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Flashcards in Exam of eye lecture Deck (37):
1

emmetropia

light rays enter the eye fall directly on the retina. Normal vision

2

Myopia

light rays fall in front of retina-nearsightedness

3

Hyperopia

light rays fall behind the retina-farsightedness

4

astigamtism

irregular shaped cornea-varying refraction

5

What cornerstones of physical exam are used on eye exam?

inspection
VERY GENTLE palpation

6

What is the vital sign of the eye exam?

Visual acuity

7

Where does the Visual acuity belong in the SOAP note?

eye exam section of the O part of the notes

8

What are the mc complaints of the eye pt?

loss of vision
pain in the eye
Visual distortion or aberrations

9

What might be indicated by acute painless visual loss?

Vitreous hemorrhage
Retinal detachment
Retinal artery occlusion
Retinal vein occlusion
exudative macular degeneration
ischemic optic neuropathy
CVA

10

Vitreous hemorrhage: symptoms, assoc dz, PE

spider webs clouding vision
DM, sickle cell
Decreased red reflex, clouding

11

Retinal detachment: symptoms, assoc d/o, PE

flashes of light, curtain covering
severe myopia, post surgery, trauma
difficult to visual with scope, VF or VA loss

12

Retinal artery occlusion: symptoms, cause, PE

Monocular visual loss sudden and nearly complete
Embolic occlusion (TIA)
VA limited to hand motion or light perception only, Cherry red spot

13

Retinal vein occlusion: symptoms, assoc dz, PE

Loss of vision
HTN
retinal hemorrhages, veins tortuous

14

Exudative macular degeneration: r/f, symptoms, PE

age > 60
slow progressive VF loss, metamorphosia
retinal hemorrhage possible

15

Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE

HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.

16

What might be indicated by acute PAINLESS visual loss?

Vitreous hemorrhage
Retinal detachment
Retinal artery occlusion
Retinal vein occlusion
exudative macular degeneration
ischemic optic neuropathy
CVA

17

Ischemic optic neuropathy: Assoc d/o, R/f, symp, PE

HTN DM >60yo
assoc scalp tenderness, neck pain
Afferent pupillary defect, sudden vision loss, swelling of optic nerve head.

18

Acute PAINFUL vision loss DDX:

Corneal ulcer
Uveitis
Acute angle closure glaucoma
Endopthalmitis

19

Corneal ulcer: r/f, PE

Hx of trauma, contact lens wearer
Little or no signs on inspection w/ slit lamp might see abrasion

20

Uveitis: signs, r/f, assoc. dz, PE

Inflammation of uveal tract
hx of photophobia
assoc: sarcoidosis, TB, IBD, psoriasis
small pupil, sluggish/non-reactive to light, circular reddening around the cornea, diminished red reflex,

21

Acute angle closure glaucoma: R/f, signs, assoc manifestations, PE:

older individuals, farsighted
hx of blurry vision, halos around lights, pain
Marked increase in IOP-H/A, N/V
Unilateral red eye, mid position pupil non-reactive, vision dec due to corneal edema,

22

Endopthalmitis: m/c cause, PE

post surgical complication
decreased vision, redness, corneal edema, mucopurulent d/c, decreased red reflex

23

Chronic progressive PAINLESS visual loss DDX

Refractive error
cataract
Open angle glaucoma
Atrophic macular degeneration
Brain tumor

24

open angle glaucoma is mc in who?

pt's with family hx of glaucoma, nearsighted pt's, african americans

25

Atrophic macular degeneration: r/f, PE

pts >60yo and fam hx.
Drusen in fundus, retinal scar or atrophic area in central macula

26

Causes of Binocular diplopia:

III nerve palsy
IV nerve palsy
VI nerve palsy
uncompensated strabismus
thyroid dz
Myesthenia graves
Blow out fracture.q

27

PE findings of III nerve palsy

gazing lateral and slightly downward. Pt unable to gaze medially or down.

28

What will a pt with IV nerve palsy complain of?

difficulty with reading or going down stairs

29

What will be seen on a pt with VI nerve palsy?

esotropia-eye at rest gazes inward instead of neutral)

30

Addies pupil

Large pupil very sluggish or no reaction to light, accommodation although slowed is present

31

anisocoria related to 3rd nerve paralysis

no reaction to light or accomodation

32

argyll-robertson pupil

small often irregular pupils that do not react to light but do to accomodation

33

Horner's syndrome

pupil is small but reacts to light and accommodations, ptosis is present on affected side and loss of sweating on the affected side of forehead.

34

Marcus Gunn pupil:

monocular blindness, light directed at affected eye shows no pupillary reaction but swing light to other eye and affected eye constricts
swing light back to affected eye and pupil dilates.

35

EOM: 3rd nerve palsy

Paralysis of medial gaze, upward and downward game on affected side (CN aren't crossed so deficits are on side of lesion).
Also-dilated pupil that does not react to light or accommodation and ptosis

36

EOM: 6th nerve palsy

paralysis or lateral gaze on affected side

37

EOM: 4th nerve palsy

affected eye cannot look down when turned inward (reading/walking down stairs)