module 8 eyes

Question 1

CN II

Answer 1

optic nerve
transmits visual signals to the brain
visual acuity

Question 2

CN III

Answer 2

oculomotor nerve
superior, medial, and inferior rectus, and inferior oblique muscles
- up and out, down and out, up and in

Question 3

CN IV

Answer 3

trochlear nerve
superior oblique muscle
- down and in

Question 4

CN VI

Answer 4

abducens nerve
lateral recuts muscle
- lateral gaze

Question 5

CN V

Answer 5

trigeminal nerve

sensory, corneal reflex

Question 6

CN VII

Answer 6

facial nerve
motor: blink
corneal reflex

Question 7

nerves in charge of small eye movement

Answer 7

III
IV
VI

Question 8

lacrimal gland

Answer 8

lateral upper portion of eyelid, under brow.

- produces tears

Question 9

lagophthalmos

Answer 9

eyes do not close completely

Question 10

ptosis

Answer 10

eyelid drooping

- covers upper portion of iris or pupil

Question 11

corneal arcus

Answer 11

lipid deposit around iris

Question 12

anisocoria

Answer 12

pupils different sizes

Question 13

miosis

Answer 13

pupillary constriction

• iridocyclitis
• miotic eye drops
• opioid abuse

Question 14

mydriasis

Answer 14

pupillary dilation

• iridocyclitis
• mydratic or cycloplegic drops
• midbrain lesions or hypoxia
• oculomotor (CN III) damage
• acute-angle glaucoma
• stimulant use; cocaine, amphetamines

Question 15

failure to respond with light stimulus

Answer 15

• iridocyclitis
• retinal degeneration
• CN II destruction
• midbrain synapses or CN III
• impairment of efferent fibers (PSNS), sphincter pupillae muscle
• mydriatics
• brain herniation

Question 16

argyll robertson pupil

Answer 16

bilateral, miotic, irregularly shaped pupils that fail to constrict with light, but retain constriction with convergence

• may or may not be equal in size
• neurosyphilis
• lesions in midbrain

Question 17

Anisocoria

Answer 17

unequal pupil size

• congenital: 20%
• local eye meds
• unilateral SNS or PSNS pathway destruction

Question 18

Iritis constrictive response

Answer 18

acute uveitis, commonly unilateral

- constriction of pupil accompanied by pain and reddened eye, especially adjacent to iris

Question 19

oculomotor nerve damage CNIII

Answer 19

pupil dilated and fixed

• eye deviated laterally and downward
• ptosis

Question 20

Adie pupil (tonic pupil)

Answer 20

affected pupil dilated and reacts slowly or fails to react to light, responds to convergence

• impairment of postganglionic PSNS innervation of sphincter pupillae muscle
• ciliary malfunction
• often accompanied by diminished tendon reflexes

Question 21

exophthalmos patho

Answer 21

bulging of eye anteriorly out of orbit

• inc. in volume of orbital contents
• Graves disease: abnml CT deposition in orbit and extraocular muscles
• when unilateral consider retro-orbital tumor

Question 22

exophthalmos subjective

Answer 22

change in eye position or valsalva maneuver

Question 23

exophthalmos objective

Answer 23

apparent eye protrusion, lids do not reach pupil

Question 24

episcleritis patho

Answer 24

inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles

• Simple: intermittent episodes of moderate to severe inflammation. 1-3 month intervals, lasting 7-10 days, and resolving after 2-3 weeks
• Nodular: prolonged attacks of inflammation, typically more painful than simple

Question 25

episcleritis subjective

Answer 25

acute onset of mild to moderate discomfort or photophobia | - painless injection (redness) and/or watery discharge without crusting

Question 26

episcleritis objective

Answer 26

diffuse or localized redness of the bulbar conjunctiva purplish elevation of a few mm. watery discharge

Question 27

band keratopathy patho

Answer 27

deposition of calcium in the superficial cornea | - most common in pt with chronic corneal disease

