The Eye Exam Flashcards
1
Q
common complaints or concerns
A
- pain
- redness
- discharge
- photophobia
- foreign body
- visual disturbances
2
Q
physical exam
A
- equipment
- visual acuity
- visual fields
- general inspection
- pupillary responses
- extraocular muscle movement (EOM)
- fundoscopic examination
- slit lamp examination
3
Q
visual acuity: VS of the eye
A
- pick a chart (snellen - 20ft, rosenbaum - 14in)
- test with and without corrective lens
- cover one eye
- smallest line read with >50% accuracy
4
Q
documentation of eyesight
A
- top number (distance between patient and chart)
- bottom number (distance at which a normal eye can read letters)
- normal vision: 20/20
- legal blindness: 20/200
- OS oculus sinister - L eye
- OD oculus dexter - R eye
- OU oculus uterque - both eyes
5
Q
pinhole testing
A
- Is blurred vision functional or structural?
- Improvement with pinhole implies functional problem (ex: refractive error)
- Lack of improvement with pinhole implies structural problem (ex: optic nerve damage)
- focuses the light waves
6
Q
myopia
A
- nearsightedness
- difficulty seeing far away
7
Q
hyperopia
A
- farsightedness
- difficulty seeing close up
8
Q
presbyopia
A
-aging vision
9
Q
diplopia
A
double vision
10
Q
scotomas
A
blind spot in visual field
11
Q
visual field cuts
A
loss of vision in part or all of a visual field
12
Q
photophobia
A
pain with vision/light
13
Q
visual field
A
entire area seen by an eye when it looks at a central point
14
Q
limits of visual fields
A
upper orbital ridge, nose (medially) and cheek bone (inferiorly)
15
Q
types of hemianopsia
A
-bitemporal hemianopsia (both eyes cant see outer half)
-homonymous hemianopsia (both eyes only see R (or L) half of vision)
Both of these are visual field cuts
-most common cause is pituitary tumor
16
Q
general inspection of the eye
A
- Position and alignment
- -Exophthalmos: protruding of eyeball
- -Enophthalmos: recession of eyeball
- Eyebrows
- -Hair distribution
- Eyelids
- -Edema, erythema, lesions, position of eyelashes
- -Adequate opening and closure
17
Q
exophthalmos
A
long palpebral fissure and exposure of the superior aspect of the iris - think hypothyroidism
18
Q
ptosis
A
interruption of CN III nerve supply, older people may be secondary to weight of eyelid, can be congenital (born with it)
19
Q
blepharitis
A
inflammation of lid margin with redness, thickening and scales of crust
helpful to wash with baby shampoo - helps to decrease bacteria on skin in the area
20
Q
xanthelasma
A
cholesterol deposits
21
Q
entropion
A
lid droops inward
lower lash may irritate conjunctiva and cornea
22
Q
ectropion
A
lid droops outward exposing palpebral conjunctiva: poor drainage and tearing occur if punctum blocked
a lot of time its due to loss of connective tissue or elasticity as we age
23
Q
chalazion
A
-beady nodule (meibomian (sebaceous) gland) inside otherwise normal eyelid, can become inflamed and tender, points inside lid not on lid margin
fill up with a little debris or pus
treat with washing with baby shampoo and warm compress
24
Q
hordeolum
A
acute
sty
painful tender infection around hair follicle lid margin - is usually tender, red infected gland at margin of eyelid
25
inspecting lacrimal apparatus
-edema, erythema, discharge
26
inspecting conjunctiva and sclera
color (icterus), nodules (pterygium), edema (allergies)
27
inspecting cornea and lens
opacities (cataracts)
28
inspecting iris
-color, pattern
29
inspecting pupils
- Size, shape, symmetry
- Extraocular movements
- Pupillary reaction to light (direct and consensual)
- Near reaction (miosis, convergence and accommodation)
30
dacryostenosis
- stricture/obstruction of gland
- if you touch it, it will feel hot and tender
- if you push on those areas, youll get pus coming out of those openings
31
dacryocystitis
infection of sac
32
what to look for in conjunctiva and sclera
- color
- injection
- nodules
- hemorrhage
33
scleral icterus
jaundice in eye
34
scleritis
vasculitis of sclera
| lupus and scleritis often times goes together
35
pterygium
benign growth of the conjunctiva
36
subconjunctival hemorrhage
most common reason is heavy vomiting
37
conjunctivitis
can be from allergies, virus, bacteria - inflammation of conjunctiva
38
anterior chamber
- cornea, iris, and lens
- separates the cornea from the iris and lens
- transmits light through lens to retina
- primary reflective element of the eye
- any disturbance in corneal clarity results in visual impairment
- avascular - blood vessels should not be present
39
arcus senilis
Common in elderly, From cholesterol deposits, may indicate hyperlipidemia
40
cataracts
Results from aging process, congenital or result of injury or infection
mature cataract - when the ens is totally opacified. Red reflex cannot be obtained
41
nuclear cataract
looks gray when seen by a flashlight
42
peripheral cataraact
produces spoke-like shadows that point outward
43
acute angle closure glaucoma
- sudden elevation in intraocular pressure that occurs when the iris blocks the eye's drainage channel—the trabecular meshwork.
