink fresh ____ _____ are pumped into the surface of the eye
Oxygenated tears
*What is the first refractive surface of the eye?
Tear film
Pool of tears on lower lid margin is known as…
The tear lake
*Describe tear flow
Produced in lacrimal gland, out through lower punctum, the lower canaliculous, through the lacrimal sac, and the nasal lacrimal duct
_______are placed on the eye then_____are pumped out
Freshly oxygenated tears
Oxygen depleted tears
*What are the tear film layers?
Mucous layer
Aqueous layer
Lipid layer
What is the outermost layer of the tear film that is full of fatty cholesterol esters
Lipid layer
What is the lipid layer of the tear film secreted by?
Meibomian glands
What is the purpose of the lipid layer in the tear film?
To prevent evaporation of the tear film.
What is the middle layer of the tear film?
Aqueous layer
What is the aqueous layer of tear film secreted by?
Lacrimal gland
What is the thickest layer of the tear film?
Aqueous layer
What is the aqueous layer of tear film full of?
Proteins and urea
What is the inner most layer of the tear film?
Mucous layer
What is the mucous layer of tear film secreted by?
Goblet cells
What is the thinnest layer of the tear film?
Mucous layer
What is the purpose of the mucous layer of the tear film.
Lend stability
How many layers does the cornea have?
6
*What are the 6 layers of the cornea?
Epithelium
Bowman’s layer
Stroma
Dua’s layer
Descement’s membrane
Endothelium
What is the only layer of the cornea that regenerates
Epithelium
What is the thickest layer of the K
Stroma
Layer of K that is one cell thick and has a purpose of pumping fluid out of K to keep it dehydrated and clear
Endothelium
You are born with a certain number of epithelial cells. How can you lose them?
With age or intraocular sx
If you lose to many endothelial cells what can happen?
You can develop endothelial dystrophy, like Fuch’s, and K can become edematous.
At what age is the K fully developed?
2
K thickest……
At periphery at about 1 mm than centrally at 1/2mm
Limbus is _____mm wide and is the point of insertion of the _____and the demarcation between the ____ and the ____
1
Conjunctiva
K
Sclera
*Where is aqueous humor produced
Ciliary body
Describe flow of aqueous humor
Produced in ciliary body, flows through posterior chamber, through the pupil, into anterior chamber, trabecular meshwork, the canal of Schlemn and the episcleral/aqueous veins
Where is crystalline lens located
Immediately behind the iris
The crystalline lens is…
Transparent
What is crystalline lender composed of?
Fibers that come from epithelial cells which help make the lens transparent
How many layers does the crystalline lens have?
4
What are the layers of the crystalline lens from surface back?
Capsule
Subcapsular epithelium
Cortex
Nucleus
*A clear membrane like structure that is very elastic that holds the lens of the eye…and helps keep the lens under constant tension.
Capsular bag
Suspensory ligaments attached to the capsular bag and to the ciliary processes hold the lens in place and aid in accommodation
Zonules
What is the uveal tract comprised of?
Choroid, ciliary body, iris
What are the 2 muscles of the iris
Sphincter muscle-allows contraction of the pupil
Dilated muscle-expands pupil
Ciliary body is full of plump folds known as…..
Ciliary processes
When ciliary body contracts it pulls zonules tight keeping the lens from ….
Accommodating
_________drug exert their affects on ciliary body causing it to contract.
Cycloplegic
What is the most vascular part in of the eye? It’s job is to nourish the retina from underneath.
Choroid
*How many layers are in the retina?
11
What are the layers of the retina?
Nerve fibers
Optic nerve
Ganglion cell
Amacrine cell
Bipolar cell
Horizontal cell
Cone
Rod
Pigment epithelium
Choroid
Sclera
Allow you to see in dim light
Va relatively poor with these
Rods
(Have about 125 million rods concentrated in peripheral retina)
Allow you to see in daylight
Helps see small visual angles with great acuity
Color va
concentrated in fovea
Cones
(Have about 6 million concentrated in macula)
Junction of the retina and ciliary body
Ora serata
RD occur as a result of separation of the anterior and posterior _________
Pigment layers
Optic nerve is inervated by the ________
2nd CN
*Optic nerve enters the globe through a fiberous seed like structure called the ……
Lamina Crabosa
*ON forms our physiological blind spot also known as
Absolute scitoma
ON extends to ____mm to the ___and another ____to the ___
25-30 to the
Optic chiasm
4-9mm to the
Brain
Optic nerve sends_______to the brain
Light messages
The _____interprets light signals from ON into something meaningful m, VA
Brain
How is orbit protected from blows
By vitreous jelly, Layers of muscle, and Layers of fat around the globe
Right side images are interpreted by left side of brain and left by the right due to..
