Exam 1 | Eye

Question 1

S&S to note

Answer 1

• photophobia: light sensitivity from excess light entering eye which may overexcite photoreceptors in retina
• Flashing lights w/ new vitreous floaters ⇒ consider detachment of vitreous from retina
  
  • Moving specs or strands ⇒ vitreous floaters
• Scotomas: area of lost or depressed vision within visual field and is surrounded by area of normal vision
• Diplopia: double vision
• Hyperopia (farsightedness): difficulty seeing close objects
• Myopia (nearsightedness): difficulty seeing far objects
• Presbyopia (aging vision): difficulty seeing close objects

Question 2

general external inspection of…

Answer 2

• eyebrows
• eyelids
  
  • red inflamed lid margins occur in blepharitis, often w/ crusting
  • failure of eyelids to close exposes cornea to serious damage
  • upward slanting palpebral fissures (space between open eyelids) visible in Down Syndrome

Question 3

Snellen Chart

Answer 3

• who: for adults and ppl who can read
• tests: visual acuity
• numerator: distance of pt from chart (always 20)
• denominator: # line pt is able to read
• better than normal vision: when denominator smaller than numerator
• legally blind: 20/200 = pt at 20 ft can read print that person w/ normal vision can read at 200 ft

Question 4

E Chart

Answer 4

• who: children or ppl unable to read
• tests: visual acuity
• used mostly for myopia (nearsightedness) bc it causes focusing problems for distance vision ppl

Question 5

Jaeger (J) Number Test

Answer 5

• tests: near visual acuity to identify need for reading glasses or bifocals

Question 6

EOMs test abnormalities and meanings

Answer 6

• movement deviations ⇒ consider brain tumor or injury
• Suspecting lid lag or know pt has hyperthyroidism ⇒ ask pt to follow finger again as you slowly move it up/down midline → normally lids should overlap iris slightly
  
  • If lid doesn’t overlap ⇒ hyperthyroidism creates abnormal protrusion of eye leaving no overlap
• Poor eye convergence ⇒ common in hyperthyroidism
• Asymmetry of corneal deviation ⇒ deviation from normal ocular alignment
• Temporal light reflection on one cornea ⇒ nasal deviation of that eye

Question 7

Pupil inspection

Answer 7

• PEERLA (tests CN III)
• direct and consensual responses, accommodation: pupil miosis (constriction) and mydriasis (dilation) should work together and happen at same time

Question 8

Ophthalmoscopic Examines…

Answer 8

• retina
• optic nerve (CNII)
• optic disc
• vessels
• macula for…
  
  • macular degeneration: subretinal hemorrhage or exudate ⇒ can cause poor central vision in elderly
  • drusen: undigested cellular debris that can be found in macula as hard and sharply defined or as soft and confluent w/ altered pigmentation

Question 9

Peripheral Vision & Visual Fields (how to test and abnormalities + meanings)

Answer 9

• tests confrontation: wiggle fingers → tell pt to tell you when they can see them from temporal to central
  
  • nurse needs to have normal vision bc wtv you see is what pt should see
• Defects in peripheral vision can be sign of normal pressure glaucoma ⇒ pt should be referred to ophthalmologist
• Hemianopsia: when pt is unable to see half of visual field and is generally on one side (can occur after CVA)
  
  • Bitemporal hemianopsia (optic chiasm): loss of peripheral vision in outer halves of both right and left visual field, caused by lesion
  • Homonymous hemianopsia (right optic tract): loss of visual field in same halves of visual fields of each eye

Question 10

Eye Alignment (how to test and abnormalities + meanings)

Answer 10

• should be tested w/ correction glasses/lenses
• If one or both eyes seem to protrude (assess from above)
• Abnormal protrusion of eye can be inward or outward ⇒ consider Grave’s Disease or ocular tumor
• Strabismus/Heterotropia: when both eyes aren’t aligned
• Exotropia (medial shift): one eye drifts away from nose
• Esotropia (lateral shift): one eye drifts towards nose
• Hypertropia (down shift): one eye drifts up
• Hypotropia (up shift): one eye drifts down
• Eye misalignment can cause amblyopia (lazy eye): reduced vision in one eye