- Treatment consists of making a hole in the peripheral iris ("iridotomy") with the laser or surgery. This procedure usually unplugs the outflow mechanism. This condition affects middle-aged or elderly patients with anatomically small anterior chambers or altered iris structure.
- Most angle-closure incidents occur spontaneously. Very few cases are precipitated by topical pupil-dilating parasympatholytics, and virtually none by orally administered parasympatholytics—despite the drug insert warnings.
44
how does acute angle closure glaucoma present?
- severe periocular pain
- photophobia
- blurred vision
- conjunctival vessels are most dilated at the corneal edge (ciliary flush, circumcorneal flush)
- The cornea is often hazy and the pupil unreactive to direct light
- Intraocular pressure will be very elevated (above 40 mm Hg).
45
Uveitis (Iritis)
-Pain, Red eye, Photophobia, Reduced vision, Tearing, Cells in the aqueous or anterior chamber of the eye (viewed under a slit lamp)
-Build up of pressure in the eye
They get a hazy cornea (from build up of pressure in eye)
Inflammation of iris itself can happen from infection, severe pain, photophobia, etc.
46
Pupils
- Size, shape and symmetry
- Corneal light reflex: ocular alignment
- Extraocular Movements: “H”
47
Strabismus
deviation of the eyes from the normally conjugate position
| "lazy eye"
48
Nystagmus
fine, rhythmic oscillations of the eyes, normal for a few beats seen at terminal range of eye movement. Sustained indicates neurological condition.
49
mydriasis
dilated pupil size
50
myosis
constricted pupil size
51
aniosocoria
< 5mm difference between pupils
| -common in 20% of population
52
pupillary reaction to light tells us about what nerve
tells us about the function of the cranial nerve 2 - optic nerve
53
accommodation
- ability of pupils to constrict when focus shifts from distance to close object
- pupils constrict to a near object or increased convexity of the lenses caused by contraction of the ciliary muscles to help bring a near object into focus – another test of the oculomotor nerve; reduced accommodation can be a sign of presbyopia (inability to focus on near objects, often age related)
54
convergence
ability of eyes to move toward the nose symmetrically when following an object moving toward them
55
near reaction
if patient is being tested for convergence, their eyes should come in and pupils should constrict (near reaction)
Near reaction is also tested from accommodation (looking far vs. near)
56
reflex arc and associated nerves
initiated by reaction to light: CN II (afferent limb to occipital lobe) and CN III (efferent limb from brain to eye)
57
dilator muscles
in iris, dilate pupil
| sympathetic innervation
58
oculomotor nerve (CN III)
parasympathetic innervation causing sphincter muscles in iris to constrict pupil
59
PERRL(A)
Pupils Equal, Round, Reactive to Light and Accommodation
60
Swinging flashlight test
-Used to test for impairment of optic nerves
-Swing light beam from one pupil to the other
-Normally each pupil constricts
-Looking for afferent pupillary defect
Looking for pupillary constriction and as the light goes away it dilates
If you have afferent pupilary defect, when you shine the first time, it constricts, but the second time it dilates
61
Nerve innervation of ocular muscles
- Lateral Rectus – Abducens nerve (CN VI)
- Superior Oblique – Trochlear nerve (CN IV)
- All others – Oculomotor Nerve (CN III)
62
ocular movements
-effected by contraction & relaxation of the EOM -
simultaneous movement of the eyes in tandem up or down, side to side or convergence.
