Exam 1 | Eye Flashcards
1
Q
S&S to note
A
- 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
2
Q
general external inspection of…
A
- 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
3
Q
Snellen Chart
A
- 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
4
Q
E Chart
A
- who: children or ppl unable to read
- tests: visual acuity
- used mostly for myopia (nearsightedness) bc it causes focusing problems for distance vision ppl
5
Q
Jaeger (J) Number Test
A
- tests: near visual acuity to identify need for reading glasses or bifocals
6
Q
EOMs test abnormalities and meanings
A
- 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
7
Q
Pupil inspection
A
- PEERLA (tests CN III)
- direct and consensual responses, accommodation: pupil miosis (constriction) and mydriasis (dilation) should work together and happen at same time
8
Q
Ophthalmoscopic Examines…
A
- 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
9
Q
Peripheral Vision & Visual Fields (how to test and abnormalities + meanings)
A
- 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
10
Q
Eye Alignment (how to test and abnormalities + meanings)
A
- 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
11
Q
Retina-Specific Inspection Using Ophthalmoscope
A
- 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
12
Q
External eye portion abnormalities
A
- Blepharitis
- Periorbital Fx
- Ptosis
- Chalazion
- Hordeolum/Stye
- Xanthelasma
13
Q
Blepharitis
A
red inflamed eyelid margins often w/ crusting
14
Q
Ptosis
A
drooping of upper eyelids
15
Q
Chalazion
A
- small, firm lump
- cause: blocked oil gland
- Tx: warm compress over periods of time
16
Q
Hordeolum/Stye
A
- 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
17
Q
Xanthelasma
A
- 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
18
Q
Internal aspects of eye abnormalities
A
- Iritis
- Conjunctivitis
- Cataract
- strabismus/heterotropia
- vitreous hemorrhage
- retinal vein occlusion
- central retinal artery occlusion
- glaucoma
19
Q
Iritis
A
- inflammation of iris (major red flag bc… )
- can lead to vision loss
- Tx: steroids, eye drops
20
Q
Conjunctivitis
A
inflammation of conjunctiva (thin, clear membrane covering white of eye and inside of eyelids)
21
Q
Cataracts
A
- clouding of eye lens (white clouds)
- Can lead to slow central vision loss
22
Q
Strabismus/Heterotropia (definition, causes, types)
A
- 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
23
Q
Vitreous hemorrhage
A
- blood floating in vitreous ⇒ occludes view or retina
- Can lead to unilateral and painless, sudden vision loss
24
Q
Retinal vein occlusion
A
- blockage in vein that drains blood from retina
- Can lead to unilateral and painless, sudden vision loss
25
Central retinal artery occlusion
- blockage of retinal artery carrying oxygen to nerve cells in retina at back of eye
- Can lead to unilateral and painless, sudden vision loss
26
Red Flags for Eyes
- Iritis: inflammation of iris ⇒ can read to vision loss
- Sudden eye pain
- White reflection instead of red reflex ⇒ cataracts
27
Open-angle glaucoma S&S
- 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
28
Glaucoma (open and closed angle) Risk Factors
- Aging
- Diabetes mellitus I, II
- FHx / Genes
- Eye injury
- Corticosteroid use
- Smoking
29
Glaucoma (open and closed angle) Prevention
- Monitor BP
- Monitor blood sugar lvls
30
Cataracts S&S
- Gradual, bilateral vision loss
- Cloudy lenses
- Monocular diplopia
- No red reflex / Dark light reflex
31
Cataracts Risk Factors
- Aging
- Diabetes mellitus I, II
- FHx / Genes
- Smoking
32
Cataracts Prevention
- Stop smoking
- Monitor blood sugar lvls
33
Macular Degeneration S&S
- Gradual, central vision loss
- Bilateral
- Painless
- Blurred vision
34
Macular Degeneration Risk Factors
- Aging
- FHx / Genes
35
Macular Degeneration Prevention
- Sunglasses
36
Gradual + Painless Eye Conditions
- Macular degeneration
- open-angle glaucoma
- cataracts
- Retinal vein occlusion (can be both sudden or gradual)
37
Sudden + Painful Eye Conditions
- closed-angle glaucoma
38
Sudden + Painless Eye Conditions
- Vitreous hemorrhage
- Retinal vein occlusion (can be both sudden or gradual)
- Central retinal artery occlusion
39
DM impact on eyes (can lead to...)
- leading cause of preventable blindness in US
- Retinopathy: retina damage
- Cataracts: cloudy lenses
- Glaucoma
- Vitreous hemorrhage
40
Hypertension (HTN) can lead to...
- A-V nicking: narrowing venule bc arteriole crosses over and compresses it
- Retinopathy: retina damage
41
Atherosclerosis impact on eyes + can lead to...
- Bilateral or unilateral, gradual effect on eye
- Leads to central retinal artery occlusion (eye stroke) ⇒ vision loss
42
Brain injury can lead to...
- papilledema (swelling of optic disc)
43
Grave’s Disease (cause of hyperthyroidism) can lead to...
- Bilateral, gradual effect on eye
- Exophthalmos
- Corneal ulceration
- Loss of vision (rare)
44
AIDS can lead to...
- Retinopathy
- Detached Retina
- Squamous cell carcinoma of eye
- Increased risk of eye infection
45
Sickle Cell can lead to...
- Bilateral, gradual effect on eye
- Subconjunctival hemorrhage
- Retinal vessel occlusion (eye stroke)
- Retinal neovascularization: creation of new, poor quality eye blood vessels
- Retinal detachment
46
Multiple sclerosis can lead to...
- Unilateral or bilateral, gradual effect on eye
- Optic neuritis: inflammation of optic nerves
- Diplopia
- Nystagmus: involuntary eye movement
47
Children considerations
- Strabismus starts often in childhood 3-5 yrs
- Failure to correct amblyopia during early childhood can result in poor vision for life
48
Geriatrics/Older Adults considerations
- 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
49
General Population health education and prevention
Eye protection– sunglasses
Contact lens care
50
Infants health education and prevention
- Should see Red Reflex from ophthalmoscopy
- No prescriptions bc eyesight still developing
51
Geriatrics health education and prevention
- Screening for glaucoma, cataracts, macular degeneration
- Near vision testing for presbyopia
52
Ppl w/ DM I health education and prevention
eye exam within 5 yrs of DM I diagnosis and yearly following
53
Ppl w/ DM II health education and prevention
eye exam at same time as DM II diagnosis and at least every 2 yrs following
