OHD 1 > Looking Inside The Eye > Flashcards

Looking Inside The Eye Flashcards

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1
Q

Why do we have a look inside the eye?

A

-Screen for internal eye diseases e.g. Glaucoma, Cataracts, Maculopathy
-Screen for systemic diseases e.g. Diabetes, Hypertension

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2
Q

When looking at the Fundus, what are some of things to look out for?

A

-Retina
-Optic disc/Optic cup
-Macula
-Blood vessels
-Periphery

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3
Q

What is the difference between the fundus and the retina?

A

The retina is a light sensitive layer of the fundus
The fundus is the back of the whole of eye interiorly

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4
Q

What is the macula and what appearance does it have?

A

Central part of a Px’s vision
Area of darker pigment

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5
Q

What blood vessels can we view when looking at the fundus?

A

-Temporal arcades
-Pre-retinal blood vessels –> lie on top of the retina and start from the optic nerve head
-Underlying blood vessels –> Choroidal

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6
Q

When looking at the Retina, what are some of things to look out for?

A

-Varying pigmentation
-Choroidal blood vessels –> underlying blood vessels
-Drusen
-Atrophy
-Detachment

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7
Q

How can we record different levels of pigmentation in the retina?

A

Use retinal pigment scores
This is a way of evaluating how much pigment is on/in/part of the retina

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8
Q

What is drusen when looking at the retina?

A

Drusen is small yellow deposits of lipids that are under the retina

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9
Q

When looking at the Macula, what are some of things to look out for?

A

-Area of darker pigment
-Drusen
-Oedema
-Scarring

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10
Q

What is the part of the macula that is an avascular zone and has a bright foveal reflex?

A

Fovea

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11
Q

When looking at blood vessels, what are some of things to look out for?

A

-Arteries vs veins
-Cilioretinal artery
-A/V ratio
-Calibre variations
-A/V crossings

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12
Q

What are the principles of Direct Fundus Biomicroscopy/Direct Ophthalmoscopy?

A

-Neutralises corneal power by using a high -ve powered Len
-Direct view of the fundus using a slit lamp
-IMAGE IS NOT INVERTED

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13
Q

What is a Hruby lens?
What type of Ophthalmoscopy is it?
How does it work?

A
  • -58D plano concave lens (concave side to Px)
    -Attached to slit lamp or headrest

-Direct ophthalmoscopy

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14
Q

What type of image does a Hruby lens give?

A

Upright image

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15
Q

How big is the field of view with a Hruby lens?

A

Small field of view as the lens is small

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16
Q

What are Contact Lenses?
What type of Ophthalmoscopy is it?
How does it work and give examples of Contact Lenses?

A

-Contact Lens is placed onto the cornea (viscous gel between lens and cornea)

-Direct ophthalmoscopy

-Examples include a Goldman 3 mirror
(use thumbnail shaped mirror to view anterior angle - Gonioscopy and use the other 2 rectangular mirrors to view the retina)

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17
Q

Does a Hruby lens give a binocular or monocular view?

A

Binocular view

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18
Q

Outline the principles of a Direct ophthalmoscope and what parts it has on it (the ones used in practice)

A

-Illumination system with a reflector that bounces light into the Px’s eye
-The light rays bounce of the Px’s retina and they then pass through the hole in the mirror and go into the practitioners eye
-The direct ophthalmoscope has a lens wheel which changes the dioptric power of the lens to compensate for the Rx of the Px + practitioner
-The direct ophthalmoscope has different apertures and has different filters e.g. red free

٭٭٭SEE VORC 1 OPTICS NOTES ON OPTOMETERS FOR INFO ON RAY DIAGRAMS REGARDING DIRECT٭٭٭

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19
Q

How does a direct ophthalmoscope (the ones used in practice) compensate for the Rx of the Px + practitioner?

A

The direct ophthalmoscope has a lens wheel which changes the dioptric power of the lens to compensate for the Rx of the Px + practitioner

THIS IS NOT TO ZOOM OR INCREASE MAGNIFICATION, HOWEVER YOU DO UNINTENTIONALLY CHANGE THE MAGNIFICATION

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20
Q

What must you do when viewing the retina when looking through a direct ophthalmoscope (the ones used in practice)?

A

To view the retina, you AND the ophthalmoscope move around

e.g. if you move the ophthalmoscope temporally, yo will also need to move temporally

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21
Q

What magnification do you get with myopes when looking through a direct ophthalmoscope (the ones used in practice)?

A

Higher magnification, smaller field of view

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22
Q

What magnification do you get with hyperopes when looking through a direct ophthalmoscope (the ones used in practice)?

A
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23
Q

What magnification do you get with emmetropes when looking through a direct ophthalmoscope (the ones used in practice)?

A

≈ x15 magnification

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24
Q

Do Contact Lenses give a monocular or binocular view?

