Ophthalmological Exam Flashcards
Refractive States
(list and define 5)
- Emmetropia: no refractive error
- Myopia: nearsightedness
- Hyperopia: farsightedness
- Presbyopia: decreased accommodation with aging
- Astigmatism: nonspherical cornea or lens; light rays not refracted uniformly
Components of Visual Exam
(6)
- Visual Acuity
- Distance/near with correction
- Visual Fields
- By confrontation
- Pupillary Examination
- With hand-held light
- External exam
- Orbit and 4 L’s
- Extraocular muscle evaluation
- Motility, alignment
- Fundoscopy
Eye Inspection
(8 structures, describe what you’re observing for)
- Position and alignment of eyes
- Eyebrows - quantity, distribution
- Eyelids
- Width of palpebral fissures
- Edema, color, lesions
- Condition and direction of eyelashes
- Adequacy of closed eyelids
- Lacrimal apparatus
- Lacrimal gland and sac for swelling
- Conjunctiva and sclera
- Color, vascular pattern
- Cornea and lens - opacities
- Iris – markings clearly defined
- Pupils – size, shape, symmetry, reaction to light (direct and consensual)
Visual Acuity Tests
(function, legal “failure”)
Function: test integrity of macula, optic nerve, optic tract, and visual cortex
Legal Blindness: 20/200 BCVA
Visual Acuity Tests
(procedure)
- Have pt read the lowest line on Snellen chart with both eyes, then each eye separately
- Record result as ratio
- Repeat test s glasses, if the pt wears them
- Have pt read the lowest line on a near vision pocket vision chart held 14 inches away from the face
- Record result as a ratio
- Repeat with/without glasses, if appropriate
Confrontation Visual Field Testing
(function)
Approximates large field defects in the four quadrants of each eye. (Bunny ears test)
- Screening* - Both eyes at same time; start in the temporal fields
- Further testing* - If a defect is found, test one eye at a time
Pupil Examination
(3 step procedure, 7 common abnormalities)
Procedure:
- Ask pt to fixate on distant target in dimly-lit room
- Shine pen light obliquely into one pupil twice; assess pupil size, shape, and symmetry of each eye
- Repeat shining light into the other eye
Note - obtaining direct and consentual eye results also checks the pupillary light reflex
Common Pathologies: The following conditions result in ansiocornia (assymetrical pupils)
- Physiologic
- CN III palsy
- Horner’s Syndrome
- Ocular trauma/inflammation
- Mydriatic eyedrops
- Recreational drugs
- Occular surgery
Accomodation Reflex
(2 step procedure)
- Ask patient to look into the distance and then at an object positioned 10 cm from the patient’s nose
- Observe normal pupil constriction and eye convergence
External Ocular Examination
(5 observations)
- Inspect the orbits looking for exophthalmos (protruding eye) and enophthalmos (sunken eye)
- Inspect the 4 “L’s”*
- Lymph Nodes - Preauricular, submandibular nodes
- Lids - Ptosis, swelling, crusting, xanthelasma (lipid deposits), smooth opening and closure, entropion/ectropion (inversion/eversion)
- Lashes - Direction and condition
- Lacrimal Appartus - Tearing, obstruction, discharge, swelling
Extraocular Muscle Evaluation
(procedure, 7 common defects)
Assess motility: Instruct patient to follow an object in six cardinal positions of gaze; look for nystagmus and ask patient to diplopia in any position
Common Defects:
- Strabismus (congenital or late onset)
- CN palsy
- Graves’ disease
- Myasthenia gravis
- Stroke
- Brain tumor
- Orbital tumor
Opthalmoscope
(3 filters, significance of numbers)
Filters:
- red-free (visualize blood vessels and hemorrhages)
- polarizing (reduce corneal reflection)
- cobalt blue (corneal abrasions upon fluorescein stain)
Numbers:
- red numbers, minus lenses for myopic eye
- green numbers = plus lenses for hyperopic eye
Opthalmoscope Procedure
(8)
- Darken the room and have the patient look off in the distance
- Switch the ophthalmoscope light and turn the lens disc to the large round beam of white light
- Turn lens disc to the 0 diopter
- Hold the ophthalmoscope in your right hand to examine the patient’s right eye with your right eye; hold it in your left hand to examine the patient’s left eye with Screening
- Both eyes at same time; start in the temporal fields
- Further Testing - If a defect is found, test one eye at a time your left eye
- Stand directly in front of the patient, 15 inches away, and start at an angle of 15 degrees lateral to the patient’s line of vision
- Shine the beam of light onto the pupil and look for an orange glow; this is the red reflex
- Follow the red reflex and move inward towards the nasal aspect of the visual field
