Flashcards in The basics of a medical eye exam Deck (83):
The first step of every patient experience?
OBSERVE AND LISTEN
Steps in a comprehensive eye and vision exam?
What questions do we ask ourselves on observation and inspection? 4
What do we externally examine? (what structures?) 4
2. Good equipment
--are they wearing glasses or contacts?
--How do they move?
--Head Turn? Tilt?
4. External examination of cornea, conjunctiva, eyebrows and surrounding eye tissue
Steps in the Medical Eye Exam?
(different from comprehensive one)
2. Visual Acuity
3. Pupillary examination
4. Visual fields by confrontation
5. Extraocular movements
6. External inspection (adnexia):
--lid and surrounding tissue
--conjunctiva and sclera
7. Anterior Stuctures
--Cornea, pupil and iris
--Anterior chamber depth
8. Tonometry (pressure check not a glaucoma check)
9. Fundus examination
View - Disc - Macula - Vessels
In the external inspection what do we look at?
lid and surrounding tissue
conjunctiva and sclera
What anterior strcuture of the eye do we examine?
Anterior chamber depth
For the fundus examination what do we look at?
What is the first part of a visual acuity measurement refering to?
how far the patient is away from the eye chart
What does the second part of the visual acuity measurement refering to?
Distance at which the letter can be read by a person with 20/20 acuity
What eye do we do first for a visual acuity test, the bad eye or the good eye?
get the bad eye first then the good eye
Is it ok to wear glasses on a visual acuity test?
Should we check eyes separately or together?
How many letters should they get right to pass the line?
yes. do one with and without the glasses
check them separetely first then together
ID half of the letter on that line
If you have a +4 lens what kind of impairment do you have and what will you get when you age?
you are farsighted and you will get more farsighted as you age probably
If you are in the zero range for sight how will your vision change as you get older?
you will get more nearsighted
When is near visual acuity indicated?
1. patient complains about near vision
At what distance so would you do a near vision acuity test?
What can amblyopia be caused by?
What is the treatment for amblyopia?
If there is a hole in the eye where will the pupil point?
towards the hole
If a patient has a pupillary dysfunciton and a cough what is something we should consider highly in our diff?
What can synchia cause?
secondary glaucoma and crearte an irregular pupil
How do we treat synchia?
steriod to reduce inflammation
What does a white relfex in the red reflex mean?
retinoblastoma or catatract
What is the difference b/w horner's syndrom and argyll-robertson pupil?
horner- pupil abnormalities
argyll-robertson- pupil abnormalities to accomodation only and not light
Primary cause for ptosis?
Secondary cause for ptosis?
What should we look for on the eyelids?
Condition and direction
What is the 1st line of defense against infection in the eye?
If we have too much tear film what is the condition called?
If we have too little in the tear film what is it called?
How do we treat dry eye?
The eye will be watery because the lacriminal gland will be producing crying tears to compensate. We treat with
1. artificial tears
What are the secondary causes of dry eye?
medication (OTC allergy)
What is epiphora caused by?
What would cause CNIII palsy?
What would cause CN VI palsy?
What tests do we use to clinically diagnose strabismus?
1. corneal light reflex
2. cover test
The light reflex for an exotropic eye is where?
nasal to pupillary center
The light reflex for an esotropic eye is where?
temporal to pupillary center
What will happen if someone has an abnormal cover test?
no movement should be detected from the eye that is uncovered. (has a resting and alert position, if they eye stays in resting position when uncovered there is a problem)
By what age is it best to correct strabismus before?
At what age is there nothing we can do about it?
What are we testing when we look at oculary motility?
1. Normal conjugate, or parallel movements of eyes (deviation)
2. Abnormal movement (nystagmus…rhythmic fine ascillation)
3. Lid lag
Why do we not tell them to turn their head at first when we are testing ocular motility?
If an adult is a head turner then their is probably an issue with their visual field
HOw long do we patch for to treat amblyopia?
2hr to 6hr
What kind of supression interrupts the normal development of vision in the amblyopia?
corticol suppresion of sensory input
What could amblyopia be caused by?
ocular disease, or maybe idiopathic
When would we do a confrontation visual field test?
neurological problem suspected
What is the only thing that will give you bitemporal vision loss?
pituitary gland tumor/adenoma
What parts of the eye does a slit lamp examine?
anterior and posterior segments of the eye
Why do we use a slit lamp?
1. look at structures in the back of the eye like optic nerve/retina
2. front of eye injuries like on the cornea or cataracts, conjunctivitis, iritis
3. detect and monitor glaucoma or macular degeneration
4. check for foreign body
5. detect eye problems with diabetes and RA.
