Unit 4 - Eyes Flashcards
(232 cards)
1
Q
What is the outer fibrous layer of the internal eye
A
Sclera posteriorly and cornea anteriorly
2
Q
What is the middle layer of the eye
A
Choroid posteriorly and ciliary body/iris anteriorly
3
Q
What is the inner layer of the internal eye
A
The retina
4
Q
What are the 5 major structurs of the internal eye
A
Slcera, cornea, iris, lens, retina
5
Q
Is the sclera vacular?
A
No it is avascular
6
Q
What is the scleras purpose
A
Supports internal eye structures
7
Q
Cornea is continuuous with the ____ anteriorly
A
Sclera
8
Q
What part of the internal eye is the sensory innervation for pain
A
The cornea
9
Q
What is the major part of the refractive power of the eye
A
The cornea
10
Q
What do the iris, ciliary body, and choroids comprise
A
The uveal tract
11
Q
What produces aqueous humore and contains the muscles controlling accomodation
A
The ciliary body
12
Q
What of the internal eye is a pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina
A
The choroid
13
Q
Where is the lens located
A
Immediately behind the iris
14
Q
How is the lens supported
A
Circumferentially by fibers arising from the ciliary body
15
Q
What changes the thickness of the lens
A
Contraction/relaxation of the ciliary body
16
Q
What is the sensory network of the eye
A
The retina
17
Q
How does the retina work
A
Transforms light impulses into electrical impulses
18
Q
What part of the brain interprets impulses as visual objects from the retina
A
The cortex
19
Q
When does the eye form
A
During first 8 weeks of gestation - can be malformed due to drug ingestion/infection
20
Q
When is lacrimal drainage complete
A
At birth
21
Q
When does the lacrimal gland begin to produce full volume of tears
A
By 2-3 weeks
22
Q
______ depends on nervous system maturation and occurs over time
A
Vision development
23
Q
What is term infants vision like
A
Hyperopic [20/400]
24
Q
When is peripheral vision fully developed compared to central vison
A
At birth, central develops later
25
When is binocular vision development complete
By 3-4 months
26
When is vision developed sufficiently so that the infant can differentiate colors
By 6 months
27
The glob of the eye grow as the childs ____ grow
Head an brain
28
Adult visual acuity is acheived by what age
4 years of age
29
What changes are common in pregnant womens eye
Hypersensitivity and changes in refractory power
30
Tears in a pregnant woman can contain an increased level of ____ resuting in what
Lysozyme; results in greasy sensation and perhaps blurred vision for contact lens wearers
31
Where does edema and thickening occur in pregnant women
Corneal
32
What type of retinopathy can happen in pregnant women
Diabetic retinopathy
33
What type of pressure falls in pregnant womens eyes
Intraocular pressure
34
What can occur/resolve spontaneously in pregnant women
Subconjunctival hemorrhages
35
What is the major physiologic eye change that occurs with aging
Progressive weakening of accomodation (focusing power) known as presbyopia
36
Loss of lens ____ and ___ formation can happen in older adults
Clarity; cataract
37
What visual exam detects and defines important neurological or ocular disease
Visual field testing
38
When is the visual acuity exam recorded
Beginning of eye exam
39
What visual exam gives valuable clinical info about disease or their processes
Pupillary exam
40
What is the order of visual examination
Visual acuity, visual field testing, pupillary exam, ophthalmoscopy
41
What color should the conjunctiva of the eye be
Should be pink at the lid margins
42
What is the acronym PERRLA for
The pupil of the eye, pupils are equal, round, reactive to light and accomodation
43
What does the pinhole occluder test for
Visual acuity improvement
44
What is standard for near vision testing
Rosenbaum near vision card
45
What is the test for color vision
Ishihara
46
What motion does the superior oblique do
Medial and downward movement
47
What motion does the inferior oblique perform
Medial and upward
48
What is innervated by the trochlear nerve
The superior oblique
49
What is innervated by the abducens nerve
The lateral recuts
50
What can you find with peripheral field tests that were previously undetected
Occipital strokes and optic chiasmal tumors (pituitary or suprasellar masses)
51
What light reflex causes the pupil to constrict with light stimulus
Direct light reflex
52
What light reflex causes opposite/contralateral pupil to consrict with light stimulus
Indirect/consensual light reflex
53
What light reflex shows light reflected in both pupils equally
Corneal light reflex
54
What is a normal variant characterized by a physiological difference in muscular tone between right and left pupils but doesnt change with illumination
Physiological anisocoria
55
What happens when the pupil of an affected eye is smaller (miotic); patient has ipsilateral ptosis and anhidrosis;difference varies with illumination
Horners syndrome
56
What abnormal pupil rsponse constricts only response to accomodation but not in response to light
Argyl robertson
57
What abnormal pupil response is seen in tertiary syphillis, diabetics, alcoholics neoplasm, infx, and is ALWAYS pathological
Argyll robertson
58
What abnormal pupil response is a. Tonic pupil that fails to constrict in response to both light and accomodation eventually may constrict but is sluggish and is ALWAYS benign
