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Flashcards in Exam 4 Deck (120):
1

Hyperopia

Farsightedness, occurs when the eye doesn't bend light enough

2

Myopia

Nearsightedness, occurs when the eye overbends light

3

Refraction

Bending light rays into the eye to the retina and reflecting back out so you can see an image

4

Emmetropia

Perfect refraction of the eye, 20/20 vision

5

Astigmatism

Refractive error caused by uneven curved surfaces in the eye, usually the cornea. The uneven surfaces distort vision

6

Miosis

Pupillary constriction

7

Mydriasis

Pupillary dilation

8

Older adults cornea

Flattens and blurs vision, worsens astigmatism. Encourage them to wear corrective lenses for best vision

9

Older adults' ocular muscles reduce in strength, making it harder to maintain an upward gaze/maintain a single image. What do you tell them?

Normal, re-focus your gaze frequently to maintain a single image.

10

Older adults lens

-Hardens, compacts, forms cataracts, yellows
-Elasticity is lost, making the point of best vision farther away
-Encourage wearing glasses and yearly eye exams

11

Older adults iris

-Decreases in ability to dilate resulting in small pupils and poor adaption to darkness
-Teach good lighting to avoid falls

12

Older adults color vision

-Difficulty in discriminating among greens, blues, and violets
-Don't use "dipstick" or other color indicator monitors of health status
-More light is needed to stimulate photoreceptors

13

Tear production in older adults

-Reduced, resulting in dry eyes, discomfort, increased risk for corneal damage/eye infections (more common in women)
-Teach pt to use saline eyedrops on a schedule, increase humidity in the home

14

Arcus senilis

An opaque, bluish white ring on the outer edge of cornea, caused by fat deposits. Very common with aging, doesn't affect vision

15

Intraocular pressure in older adults

Slightly higher

16

Presbyopia

The point at which an object can be can be seen clearly decreases. Objects must be placed farther away. Commonly begins in 40s

17

Glaucoma

Increase intraocular pressure with aging causes hypoxia of photoreceptors and nerve fibers. Extra pressures push on capillaries and nerve fibers, preventing blood flow.

18

Cataract

A lens loses its transparency.

19

Lens

Circular convex structure behind the iris that bends rays of light through the pupil so they focus on the retina

20

Which drugs tend to dry the eye and increase IOP?

Decongestants and antihistamines

21

Systemic conditions which can affect vision

Diabetes, HTN, Lupus erythematosus, thyroid dysfunction, immune deficiency, sarcoidosis, cardia dz, multiple sclerosis, pregnancy

22

Vitamin A deficiency

Can cause dry eye, karatomalacia, blindness

23

Diet for eye health

Rich in fruit and red, orange, and dark green veggies. Lutein and beta carotene maintain retinal function

24

When do you notify an ophthalmologist immediately?

For sudden or persistent loss of vision within the past 48 hours, eye trauma, foreign body in eye, or sudden ocular pain.

25

What would a pt do with double vision?

Cock the head to the side to focus the two images into one or close one eye to see more clearly

26

Exophthalmos

Protrusion of the eye, "bulging"

27

Enophthalmos

Sunken appearance of eye

28

Anisocoria

Unequal pupils

29

Nystagmus

Involuntary rapid twitching of the eyeball. Normal finding for the far lateral gaze

30

Ishihara Chart

Tests color vision by showing numbers composed of dots of one color within a circle of dots of a different color. Test each eye seperately

31

Slit-Lamp Exam

Magnifies the anterior eye structures. Pt leans chin on a rest

32

Corneal Stain

Places fluorescein/topical dye into conjunctival sac. The dye outlines irregularities of corneal surface. Used for problems with contacts, and corneal traumas. Noninvasive, performed under aseptic conditions. Viewed through a blue filter, non intact areas of the cornea stain a bright green color

33

Tonometry

Measures IOP. Indicated for pts over 40, adults w/ family history of glaucoma should test twice a year.

34

Ophthalmoscopy

Views eye's external and interior structures. Can be done by a nurse. Start 12-15 inches away. Red reflex is a reflection of the light on the retina. Absent red reflex may indicate a lens opacity or cloudiness of the vitreous. Avoid this test w/ a confused pt and use an interpreter for one who doesn't speak your language.

35

Angiography

Provides detailed image of eye circulation. Used for assessing problems of retinal circulation or diagnosing intraocular tumors. Instill mydriatic eyedrops to dilate pupils 1 hour before the test. The dye may cause the skin to appear yellow or green for hours after test. IT eliminates through the urine, which will be bright green, drink fluids. Start an IV and inject 5 mL of 10% fluorescein. A digital camera takes pictures, takes only a few minutes. See results immediately.

36

Perimetry

Screens visual fields. Pt looks straight ahead and presses a control button when a light enters peripheral vision. Draws a "map" of peripheral vision.

37

Gonioscopy

Performed when a high IOP is found and determines whether open angle or closed angle glaucoma is present. Uses a special lens that eliminates the corneal curve, is painless, allows visualization of the angle where the iris meets the cornea.

