External Eye

Question 1

What are the baseline functional tests?

Answer 1

Snellen or Sloan eye charts

Question 2

What do the Snellen or Sloan eye charts directly test? Indirectly?

Answer 2

Directly - visual acuity at a distance

Indirectly - Screening of anterior eye segments, central vision, optic nerve, and visual brain centers

Question 3

What is the specific distance used for the Snellen chart? Sloan?

Answer 3

Snellen - 20 feet

Sloan - 10 feet

Question 4

In regards to eye tests, what does “OD” stand for? “OS”? “OU”?

Answer 4

OD = oculus dextra (right eye)
OS = oculus sinistra (left eye)
OU = oculus uterque (both eyes)

Question 5

What does it mean if a person’s vision is considered to be 40/20?

Answer 5

At 40 feet, he/she can see what most can see at 20 feet (worse than average vision)

Question 6

What does it mean if a person’s vision is considered to be 10/20?

Answer 6

At 10 feet, he/she can see what most can see at 20 feet (better than average vision)

Question 7

What is hyperopia?

Answer 7

Eye has far sight but poor near sight

Question 8

What term means the eye has near sight but poor far sight?

Answer 8

Myopia

Question 9

What condition arises around the age of 40 years where the lens loses its elasticity and causes diminished near sight but continued far sight?

Answer 9

Presbyopia

Question 10

What is the term for moving marks like sports or smudges seen by the patient in their field of vision usually in those over 50 years of age?

Answer 10

Vitreous floaters

Question 11

When are vitreous floaters an issue?

Answer 11

When new ones or flashes of light appear among those that have been there for a long time and remained unchanged

Question 12

What chart is used to test for near vision?

Answer 12

Rosenbaum chart

Question 13

What is being tested when the doctor is moving a wiggling finger slowly into the patient’s field of vision from the top, bottom, and both sides of each eye while the patient focuses straight ahead?

Answer 13

Peripheral vision

Question 14

What are the anatomical boundaries of the test for peripheral vision?

Answer 14

Surround eye anatomy (eyebrow, cheek, nose, and lateral face)

Question 15

What kinds of general things can cause visual field deficits?

Answer 15

1 anterior eye segment abnormalities (scratching, edema, cataracts, pus/blood in fluid, etc.)
2 chronic glaucoma
3 retinal detachments
4 neural lesions

Question 16

What cranial nerves can be assessed by testing the cardinal planes of gaze?

Answer 16

III, IV, VI

Question 17

What shapes are made in the air with the doctor’s finger during the cardinal planes of gaze?

Answer 17

Either a capital H or an asterisk

Question 18

What is the term for a fatty deposit seen in the eye region?

Answer 18

Xanthoma

Question 19

When xanthomas are present on a patient, what underlying condition can be assumed?

Answer 19

Hyperlipidemia

Question 20

When a patient presents with xanthomas and hyperlipidemia, they are at risk for what other conditions?

Answer 20

Stroke and heart disease

Question 21

What tests are used to check symmetrical alignment of the eyes and therefore binocular vision?

Answer 21

1 corneal light reflex

2 cover-uncover test

Question 22

What is the clinical term for a lazy eye?

Answer 22

Amblyopia

Question 23

What is implied with an asymmetrical reflection seen in the corneal light reflection test?

Answer 23

Acquired or congenital muscle imbalance resulting in strabismus

Question 24

What is implied with movement of either eye during the cover-uncover test?

Answer 24

Acquired or congenital muscle imbalance resulting in strabismus

Question 25

Strabismus can lead to what big issue?

Answer 25

Monocular vision (thus affecting depth perception)

Question 26

What is the term for when the upper eyelid is slow to react as the eye looks down thus exposing the sclera between the lid margin and iris?

Answer 26

Lig (lag) retraction

Question 27

Lid (lag) retraction suggests what overlying condition?

Answer 27

Hyperthyroidism (early exopthlamos)

Question 28

If unilateral lid lag is observed, what could be the cause?

Answer 28

1 damage to cranial nerve VII | 2 tumor behind the eye

Question 29

What is the term for an upper eyelid drooping compared to the opposite eye?

Answer 29

Lid (sag) ptosis

Question 30

What is the cause of ptosis?

Answer 30

Congenital or acquired weakness of the levator muscle or paresis of a branch of the 3rd cranial nerve

Question 31

What is the term for inflammation of the eyelash follicles and Meibomian gland resulting in red, swollen, crusty lid margins?

Answer 31

Blephaitis

Question 32

Blephaitis may be associated with what other conditions?

Answer 32

Allergies, seborrheic, dermatitis, and psoriasis

Question 33

What is the term for a bacterial infection of a gland in an eyelash follicle causing a well circumscribed red, swollen and tender pustule?

Answer 33

Sty(e) aka hordeolum

Question 34

What is a chalazion?

