Eye exam

Question 1

Iris/Pupil

1) what should the room be
2) how do you test the iris
3) what do you put on the SOAP?

Answer 1

Darken the room

shine light into each eye and check for constriction (consensual and direct)

PERRLA

Question 2

what happens if people can’t close their eyes all the way?

Answer 2

risk for corneal abrasions

Question 3

Proptosis/exophthalmos?

Answer 3

hyperthyroidism sometimes caused by graves disease

Question 4

Increased intracranial pressure indicates what?

what do you see?

Answer 4

papilledema

optic nerve swelling

Question 5

Pustules on the periorbital area?

Answer 5

acne, insect bites, other stuff.

Question 6

Erythema on the eyelids/eyelashes?

blepharitis?

Answer 6

contact dermatitis/allergies from makeup

swelling, scaling, reddening, crusting of the eyelid

Question 7

Cover, Uncover test?

what is this causing?

what are the two things to know about this?

Answer 7

cover one eye, look at the uncovered eye and see if it moves to the center –> indicates one is subtly off.

strabismus

Esotropia –> eye turns in.. when you cover it moves more outward.

Exotropia –> eye turns out

Question 8

Dacrocystitis

Answer 8

infection in the tear duct

super common in infants

Question 9

EOMI?

nystagmus, horizontal vs vertical?

Answer 9

extra ocular muscles intact

horizontal can be seen at extremities.. this can be normal

vertical is NEVER normal

Question 10

how do you treat strabismus?

Answer 10

eyepatch.

Question 11

Corneal abrasion, how do we treat this?

Answer 11

they can be super painful. we take a fluorescein stain and a blue light to visualize the cornea

important to look for and remove foreign body

Question 12

If you have a rash of the periorbital area straight lining to the hairline, what would you think?

Answer 12

Herpes Zoster (shingles)

Question 13

Periorbital region, what is to note about examination?

1) what can cause edema?
2) what about changes in elasticity?
3) shiners?
4) what would tell you to check cholesterol levels?

Answer 13

Edema –> allergies, hyperthyroidism, hypothyroidism, trauma.

Change in elasticity –> lipoatrophy (fat changes), lipohypertrophy –> both of these coming from

allergic shiner

Xanthelasma –> lipid deposits.

Question 14

what is a brown birthmark called on the eye? what are they more likely to have?

Nevus of Ota. what is it?

Answer 14

Oculodermal melanocytosis. Glaucoma

discoloration of sclera AND periorbital tissue. it’s a birthmark!

Question 15

Blepharitis?

Answer 15

scales. Collarettes along the eye lashes.

patient can lose their eyelashes and have a red lid.

you spend time removing the crusty parts with baby soap.

Question 16

Cornea:

1) what happens if you see a brown tint? what could have caused it?
2) whitish scar?
3) what tests utilize the cornea?

Answer 16

hyphema –> blood from trauma in anterior chamber

abrasion/ulcer

testing cranial nerve V and blinking with VII

Question 17

what general meds can have ocular effects?

Answer 17

steroids, antihistamines, antidepressants, antipsychotics, antiarrhythmics, beta blockers

Question 18

if you dilate the eyes, what must you check for first before you do it?? **

what happens if you do without checking and they have this?

Answer 18

check for a shallow anterior chamber –> this could represent acute angle glaucoma.

dilate the eyes with this you can precipitate an ocular event which is emergent.

Question 19

Entropion vs Ectropion?

Answer 19

lashes go in toward the eye because the lid turns inward

lashes are everted –> exposes the lower palpebral conjunctiva (lower lid margin turns outward)

both are associated with increased risk of infections

Question 20

Drusen bodies?

Answer 20

precursor to macular degeneration

they are small yellow or white spots on the retina.. at an early age is age related macular degeneration.

Question 21

Corneal light reflex?

Answer 21

checking the reflection of light symmetry

Question 22

Conjunctiva? what should it look like?

what if you see erythema?

purulence?

pterygium? what causes this? what does it look like?