38

Looks at the bony eye structures and EOM, used for detecting tumors in the orbital space. Not painful, must keep head still. Use contrast dye unless trauma is suspected

CT

39

Examines orbits and optic nerves, evaluates tumors. DO NOT use with metal in the eye

MRI

40

Most common method to measure IOP by an ophthalmologist

Goldman's applanation tonometer with a slit lamp. IOP is usually hight in the morning but may peak at any time of the day. Record the time of procedure and tell pts to measure IOP at the same time each day.

41

When is easiest to examine the fundus?

When the room is dark bc the pupil will dilate.

42

How many times does a normal person blink per minute?

5-10

43

Inflammation of the eyelid edges

Blepharitis

44

Blepharitis is caused by what in older adults?

Dry eye syndrome

45

Seborrhea

Greasy and scaly, draining eye. Occurs with blepharitis

46

Pt's eye is itchy, red, and burning.

Blepharitis

47

How to treat blepharitis

Warm compress, dilute baby shampoo, don't rub

48

Turning inward of eyelid causing lashes to rub against eye. Corneal abrasion may result from constant irritation

Entropion

49

Turning outward and sagging of eyelid, reduces the washing action of tears, leads to cornea drying and ulcers

Ectropion

50

Entropion is caused by what?

Eyelid muscle spasms or post-trauma

51

Ectropion is caused by what?

Muscle relaxation or weakness w/ aging

52

Pt has pain and tears, conjunctiva is red, "feels something in their eye"

Entropion

53

Pt has constant tears and a sagging lower eyelid

Ectropion

54

How to treat entropion

Surgery tightens orbicular muscles and moves eyelid to normal position or prevents inward rotation. The pt wears an eyepatch after surgery until they're seen by the ophthalmologist. Tell them to report any pain or drainage under the patch.

55

How to treat extropion

Surgery restores lid alignment, teaching is same as for entropion

56

Hordeolum

"Stye," infection of sweat glands or sebaceous glands in eyelid, doesn't affect vision. Caused by staph or strep, affects 1 eye at a time

57

Management of a stye

Warm compresses four times a day, antibacterial ointment. When the lesion opens, the pus (purulent material) drains and the pain subsides

58

When more than one topical eye drug is prescribed, pts should wait how long in between instillation of each drug?

10-15 minutes

59

Inflammation of a sebaceous gland in the eyelid that protrudes on the inner lid

Chalazion

60

Begins with redness and tenderness, followed by a gradual painless swelling. Pt has fatigue, light sensitivity, and excessive tears

Chalazion

61

Surgery for removing a chalazion

Keep a non pressure eye patch in place for 6 hours and then remove and apply warm compresses. Teach pt to report increasing redness, purulent drainage, or reduced vision to the ophthalmologist

62

Keratoconjunctivitis sicca

Dry eye syndrome

63

Results from changes in tear production/composition/distribution or drugs.

Dry eye syndrome

64

Injury to which cranial nerve inhibits tears?

VII

65

Pt has foreign body sensation in eye, burning and itching, photophobia, tears contain mucus strands and the corneal light reflex is dulled

Dry eye syndrome

66

How to treat allergic conjunctivitis

Vasoconstrictor or corticosteroid eyedrop

67

Bacterial conjunctivitis

"Pink eye," caused by staph or Haemophilus influenza

68

Inflammation or infection of conjunctiva caused by exposure to allergens, irritants, infection/bacteria/virus and is very contagious

Conjunctivitis

69

Allergic conjunctivitis manifestations

Edema, sensation of burning, "bloodshot" eye appearance, excessive tears, itching.

70

Bacterial conjunctivitis manifestations

Blood vessel dilation, mild edema, tears, watery at first discharge and then it becomes thicker with shreds of mucus

71

Chronic conjunctivitis, similar symptoms of bacterial pink eye

Trachoma

72

Trachoma is caused by what

Chlamydia trachomatis

73

Scars the conjunctiva and is a common cause of preventable blindness, more often in warm, moist climates where sanitation is poor

Trachoma

74

Incubation period of trachoma

5-14 days

75

How to treat trachoma

"Big Daddy" antibiotics like erythromycin and tetracycline

76

Causes of corneal abrasion

Contact lens use, small foreign body, trauma, malnutrition, dry eye syndrome, cancer treatment

77

Why is corneal ulceration a medical emergency?

Lack of blood supply and permanent vision impairment

78

S/S of corneal abrasion

Pain, vision loss, photophobia, cloudy at injured site, open allowing germs in, can cause ulcerations

79

How to treat corneal abrasions

Antibiotic eye drops every hour for 24 hours to prevent vision loss

80

Degeneration of corneal tissue causing abnormal corneal shape, caused by trauma or genetic disorder

Keratoconus

81

Treatment for keratoconus when it obscures vision

Keratoplasty (corneal transplant) pt wears eye patch until next day when they return to surgeon. Tell pt to lie on the nonoperative side to reduce IOP. Wear shield at night or around kids/pets. DO NOT use ice pack.

82

What do you notify the ophthalmologist of after a keratoplasty?

Changes in vitals or drainage on the dressing.

83

Which drugs may need to be d/c before cataract surgery?