Question 28

band keratopathy subjective

Answer 28

dec. in vision as deposition progresses | foreign body sensation and irritation

Question 29

band keratopathy objective

Answer 29

line just below the pupil, passes over the cornea rather than around the iris as with arcus senilis - horizontal grayish bands interspersed with dark areas that look like holes

Question 30

corneal ulcer patho

Answer 30

disruption of the corneal epithelium and stroma - CT disease or systemic vasculitic disorder - infection: viral or bacterial - extreme dryness

Question 31

corneal ulcer subjective

Answer 31

``` pain photophobia hx of wearing contacts blurry vision feeling that something is in the eye ```

Question 32

corneal ulcer objective

Answer 32

visual acuity affected variably, depending on location inflammation and erythema of the lids and conjunctiva purulent exudates ulcer often round or oval and the border sharply demarcated, base appearing ragged and gray

Question 33

strabismus patho

Answer 33

both eyes do not focus on an object simultaneously but can focus with either eye

Question 34

strabismus subjective

Answer 34

poor vision may have sudden onset of double vision report of eye deviation

Question 35

strabismus objective

Answer 35

extraocular muscle impairment: eye will not move in the direction controlled by that muscle detected by the cover-uncover test

Question 36

horner syndrome patho

Answer 36

interruption of SNS to the eye - congenital, acquired, or hereditary - lesion of primary neuron, stroke, trauma

Question 37

Horner syndrome triad

Answer 37

ipsilateral miosis mild ptosis loss of hemifacial sweating

Question 38

Horner syndrome subjective

Answer 38

s/s depend on underlying cause

Question 39

horner syndrom objective

Answer 39

ptosis is subtle: note amount of iris seen superiorly pupil on affected side round and constricted Aniscoria (size difference) greated in darkness affected pupil dilates more slowly than nml pupil dry skin on same side of face as affected pupil

Question 40

cataract patho

Answer 40

opacity in lens - denaturation of lens protein caused by aging - peripheral: hypoparathyroidism - Meds: steroids - Congenital: maternal infections, fetal insult during 1st trimester.

Question 41

cataract subective

Answer 41

``` cloudy or blurry vision faded colors headlights, lamps, or sunlight appear too bright halo around lights poor night vision or double vision frequent Rx changes ```

Question 42

cataract objective

Answer 42

cloudiness of the lens

Question 43

diabetic retinopathy (nonproliferative) patho

Answer 43

dot hemorrhages or microaneurysms and the presence of hard and soft exudates - hard: lipid transudation through incompetent capillaries - soft: infarction of the nerve layer

Question 44

diabetic retinopathy nonproliferative subjective

Answer 44

asymptomatic in initial stages | blurred vision, distortion, or visual acuity loss in more advanced stages

Question 45

diabetic retinopathy nonproliferative objective

Answer 45

on ophthalmoscopic examination - blood vessels with balloon-like sacs blots of hemorrhages on the retina itself tiny yellow patches of hard exudates

Question 46

diabetic retinopathy proliferative patho

Answer 46

development of new vessels as result of anoxic stimulation | - vessels grow out of retina toward vitreous humor

Question 47

diabetic retinopathy proliferative subjective

Answer 47

generally asymptomatic floaters blurred vision progressive visual acuity loss in advanced stages

Question 48

diabetic retinopathy proliferative objective

Answer 48

visualization of these vessels may require change in the lens setting - vitreous hemorrhage may also be seen, can obstruct view of retina

Question 49

glaucoma patho

Answer 49

disease of the optic nerve where the nerve cells die - usually due to high intraocular pressure - Acute angle: occur acutely with dramatically elevated pressure if iris blocks exit of aqueous humor from anterior chamber - Open angle: caused by dec. aqueous humor absorption - > inc. resistance and painless buildup of pressure in the eye

Question 50

glaucoma subjective

Answer 50

open-angle: - gradual loss of peripheral vision over a period of years Acute: - intense ocular pain, blurred vision, halos around lights, red eye, dilated pupil Occasionally: abd. pain, N/V

Question 51

glaucoma objective

Answer 51

optic nerve damage can clearly be seen during dilated eye exam and produces a characteristic appearance of the optic nerve ( increased cupping) - visual field test may show los of peripheral vision