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Ophthalmology > Clinical examination of the eye 1 and 2 > Flashcards

Clinical examination of the eye 1 and 2 Flashcards

(43 cards)

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1
Q

3 main owner concerns

A
  • altered appearance
  • loss of vision
  • pain
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2
Q

1st part of opthalmic exam

A

Hands-off observation of facial/ocular symmetry

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3
Q

How do you take a tear reading?

A

Schirmer tear test 1 (STT1 - i.e. no anaesthesia)

  • BEFORE light, eyelid manipulation
  • do LATERALLY, b/w eyelid and cornea, don’t poke cornea, 3rd eyelid shouldn’t interfere
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4
Q

How do corneal sensitivities vary?

A

sensitivity varies depending on the number of corneal nn - humans have many, dogs have much less, brachycephalics the least

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5
Q

Where do you insert the tip of the STT notch into?

A

into the lower conjunctival fornix

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6
Q

Outline STT-1 results

A

Rough guide (always correlate with CS, other eye):
15mm/min + are normal
10 mm/min less are low
In between =unclear so repeat test

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7
Q

Describe the progression of dry eye (KCS)

A

asymmetrical and progressive

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8
Q

When to do assess the menace response…

A

after STT1 readings but can do it before

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9
Q

Outline menace response examination

A

Quickly part fingers in front of eye
You may touch medial/lateral canthi before testing
This is a learned response (cortical, not reflex)
Tests for vision (crudely)

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10
Q

How do you examine the eye with light?

A

From outside inwards:

  • eyelids and nictitans
  • tear film and NSL
  • cornea
  • conjunctiva
  • episclera/sclera
  • intraocular structures (uvea, lens, retina)
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11
Q

Name 3 light exam techniques

A

1 transillumination/slit examination
2 direct opthalmoscopy (DO) - distant and close-up
3 indirect opthalmoscopy (IO)

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12
Q

What are the 2 points of transillumination/slit exam

A
  • Anterior structures of the eye (transilluminable versus non- transilluminable structures)
  • Reflexes (dazzle, PLR via direct (R and L) and indirect (R to L)
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13
Q

Name non-transilluminable structures of anterior eye

A

eyelids, conjunctiva, 3rd eyelid

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14
Q

List transilluminable structures of the anterior eye

A

cornea, iris and anterior lens

- assess contour and lesion depth (ulcer, cataract)

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15
Q

What is a rheostat?

A

Part of the opthalmoscope - it is the on/off switch and dimmer

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16
Q

Name light filters on an opthalmoscope

A

BLUE - to show fluorescein dye (ulcers)

GREEN - red free, blood/BVs appear black, pigment remains brown

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17
Q

What can you see with a circular, bright beam

A 
Upper/lower puncta
Meibomian glands
===
Overall brightness and moisture
Conjunctiva colour
Purkinjke reflexes
PLR and dazzle reflexes (blinding cataracts have no effect on these if the light is bright enough)
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18
Q

What do you use the slit beam to asses? 3

Study These Flashcards
A

Surface contour - cornea, iris, anterior lens
Layers - cornea (ulcer depth), lens (cataract localisation)
Anterior chamber - aqueous humor quality (transparent/turbid, blood/cells/protein)

19
Q

What is flare?

Study These Flashcards
A

What you see when you pass through aqueous humor that has debris in it. Results in keratic precipitates if these settle.

20
Q

What is the major limitation of examining the cornea with light?

Study These Flashcards
A

ulcer depth calculation requires a fine (0.1mm) focused slit from a slit lamp, which hand help opthalmoscopes don’t have, and require years of practice under investigation.

21
Q

List changes of the anterior chamber (AC)

Study These Flashcards
A
  • Aqueous flare = ‘tyndall effect’
  • Keratic precipitates (deposits on ventral endothelium)
  • Hyphema (blood)
  • Hypopion (WBC accumulation, pus)
  • Posterior/anterior synechia
  • Anterior lens luxation (ALL)
  • Anterior presentation of the vitreous
  • Protein accumulation in AC
22
Q

What is the ‘tyndall effect’?