A

Binocular view

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25
Does a direct ophthalmoscope give a monocular or binocular view?
Monocular view
26
How do you increase your field of view? What can you do to the Px's pupil?
Dilate the Px's pupils
27
How big of a field of view can you get when using a direct ophthalmoscope (the ones used in practice)?
5° - 10° view of the retina Can get up to a 180° view
28
What gives the biggest field of view when looking through a direct ophthalmoscope (the ones used in practice)?
Hyperope + dilated pupils
29
How should you view a Px's fundus using direct ophthalmoscopy (the ones used in practice)?
Work your way out from the optic disc
30
How do you tell the Px where to look when using direct ophthalmoscopy (the ones used in practice)?
Always tell the Px where to look (left and right) from the Px's perspective To look in the periphery, Px looks in that direction AND you look in the same direction
31
How is the field of view maximised when using a direct ophthalmoscope?
Field of view is maximised by minimising the distance between the patient and practitioner
32
What are the principles of indirect ophthalmoscopy?
-Illumination system -Focussing lens/system (could use a slit lamp) -Condensing lens
33
What is a condensing lens?
A lens held in front of the Px's eye (in between practitioner and Px)
34
What type of image does a condensing lens create?
Creates a real, inverted, aerial (in air) image Image is inverted and laterally reversed
35
How do you view the aerial image created by a condensing lens?
Need to align the focal point of the slit lamp with the aerial image
36
What are Bio condensing lenses (aka Volk lenses)? What type of Ophthalmoscopy is it? How does it work?
Bi-convex lenses that you hold in front of the Px's eye to view the fundus Indirect ophthalmoscopy
37
Do Bio condensing lenses (Volk) give a monocular or binocular view?
Binocular view
38
What must you do once you have measured something e.g. the optic disc/lesion with the slit height when using a Volk lens?
You must multiply the slit height by the appropriate correction factor for that lens Different powered Volk lenses will have different correction factors
39
What do stronger Volk lenses result in?
Stronger Volk lenses result in less magnification and a bigger field of view
40
When would we use Volk lenses and do they allow us to view the whole of the fundus?
Well it's the primary way of looking at the retina They don't allow us to view the whole fundus
41
Give the 2 ways of using a Volk lens
1) -Set up slit lamp -Focus central cornea -Introduce lens in front of Px eye (1cm approx) -Looking around the slit lamp ensure the light passes through the pupil -Pull slit lamp back until the aerial image of the fundus is seen 2) -Set up slit lamp -Focus central cornea Introduce lens in front of Px eye (1cm approx) -Pull slit lamp back until an inverted view of the external eye is seen -Centre the image of the pupil and move forward to view the fundus image
42
How do you look in the periphery when using a Volk lens? Note : the image is inverted and laterally reversed
Remember the image is inverted and laterally reversed The patient should be asked to look : UP – view the LOWER edge of the image for the superior fundus DOWN – view the UPPER edge of the image for the inferior fundus LEFT – view the RIGHT hand side of the image for the left periphery RIGHT – view the LEFT hand side of the image for the right periphery So, the patient looks in the same direction as they do if you’re doing DIRECT ophthalmoscopy, but your view of that bit of retina is INVERTED
43
What is a Headset ophthalmoscopy? What type of Ophthalmoscopy is it? How does it work?
-Binocular headset with illumination replaces focussing system (slit lamp) -Hand held condensing lens -Must dilate pupils -Indirect ophthalmoscopy
44
Does Headset ophthalmoscopy give a monocular or binocular view?
Binocular view
45
What field of view can you get when using Headset?
roughly a 25° field of view
46
What other piece of equipment can you use with Headset, what does it do and what technique is this called?
Can use headset with a depressor The depressor pushes the Px's sclera and retina and allows for a better field of view (can see the ora serrata) -Uncomfortable for the Px
47
What is the Welch Allyn Panoptic? What type of Ophthalmoscopy is it? How does it work?
-Hand held indirect ophthalmoscope
48
Is the image upright or inverted with the Welch Allyn Panoptic?
Upright as it has an incorporated erecting prism which makes the image upright
49
Does the Welch Allyn Panoptic give a monocular or binocular view?
Monocular view
50
Compare the Welch Allyn Panoptic to direct ophthalmoscopy
The Welch Allyn Panoptic has a : -25° field of view -26% increase in magnification -Greater WD between Px and practitioner
51
Compare the Welch Allyn Panoptic to indirect ophthalmoscopy
You are much closer to the Px when using the Welch Allyn Panoptic compared to other indirect ophthalmoscopy
52
What is the Keeler Wide Angle Twin Mag Ophthalmoscope? What type of Ophthalmoscopy is it? How does it work?