The selective crossing of our nasal retinal fibers at the optic chiasm
Temporal retinal fibers stay on the ______side of the brain
Same
Due to The selective crossing of our nasal retinal fibers at the optic chiasm we get a _____response
Consensual light response
Where is the origin of visual impulses
ON
*Primary destination of visual impulses is
The primary visual cortex, the back part of brain that interprets the light impulses into vision
We see with our _____not with our eyes
Primary visual cortex
What are the 3 characteristics to color vision?
Hue, saturation, brightness
Depends upon what wavelength of light an object absorbs vs reflects
Hue
ROYGBIV
Red
Orange
yellow
Green
Blue
Indigo
Violet
(Longest wavelength to shortest)
(Wavelength determines color)
White objects have_____wavelengths and is absorbing _____
No
All
Black objects reflect ___wavelengths and absorb _____
All
None
Purity of the hue
And is Dependent upon how many wavelengths of light are mixed in
Saturation
Depends on light intensity
More light=brighter color perceived
Brightness
*Color vision:
pro=
Deuter=
Tri=
Red
Green
Blue
Color vision:
Anopia=
Chromat=
Absent
Number of colors they see
What is most common color va deficiency
Protanopia
What is protanopia
Red absent
Deuteranopia means
Green absent
Least common color va deficiency
Tritanopia
Tritanopia means
Blue absent
Normal color va
Trichromat
Trichromat means
3 cone pigments (can see all three red green blue)
Anomalous trichromat
Partial deficiency
Dichromat
2 cone pigment (not specific to which color)
Monochromat
1 cone pigment
When micro-organisms invade tissue
Infection
3 causes of infection
Bacteria
Virus
Fungus
Inflammation can be cause by
Infection or injury and allergy
*S&S of inflammation
Redness, swelling, pain, heat, loss of function
Redness or inflammation of conj
Conjunctivitis
Causes of conjunctivitis
Infection
Dryness
Allergies
Chemicals
Broken blood vessel under conj
Sub conj heme
Epithelium comes off, painful, heals quickly
K abrasion
Stroma swelling
K edema
Causes of k edema
Inflammation
Infection
K infection (ulcer)
K scaring impairing VA(transplant)
Which eye muscle allows you to squeeze your eyes
Orbicularis oculi muscle
What is the newly discoverd layer of the cornea that is thin and in between stroma and descement’s membrane
Dua’s layer
The ciliary body is adherent to the _____
sclera
Faulty development or loss of function or structure with age of the K
Corneal dystrophy and degeneration
What is a positive Munson sign
Hold pt eye lid up and have pt look down at toes and lower eyelid is deserted from its normal u shape into more of a v shape…. Testing for KCN
Fuch’s endothelial dystrophy is characterized by ____
Guttata
Redundant conj skin that encroaches on the K
Pterygium
Redundant conj skin that does not encroach on the K
pinguecula
Pinguecula and pterygium can both occur due to …
Can get them medially and laterally on conj
Wind and sun
Pt with pterygium can have increasing and irregular ___
Astigmatism
A mal directed lash where as the lash is growing wrong
Trichiasis
Entropian is correct by…..
surgeon repositioning the eyelid
How can a patient with entropian get some symptomatic relief
by taping eye lid into the proper position
When the eyelid has lost it’s muscular tone and is no longer laying flush against the orbit, so pt will have constant tearing and dryness
ectropian
How do you treat ectropian?
Surgeon makes incision at the lateral canthus and repositions the lower eye lid.
How can a patient get symptomatic relief from Lagophthalmos?
Tape lids, uses gels to protect K, moisture shield goggles to protect the K, can also have sx procedure to plant gold weights in eyelids.
Dermatochalasis is treated by….
Blepharoplasty
True or False
CAT can be formed in any layer of the lens
True