Drugs that affect blood clotting such as warfarin, aspirin, plavix

84

Opacity of the lens causing blurred vision

Cataract

85

Cataract risk factors

Aging, smoking, congenital, trauma/injury, poorly controlled diabetes, steroids

86

Senile cataracts

Due to aging

87

Immature cataracts

Partially cover lens

88

Mature cataracts

Cover entire lens

89

Optic neuropathy w/ gradual peripheral vision loss and increased IOP, leading cause of blindness, IOP increases due to problems with aqueous humor

Glaucoma

90

Risk factors for primary glaucoma

Age, more common in AA and hispanics

91

Risk factors for associated glaucoma

W/ another dz, diabetes, HTN, myopia

92

Risk factors for secondary glaucoma

Infection, trauma, cataract which pressed against and caused pressure

93

Open-angle glaucoma

Most common, normal angle, slow progression, partially obstructed aqueous humor, gradual vision loss. Late sign: night vision decreases, halos

94

Closed-angle glaucoma

Aqueous humor outflow blocked, abrupt onset, fast and permanent vision loss, unilateral, worse with pupil dilation. S/S: severe pain, abrupt change in vision, red conjunctiva, pupil fixed and non-reactive

95

Bleeding into vitreous cavity from aging, systemic dz, trauma. Caused by torn vessels bleeding, DM, HTN

Vitreous Hemorrhage

96

How to treat Vitreous Hemorrhage

Vitrectomy if the hemorrhage is still there weeks to months later and doesn't absorb without treatment.

97

S/S of Vitreous Hemorrhage

Reduced visual acuity is the main sign. A mild hemorrhage may cause pt to see a red haze or floaters. A moderate hemorrhage may cause pt to see black streaks or tiny black dots. Severe hemorrhage may reduce visual acuity to hand motionThe eye has a reduced red reflex bc light rays do not reach the retina

98

Inflammation of iris, ciliary body, or choroid

Uveitis

99

Anterior uveitis

Can be caused by exposure to allergens, infectious agents, trauma, systemic dz (RA or herpes) and may follow local or systemic bacterial infection

100

Posterior uveitis

"Retinitis" or "Chorioretinitis" occurs from TB, syphilis, toxoplasmosis

101

S/S of uveitis

Reduced vision in the affected eye results from fluid, fibrin, and cells leaking into the vitreous cavity. The pupil is small, nonreactive, and irregularly shaped. Black dots are visible against the red background of the funds. Lesions appear as grayish yellow patches on the retinal surface.

102

Treatment of uveitis

Management: resting ciliary body with a cycloplegia drug to paralyze the ciliary muscles and dilate the pupil. Steroid drops are given hour to reduce inflammation and prevent adhesion of the iris to the cornea and lens.

103

Breakdown of macula that distorts central vision

Macular Degeneration

104

Types of Macular Degeneration

1. Nonexudative (dry) no cure. Central vision declines, pts c/o mild luring and distortion
2. Exudative (wet) Pts have a sudden decrease in vision after a serous detachment of pigment epithelium in the macula. Newly formed blood vessels invade this injured area and cause fluid and blood to collect under the macula like a blister resulting in scar formation and visual distortion

105

Treatment of macular degeneration

VEGFI (vascular endothelial growth factor inhibitors) are successful with wet degeneration

106

How to diagnose macular degeneration

Amsler

107

Separation of the retina from the pigmented vascular layer

Retinal Detachment, medical emergency!

108

Rhegmatogenous retinal detachment

Occur following a hole or tear in the retina caused by mechanical force, creating an opening for the vitreous to move under the retina

109

Traction retinal detachment

Occur when the retina is pulled away from the support tissue by bands of fibrous tissue in the vitreous

110

Exudative retinal detachment

Caused by fluid collecting under the retina. Often occur with a systemic dz or ocular tumors. No retinal break occurs

111

Risk factors for retinal detachment

Eye dz, cataract surgery, family hx, retinal detachment of the other eye

112

How to diagnose retinal detachment

On ophthalmoscopic examination, detachments are seen as gray bulges or folds in the retina that quiver.

113

Treatment for retinal detachment

Create an inflammatory response using a freezing probe (cryotherapy), a laser (photocoagulation) or a high-frequency current (diathermy) that will bind the retina and choroid together around the break. Surgery: scleral buckling

114

Hemorrhage in anterior chamber when force is applied to eye and breaks blood vessels

Hyphema

115

Traumatic contact from blunt object with eye pushed back into socket

Contusion

116

Most common malignant eye tumor in adults age 30-40

Ocular Melanoma

117

Ocular Melanoma is caused by what?

Exposure to UV light

118

Where can ocular melanomas spread?

Surrounding tissue and brain

119

S/S of ocular melanoma

Blurred vision may occur if the macular area is invaded. Visual acuity is reduced if the tumor grows inward toward the center of the eye from the choroid and alters the visual pathway. Increased IOP, iris color changed when the tumor infiltrates the iris.

120

Enucleation

Usually for ocular melanoma, surgical eye removal. A ball implant is inserted as a base for the socket prosthesis.