Monocular indirect ophthalmoscope Creates an upright view due to built in erecting prism An additional corneal/condensing lens is available to allow examination of corneal pathology Twin magnification levels 1x – 250 FOV and 15x magnification 1.5x – 17.50 FOV and 22.5x magnification
53
When would you use monocular indirect ophthalmoscopy?
-Use when a Px can't get to a slit lamp -Good to use in a bright surrounding (e.g. outside) when light is not dim
54
What are the types of retinal disorders?
Benign - Don't have to do anything about them (nothing bad will come of them) Pathological - Part of a persons physiology
55
Should pre retinal nerves have myelin sheath around them, if not why?
Pre retinal nerves should not have myelin sheath as we want light to pass through the pre retinal layer
56
If a Px has myelinated nerve fibres, where would they be located?
Located around the optic disc and have an arc shape
57
Where do Intraretinal degenerations occur and give examples of some?
Occur in the retina Examples : -Microcystoid -Retinoschisis
58
Where do Retinovitreal degenerations occur and give examples of some?
Retinovitreal degenerations occur on the surface layer (retina and vitreous) Examples : -Lattice -Snailtrack
59
Where do Chorioretinal degenerations occur and give examples of some?
Chorioretinal degenerations occur in the retina and choroid Examples : -Paving/Cobblestone -Reticular Pigmentary (aka Honeycomb)
60
What are all these called? -Microcystoid -Retinoschisis -Lattice -Snailtrack -Pavingstone
Peripheral Retinal Degenerations
61
What is Microcystoid?
-Most common peripheral degeneration -Increases with age -Greyish white vesicles/vacuoles -In outer plexiform and inner nuclear layers -Does not predispose (lead to) retinal detachment
62
What is Snailtrack?
-Glistening in the retinovitreal interface -Early form of lattice (will develop into lattice) -->Sharply defined, well circumscribed, frosted appearance -Potentially a degeneration of neural layers (1st layers of the retina)
63
What layers are the neural layers of the retina?
Neural layers are the 1st layers of the retina
64
What is Lattice?
-Made up of ghost vessels which used to be blood vessels -Areas of hyperpigmentation from the pigmented retinal epithelium -Underneath photoreceptors -More common in Px's with retinal detachments
65
What is Paving or Cobblestone?
-Discrete well circumscribed white patches -Pigmentary distrurbances (hyperpigmentation - dark bits/hypopigmentation - light bits) -Between ora serrata and equator -Benign
66
What is hyperpigmentation?
Too much pigmentation Dark bits
67
What is hypopigmentation?
Not enough pigmentation Light bits
68
Is paving/cobblestone present at the posterior pole?
No, only present in the periphery
69
What is Reticular Pigmentary (aka Honeycomb)?
-Areas of hyperpigmentation/hypopigmentation -Can affect Retinal Pigmented Epithelium + Choroid -Can get peripheral drusen -Occurs as a result of poor choroidal perfusion (lack of blood and oxygen getting to the choroid) -Associated with/more likely to get AMD
70
What disease is Honeycomb a warning sign for?
AMD
71
What is Retinopathy of Prematurity?
-Premature babies are given oxygen at birth (oxygen perfusion of the retina) as their lungs are still developing -When oxygen levels get too high it damages the retina (which is also still developing) --> Case history : Was the Px's birth full term or premature?
72
What are complications of Retinopathy of Prematurity?
-Amblyopia - lazy eyes -Strabismus -High myopia -Glaucoma -Cataract -Retinal detachment
73
What are the different Pigmentary lesions?
-Retinal Pigmented Epithelium Hypertrophy (Congenital Hypertrophy or the Retinal Pigmented Epithelium) CHRPE -Choroidal Naevus -Choroidal Melanoma
74
What does congenital mean?
Of a disease or physical condition present from birth
75
What is a CHRPE?
-Unilateral (one eye) -Flat - 1-3 disc diameters in size -Dark grey/black -Hyperpigmentation + hypopigmentation
76
What is a Choroidal Naevus?
-Asymptomatic -Take photographs to monitor -Flat or slightly elevated -Slate grey -Generally < 2 disc diameters, may be up to 5 -Indistinct margins
77
What is a Choroidal Melanoma?
-Rare -Asymptomatic unless detachment occurs -Looks similar to Choroidal Naevus -Take photographs to monitor -Can metastasise to other parts of the body -Significantly elevated -Has a blood supply/vessels Vessels are leaky which leads to fluid leakage and retinal detachments -White to greenish grey - >10 disc diameters -Has lipofuscin --> orange pigment on top of melanoma
78
What happens to the retina in high myopes?
-The retina is stretched
79
What causes the retina to stretch?
Axial myopia High - myopia > 6.00DS
80
What happens as a result of the retina being stretched?
Atrophy -Caused by the retina being stretched over a greater area Cracks = Lacquer cracks Blob = Geographical Atrophy
81
What can you see as a result of the retina being stretched in high myopes?
Can see underlying sclera
82
What is Foerster/Fuchs spots?
Spots that are hyper pigmented
83
What is a risk of having high myopia in terms of the retina?
-Higher risk of retinal detachment -Early onset nuclear sclerosis cataract or Posterior Sub-capsular cataract
84
What are systemic associations with high myopia?
-Marfans -Down syndrome
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