What should PAs never prescribe for pts to put int heir eyes withour direction from an opthamologist?
steroids
what are the side effects of steroids in the eye?
weakened, perforated cornea
True or false: you should always answer “refer to opthamologist” if it is an option
TRUE
what are the corners of the eyes called?
lateral and medial canthus
what gland is just above the eye?
lacrimal gland
what is the part of the eylid that is found under the eyelashes?
palpebral fissure
what are the holes on the superior and inferior palpebral fissures near the medial canthus?
superior/inferior lacrimal punctum
where is the caruncle located?
the red spot in the nasal corner of the eye
what duct empties into the inferior nasal turbinate?
the nasolacrimal duct
what is the funciton of tears?
protect conjunctiva/cornea from drying, inhibit microbial growth, make surface of cornea smooth
What disease is associated with a lack of tears?
Sjogrens
what CN is associated with closing the eye?
VII
what CN is associated with opening the eye?
III
what are the major CN associated with the eye?
3, 4, 6, 7
what CN is associated with changing the shape of the ciliary muscle to focus the lens?
III
What is the canal of schlem?
drains the vitreous humor of the eye
What can form if the canal of schlem is blocked? How is it treated?
glaucoma, vitrectomy to laster through and form the canal again
what parts of the eye are associated with the anterior chamber?
cornea, pupil, iris, lens
What parts of the eye are associated with the posterior chamber?
retina, vitreous humor, macula, choroid
distinguish the bulbar conjunctiva from the palpebral conjunctiva
the bulbar conjunctiva is associated with the eye and the palpebral conjunctiva is associated with the eyelid
what makes up the optic nerve?
choroid + retina
what size is the optic cup relative to the optic disc?
cup = 1/2 the disc diameter
on eye exam, what is the dark middle region of the eye?
macula with the fovea in the middle
what CN are associated with eye muscles?
all are asscoiated with CN III except SO4 and LR6
how shoud the pupil respond to light exam with direct light?
pupil should become myotic, the other eye should respond consensually
what is accomodation?
how the eye focuses on objects coming towards or moving away from them
what CN are associated with accommodation?
II and III
how is a normal eye exam documented?
PERRLA
Distinguish the Jaeger from the Snellen chart
Jeager: hand-held near vision chart; Snellen: distance chart
How close should the snellen and jaeger charts be away from the pt?
snellen: 20ft; Jaeger: 14ft
what does 20/200 vision mean?
you see at 20ft what someone with normal vision sees at 200ft
what vision is considered legally blind?
20/200
what tool is used to determine color blindness?
ishihara cards
What constitutes most color blindness?
dichromacy (red and green color lost)
What causes color blindness?
genetic issues with retinal cones
what population is a higher incidence of color blindness?
males (1% of males)
what are the most common types of dichromacy?
protanope and dueteranope vision (loss of red, green or yellow combo)
how is the palpebral conjunctiva inspected on exam?
have pt look down, using a Qtip place it on the eyelid and evert the eyelids
what is the normal pupil size?
3-5mm
what drugs can cause miosis and miodriasis?
miosis: opiates, miodriasis: sympathomimetic drugs
what are 3 common APD?
marcus gunn, argyll robertson, CNIII palsy
what is the MCC and features of marcus gunn?
MCC: optic nerve disease/lesion, eyes react with no accommodation
What is the MCC and features of argyll roberston?
MCC: syphilis, accommodation with no reaction
What is the MCC of CN III palsy and features?
MCC: DM II, lid lag, big pupils
what are causes of absent light relfex of the eye?
cataracts, retinoblastoma, retinal detachment
when is retinoblastoma usually seen?
newborn exam
what does an asymmetric light reflex mean?
disconjugate gaze (one eye is looking straight in a gaze and the other is looking off)
how can you evaluate disconjugate gaze?
cover-uncover test, when the normal eye is covered, the one in the gaze with straighten out
what is a nasal/temporal disconjugate gaze called?
esotropia (adducted) exotropia (abducted)
what CN is responsible for the corneal reflex?