Question 11

Retina-Specific Inspection Using Ophthalmoscope

Answer 11

• Glaucoma: increase intraocular pressure ⇒ damages optic nerve ⇒ impacts vision
  
  • Open-angle: gradual, painless increase in intraocular pressure ⇒ peripheral vision loss/tunnel vision (can progress to central vision loss too)
  • Closed-angle: sudden, dramatic, painful increase in intraocular pressure ⇒ quick vision loss starting peripheral then quickly to central
• Papilledema: gradual swelling of optic disc and anterior bulging of cup (can be sign of serious brain disorder– subarachnoid hemorrhage, meningitis, trauma, mass lesions)
• Retinopathy: gradual vision loss and blindness from damaged retinal blood vessels

Question 12

External eye portion abnormalities

Answer 12

• Blepharitis
• Periorbital Fx
• Ptosis
• Chalazion
• Hordeolum/Stye
• Xanthelasma

Question 13

Blepharitis

Answer 13

red inflamed eyelid margins often w/ crusting

Question 14

Ptosis

Answer 14

drooping of upper eyelids

Question 15

Chalazion

Answer 15

• small, firm lump
• cause: blocked oil gland
• Tx: warm compress over periods of time

Question 16

Hordeolum/Stye

Answer 16

• painful, red, pus-filled bump that occurs on edges of eyelid
• cause: bacterial infection of oil gland in eyelid
• Tx: warm compress over periods of time

Question 17

Xanthelasma

Answer 17

• harmless bump near eyelid
• Chronic and benign disease
• Fat appears
• High risk of stroke bc it can be sign of high cholesterol, thyroid issues, or diabetes

Question 18

Internal aspects of eye abnormalities

Answer 18

• Iritis
• Conjunctivitis
• Cataract
• strabismus/heterotropia
• vitreous hemorrhage
• retinal vein occlusion
• central retinal artery occlusion
• glaucoma

Question 19

Iritis

Answer 19

• inflammation of iris (major red flag bc… )
• can lead to vision loss
• Tx: steroids, eye drops

Question 20

Conjunctivitis

Answer 20

inflammation of conjunctiva (thin, clear membrane covering white of eye and inside of eyelids)

Question 21

Cataracts

Answer 21

• clouding of eye lens (white clouds)
• Can lead to slow central vision loss

Question 22

Strabismus/Heterotropia (definition, causes, types)

Answer 22

• when both eyes aren’t aligned
• causes: neurological problems, genes, issue of extraocular muscles or nerve issues
• Exotropia (medial shift): one eye drifts away from nose
• Esotropia (lateral shift): one eye drifts towards nose
• Hypertropia (down shift): one eye drifts up
• Hypotropia (up shift): one eye drifts down

Question 23

Vitreous hemorrhage

Answer 23

• blood floating in vitreous ⇒ occludes view or retina
• Can lead to unilateral and painless, sudden vision loss

Question 24

Retinal vein occlusion

Answer 24

• blockage in vein that drains blood from retina
• Can lead to unilateral and painless, sudden vision loss

Question 25

Central retinal artery occlusion

Answer 25

- blockage of retinal artery carrying oxygen to nerve cells in retina at back of eye - Can lead to unilateral and painless, sudden vision loss

Question 26

Red Flags for Eyes

Answer 26

- Iritis: inflammation of iris ⇒ can read to vision loss - Sudden eye pain - White reflection instead of red reflex ⇒ cataracts

Question 27

Open-angle glaucoma S&S

Answer 27

- Usually asymptomatic bc of gradual progression ⇒ any Sxs felt means it’s severe - Peripheral vision loss / Tunnel vision - Enlarged central cup - Increased cup-to-disk ratio

Question 28

Glaucoma (open and closed angle) Risk Factors

Answer 28

- Aging - Diabetes mellitus I, II - FHx / Genes - Eye injury - Corticosteroid use - Smoking

