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Pt Assess Final > Eye Lecture > Flashcards

Eye Lecture Flashcards

1
Q

Emmetropia

A
  • Light rays fall directly on retina

- Normal vision

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2
Q

Myopia

A
  • Light rays fall in FRONT of retina

- Nearsightedness

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3
Q

Hyperopia

A
  • Light rays fall BEHIND retina

- Farsightedness

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4
Q

Astigmatism

A

Varying refraction due to irregular shape of cornea

cylindrical lenses needed as correction

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5
Q

Vital sign of the eye?

A

Visual acuity

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6
Q

Acute painless visual loss could be:

A
  • Vitreous hemorrhage
  • Retinal detachment
  • Retinal artery occlusion
  • Retinal vein occlusion
  • Exudative macular degeneration
  • Ischemic optic neuropathy
  • Stroke
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7
Q

Vitreous hemorrhage

A
  • “Spider webs” clouding vision
  • A/w diabetes, sickle cell anemia
  • Low red reflex, clouding of retina (or not seen at all)
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8
Q

Retinal detachment

A
  • Photopsia/floaters
  • “Curtain” covering vision
  • Pts w/severe myopia
  • Diplopia only goes away when the bad eye is closed
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9
Q

Photopsia

A

Flashes of light

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10
Q

Amaurosis fugax

A
  • Transient painless monocular visual loss

- Occurs when blood clot or plaque blocks artery in eye

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11
Q

Retinal artery occlusion

A
  • Sudden and nearly complete amaurosis fugax
  • A/w carotid artery, valvular disease
  • Vision limited to hand motion/light perception only
  • Cherry red spot in macula, diffusely pale retina
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12
Q

Retinal vein occlusion

A
  • A/w HTN, blood abnormalities (dyscrasias)

- Retinal hemorrhages, veins are tortuous and dilated

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13
Q

Exudative macular degeneration

A
  • 60+ yo
  • Slow, progressive
  • Metamorphosia
  • Retinal hemorrhage may be seen in macular region
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14
Q

Metamorphosia

A

Distortion of straight lines

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15
Q

Ischemic optic neuropathy

A
  • Can be a/w HTN, diabetes
  • Scalp tenderness, neck pain
  • Marcus Gunn pupil, swelling of optic nerve head
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16
Q

Stroke

A

Normal exam of eye

Functional vision loss, painless

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17
Q

Corneal ulcer

A

-Hx of trauma or contact lens wear (esp during sleep)

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18
Q

Uveitis

A
  • Inflammation of uveal tract (iris, ciliary body, choroid)
  • Can be a/w sarcoid, TB, IBD, psoriasis
  • Small pupil, sluggish or non-reactive to light, circumlimbal flush, low red reflex, usually unilateral
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19
Q

Circumlimbal flush

A

Circular reddening around cornea

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20
Q

Acute painful loss of vision could be:

A
  • Corneal ulcer
  • Uveitis
  • Acute angle glaucoma
  • Endophthalmitis
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21
Q

Acute angle glaucoma

A
  • Older farsighted pts
  • Blurry vision, haloes around light, pain
  • Unilateral redy eye, non reactive pupil
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22
Q

Endophthalmitis

A
  • Inflammation/infection of eyeball
  • MC post surgical complication
  • Redness, corneal edema, mucopurulent d/c, low red reflex
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23
Q

Chronic progressive painless vision loss could be:

A
  • Refractive error
  • Cataract
  • Open angle glaucoma
  • Atrophic macular degeneration
  • Brain tumor
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24
Q

Binocular diplopia could be:

A
  • CN 3, 4, 6 palsy
  • Uncompensated strabismus
  • Hyperthyroidism
  • Myasthenia gravis
  • Blow out fracture of orbit
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25
Q

MC cause of gradual visual loss?

A

Refractive error

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26
Q

Cataracts

A

Common in elderly

Low red reflex, visualization of retina is difficult, normal pupillary response

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27
Q

Open angle glaucoma

A
  • MC in pts w/fam hx, myopia, DM, AAs

- Elevated IOP

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28
Q

Atrophic macular degeneration

A
  • 60 yo+, may have fam hx

- Drusen (hyaline nodules) in retina

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29
Q

CN 3 palsy

A
  • Usually painless diplopia

- A/w aneurysm, diabetes, tumor, trauma, uncal (brain) hernitation

30
Q

CN 3 palsy PE findings

A
  • At rest: eye can only gaze laterally, pupil dilated and may be fixed
  • With herniation: unconsciousness, contralateral hemiparesis
  • Droopy eyelid
31
Q

How to confirm binocular diplopia?

