Part 2 Flashcards
It is a drooping of the upper eyelid that causes from myasthenia gravis, damage to the oculomotor nerve (CN III), and damage to the sympathetic nerve supply (Horner syndrome).
Ptosis
More common in the ederly, which is an inward turning of the lid margin. The lower lashes which often invisible when turned inward, irritate the conjunctiva and lower cornea.
Entropion
The lower lid margin turns outward, exposing the palpebral conjuctiva.
Ectropion
A wide-eyed stare suggests_____
Lid Retraction
Decribes protrusion of the eyeball, a common feature of Graves ophthalmopathy, triggered by autoreactive T lymphocytes
Exophthalmos
Swelling and Excessive tearing are seen in
- Conjunctival inflammation
* Corneal irritation
Dryness of the lacrimal apparatus from impaired secretion
Sjogren Syndrome
Impaired Drainage of Lacrimal Apparatus
- Ectropion
* Nasolacrimal duct obstruction
A harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris.
Pinguecula
A localized ocular inflammation of the episcleral vessels. Seen in rheumatoid arthritis, Sjogren syndrome, and herpes zoster.
Episcleritis
A painful, tender, red infection at the inner or outer margin of the eyelid, usually from Staph aureus.
Stye (Hordeolum)
A subacute nontender, usually painless nodule caused by a blocked meibomian gland.
Chalazion
Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area that resolves over 2 weeks; no pain; vision not affected; no ocular discharge; pupil not affected; clear cornea; may result from trauma, bleeding disorders, or sudden increase in venous pressure, as from cough
Subconjuctival Hemorrhage
Diffuse dilation of conjunctival vessels with redness that tends to be maximal peripherally; mild discomfort rather than pain; vision not affected except for temporary mild blurring due to discharge; watery, mucoid or mucopurulent ocular discharge; pupil not affected; clear cornea; bacterial, viral, and other infections, highly contagious; allergy, irritation
Conjunctivitis
Pain is moderate to severe, superficial, vision usually decreased, watery or purulent ocular discharge; pupil not afffected unless iritis develops; cornea changes depending on cause
Corneal Injury or Infection
Severe, aching, deep pain; decreased vision; no ocular discharge; dilated, fixed pupil; steamy, cloudy cornea; acute increase in intraocular pressure constitutes an emergency
Acute Angle Closure Glaucoma
Moderate, aching, deep pain, decreased; photophobia vision; no ocular discharge; small and irregular pupil; clear or slightly clouded; injection confined to corneal limbus cornea
Acute Iritis
A thin grayish white arc or circle not quiet at the edge of the cornea. Usually benign.
Corneal arcus
A golden to red ring, somtimes shading to green or blue, from copper desposition in the periphery of the cornea found in WIlson disease
Kayser-Fleischer RIng
A superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation. Visible on a deeper plane and only through the pupil.
Corneal scar
A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side.
Pterygium
Opacity of the lenses visible through the pupil. Risk factors are old age, smoking, diabetes, corticosteriod use
Cataracts
Produces spokelike shadow that point-gray against black, as seen with flashlight, or black against red with an ophthalmoscope.
Peripheral Cataract
Increases the risk for acute narrow-angle glaucoma in iris
•Narrow angle
The normal spatial relation between iris and cornea is preserved.
Open-angle glaucoma
Considered benign if it is equal in dim and bright light, and there is brisk pupillary constriction to light.
Simple anisocoria
When anisocoria is greater in bright light than in dim light. The larger pupil cannot constrict properly.
It causes
- trauma to the eye.
- open-angle glaucoma.
- impaired parasympathetic innervation to the iris
- tonic pupil and oculomotor nerve (CN III) paralysis.
•When anisocoria is greater in dim light, the smaller pupil cannot dilate properly is seen in which caused by an interruption of the sympathetic innervation
Horner syndrome
- Direct reaction -
* Consensual reaction -
- Direct reaction - pupillary constriction in the same eye
* Consensual reaction - pupillary constriction in the opposite eye
Pupil is dilated, regular, and usually unilateral. Reaction to light is severely reduced and slowed or even absent. Constriction during the near vision is present, although very slow.
Tonic PUpil (Adie Pupil)
The pupil is large and fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of th eye downward and outward are almost always present.
Oculomotor Nerve (CN III) Paralysis
The affected pupil is small, unilateral, reacts briskly to light and near effort, but dilates slowly, especially in dim light. Anisocoria is >1mm, with ipsilateral ptosis of the eyelid and often loss of sweating on the forehead. (miosis, ptosis and anhydrosis)
Horner Syndrome
The pupils are small, irregular and usually bilateral. They constrict with near vision and dilate with far vision but do not react to light, seen in neurosyphilis and rarely in diabetes.
Small, Irregular Pupils (Argyll Robertson Pupils)
Unilateral blindness does not cause anisocoria as long as the sympathetic and parasympathetic innervation to both irises is normal. A light directed into the seeing eye produces a direct reaction in that eyeand a consensual reaction in the blind eye.
Equal Pupils and One Blind Eye
The normal conjugate movements of the eyes in each direction.
Extra Ocular Muscles
•A fine rhythmic oscillation of the eyes. A few beats of nystagmus on extreme lateral gaze are normal. If you see this, bring your finger in to within the field of binocular vision and look again.
Nystagmus
• Proptosis
• Characteristic “stare” on frontal gaze.
- Poor convergence
Hyperthyroidism
Consider an orbital tumor or retrobulbar hemorrhage from trauma.
Unilateral Proptosis
Consider an orbital tumor or retrobulbar hemorrhage from trauma.
Unilateral Proptosis
Contraindications for mydriatic drops
- Head injury and coma
• Any suspicion of narrow-angle glaucoma.
Swelling of the optic disc and anterior bulging of the physiologic cup suggest ___ which is associated with increased intracranial pressure
Papilledema
Absence of a red reflex of the fundus suggests:
Less common ones
- opacity of the lens (cataract)
• Opacity of the vitreous
• Artificial eye
Less commonly
• Detached retina
• Retinoblastoma in children
They focus anterior to the retina and the retinal structures look larger than normal.
myopia
They focus posterior to the retina.
hyperopia
An enlarged cup suggests
Chronic open-angle glaucoma
Occurs with high intracranial pressures above 190 mm H2O. Other causes include glaucoma and retinal vein occlusion
Loss of Spontaneous Venous Pulsation(SVPs)
Is an important cause of poor central vision in older adults.
Macular degeneration
Types of Macular degeneration
Dry atrophic - more common but less severe
Wet exudative, or neovascular.
Elevated intracranial pressure causes intraaxonal edeman along the optic nerve, leading to engorgement and swelling of the optic disc; it has a color pink, hyperemic appearance; often with loss of venous pulsations; dics swollen with margins blurred, the physiologic cup is not visible; and seen in intracranial mass, lesion, or hemorrhage, meningitis
Papilledema
- Tiny disc vessels give normal color to the disc
- color yellowish orange to creamy pink
- disc margins sharp
- physiologic cup located centrally or temporally, maybe conpiscious or absent
Normal Optic Disc
- Increased intraocular pressure within the eye leads to increased cupping (backward depression of the disc) and atrophy
- the base of the enlarged cup is pale
- death of optic nerve fibers leads to loss of the tiny disc vessels
Glaucomatous Cupping
