Cornea, Iris and Lens

Question 1

Corneal arcus senilis

Answer 1

common in elderly
-whitish area around cornea (opacification)
-not pathologic
may be seen in severe hypercalcimia

Question 2

corneal abrasion

Answer 2

very painful

• typically has history of trauma
• need to use fluoroscene stain, because it is not visible with the naked eye
• superficial, epithelial layer

Question 3

which CN innervates the cornea?

Answer 3

ophthalmic branch of CN V

Question 4

corneal ulcer

Answer 4

very painful
long onsetting (a few days)
deep into the stroma
-usually related to an infectious process (herpes)
-opaque and can be seen with the naked eye

Question 5

hypopyon (hypopion)

Answer 5

pus layers behind the cornea

• corneal ulcer
• iritis
• result of an inflammatory process in the anterior of the eye

Question 6

corneal scar

Answer 6

opaque patch that is secondary to chronic ulceration (abrasions typically don’t scar)

Question 7

iritis

Answer 7

inflammation of the iris

• typically very painful
• inflammation extends to the limbus
• associated with other inflammatory conditions (RA, IBS)

Question 8

hyphema

Answer 8

blood in the anterior chamber

• most common cause is trauma
• will stain to stain
• can cause severe tension in the eye

Question 9

cataract (peripheral)

Answer 9

opacification of the lens

• common complaint is difficult night vision
• treatment is surgical correction
• more at risk of getting it if you have high exposure to UV lights
• no. 1 cause of blindness world wide

Question 10

glaucoma

Answer 10

intraocular pressure

-pressure begins in the anterior portion of the eye

Question 11

open-angle glaucoma

Answer 11

angle of canal is open, but flow through trabecular meshwork is slow (overproduction or poor drainage)

• chronic problem
• treatment, create less aqueous humor or allow more flow
• not painful
• high blood pressure of the eye

Question 12

closed-angle glaucoma

Answer 12

iris contracts, angle closes and fluid can’t flow out

• acute onset
• painful, red eye
• headache, nausea, vomiting
• mid-dilated fixed pupil

Question 13

how does glaucoma cause visual loss?

Answer 13

increased pressure in the anterior of the eye over time can compress the retina and optic disc thereby impairing vision

Question 14

glaucomatous cupping

Answer 14

pressure spreads the optic disc out and you see a big wide optic disc

Question 15

hirshberg test

Answer 15

test of corneal light reflection

-normally is slightly nasal to the center of the cornea

Question 16

esotropia

Answer 16

corneal light reflection is positioned lateral to the center

• eye deviates toward the nose
• convergent strabismus
• light reflection looks more lateral

Question 17

exotropia

Answer 17

corneal light reflection is positioned nasal to the center (lazy eye)

• outward deviation of the eye
• divergent strabismus
• light reflection looks closer to the nose

Question 18

convergence

Answer 18

when eyes come together to focus on an object coming near

Question 19

dysconjugate gaze (strabismus)

Answer 19

abnormal alignment of the eye

Question 20

paralytic strabismus

Answer 20

weakness or paralysis of one or more extraocular muscles (CN lesions)
-can’t be overcome
-

Question 21

non-paralytic strabismus

Answer 21

imbalance in muscular tone and may be overcome

-generally developmental/congenital

Question 22

cover/uncover test

Answer 22

can help differentiate between paralytic or non-paralytic strabismus

Question 23

VI cranial nerve palsy

Answer 23

paralytic strabismus in which patient cannot abduct laterally (can’t look outward)

Question 24

CN III palsy

Answer 24

paralytic strabismus in which pt has an eye deviated outward all the time
-constant dilation

Question 25

CN IV palsy

Answer 25

paralytic strabismus in which pt cannot look down and in | -least common

Question 26

amblyopia

Answer 26

reduced vision in one or both eyes caused by visual deprivation (seen in childhood) -strabismus or deprivation

Question 27

nystagmus

Answer 27

repetitive, oscillatory, jerky eye movements -seen in disorders of labyrinth -cerebellar disease -dilantin toxicity pathology indicated especially when the nystagmus is -vertical and rotary normal in extremes of gaze

Question 28

which are the most common disease states that cause pathology of the retina?

Answer 28

diabetes | hypertension

Question 29

microaneurysms

Answer 29

small tiny out pouching in retinal vessels | look like red dots

Question 30

flame hemorrhages

Answer 30

ruptures of aneurysms | shaped like a candle flame

Question 31

dot/blot hemorrhages

Answer 31

rupture of hemorrhage

Question 32

pre-retinal hemorrhage

Answer 32

hemorrhages in front of the retina

Question 33

hard exudates

Answer 33

material exudes into the retinal tissue - usually lipid and protein material - looks like yellow dots - infarcted retinal tissue - tiny, pinpoint

Question 34

cotton wool spots (soft exudates)

Answer 34

look like white or yellowish cotton | -infarcted retinal tissue

Question 35

neovascularization

Answer 35

new vessel formation | -very bad

Question 36

proliferative retinopathy

Answer 36

has neovascularization | -new vessels are weak and likely to rupture into the vitrous, which will impair vision

Question 37

background retinopathy

Answer 37

does not have neovascularization, but does have other evidence of retinopathy (cotton wool spots, hemorrhage)

Question 38

hypertensive retinopathy findings

Answer 38

tapering-artery comes to a point on either side of the vein instead of bein perpendicular AV nicking-vein stops abruptly on either side of artery (thickening of vessel wall) AV banking-twisting of the vessels copper wire artery-develops increased like reflex from being engorged silver wire artery-portion of narrowed artery becomes opaque, no blood is visible

Question 39

macular degeneration

Answer 39

degeneration of the macula - dry type is atrophy with age and time - presents with drusen (white spots) - wet type develops edema under the macula and can lift the macula away from underlying structures (more aggressive, but less common)

Question 40

papilledema

Answer 40

swelling of the optic nerve - fluid behind the eye or brain tumor - increased cranial pressure behind the eye