prelim chap 7 and 8 Flashcards
purpose of case history taking: (4)
- establish caring relationship w px, showing compassion, empathy and respect
- to gather information about chief complaint, visual function, ocular and systemic health, risk factors and lifestyle
- to begin the process of differential diagnosis
- to begin the process of px education
to identify gross abnormalities of the eye and adnexa
external observation
under ocular motility and binocular vision test (7 )
cover test
corneal reflex test
near point of convergence test
near point of accommodation
motility tests
tests of pupillary functions
tests of stereopsis
this test depends on retinal focus
done to all patients after case history taking
visual acuity
decreases retinal blur and increases patient’s depth focus
if done, acuity will improve if there’s no ocular abnormalities
pinhole va test
measures patient’s ability to change focus of lens in response to near stimulus
amplitude of accommodation
significant test for the assessment of macular cone and optic nerve function
color vision test
- assess the presence of magnitude of phoria or tropia (strabismus)
- assess presence or absence of motor fusion
cover test
determine magnitude of the demand placed on a px’s fusional vergence system
cover test
measure px’s fine depth perception through his ability to fuse stereoscopic targets
stereopsis
assess px’s flat fusion ability at distance and near
detect small unilateral central scotoma
worth 4 dot
indicated when stereopsis is less that 40 seconds of arc
used for differential diagnosis of unilateral decreased VA
worth 4 dot
determine patient’s convergence eyes while maintaining fusion
near poimt convergence
determine positions of visual axes of 2 eyes under binocular conditions at near
used to identify strabismus when other more precise tests cannot be used
hirschberg and krimsky
assess symmetry of binocular fixation by comparing the brightness of red-reflex in each eye
screen for the presence of refractive error
bruckner
used to screen for strabismus, anisometropia, media opacity, posterior pole anomalies in young children
bruckner
assess patient’s ability to perform conjugate eye movement’s
extraocular motility test
assess afferent and efferent neurological pathway responsible for pupillary function
pupils
screen for previously unnoted visual field defects
only for substantial field loss
screening for visual field / finger counting vf
determine the distance in millimeters between the entrance pupils of two eyes for a given viewing distance
interpupillary distance
DPA diagnostic pharmaceutical agents
- topical anesthetics
- mydriatics
- cycloplegics
- used to anesthesized the cornea prior to tonometry gonioscopy
- reduce permeability or nerve cell membranes to sodium ions
topical anesthetics
first anesthetic drug
cocaine
- proparacaine: ophthaine, ophthetic, alcaine. 0.5%, agent of choice
- benoxinate: dorsacaine. 0.4%. contraindicated to cardiac, thyroid and allergies
- tetracaine: potocaine. 0.5%. causes CNS stimulation, convulsion and depression
used to dilate the pupil prior to the use of: binocular indirect ophthalmoscopy, biomicroscopy involving the posterior segment
mydriatics
classifications of mydriatics
- sympathomimetic agents: phenylephrine (neosynephrine) and hydroxyamphetamine (paradrine)
- antimuscarinic (atropine like) agents: cyclopentolate (cyclogyl), tropicamide (mydriacyl)
- objective and subjective refraction for px with latent hyperopia or ciliary spasm
cycloplegics
sample of cycloplegics
- cyclopentolate
- atropine
- tropicamide
risk of angle closure glaucoma upon instillation
cycloplegics- close angle by dilating pupil incress laxness of peripheral iris
mydriatics- tightening dilator of iris causing pupillary block
methods of illumination slitlamp biomicroscopy
- direct
- indirect
- oscillation
- retroillumination
- sclerotic scatter
- specular reflection
dandruff of the scalp, mild itching, contraindicated CL.
sebhorreic blepharitis:
bacterial infection, more serious than seborrheic. lids are reddened, tiny ulcerated areas along lid margin, falling lashes. antibiotiv tx
ulcerative blepharitis:
infection of lash follicle
stye/ hordeolum
chronic granulomatous infection meibomian gland. no inflammation
chalazion
found in skin of lids. benign/malignant.
neoplasm
most common malignant tumor of lid
may erode orbit if not removed
basal cell carcinoma
ocular fundus evaluate
optic nerve head
retinal vessels
macular area
fundus background
peripheral fundus
inflammation of the optic nerve, elevation upto 3.00D
papillitis
due to intracranial pressure elavation upto 9.00D
papilledema
normal eye but appears elevated
pseudopapilledema
arterovenous crossing- artery and vein cross, share the same outer layer (outer layer is called ?)
tunica adventitia
caused by retinal pigment epithelium hyperplasia occurs in the form of patches of black pigment
hyperpigmentation
gray indefinite borders
choroidal nevus
forming a mass within the globe, are malignant tumors that would metastasize causing death
treatment is enucleation
choroidal melanoma
located in the deeper layer of the retinal most common cause is rupture microaneurysm in diabetic retinopathy
hemorrhages
small, first indication that anything is wrong is when they rupture
microaneurysm
white, cottony appearing deposits in the retina, smaller that the optic disk
cotton-wool exudates
yellowish, waxy appearing deposits in the retina resulting to retinal edema
hard exudates
continuous belt of tight intercellular junctions
zonula occludens
purpose of photodocumentation
- provide the practitioner with a permanent record of the appearance of a lesion or other abnormalities
- important for lesions that are apt to progress or benign tumors that might become malignant
- allows practitioner to send photographs to ophthal, derma, etc
- for patient education
central visual field testing
kinetic perimetry
tangent screen test
static perimetry
Types of sympathomimetic drugs
phenylephrine (neosynephrine)
hydroxyamphetamine (paradrine)
Types of antimuscarinic agents:
cyclopentolate (cyclogyl
tropicamide (mydriacyl)
dandruff removing shampoo treatment for seborrheic bleph
selenium sulfate