Answer 34

Hard, painless papule on the eyelid due to an obstruction of a Meibowmian (oil) gland

Question 35

A chalazion is just like what other kind of growth elsewhere on the body?

Answer 35

Sebaceous cyst

Question 36

What is the term for a loss of muscle tone with aging causing the lower lid to turn OUTWARD interfering with proper tear drainage?

Answer 36

ECtropion (turning out)

Question 37

What muscle is affected with ectropion?

Answer 37

Orbicularis oculi

Question 38

What overlying condition can be another cause of ectropion?

Answer 38

Facial nerve palsy (Bell's palsy)

Question 39

What is the term for the INVERSION of the lower eyelid allowing the eyelashes to irritate the conjunctive and cornea?

Answer 39

ENtropion (turning in)

Question 40

What is the cause of entropion?

Answer 40

Scar tissue formation on the inner surface of the lid

Question 41

What is dacryocystitis?

Answer 41

Inflammation of the tear sac secondary to dacryostenosis

Question 42

What is dacryostenosis?

Answer 42

Chronic obstruction or narrowing of the nasolacrimal duct

Question 43

What population is usually affected by dacryocystitis?

Answer 43

Infants

Question 44

What is dacryoadenitis?

Answer 44

Inflammation of the lacrimal gland

Question 45

What develops with dacryocystitis?

Answer 45

Painful, swollen nodule between nose and eye with accompanying tearing and discharge

Question 46

Tears come out of which anatomical structure?

Answer 46

Lacrimal punctum

Question 47

When the inside of the eyelid appears pale, what condition can be expected?

Answer 47

Anemia

Question 48

What is the term for the mucous membrane that lines the inside of the eyelids and the visible part of the sclera?

Answer 48

Conjunctiva

Question 49

What is the clinical term for pink eye?

Answer 49

Contagious conjunctivitis

Question 50

What can cause contagious conjunctivitis?

Answer 50

Bacteria, virus, or allergies

Question 51

What is unique about the symptoms of contagious conjunctivitis?

Answer 51

1 pain is minimal | 2 vision is unaffected

Question 52

What is the appearance of blood vessels involved in contagious conjunctivitis?

Answer 52

Dilate from periphery to the center of the eye SPARING the area around the cornea (limbus)

Question 53

What is the difference between the symptoms of contagious conjunctivitis and allergic or chemical conjunctivitis?

Answer 53

Same signs and symptoms but less thick discharge with allergic/chemical

Question 54

What is the term for a plaque formed from yellow elastic fibers on either side of the cornea?

Answer 54

Pinguecula

Question 55

What causes a pinguecula?

Answer 55

Chronic irritation to the bulbar conjunctiva

Question 56

What is the term for when growth of a pinguecula is stimulated to form a vascular membrane that extends over the cornea?

Answer 56

Pterygium

Question 57

What kinds of things can cause a pterygium?

Answer 57

Windy, sunny, or dusty conditions that stimulate the growth of the pinguecula

Question 58

What things can cause a subconjunctival hemorrhage?

Answer 58

Sneezing, straining, or coughing

Question 59

Where does the blood get trapped following a subconjunctival hemorrhage?

Answer 59

Between the clear mucous membrane and the sclera

Question 60

What is the tough, white outer coat of the eye?

Answer 60

Sclera

Question 61

What condition involves uniform yellowing of the sclera?

Answer 61

Jaundice

Question 62

Where is jaundice usually seen first?

Answer 62

Eyes (natural light reveals it best)

Question 63

What substance has been known to produce harmless yellowing of the sclera in dark-complected people?

Answer 63

Antimalarial drugs

Question 64

Blue sclera is indicative of what condition?

Answer 64

Osteogenesis imperfecta

Question 65

Why is a blue sclera associated with osteogenesis imperfect?

Answer 65

Sclera thins allowing the choroid to show through as blue

Question 66

When do we seen brown sclera, and what is it?

Answer 66

Common in people with dark complexions; occur due to patches of melanin

Question 67

The cornea is a transparent extension of what structure?

Answer 67

Sclera

Question 68

Following a corneal abrasion, the vessels dilate and radiate outward from around what structure?

Answer 68

Limbus (edge of the cornea)

Question 69

What does it mean when a corneal arcus/ring is seen in a patient?

Answer 69

Above 60 years old: clinically insignificant | Under 40 years old: indicative of hyperlipidemia

Question 70

What is the term for the golden-brown band seen around the limbus of the cornea in a patient with Wilson's disease?

Answer 70

Kayser-Fleischer ring

Question 71

What is Wilson's disease?

Answer 71

Inherited disease where copper accumulates in the liver and throughout the body resulting in neurologic symptoms

Question 72

Iritis can be secondary to what condition?

Answer 72

Ankylosing spondylitis

Question 73

Which is more painful: conjunctivitis or iritis?

Answer 73

Iritis

Question 74

What are the signs and symptoms of iritis?