Adies pupil
59
What is an afferent pupillary defect also called
Marcus gunn pupill
60
What is marcus gunn pupil
Has normal efferent system, but abnormal afferent pathway,
61
What is the mc cause of marcus gunn pupil
Optic neuritis, also assymmetric optic neuropathy
62
What are causes of optic neuritis
Demyelinating diseases, infx, sinus infx, drugs, radiation therapy
63
What is a cobalt aperature filter for
To evaluate small lesions, corneal abrasions, foreign bodies
64
What is a red free filter aperature used for
Highlights hemorrhages
65
What pathology has an opaque gray ring at the periphery of the cornea just within sclerocorneal junction
Arcus cornealis
66
Who frequently gets arcus cornealis
Elderly
67
What causes arcus cornealis
From fatty granules in or hyaline degeneration of lamellae and cells of cornea
68
What is another name for a hordeolum
A stye
69
What is an inflammation of the lash follicle
Hordeolum
70
What pathology has a plugged meibomian gland
Chalazion
71
How do you tell the difference between the hordeolum and chalazion
Hordeolum is painful, chalazion is non tender
72
What pathology has inflammation of eyelids, hard to manage due to recurrence and what are the 2 types
Blepharitis (anterior = outer lid bacteria) (posterior = inner lid caused by oil or meibomian)
73
What pathology has a yellowish flat plaque that occurs near inner canthus of eyelid mc on upper lid and can be soft or semi hard, frequently symmetrical
Xanthelasma
74
How many xanthelasma occur with elevated plasma levels
50%
75
What can cause xanthelasma
High plasma lipid levels, altered lipoprotien composition
76
Who frequently gets xanthelasma
Frequently occur in patients with type 2 hyperlipidemia
77
What pathology is a wedge shaped growth lateral to the iris that can cover iris
Pterygium
78
What are two abnormal growths on the surface of the eyes
Pinguecula and pterygium
79
Where are cases of pterygum and pinguecula usually seen im the world
Warm dry climates
80
What is cats eye called
Coloboma
81
What is a white reflex that indicates something is changing the normal color of the retina (decreased BS) or that something is obstructing the normal reflex
Leukocoria
82
What causes leukocoria
Mc congenital cataract
83
What is the most serious cause of the leukocoria
Retinoblastoma
84
What pathology is a condition that affects normal use of the eyes and visual development
Amblyopia
85
What are 3 major causes of amblyopia
Strabismus, unequal focus, cloudiness of the eye tissues
86
What is the mc cause of blindness in individuals under the age of 65
Diabetic retinopathy
87
What is the risk factor for diabetic retinopathy
Duration of the diabetes, 90% in those with the disease more than 15 years
88
What is the most common form of diabetic retinopathy
Nonproliferative diabetic retinopathy
89
Who is more common to get NDR
Type 1 diabetes = 100%, type 2 = 60%
90
What pathology is characterized by growth of new vessels on the surface of the retina
Proliferative diabetic retinopathy
91
What pathology has progressive loss of vision, fine-severe loops of new vessels growing in optic disc, leak causeing retinal edema
Proliferative diabetic retinapathy
92
What pathology has small yellowish areas of coloration in the retina and occur due to swelling of surface of retina (microinfarcts)
Cotton wool spots
93
What are the mc causes of cotton wool spots
Diabetes and high bp
94
What is often the earliest recognizable clinical sign of diabetic retinopathy
Microaneurysms
95
What pathology has small round dark red dots on the retinal surface that are less than the diameter of the optic veins
Microaneurysms
96
What happens to microaneurysms as the degree of retinal involvement progresses
They increase in number
97
What pathology resembles bundles of straw and may be round/flame shaped
Hemorrhages
98
What indicates an increasingly ischemic retina
Hemorrhages
99
As the number of _____ increase the retinal vessels become more damaged and leaky, leading to exudation of fluid, lipid, and proteins
Hemorrhages
100
What pathology has bright reflective white or cream colored lesions on the retina
Exudates
101
What do exudates on the retina indicate
Vessel permeability and increased risk of retinal edema
102
If exudate swelling occurs on macula what hapens
Vision may be lost
103
Who is more likely to have hypertensive retinopathy
AA patients with only hypertensive retinopathy that is asymptomatic
104
All the findings of hypertensive retinopathy stem from hypertension induced changes in what
Retinal microvasculature
105
Hypertension leadss to lying down of what in the tunica intima of mediaum and large arteries
Cholesterol
106
Hypertensive retinopathy leads to decreassd lumen size of vessels and focal closure giving rise to what
Hemorrhages and cotton also related to increase in ICP
107
What is the normal arteriovenous ratio
3;5 to 2;3
108
The site of crossinng the arteriole and vein share a common what
Adventitial sheath
109
What causes a compression of the underlying lumen resulting in AV nicking or a tapering of a venule
Vascular sclerosis
110
What is the most common reason for AV nicking
Prolonged systemic hypertension
111
What are round yellow deposits that form within a layer under the retina that cause vision to be effected when forming in the macula
Drusen bodies
112
The increased pressure of glaucoma leads to what