Question 29

Glaucoma (open and closed angle) Prevention

Answer 29

- Monitor BP - Monitor blood sugar lvls

Question 30

Cataracts S&S

Answer 30

- Gradual, bilateral vision loss - Cloudy lenses - Monocular diplopia - No red reflex / Dark light reflex

Question 31

Cataracts Risk Factors

Answer 31

- Aging - Diabetes mellitus I, II - FHx / Genes - Smoking

Question 32

Cataracts Prevention

Answer 32

- Stop smoking - Monitor blood sugar lvls

Question 33

Macular Degeneration S&S

Answer 33

- Gradual, central vision loss - Bilateral - Painless - Blurred vision

Question 34

Macular Degeneration Risk Factors

Answer 34

- Aging - FHx / Genes

Question 35

Macular Degeneration Prevention

Answer 35

- Sunglasses

Question 36

Gradual + Painless Eye Conditions

Answer 36

- Macular degeneration - open-angle glaucoma - cataracts - Retinal vein occlusion (can be both sudden or gradual)

Question 37

Sudden + Painful Eye Conditions

Answer 37

- closed-angle glaucoma

Question 38

Sudden + Painless Eye Conditions

Answer 38

- Vitreous hemorrhage - Retinal vein occlusion (can be both sudden or gradual) - Central retinal artery occlusion

Question 39

DM impact on eyes (can lead to...)

Answer 39

- leading cause of preventable blindness in US - Retinopathy: retina damage - Cataracts: cloudy lenses - Glaucoma - Vitreous hemorrhage

Question 40

Hypertension (HTN) can lead to...

Answer 40

- A-V nicking: narrowing venule bc arteriole crosses over and compresses it - Retinopathy: retina damage

Question 41

Atherosclerosis impact on eyes + can lead to...

Answer 41

- Bilateral or unilateral, gradual effect on eye - Leads to central retinal artery occlusion (eye stroke) ⇒ vision loss

Question 42

Brain injury can lead to...

Answer 42

- papilledema (swelling of optic disc)

Question 43

Grave’s Disease (cause of hyperthyroidism) can lead to...

Answer 43

- Bilateral, gradual effect on eye - Exophthalmos - Corneal ulceration - Loss of vision (rare)

Question 44

AIDS can lead to...

Answer 44

- Retinopathy - Detached Retina - Squamous cell carcinoma of eye - Increased risk of eye infection

Question 45

Sickle Cell can lead to...

Answer 45

- Bilateral, gradual effect on eye - Subconjunctival hemorrhage - Retinal vessel occlusion (eye stroke) - Retinal neovascularization: creation of new, poor quality eye blood vessels - Retinal detachment

Question 46

Multiple sclerosis can lead to...

Answer 46

- Unilateral or bilateral, gradual effect on eye - Optic neuritis: inflammation of optic nerves - Diplopia - Nystagmus: involuntary eye movement

Question 47

Children considerations

Answer 47

- Strabismus starts often in childhood 3-5 yrs - Failure to correct amblyopia during early childhood can result in poor vision for life

Question 48

Geriatrics/Older Adults considerations

Answer 48

- Poor central vision in elderly is caused by macular degeneration - Types of macular degeneration: Dry atrophic, Wet exudate, Wet neovascular - More at risk for glaucoma, cataracts, and macular degeneration

Question 49

General Population health education and prevention

Answer 49

Eye protection– sunglasses Contact lens care

Question 50

Infants health education and prevention

Answer 50

- Should see Red Reflex from ophthalmoscopy - No prescriptions bc eyesight still developing

Question 51

Geriatrics health education and prevention

Answer 51

- Screening for glaucoma, cataracts, macular degeneration - Near vision testing for presbyopia

Question 52

Ppl w/ DM I health education and prevention

Answer 52

eye exam within 5 yrs of DM I diagnosis and yearly following

Question 53

Ppl w/ DM II health education and prevention

Answer 53

eye exam at same time as DM II diagnosis and at least every 2 yrs following