Answer 22

inside of upper and lower eyelid. –> should be clear

erythema –> subconjunctival hemorrhage

Purulence –> pink eye, conjunctivitis

Pterygium –> overgrowth of conjunctiva toward the pupil –> excessive exposure to sun!

Question 23

Hordeolum vs Chalazion?

Answer 23

Hordeolum (stye) is ALONG THE LASH LINE. these are tender and painful. –> blocked meibomian gland or tear eyelash follicle or tear gland.

Chalazion –> IN THE LID.. blocked meibomian gland. NONTENDER and NONPAINFUL unless become inflamed.

Question 24

when looking at the eyes, what if the red reflex is not equal on both sides?

yellow or gray instead of red?

brown?

Answer 24

the side that you’re not getting probably has a misalignment.

cataract, or can be normal in people with increased melanin

cataract

Question 25

what is the term for”dilating the pupils”

Answer 25

Mydriasis

Question 26

Relevant ROS for eye complaints?

neuro

cardio

endocrine

MSK

skin

gi

general

Answer 26

neuro: headache, motor weakness, dizziness

cardio - chest pain

endocrine - thirst, urination, hypoglycemia

msk - back pain, joint pain

skin - frequent infections, dry skin

GI - changes in bowel function

general - fever, weight change

Question 27

what do you see depositing along the outside of the cornea in older adults?

when is it common?

what if its below 40?

Answer 27

arcus senilis

it’s a lipid deposition encircling the iris

after 60

get cholesterol level

Question 28

Sclera

1) what color should it be?
2) what if you see brown or gray spots? what is increased here? what are they at higher risk for?
3) blue sclera?
4) yellow? what is the term called? what is it associated with? what complications?

Answer 28

white

birthmarks. increased melanin in sclera. Glaucoma

brittle bone disease

“icterus” is the term. increased bilirubin. liver disease, pancreatic cancer, GB disease.

Question 29

Lacrimal Apparatus

Answer 29

you can get skin lesions/cancer around the Punctae there and autoimmune diseases.

Question 30

Associated symptoms for eye complaints?

Answer 30

pain, drainage, itching/burning, vision change, blurry vision, flashing lights

Question 31

What happens if you see cotton wool spots?

what else can you see with a similar pathology?

Answer 31

fluffy white patches on the retina from damages to nerve fibers. –> vascular disease from HTN or DM

retinal proliferation –> HTN or DM

Question 32

Eyebrows, what is to note about examination?

Answer 32

people pluck eyebrows out for stress - trichotillomania

eyebrows are falling out

scaly skin - Seborrheic dermatitis

scarring

Question 33

Glaucomatous Cupping?

Answer 33

you see a white circle with a pink circle outlying it. looks like you’re looking into a cup.

Question 34

Conjunctivitis:

1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance

Answer 34

redness is mostly peripheral

mild discomfort rather than pain

not affected except for blurring due to discharge

watery, mucoid, mucopurulent

not affected

Clear

bacterial, viral, other. HIGHLY contagious

Question 35

Subconjunctival hemorrhage

1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance

Answer 35

Leakage of blood outside of vessels, producing a sharply demarcated red area that resolves over 2 weeks.

Painless

Not affected

None

Not affected

Clear

may result from trauma, or venous pressure, but no significance really

Question 36

Corneal injury / infection

1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance

Answer 36

diffusely red

moderate to severe, superficial pain

decreased vision

watery or purulent

not affected

changes depending on cause

abrasions, other injuries; viral and bacterial causes too

Question 37

Acute Iritis

1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance

Answer 37

diffusely red

moderate, aching, deep pain

decreased; PHOTOPHOBIA

absent

SMALL and irregular

clear or slightly clouded

systemic infection, herpes zoster, tuberculosis, autoimmune diseases

Question 38

Acute Angle Closure Glaucoma

1) pattern of redness
2) pain
3) vision
4) ocular discharge
5) Pupil
6) Cornea
7) significance

Answer 38

diffusely red

SEVERE ACHING DEEP PAIN

Decreased vision

Absent

DILATED + FIXED

Steamy, cloudy

Acute increase in intraocular pressure constitutes an emergency.