Eyes Flashcards
(35 cards)
Objective Data:
-Preparation: Position person standing for vision screening; then sitting up with head at your eye level
-Equipment needed: Snellen eye chart Handheld visual screener Opaque card or occluder Penlight
most commonly used and accurate measure of visual acuity
Snellen alphabet chart is
20 ft away from tester, test one eye at a time
-go low as possibly can
For those who report increasing difficulty reading
Test
near vision with handheld vision screener with various sizes of print
Ex. Jaeger card
-difficulty w/ reading
Confrontation Test:
Gross measure of peripheral vision; compares person’s peripheral vision with yours
2ft apart with a pen or finger and bring them together
Corneal Light Reflex
Hirschberg test
- pen light at bridge of nose, light should shine on pupil - should be on same place
- determine eyes are aligned
Cover Test:
This test detects small degrees of deviated alignment
Diagnostic Positions Test:
Leading eyes through six cardinal positions of gaze will elicit any muscle weakness during movement to determine muscle weakness
- What should happen: smooth motion and Nystagmus at the far e extremes of lateral vision (small jiggles)
- No white around eye (lid lack)
General Inspection and Eyebrows:
- General: begin with external points, work inward
- Eyebrows
- Eyelids and lashes: lids should come together
- Eyeballs
- Conjunctiva and sclera: tissue inside inner eyelid is pink and moist, not a lot of red blood vessels
- Lacrimal apparatus: produces tears and moisture
Cornea and Lens:
Shine light from side across cornea, and check for smoothness and clarity
-not rough or sandpaper textured
Iris and Pupil:
- Iris normally appears flat, with round regular shape and even coloration
- Note size, shape, and equality of pupils
- Test pupillary light reflex
- Normal response includes
- -Pupillary constriction
- -Convergence of axes of eyes
- shine light in one eye, it constricts, the other is consensual and also constricts
Pupils record normal response to all these maneuvers as PERRLA:
Pupils Equal Round React to Light and Accommodation: far & near vision
How to Inspect a Ocular Fundus
Ophthalmoscope
To examine person with inspection of ocular fundus:
- Darken room; dilating eyedrops are not needed during a screening examination
- Select large round aperture with white light for routine examination
- If pupils are small, use smaller white light
- Ask person to please keep looking at mark on wall across room
- Staring at distant fixed object helps to dilate pupils and to hold retinal structures still
To examine person (Cont.)
for ocular fundus:
-Begin about 25 cm (10 inches) away from person at angle of 15 degrees to person’s line of vision
-Note red glow filling person’s pupil; this is red reflex, caused by reflection of ophthalmoscope light off inner retina
-Keep sight of red reflex, and steadily move closer to eye
-If you lose red reflex, adjust angle to find it again
-As you advance, adjust lens to #6 and note any opacities in media; these appear as dark shadows or black dots interrupting red reflex; normally, none is present
To examine person (Cont.)
Progress toward person until foreheads almost touch
Adjust diopter to bring ocular fundus into sharp focus; if you and person have normal vision, this should be at 0
Moving diopters compensates for near- or farsightedness
Use red lenses for nearsighted eyes
Use black lenses for farsighted eyes
Moving in on 15-degree lateral line should bring your view just to optic disc
If disc is not in sight, track a blood vessel as it grows larger and it will lead to disc
To examine person ocular fundus
Systematically inspect
structures in ocular fundus Optic disc Retinal vessels General background Macula
Most prominent landmark is optic disc, located on nasal side of retina; explore these characteristics:
Color: creamy yellow-orange to pink
Shape: round or oval
Margins: distinct and sharply demarcated, although nasal edge may be slightly fuzzy
Cup-disc ratio: distinctness varies; when visible, physiologic cup is brighter yellow-white than rest of disc; width not more than one half disc diameter
is standard measure for other fundus structures
Diameter of disc, or DD,
-To describe finding, note its clock-face position and relationship to disc in size and distance (e.g., at 5:00, 3 DD from disc)
Only place in body where you can view blood vessels directly:
Retinal Vessels
Follow a paired artery and vein out to periphery in four quadrants, noting these points:
Number: paired artery and vein pass to each quadrant; vessels look straighter at nasal side
Color: arteries brighter red than veins; also have arterial light reflex, with thin stripe of light down middle
A:V ratio: ratio comparing artery-to-vein width is 2:3 or 4:5
Caliber: arteries and veins show a regular decrease in caliber as they extend to periphery
A-V, arteriovenous crossing:
artery and vein may cross paths; not significant if within 2 DD of disc and if no sign of interruption in blood flow is seen; should be no indenting or displacing of vessel
Tortuosity:
-mild vessel twisting when present in both eyes is usually congenital and not significant
Pulsations:
-present in veins near disc as their drainage meets intermittent pressure of arterial systole
General background of fundus
Color normally varies from light red to dark brown-red; view of fundus should be clear; no lesions should obstruct retinal structures
Macula
- 1 DD in size, located 2 DD temporal to disc
- Inspect last in funduscopic examination; bright light causes some watering, discomfort, and pupillary constriction
- -Normal color somewhat darker than rest of fundus but even and homogeneous
- -Clumped pigment may occur with aging
