H&P Ophtho Exam Flashcards
(17 cards)
What do you start with ALWAYS?
Visual Acuity Exam
- Snellen Eye Chart
Examination of the External Structures
Inspection
- Protrusion of the eyes - hyperthyroidism or retrobulbar tumor
- Strabismus
- Lids- *ptosis, entropion, ectropion, styes, chalazion *
- Lashes/brows: presence/sparcity - indicates thyroid disease
- Puncta: abnl lacrimal damage, matter - *lacrimal duct obstruction, conjunctivitis *
Palpate
- orbits and lacrimal glands - tenderness
Inspection of anterior structures
- Conjunctiva - color, vascular pattern, nodules, swelling, opacities, abraisions, foreign bodies, pterygium
- Palpebral - pull down lid, use light source
- Bulbar: evert lid
- Sclera - jaundice (icterus)
- Cornea - Arcus
- Pupils: size, shape, symmetry
- anisocoria is benign if <0.5mm difference and reacts normally to light
Cardinal Fields of Gaze
Symmetry of movement
Nystagmus - one or two beats at the extreme of peripheral vision are normal
Lid lag - suspect thyroid disease
LR6 SO4 AO3
Pupillary Reflexes
- Direct
- Consensual
- Accomodation
- Also: inspect iris with tangential light
- should see crescentric shadow or bowing of iris indicative of glaucoma
Conjugate Gaze
Light reflex
- hold light ~2 ft directly in front of pt
- reflection should be symmetric and just nasal to the midline of the pupil
- *assymmetry of corneal reflections indicates deviation from normal ocular alignment *
Cover/uncover
- weak eye will re-centralize after uncovering
- *subtle muscle imbalance or weakness *
Peripheral vision by confrontation
- bilateral exam in temporal quadrants is adequate for screening
- if abnl perform unilateral testing in all four quadrants
- hemianopsia and quadratic defects
- *most deficits occur in temporal fields *
- temporal defect indicates nasal defect in other eye
Posterior Structure Exam by Fundoscopy
Lens: clarity - normally clear
Red Reflex
Optic disc/cup dimensions and borders: normal ratio is 1:2 (cup should not exceed half the diameter of the disc). Blurry margins or increased ratio indicates papilledema.
Retina: inspect arteries and veins in 4 directions, retinal exudates and hemorrhages - assess for AV nicking or inverion
Fovea and Macula - assess for macular degeneration
Vitreous +10-12 diopters - assess for vitreous floaters, cataracts, or anterior chamber pathology
Cranial Nerves in Ophthomolgy
Viscular acuity, fields, fundi - CNII
Pupillary reaction - CN II, III
Extraocular movements - CN III, IV, VI
Corneal reflex - CN V
History: Acute Causes of Vision Loss
retinal detachment
vitreous hemorrhage
central retinal artery occlusion
History: Gradual Vision Loss (Degenerative)
myopia - near-sighted
hyperopia - far-sighted
presbyopia - aged eye
hyperglycemia? can lead to retinopathy/damage retinal vessels
slow central vision loss
cataract
macular degeneration
slow peripheral vision loss
advanced open angle glaucoma
one-sided vision loss
hemianopsia or quadrantic defects
flashing lights or new vitreous floaters
retinal detachment
causes of diplopia
central causes: brainstem or cerebellum (+/- nystagmus)
peripheral causes: weakness or paralysis of CN III or VI (horizontal) or CN III or IV (vertical)
Diplopia in one eye with the other closed suggests pathology of the cornea or lens
Visual Acuity and Legal Blindness
VA = pt’s tested vision/normal vision
US legal blindness:
20/200 with correction, in better eye
OR
constricted peripheral field of vision of 20 degrees or less in better eye
Physiologic blind spot - enlargement
- can have pt close one eye and use the tip of a pencil to determine the size
- normal is about the size of a finger tip
- *enlargement occurs in optic nerve conditions like papilledema, glaucoma, and optic neuritis *
