Ophthalmic History and Examination Lecture Powerpoint

Question 1

Common causes of burning in eyes

Answer 1

Dry eye syndrome
Blepharitis (dandruff of eyelashes)
Chemical splash

Question 2

Common causes of transient visual loss

Answer 2

Few seconds - papilledema (bilateral)
Few minutes - amaurosis fugax (unilateral) vertebrobasilar insufficiency (bilateral)
10-60 min - migraine (acephalgic visual without headache or classic visual precede headache)
>24 hrs sudden painless - retinal artery or vein occlusion, ischemic optic neuropathy, vitreous hemorrhage, retinal detachment
>24 hrs gradual painless loss - cataracts, refractive error (glasses need), open angle glaucoma, macular degeneration, diabetic retinopathy
>24 hours painful loss - acute angle closure glaucoma, optic neuritis, uveitis

Question 3

Double vision (diplopia) common associated condition

Answer 3

Due to cranial nerve palsy until proven otherwise

Question 4

Flashes of light common associated conditions

Answer 4

Indicates posterior vitreous detachment (floaters), retinal detachment, or migraine

Question 5

Foreign body sensation common associated conditions

Answer 5

Dry eye syndrome, blepharitis, foreign body, contact lens related

Question 6

Itchy eye comon associated condition

Answer 6

Allergic conjunctivitis, contact dermatitis

Question 7

Red eye common associated conditions

Answer 7

Discharge presence: conjunctivitis and blepharitis

No discharge: subconjunctival hemorrhage, corneal abrasion, uveitis

Question 8

Tearing eyes common associated conditions

Answer 8

Pain - corneal abrasion, foreign body, uveitis
Minimal pain - drye eye syndrome, nasolacrimal duct obstruction
Children - nasal lacrimal duct obstruction or congenital glaucoma

Question 9

Vision physical exam

Answer 9

• Check corrected vision first
• check vision at the correct distance for specific chart you are using
• check one eye at time
• OD is right, OS is left, and OU is both eyes, write as 20/__

Question 10

Origin of 20/20 vision

Answer 10

Dutch ophthalmologist developed standardized eye chart in 1800’s, 20/40 means that a person can see at 20 what a normal eye can see at 40 feet, as bottom number gets larger vision is less acute/more blurry

Question 11

Pupils physical exam

Answer 11

• Checking pupil size, if >1mm diff called anisocoria
• shape should be round unless previous eye surgery, trauma, or congenital abnormality
• Have patient fixate on distant object, shine bright light source into one eye, pupil should constrict, and other should as well due to consensual light reflex

Question 12

3rd nerve palsy with fixed or dilated pupil (no indirect acommondation) could indicate…

Answer 12

…aneurysm?

Question 13

Relative afferent pupillary defect (marcus gunn pupil)

Answer 13

Occurs upon flashlight testing of eye resulting in abnormal dilation upon exposure to the light indicating pathology of the optic nerve or severe retinal disease

Question 14

Extraocular muscles testing physical exam

Answer 14

• Have patient follow and object in an H pattern to test both eyes
• test to what %in all directions the eye can move direction in that gaze from 0-100% (100% being best)

Question 15

Superior oblique allows eye to move ____. Inferior oblique allows eye to move ____

Answer 15

down and nasally, upward and nasally

Question 16

Visual fields by confrontation physical exam

Answer 16

-have patient look right at nose and cover one eye, hold hand in each of the 4 quadrants using 1,2, or 5 fingers then ask patient to identify, impairmnet may signify a stroke, optic neuropathy, or retinal detachment

Question 17

What physical exam must be performed on any patient who cmplains of decreased vision

Answer 17

Visual fields by confrontation

Question 18

Why do eyes bulge in thyroid disease

Answer 18

Muscles constrict squeezing eyes more outwardly?

Question 19

Assessing clarity of cornea

Answer 19

Stain with fluorescin dye and cobalt blue filter on opthalmoscope to assess iris details for scratched cornea

Question 20

Angle closure glaucoma finger technique

Answer 20

-Have patient close eyes then push down on it with fingers, if one eye feels much harder closer to a golf ball then that indicates the pressure is markedly elevated

Question 21

Green lenses on opthalmosope vs red

Answer 21

Green pull the image forward or are positive to focus items that are close
Red push the image backward or are negative to focus items that are far

Question 22

Optic disk margins

Answer 22

Should be well defined, if no edges and cotton wool spots may be glaucoma or other pathology

Question 23

Normal cup to disk ratio

Answer 23

.1-.3

Question 24

AV nicking

Answer 24

Where artery and vein cross, a sign of high blood pressure

Question 25

Retinal vessel differentiation between arteries and veins

Answer 25

Arteries are narrower than veins