Eye Exam Basics

Question 1

What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?

Answer 1

• Hx
• Visual acuity
• pupillary examination***
• visual fields by confrontation
• extraocular movements
• external inspection
• -lid and surrounding tissues
• -conjunctiva and sclera
• Anterior Structures
• -cornea, pupil, and iris
• -anterior chamber depth
• -lens clarity
• tonometry
• fundus examination
• -view-disc-macula-vessels

Question 2

Distance Visual Acuity testing

Answer 2

• position 20 ft from chart (unless its a 10ft char)
• may use glasses
• test OD, OS, OU
• must ID 1/2 the figures

Question 3

Near visual acuity testing

Answer 3

• 14-16inches from face
• test OD, OS, OU

*Be aware of their age, ask them if they have dbl vision, what they do for work.

Question 4

Amblyopia

• aka
• what is it?
• what is it caused by?
• tx

Answer 4

• lazzzzyyy eeeeyyyyeeeee
• the eye has never had an opportunity to learn to see
• caused by refractive amblyopia, strabismic amblyopia, deprivation

Tx:

• lenses
• training
• patches
• surgery

Question 5

Pupillary Examination

Answer 5

• use pen light
• -direct and consensual
• -PERRLA

Question 6

why might the pupil be messed up?

Answer 6

• head or neck trauma
• whole in the eye (pupil points to hole)
• coughing (watch for lung carcinomas) (pancoast**)

Question 7

What do we watch for when testing accommodation and convergence?

Answer 7

pupillary constriction (not related to light)

Question 8

Synchia, what is this?

Answer 8

• pupil can adhere to the front of the lens (posterior synchia) or to the corneal endothelium (anterior snychia)
• may cause secondary glaucoma

Question 9

Leukocoria: how does this present?

Answer 9

-white pupil during red reflex w/ camera flash

must rule out cataract or retinoblastoma to dx this.

• fatal in children if not caught

Question 10

What are some types of pupillary abnormalitis?

Answer 10

• Horners Syndrome (ptosis, constriction of pupil, decreased sweating)
• Argyll- Robertson pupil (no rxn to light but constriction w/ accomodation).

^^^PANCE!!!!!^^^

-dilated fixed pupils (drugs/ neuro trauma/scopolamine patch)

Question 11

What to look for in a patients eyebrows?

Answer 11

• quantity
• distribution
• scaliness of underlying skin

Question 12

Ptosis

-may be caused from?

Answer 12

• trauma
• age
• nerve damage

Question 13

Look at eyelids for?

Answer 13

• edema
• color (redness)
• lesions
• condition and direction
• ptosis
• ectropian
• entropian
• periorbital edema
• retraction of the upper eyelid and exophthalmos

Question 14

Lumps and Swelling in and around the eyes may be caused from?

Answer 14

• pincuecula
• stye
• chalazion
• xanthelasma
• basal cell carcinoma
• dacrocystitis
• enlargment of the lacrimal gland

Question 15

What are tears made of? What is their function? Too much tears vocab term? Too little tears vocab term?

Answer 15

-oil, water, and mucus

Function: 1st line of defense against infection

Too much- epiphora
too little- dry eye

Question 16

What happens when you dont have enough basal tears?

Answer 16

If you don’t have enough of the basal tears your secondary tears get kicked in producing excessive watering in the eyes, the underlying problem is dry eye!

Question 17

What are some secondary causes of dry eye?

Answer 17

• age
• medication
• systemic disease

Question 18

What may cause the following cranial nerves to be no longer intact?

• III
• IV
• VI

Answer 18

CN III Palsy- think brain; aneurysm, brain tumor

CN IV- think trauma

CN VI-think diabetes
**PANCE!

Question 19

Strabismus

• what is it?
• how to diagnose it

Answer 19

• misalignment of the two eyes d/t multiple causes
  ex. EOM weakness

-corneal light reflex
cover test

Question 20

what is an Exotropic and Esotropic eye
Hypertrophia?
Exophoria?

Answer 20

exotropic- lateral gaze with one

esotropic- medial gaze with one eye

Hypertrophia- vertical (up/down) gaze in one eye

Exophoria- normal, goes into its rest position and pops back with cover uncover test

Question 21

Strabismus

• temporary or permanent vision loss?
• at what age is strabismus no longer cureable?

Answer 21

• permanent

- 16-18years

Question 22

What are the EOM?

What cranial nerves control them and what is their function?

Answer 22

Lateral Rectus - CN VI Motor
Superior Oblique- CN IV Motor

Superior rectus, medial rectus, inferior rectus, inferior olique- CN III Mixed

Question 23

When we test ocular motility of the EOM what are we inspecting for?

Answer 23

• normal conjugate or parallel movements of the eye (Deviation)
• abnormal movement (nystagmus)
• lid lag

Question 24

Amblyopia

• is this correctable?
• what is the cause?
• treatment?