-Convergence is another test of CN III (someone shifts their gaze from a far object to a near one)
63
lateral rectus and medial rectus
move eyes left and right
64
superior rectus and inferior rectus
move eye up and down
65
paralysis of left lateral rectus
cranial nerve VI palsy
| pt cant look to the left with L eye
66
nystagmus
Rhythmic oscillation of the eyes, many causes
| Direction of components, plane of movements
67
fundus
posterior aspect of the eye seen through the ophthalmoscope
68
retina
Retina – visual screen and inner layer of the eye
69
optic disc
Optic disc: contain optic nerve (CN II), retinal vein and arteries
70
fovea
Fovea: lateral and slightly inferior to the disc, a small depression in the retinal surface where largest concentration of cones are contained therefore the central point of vision
71
macula
Macula: yellow oval around the fovea– acts as a natural blocker of UV light or sunblock for the fovea
72
physiologic cup
Physiologic cup: depression in the optic disc
73
red reflex
- light reflecting off retina
| - absent in cataract and sometimes in vitreous hemorrhage
74
papilledema
- From swelling of the optic disc and bulging of the cup.
- Disc vessels are more visible, disc is swollen with blurred margins, cup is absent.
- Seen in hypertension, increased intracranial pressure from brain hemorrhage, trauma, meningitis.
75
optic disc cupping
normal ratio of disc to cup is 2:1
in cupping, cup gets bigger
indication of optic nerve damage which may be associated with loss of peripheral vision
usually presents without symptoms
76
glaucoma
disease that causes damage to the optic nerve. There are two types. Open angle glaucoma and acute closed angle glaucoma
77
open angle glaucoma
- second leading cause of blindness in Americans.
- painless, gradual and irreversible vision loss, usually starting with peripheral vision loss, pallor and increasing size of the optic cup.
- some associated with increased intraocular pressures but some arent
- risk factors: DM, age, family hx, myopia
78
acute closed angle glaucoma
sudden increased in intraocular pressure that is a medical emergency.
79
A-V tapering
The vein appears to taper on either side of the artery – seen in hypertensive retinopathy. From decreased transparency of the retina and arterial walls.
80
A-V nicking
vein abruptly stops on either side of the artery
81
copperwiring
increased light reflection off of artery, commonly seen as vessels close to the disc.
happens because of the pressure
82
A-V crossing
Arterial wall is transparent – what is seen is the column of blood passing through it and a reflection of the light, thus when an artery crosses over top of a vein, you can see the vein right up to the column of blood in the artery – AV crossing
-types = AV-nicking and AV-tapering
83
fovea
lateral and slightly inferior to the disc, a small depression in the retinal surface where largest concentration of cones are contained therefore the central point of vision
84
macula
yellow oval around the fovea– acts as a natural blocker of UV light or sunblock for the fovea
85
macular degeneration
cause of poor central vision in the elderly
| Two kinds wet and dry
86
diabetic retinopathy
Hard exudates
Cotton wool patches
Deep hemorrhages
87
hypertensive retinopathy
AV tapering, banking and nicking
Copper wiring
Hard exudates
Papilledema
88
cotton wool patches
soft exudates - white or grayish, irregular shaped lesions – result from infarcted nerve fibers – seen in hypertension and diabetes
89
neovascularization
happens because of diabetes or hypertention to try to get more nutrients and blood supply to the eye
Form due to cotton wool patches (infarcted nerve fibers)
90
hard exudates
Creamy or yellow in color, bright with well defined borders, often occur in clusters. Seen in diabetes and hypertension – hard deposits of lipids or proteins – leak from surrounding capillaries
Exudates = damage to the retina vision loss due to exudates
91
slit lamp examination
- Magnifying device to examine anterior portion of eye: Cornea, Anterior chamber, Iris, Lens
- Used primarily in ED and by Ophthalmologists/Optometrists
92
eye exam checklist
- visual acuity bilaterally
- inspect external eye
- inspect pupils
- pupillary reaction to light and accommodation
- assess visual fields by confrontation bilaterally
- assess extraocular movements, convergence
- fundoscopic examination
93
acute narrow-angle glaucoma
crescentic shadow on iris
94
Binocular vision muscles
- Depends on 3 pairs of muscles
1. Medial & Lateral rectus
2. Superior & Inferior Rectus
3. Superior & Inferior Obliques