Sensory: V; Motor: VII (opthalmic branch)
how is the cornea reflex performed?
touch a Qtip to the pts eye, they should blink
what disease causes worsening of visual fields?
glaucoma
what is nystagmus?
beating of the eyes when looking up and down or side to side
What does up and down nystagmus indicate?
lesion to the brain, MS, doesn’t stop
What does nystagmus side to side indicate?
vertigo, vetibulocochlear problems, stops
when is nystagmus normal?
just a few beats side to side
what is the uvea of the eye made up of?
iris, choroid, ciliary body
anisocoria
pupils are unequal size - slight variation is normal in 35% of people who have it
What can cause exopthalmos
bilateral: Grave’s, unilateral: tumor, orbital cellulitis
Xanthelasma
lipid deposits on the outside of the eye due to severe hyperlipidemia
pterygium
Visual disturbance caused by bulbar conjunctive invading the pupil
Kayser-fleischer rings
wilson’s disease, Copper deposits
corneal (Senile) arcus
grey hue around cornea - in young people it is due to hyperlipidemia
Key points of funduscopic exam
Dilate pupils, use lowest brightness, start at 0 diopters, start 12 inches away at 15 degrees and move in
What is a cataract?
thickening of the cornea
General order of funduscopic exam
red reflex first, cornea, lens, background, arteries and veins, optic disc, macula
what is the fovea?
high concentration of cones, found in the macula
True or false: arteries are more transparent than veins
TRUE
choroid crescent
hyperpigmentation around the optic disc
What can cause AV nicking?
HTN
What can cause hemorrhages on fundus exam?
HTN, swelling, occlusion of retinal veins, DM
differentiate deep from superficial hemorrhages
superficial: obscure margins, deep: redder, rounder
what can cause preretinal hemorrhage?
increased ICP
What does neovascularity look like on fundus exam?
tortuous, fragile
What can cause neovascularity?
DM retinopathy
What can cause soft exudates? What do they look like?
soft edges; HTN, DM
What can cause hard exudates and what do they look like?
sharp edges; HTN, DM
What is drusen and what is it a sign of?
tiny yellow or white accumulations of extracellular material, sign of macular degeneration
What are signs of DM retiopathy?
neovascularity, AV nicking, hard exudates
how can hypertensive retinopathy be diagnosed on fundus exam?
hemorrhages, soft/hard exudates
What is papilledema?
swelling of the optic disc due to increased ICP causing hemorrhages
where is the lesion in right homonymous hemianopsia?
L optic tract: missing vision on right side of both eyes
where is the lesion for bitemporal hemianopsia?
optic chiasm, can only see nasal side of both eyes
where is the lesion for homonyous right quadrantic defect?
L optic radiation, missing vision in right upper quadrant of both eyes
where is the lesion responsible for Horner’s syndrome?
stellate ganglion in neck caused by carotid dissection or pancoast tumor
characteristics of horner’s syndrome?
myosis, ptosis, anhidrosis
Causes of ectropion?
older pts, excessive tearing
causes of entropion?
older pts, tearing issues
What is Blepharitis
inflammation of the eyelid caused by staph or seborrheic blepharitis - increase in cebum blocks glands leading to itchiness, can alos be fungal
What is periorbital cellulitis?
due to URI, fever, staph/strep - pain with EOM and proptosis
how is blepharitis treated?
cleansing, topical abx
how is periorbital cellulitis treated?
augmentin, 3rd gen cephalosporin
What can cause periorbital edema?
allergies, hypothyroidism, nephrotic syndrome
What causes herpes zoster opthalmicus?
varicella infection of the trigeminal nerve (V, opthalmic branch)
Signs of herpes zoster opthalmicus?
deutritic lesions, hutchinson’s sign (lesion on top of nose causing occular involvement, keratosis, and blindness)
What causes hordeolum (stys)?
staph infection of meibomian gland in tarsal plates
how are stys treated?
warm compress, abx
What is a chelazion?
chronic inflammation of meibomian gland following hordeolum, not infectious (tx: steroids)
What is dacrocystitis?
bacterial superinfection of lactrimal tract due to strep/staph - treated with cephalosporin
What causes conjunctivitis?
srep, adenovirus, chlamydia
Signs of bacterial conjunctivitis?
unilateral, discharge, purulent, adenopathy - treat with abx
signs of viral conjunctivitis?
bilateral, not as red, less discharge, periocular adenopathy - treat with abx
signs of allergic conjunctivitis?
stringy discharge, less red
what is a subconjunctival hemorrhage?
rupture of small vessels of sclera due to valsalva, HTN, coagulopathy - BENIGN, well-demarcated, no tx
what is iritis?
medical emergency, autoimmune disease (SLE, sarcoid, ankylosing sponydlitis
Signs of iritis?
pain with EOM, ciliary injection, cells in flare, photophobia, blurred vision, myotic pupil
What is acute glaucoma?
painful red eye, vision loss, emergency, steamy cornea, ciliary injection, N/V, HA - Tx: BB, carbonic anhydrase inhibitors, psychoplegics contraindicated
What is a hyphema
blood in the anterior chamber due to a blow to the eye - pain, red, vision loss - tx: drain, tPa, F/u in 5 days
what is pinguecula?
overgrowth of sclera in the bulbar conjunctiva due to age, sun, wind - yellow spot on sclera