Answer 24

-loss of visual acuity not correctable by glasses

• brain selects the better image and suppresses the blurred or conflicting image, cortical suppression of sensory input interrupts the normal development of vision
• may be caused by strabismus, refractive error, ocular disease, idiopathic
• development problem in the brain
• chemical or physical patch done ages 3-18

Question 25

Confrontation Visual Fields | -how to perform this exam

Answer 25

-ask cover one eye, from 2 ft away teset 8 fields

Question 26

Possible causes of an abnormal visual field

Answer 26

``` glaucoma DM HTN MN Hyperthyroidism Pituitary adenoma Stroke ```

Question 27

Visual field defects: | What tumor might cause bi-temporal field loss?

Answer 27

-pituitary adenoma

Question 28

What does a slit lamp examine?

Answer 28

- anterior and posterior segment of the eye - can see optic nerve or retina - cataracts, conjunctivitis, iritis - glaucoma or macular degeneration - check for foreign body - detect eye problems that my be caused by other diseases such as diabetes, rheumatoid arthritis Cornea & Iris opacities: - arcus senilis (narrow opaque band around iris) - corneal scarring - pteryguim - pharmacolgic

Question 29

What does a herpetic ulcer look like under woods lamp?

Answer 29

dendritic

Question 30

When inspecting the conjunctiva, episclera, and sclera what are some things you will be looking for?

Answer 30

- Color: pale, yellow, red, injection, blanched - Edema- chemosis (edema of the conjunctiva), cycts, hemorrhages - Growths- Neoplasms, pinguecula, Pteryguim

Question 31

Keys to Iritis Dx

Answer 31

-red around the limbus and very painful when the pupil dilates/constricts

Question 32

IN trauma what happens with pupil?

Answer 32

pupil points to the trauma

Question 33

Anesthetic drops - types - uses - SE

Answer 33

- proparacaine - tetracaine - benoxinate Use: anesthatize cornea (last 10mins) - foreign corneal body removal - tonometry - examine damaged corneal surface SE: - allergy, systemic or local - toxic to corneal epithelium - epithelial sluffing if over used

Question 34

What is normal intraocular pressure?

Answer 34

10-22 - Benner | 12-20- RMC

Question 35

Classes of Pupil Dilation

Answer 35

- Cholinergic- blocking (Parasympathetic; sphinctor) | - Adrenergic- stimulating (sympathetic; dilator)

Question 36

Cholinergic blocking drugs - action - example med, how long effects, SE

Answer 36

-dilate by paralyzing iris sphinctor muscles (cycloplegic) by inhibiting the parasympathetic response (constriction) ``` -Tropicamide: pupil dilation 30mins effects diminishes 4-5hrs SE: Rare, n/v, pallor, fainting ```

Question 37

Adrenergic Stimulating Drugs - action - example med, how long effects, SE

Answer 37

-dilates the pupil, by stimulating the sympathetic response (dilation) -Phenylephrine 2% or 10% Dilates in 30mins SE: acute hypertension or MI (10%)

Question 38

What to observe in ophthalmioscopy

Answer 38

- red reflex - clarity of disc outline - color of disc - look at rim of optic disc - presence of normal white or pigmented rings, crescents around discs - size and color of cup *in normal exam both should look similar

Question 39

Optic Neuritis - cause - symptoms

Answer 39

-idiopathic or associated with MS in young adult - Sx: - decreased visual acuity and color vision - pain w/ ocular movement***** - disc swelling (bulbar) or you wont see anything (retro bulbar)

Question 40

Abnormalities of the optic disc

Answer 40

- optic atrophy - papilledema *young fertile females, overweight pseudotumor cerebri*

Question 41

Arteries and veins/ arterioles and veinuoles/ capillary beds: characteristics during fundoscopic exam

Answer 41

- color (veins are darker) - size- ratio (4/5, artery; vein) - crossings- nicking/pinching - red colored spots Cotton wool spots- white fluffy, ischemia hard exudates- white/yellow lipids colloid bodies- abnormal growths of inner layer of choroid drusen (in or around macula); - made up of lipids

Question 42

What would you find on ophthalmic exam of someone with Central Retinal Artery Occlusion?

Answer 42

- -cherry red spot - no optic disc swelling, unless carotid artery occlusion - months in, pale disc due to death of ganglion cells and their axons *TRUE EMERGENCY!!!

Question 43

Branch Retinal Artery Occlusion (BRAO) - what is this? - Tx

Answer 43

- sector of retina is opacified and vision is partially lost - most often d/t embolus - treat as CRAO

Question 44

What would you find on ophthalmic exam of someone with Central Retinal Vein Occlusion?

Answer 44

Findings: | -disc swelling, venous engorgement, cotton wool spots, diffuse retinal hemorrhage

Question 45

List Urgent Eye Situations

Answer 45

- penetration of globe - conjunctival or corneal foreign body - hyphema - lid laceration (vertical worse than horizontal) - traumatic optic neuropathy - radiant energy burns (welding) - corneal abrasion - sudden loss of vision - "curtains" retinal detachment

Question 46

Semi- Urgent Eye SItuations

Answer 46

- orbital fx (urgent if muscle is trapped) - subconjuncitval hemorrhage in blunt trauma * refer within 1-2 days - new/ repetitive flashes/floaters - eye pain - staining of cornea w/ no hx of trauma - zoster around eye or tip of nose - dbl vision

Question 47

perforating injury will appear this way. what to avoid with perforating injury

Answer 47

- teardrop shaped pupil and flat anterir chamber | - avoid digital palpation of the globe

Question 48

Chemical burns - what type is the worst? - first line of action for tx

Answer 48

- Alkaline is worse than acidic | - irrigation before and during transport