Answer 74

1 perilimbal and conjunctival injection 2 red, teary eyes with constricted and slow pupil 3 significant pain 4 decreased visual acuity

Question 75

Is visual acuity decreased with conjunctivitis?

Answer 75

NO; vision is unaffected

Question 76

What does PERRLA stand for in regards to the pupil?

Answer 76

``` Pupils (should be) Equal Round (and) Reactive (to) Light (and) Accommodation ```

Question 77

What is the expected response from the direct light reflex?

Answer 77

Pupil (one having light shined into it) should constrict briskly

Question 78

What is a sluggish or no response to the direct light reflex indicative of?

Answer 78

Problem along neural path from sensory receptor through C.N. II to brain center and back through C.N. III to the circular iris muscles

Question 79

What is the expected response from the consensual (indirect) light reflex?

Answer 79

Contralateral pupil should constrict briskly

Question 80

What does a sluggish or absent response to the consensual (indirect) light reflex indicate?

Answer 80

Problem along neural reflex path

Question 81

During which test is constriction seen at a greater level: direct or indirect light reflex?

Answer 81

Direct

Question 82

According to the accommodation reflex, what happens to the eyes?

Answer 82

Constriction and convergence as object moves from distant to near point

Question 83

What kinds of general things can cause the pupils to constrict or dilate?

Answer 83

1 brain injury 2 prescription 3 illegal drug use

Question 84

Which two pupil condition discussed are bilateral findings?

Answer 84

1 coloboma | 2 argyll robertson pupil

Question 85

What is the clinical term for inequality of pupil size?

Answer 85

Anisocoria

Question 86

What is the clinical term for congenital anisocoria?

Answer 86

Physiologic anisocoria

Question 87

What can cause anisocoria?

Answer 87

Congenital, head trauma, nervous system diseases

Question 88

What condition involves a fixed dilated pupil with poor response to the pupillary reflexes?

Answer 88

Adie's tonic pupil

Question 89

What condition involves a failure of the iris to close during fetal development resulting in a keyhole-shaped pupil?

Answer 89

Coloboma

Question 90

What condition involves an irregularly shaped pupil due to an adhesion of part of the iris to the cornea in front of it or the lens behind it?

Answer 90

Synechia

Question 91

What conditions is synechia secondary to?

Answer 91

Trauma, surgery, cataracts, glaucoma, iritis, etc.

Question 92

What is the result of synechia?

Answer 92

Flow of aqueous fluid blocked and may lead to acute glaucoma and potential blindness

Question 93

Argyll Robertson pupil can be caused from a CNS defect from what overlying disease?

Answer 93

Syphilis

Question 94

What is the condition where there is decreased or absent response to the light reflexes yet the pupils respond to accommodation?

Answer 94

Argyll Robertson pupil

Question 95

What four things can cause red eyes?

Answer 95

1 conjunctivitis 2 corneal abrasion 3 iritis 4 acute glaucoma

Question 96

What causes Horner syndrome?

Answer 96

Interruption of sympathetic nerve supply to the eye

Question 97

What are the results of Horner syndrome?

Answer 97

``` 1 miosis (constricted pupil) 2 ptosis ```

Question 98

What conditions can cause cervical sympathetic trunk damage that is associated with Horner syndrome?

Answer 98

Mediastinal tumors, bronchogenic or metastatic cancer

Question 99

Pancoast tumors are associated with which eye condition?

Answer 99

Horner syndrome

Question 100

People with a shallow anterior chamber are prone to which eye condition?

Answer 100

Acute glaucoma

Question 101

What structure in acute glaucoma becomes blocked and allows aqueous fluid to build up rapidly in the eye produces severe eye pain, blurred vision, corneal edema, conjunctival and perilimbal injection, and a fixed dilated pupil?

Answer 101

Canal of Schlemm

Question 102

In pressure in the eye following acute glaucoma is not reduced, how long does it take blindness to occur?

Answer 102

2-5 days only

Question 103

What is the most common form of glaucoma?

Answer 103

Chronic

Question 104

Which has more abrupt and dramatic signs: acute or chronic glaucoma?

Answer 104

Acute

Question 105

What kinds of tools are used by the optometrist and ophthalmologist to routinely assess people at risk of glaucoma?

Answer 105

"Puff test", tonometry, and perimetry

Question 106

What kind of vessel injection is seen with conjunctivitis that differentiates it from other conditions?

Answer 106

Vessels radiate from periphery toward limbus of the corner but don't directly touch the limbus

Question 107

In which condition is the burning/itching relatively mild: iritis, conjunctivitis, or corneal abrasion?

Answer 107

Conjunctivitis

Question 108

What kind of vessel injection is seen with corneal abrasions and iritis?

Answer 108

Perilimbal (aka circumcorneal/ciliary)

Question 109

What kind of eye condition presents with BOTH conjunctival and perilimbal injection?

Answer 109

Acute glaucoma