The Basics of an Eye Exam

Question 1

Direct Pupillary Examination

Answer 1

Constriction of ipsilateral eye

Question 2

Consensual Pupillary Examination

Answer 2

Constriction of contralateral eye

Question 3

Synchia

Answer 3

The pupil can become adhered to the front of the lens or to the endothelium

This can cause a secondary glaucoma and create an irregular pupil

Question 4

Leukocoria

Answer 4

White Pupil - red reflex with camera flash

R/O : Cataract or Retinoblastoma

Question 5

Epiphora

Answer 5

Watery eye… weepy
Insufficient drainage
Lid position / blocked drainage/ age / trauma / scar

Question 6

Ocular motility

6 cardinal fields (H shaped pattern)

Answer 6

6 Cardinal fields (H shaped)
Inspection for:
1. Normal conjugate, or parallel movements of eyes (deviation)
2. Abnormal movement (nystagmus…rhythmic fine ascillation)
3. Lid lag

Convergence………sustained to within 5-8 cm
(watch for eye to Trope)

Question 7

arcus senilis

Answer 7

white ring around eye, normal in elderly, think cholesterol issues in young population

Question 8

Anesthetics uses

Answer 8

Anesthetize cornea within 15 sec, last 10 mins
Remove corneal foreign bodies
Perform tonometry
Examine damaged corneal surface

Question 9

cholinergic-blocking ( parasympatholytic) Pupil Dilation

Answer 9

Dilate by paralyzing iris sphincter muscle
Cycloplegia by paralyzing ciliary body muscles

Tropicamide				
Max pupil dilatation 30 min		
Effect diminishes 4-5 hrs			
Side effects: 
Rare
Nausea / vomiting
Pallor
Vasomotor collapse

Question 10

Adrenergic-stimulating (sympathomimetic) Pupil Dilation

Answer 10

Phenylephrine 2.5% 10%
Dilates in 30 mins, no effect on accommodation
Pupil remains reactive to light
Combine with Tropicamide for maximal dilatation
Infants combine Cyclopentolate 0.2% & Phenylephrine 1%

Side effects:
acute hypertension or MI (with 10%)

Question 11

Optic neuritis

Answer 11

idiopathic or associated with multiple 	sclerosis
young adults
decreased visual acuity and color vision
pain with ocular movement
bulbar (disc swelling) 
retro bulbar (you both see nothing)

Question 12

Central Retinal Artery Occlusion (CRAO)

Answer 12

True ophthalmic emergency!
Sudden painless and often severe visual loss
Permanent damage to the ganglion cells caused by prolonged interruption of retinal arterial blood flow
Characteristic “ cherry-red spot ”
No optic disc swelling unless there is ophthalmic or carotid artery occlusion
Months later, pale disc due to death of ganglion cells and their axons

Question 13

Branch Retinal Artery Occlusion (BRAO)

Answer 13

Sector of the retina is opacified and vision is partially lost
Most often due to embolus
Treat as CRAO

Question 14

Retinal Emboli

Answer 14

Often called a Hollenhorst Plaque

Question 15

Urgent Situations

Answer 15

Penetrating injuries of the globe
Conjunctival or corneal foreign bodies
Hyphema (blood in front of eye)
Lid laceration (suture if not deep and neither the lid margin nor the canaliculi are involved)
Traumatic optic neuropathy
Radiant energy burns (snow blindness or welder’s burn)
Corneal abrasion
Sudden loss of vison
“Curtains” blocking all or some of Vision