What should we never ever prescribe with herpes simplex?
What is worse, scleritis or episcleritis?
scleritis we treat with oral steriods because there is also other systemic issues if this is going on. It will hurt
Episcleritis wont hurt
What is often the diagnosis for ciliary flush?
Its like spraining your ankle and you keep moving the muslces so the inflammation gets worse. Just the same for the constrictor muscles in the iris. Keep constricting them and they get more sore/red.
What are things that could cause subconjunctival hemorrhage?
blood pressure meds
At what age do we consider this normal?
normal white ring in the iris
if younger they probably have high blood pressure
A yellow lens indicates what?
What are our two pupil dilaiton meds?
1. Cholinergic-blocking ( parasympatholytic)
2. Adrenergic-stimulating (sympathomimetic)
Action of cholinergic blocking drugs?
Dilate by paralyzing iris sphincter muscle
Cycloplegia by paralyzing ciliary body muscles
When is the max pupil dilation for tropicamide?
When does the effect diminish?
What are the side effects of tropicamide?
Nausea / vomiting
Vasomotor collapse (fainting)
How should we use adrenergic stimulating drugs, like phenylephrine, for best results?
combone with tropicamide fo4r maximal dilaiton
Side effects if adrenergic stimulating drugs/phenylephrine?
acute hypertension or MI with the 10% solution
What are we examining when we are doing direct ophthalmoscopy?
1. Red reflex
2. Clarity of the disc outline
3. Color of disc
4. Presence of normal white or pigmented rings, crescents around discs
5. Size and color of the cup
Characteristics of optic neuritis?
1. associated with MS or its idiopathic
2. decreased visual acuity and color vision
3. pain with ocular movement
4. bulbar (disc swelling)
5. retro bulbar (no signs because the swelling is behind the eyeball)
What could be a retinal problem associated with young, overweight, fertile females?
opitc atrophy and papilledema due to malignant hypertension
Ratio of arteries and veins in retina?
arteries = 4, veins = 5
When are railroad crossings seen the most and what is happening when you see it?
see them mostly in people with uncontrolled hypertension
-artery causing the vein to twist
After 10 yrs with diabetes what percent will have some background retinopathy?
What about after 12?
Characteristics of diabetic retinopathy?
2. hard exudates
3. flame shaped and dot and blot hemorrhages
What cells are permanently damages in CRAO?
What is often a present characteristic of CRAO?
cherry red spot
How much time do we have to correct CRAO before permanent vision loss?
90 m in
What is CRAO a warning for?
carotid plague or embolis from the heart
Whats a Hollenhorst plaque?
Chacracteristics of CRVO?
cotton-wool spots and
diffuse retinal hemorrhage.
Risk factors for CRVO?
arteriosclerotic vascular disease, conditions that increase blood viscosity (polycythemia vera, sickle cell disease, lymphoma , leukemia)
What does CRVO make us more at risk for?
long term risk fro neovascular glaucoma
Urgent situations that we need to refer immediately!!!!
1. Penetrating injuries of the globe (high speed- worried about it.
2. Conjunctival or corneal foreign bodies
3. Hyphema (blood in front of eye) REFER
4. Lid laceration (suture if not deep and neither the lid margin nor the canaliculi are involved)
5. Traumatic optic neuropathy
6. Radiant energy burns (snow blindness or welder’s burn) UV burn on the front of the eye(use a narcotic and knock that patient out but it will be fine after 48 hours)
7. Corneal abrasion
8. Sudden loss of vison
9. “Curtains” blocking all or some of Vision- retinal detachment flashes of light/floaters (REFER IMMEDIATLRY)
High speed, hot foreign bodies in eye how do we treat?
take it out and just put in office antibiotics in. probably already sterile
How do we treat slow speed dirty gunky stuff?
take out but treat with at least 5 days of antibiotics
If a patient can look side to side but not up what is injured?
inferior rectus muscle
Semi urgent situations?
orbital fracture (unless the muscle is trapped then its urgent)
Subconjunctival hemorrhage in blunt trauma
In what situations would we make sure a patient is refered and sees a ophthomologist in 1-2 days?
1. New and / or Repetitive flashes / floaters
2. Eye Pain from unknown cause
3. Staining of the cornea with no history of trauma or CL over wear
4. Zoster around eye (especially if tip of nose involved)
5. Double vision
A teardrop shaped pupil and flat anterior chamber in trauma are associated with what?
In a perforating injury what should we avoid doing?
avoid digital palpation of the globe
In a chemical burn patient what is the first thing we do immediately?