A

Have pt close either eye and diplopia should resolve completely

32
Q

CN 4 palsy

A
  • Vertical diplopia, difficulty looking down

- A/w tumor, aneurysm, diabetes

33
Q

CN 4 palsy PE findings

A
  • Vertical diplopia
  • Affected eye “sits” higher than other
  • Head tilt as pt tries to compensate for vertical diplopia
34
Q

CN 6 palsy

A
  • Horizontal diplopia

- Tumor, DM, aneurysm, temporal arteritis

35
Q

CN 6 palsy PE findings

A

-Eye “sits” with some esotropia (inward gaze)

36
Q

Uncompensated strabismus PE findings

A
  • If horizontal diplopia/deviation, exotropia OR esotropia

- If vertical, one eye will “sit” higher than other

37
Q

Hyperthyroidism PE findings

A
  • Proptosis w/decreased movement
  • Results in diplopia
  • Lid lag
38
Q

Myasthenia gravis

A
  • Weakness of facial muscles, upper limbs

- Worsens w/fatigue

39
Q

Blow out fracture of orbits

A
  • May result in CN entrapment

- SC air may be present

40
Q

What can cause itching/burning of the eye?

A

Conjunctivitis (bacterial or viral)

41
Q

What can cause FB sensation in the eye?

A

FB
Corneal abrasion
Dry eyes
Entropion

42
Q

What can cause excessive tearing?

A

Ectropion

Entropion

43
Q

Ectropion

A
  • Outward turning of eyelid

- Tears do not reach drainage points

44
Q

Entropion

A
  • Inward turning of eyelid

- Excessive tear production

45
Q

Visual acuity - distance from wall chart

A

20 feet

46
Q

Visual acuity - distance from pocket Rosenberg chart

A

14-16 inches

47
Q

OD
OS
OU

A

Right eye
Left eye
Both eyes

48
Q

Interpret OD = 20/30 + 2

A

Pt read 20/30 line without mistakes and then got 2 right on the 20/20 line

49
Q

Visual fields test

A
  • Crude
  • Each eye must be tested separately
  • May only be possible to pick up significant deficits (not subtle)
50
Q

Visual fields test - distance from patient

A

18 inches at the SAME level

51
Q

If palpebral conjunctiva is pale, this could indicate:

A

Anemia

52
Q

Arcus senilis

A

Whitish arc around edge of cornea in older patients (benign)

53
Q

Pterygium

A
  • Fleshy growth arising from conjunctiva over outer portion of cornea
  • Usually nasal side
54
Q

Cataract

A
  • Opacity of the lens
  • Pupil looks cloudy/hazy
  • Reduced red reflex
55
Q

Anterior depth chamber

A
  • Iris is flat so you should see a small crescent of light on nasal side
  • If there is a shadow, it would indicate a shallow anterior chamber due to bowing of the iris
56
Q

Anisocoria

A

Unequal pupils

Normal in about 20% pts

57
Q

Adie’s pupil

A

Large, very sluggish or no reaction to light, slow accommodation

58
Q

CN 3 palsy pupillary reaction

A

No reaction to light or accommodation

59
Q

Argyll-Robertson pupil

A

“Whore’s pupil”

Small, irregular pupils that accommodate but do not react (to light)

60
Q

Horner’s syndrome pupil

A
  • Small, but reactive to light and accommodation
  • Ptosis is present on affected side
  • Loss of sweating on affected side forehead
61
Q

Marcus Gunn pupil

A
  • Swinging flashlight sign
  • 1st light into affected eye shows no reaction
  • Then light in other eye affected eye constricts
  • Shine back into affected eye and it dilates
62
Q

How does a CN 3 palsy affect the eye movement?

A

Paralysis of medial, upward, downward gaze on affected side

  • CN are not crossed so deficits are on the side of the lesion
  • Also causes dilated non-reactive pupil and ptosis
63
Q

How does a CN 6 palsy affect the eye movement?

A

Paralysis of lateral gaze on affected side

64
Q

How does a CN 4 palsy affect eye movement?

A

Affected eye cannot look downward when turned inward

65
Q

What is a rheostat?

A

Brightness/dimmer control on opthalmoscope

66
Q

How do you perform the red reflex?

A

Tilt scope to ~15 degrees about 16 inches from patient

67
Q

Venous pulsations of the eye

A

Sign of normal intracranial pressure

68
Q

Venous pulsations of the eye are lost when:

A

ICP increases

Papilledema develops

69
Q

Papilledema

A

Raised optic disc with blurred margins due to edema

70
Q

T/F: Panoptic allows you to see entire fundus panoramically

A

True

71
Q

Monocular vs. binocular diplopia

A 
Monocular = problem with one of the eyes and it only is resolved when the bad eye is closed
Binocular = EOM (should resolve when either eye is closed)

Pt Assess Final (7 decks)

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