Study These Flashcards
A

AKA aqueous flare
An accumulation of proteins and cells in the AC
- Becomes keratic precipitates when these materials settle ventrally

23
Q

How can you differentiate nuclear sclerosis from a cataract?

24
Q

How can you examine the posterior segment of the eye?

Study These Flashcards
A
  • CDO or IO

- Retina mostly, also vitreous and lens

25
Describe direct opthalmoscopy
Look directly through opthalmoscope into eye | 2 methods - distant (DDO) and close (CDO)
26
Describe indirect opthalmoscopy (IO)
Look indirectly, at image of the fundus. - Use a 15-20-30D lens and hand held/head-mounted opthalmoscope - inverted, L to R, - -> VIRTUAL image ( as upside down and back to front) - wide field of view but less magnified
27
What is the lens wheel on an opthalmoscope?
found on the part of the opthalmoscope facing the patient, it has: - positive lenses (green or black) 20,18....,6,4,2 - mid point = neutral setting = 0 (for perfect vision, adjust if you wear glasses, different for DDO and CDO) - negative lenses (red) -2,-18,-16...-20
28
How do you adjust the mid point/neutral setting for someone who is near sighted?
From -2 to -4
29
How do you adjust the mid point/neutral setting for someone who is far-sighted?
from +2 to +4
30
What do you aim to do with DDO?
Aim to use the tapetal reflection (angle your view towards the patient, make the patient's pupil shine). Thus the tapetal light retroilluminates the lens. This helps to differentiate nuclear sclerosis and cataracts: - Nuclear scleorsis = transparent - Cataracts = black
31
What should you do with CDO?
- locate optic disc - divide into quarters - make a mental collage - big area, all BVs lead to optic disc) - right eye to right eye THEN left eye to left eye (or if you cannot close one of your eyes, 'go over' the nose)
32
Using CDO, if you see a lesion clearly at a reading of 0 where is it likely to be?
at the back of the eye
33
Using CDO, if you see a lesion clearly at a reading of +15 to +10 where is it likely to be?
lens
34
How does the diopeter power with indirect opthalmoscopy (IO) affect the magnification?
The larger the diopeter power, the lower the magnification
35
How does the magnification with indirect opthalmoscopy (IO) affect the field of view?
The lower the magnification the larger the field of view, therefore increased diopter power, decreases magnification, increases field of view
36
What is a panoptic opthalmoscope?
A type of indirect opthalmoscopy where the benefits of a wide filed of view and normal anatomy (i.e. not upside down and back to front) are combined
37
List some additional tests for the opthalmic exam
- Fluorescein staining - ulcer, jones test - IOP - tonometry - Gonioscopy - a specialist's tool - Imaging (US, CT, MRI)
38
Outline the fluorescein staining
- strips are preferred over drops - adheres to stroma (hydrophilic) - repelled by epithelium - don't touch strip to cornea (dry or wet) - wet strip with saline - apply a drop onto dorsal conjunctiva - look for ulcers or nasolacrimal duct patency WITH ULCERS: - rinse thoroughly with saline, examine corneal surface and always look with a blue light
39
What is the Jones test?
an adaptation of the fluorescein test. - do not rinse - wait a few minutes
40
How can IOP be assessed?
Tonometry: Indentation (old, cheap, inaccurate) - Schiotz Applanation (new, expensive, accurate) - Tonopen Vet Rebound (new, expensive, accurate) - Tonovet
41
What is tonometry useful in?
``` Distinguishing glaucoma (increased IOP) from uveitis (decreased IOP). Normal IOP range is 12-22(24) mmHg ```
42
What is gonioscopy?
Gonioscopy is an eye examination to look at the front part of your eye (anterior chamber) between the cornea and the iris. Gonioscopy is a painless examination to see whether the area where fluid drains out of your eye (ICA) is open or closed. BUT a narrow or closed ICA doesn't always correlate with glaucoma (i.e. a raised IOP)
43
What is US scanning not good for?
not great for the retrobullar area

Ophthalmology (14 decks)

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