procedural skills Flashcards
should the patient wear glasses during a VA test
reading glasses should not be worn but distance glasses should be
how to verbalise visual acuity
numerator is the distance of the chart from the patient
denominator is distance at which a normal eye can read that line of the chart
if the patient gets one wrong, subtract this
if a patient gets more than 3 wrong
expressed as the previous line plus any numbers they got right on the next line
if the patient doesnt get a perfect 6/6
use the pinhole and see if the visual acuity improves
this shows that the patients vision could be improved with glasses
if the patient is reading from a chart loser than 6 metres
use the distance that theyre actually looking at the chart at as the numerator
if the patient cant read the largest letters on the chart
move the patient to half the distance
and check again
use 3 instead of 6 as the numerator
if they still cant read the largest letter at hlaf the distance from the chart
check counting fingers (CF) vision at 1 metre
if the patient cant count fingers
check hand wave (HW) vision
if they cant see hand movements
check perception of light (PL) vision
if they cant see the light
no perception of light (NPL)
what should you include when recording the visual acuity
aided or unaided
pinhole or not pinhole
right and left eye
slitlamp is used for
examining the anterior section of the eye
settings on the slit lamp for a standard examination
slit width 1mm
slit height 8mm
grey light filter (or off for AC)
focus rings on zero f you dont have a refrective error
start with low magnification
how to dilate the patients pupils for fundoscopy
mydriatic from such as tropicamide 0.5% or 1% eye drops
what should you do before fundoscopy
visual acuity, reflexes and feilds because you wont be able to do these properly once the patients eye are dilated
to exmine the patients right eye with fundoscopy
use your right eye with the opthalmoscope in your right hand
an absent or dull red reflex indicates
an opacity somewhere - may be in the corena, anterior chamber, lens or vitreous
absent red reflex in babies
urgent opthalmology referral - this may be a retinoblastoma
quadrants of the eye
infronasal,
infrotemporal
supranasal
supratemporal
optic nerve is located
nerve is nasal
asssessing the 3 Cs of the optic disc
colour - normal is yellow.
cup
contour - should be well defined
abnormal colours of the optic disc
normal is yellow
pale if ischaemic optic neuropathy or GCA
reddish if hyperaemic disc from optic disc swelling
abnormality of the countour of the optic disc
should be well defined
blurred or fuzzy = optic disc swelling
if present in both eyes, this is pallioedema caused by raised ICP or malignant hypertension
raised intracranial pressure may be caused by
intracranial tumour
idiopathic untracranial hypertension
cerebral abscess
hydrocephalus
central pale portion of the optic disc
optic cup
abnormalities of the cup
normal cup-disc ratio is 0.3-0.5
if the ratio is above this or there is asymmetry, the patient should be evaluated for glaucoma
in patients with diabetes
check for neovascularisation
fine-frilly vessels
macula
ask the patient to look directly into the light
should be dark orange or reddish
drusen
seen in age related macula degenration
haemorrhages and hard exudates
seen in diabates
pale white macula with a central cherry red spot
central retinal artery occlusion
pigmented occular tumour
choroidal naevus
papilloedema is due to
raised intracranial pressure due to a tumour in the brain