Destruction of optic nerve fibers and visual field deficits
113
Ophthalmological exam of glaucoma reveals what
Cupping of the optic disk
114
What is common when there is traction on the retina by viterous gel
Retinal tears
115
What is posterior vitrous detachment
With aging vitreous humor detaches from the retina and can cause floaters in the eye
116
What layers are associated with retinal dettachement
Sensory and pigmented layers
117
Retinal detachment is considered an _____ because it can cause permanent visual damage
Ocular emergency
118
What type of retinal detachment is common in nearsightend that have undergone eye surgery or have experience serious eye injury
Sensory layers and fluid seeps underneath the retina
119
What is the 2nd most commmon type of retinal detachment
When strands of vitreous or scar tissue create traction on retina
120
Patients with diabetes are more likley to experience whatt type of retinal detachement
2nd kind where scar tissue creates traction
121
Whatt is the 3rd type of retinal detachment
Fluid collects underneath layers causing separation
122
How are 1st and 3rd retinal detach different
1st involves sensory layer breaking
123
What retinal detachment occurs in conjunction with another disease that affects the eyes
3rd
124
What symptoms have light flashes, wavy/watery vision, shower of floaters, sudden decrease in vision
Retinal detachment
125
What is an optic disc swelling secondary to eleveated ICP
Papilledema
126
Papilledema is almost always present as a ______ phenomenon and may develop over hours to weeks
Bilateral
127
The disk swelling of papilledema is result of what
Axoplasmic flow stasis with intra axonal edema in optic disc
128
How much larger is the pan optic ophthalmascope than traditional
Pan optic = 25, 5 degrees is traditional
129
The panoptic has a larger field of view and therefore what shows five times larger
The fundus is five times larger
130
What is used for detecting strabismus
Strabismoscope
131
Photoscreening is used to detect what
Amblyopia (lazy eye) and strabismus is children
132
What else is photoscreening used for other than amblyopia and stabismus
Obtain images of pupillary reflexes and red reflexes
133
The snellen chart is used for a screening examination of ___ vision
Far vision
134
Visual acuity is recorded as a what
Fraction with numerator of 20
135
The larger the denominator in visual acuity equals what
Poorer the vision
136
Measurement other than 20/20 indicates what
Either refractive error or an optic disorder
137
If a patient is able to read some but not all the letters of the next smaller line indicate this by what
You adding number of letters read correctly on that line (20/25 +2) meaning thet can read all letters of 20/25 line and also 2 of the letters of the 20/20 line
138
What is used for young children 3-5 years old unable to read letters/use snellen chart
The tumbing e or HOTV
139
What does the LEA or LH symbols chart use
Four optotypes (circle square apple house)
140
What eye test consists of six pairs of cards with different accuities
The broken wheel test
141
What test is where the child identifies the card that has the broken wheels on a pictured car
Broken wheels card test
142
To assess for near vision what charts are used
Rosenbaum or Jaeger charge
143
A screening test for use with individuals at risk of macular degeneration is provided with the _____
Amsler grid
144
What monitors about 10 degrees of central vision and is used when retinal drusen bodies are seen during examination or when strong family history of macular degeneration
Amsler grid
145
What is a grid of straight lines that has a black dot that acts as fixation point
Amsler grid
146
What provides oils to the tear film in the eye
Meibomian glands
147
What distributes tears over the surface of the eye,limits amount of light entering, and protects from foreign bodies
The eyelid
148
What conjunctiva coats the inside and outside of the eyelids
Palpebral conjunctiva = inside, bulbar (ocular) conjuctiva = outer
149
What protects the anterior surface of the eye with the exception of the cornea and the surface of the eyelid contacting the glob
The bulbar conjunctiva
150
What is a biconvex transparent structure located immediately behind the iris
The lens
151
What changes the thickness of the lens permitting images of varied distances to be focused on the retina?
Thee ciliary body (contraction or relaxation)
152
When is accurate binocular vision acheived
When an image is fused on the retina by the cornea and the lens
153
Fibers located on the ______ decussate in the optic chiasm
Nasal retina
154
Accurate binocular vision requires the synchronous functioning of the what
Extra-ocular muscles
155
What is one of thee earliest visual responses of an infant
The mothers face
156
Lacrimal drainage is complete at when
At the time of term birth
157
By 3 to 4 months of age ____ vision development is complete
Binocular vision
158
When are the eyes developed enough to differentiate colors
By 6th months
159
Young children become less ____ with growth
Hyperopic
160
Adult visual acuity is achieved at about how old
4 years of age
161
What types of changes can eyes undergo in pregnant women
Hypersensitivity (change refractive power), tears increased lysozyme (greasy/blurred vision), mild corneal edema
162
Does intraocular fall or rise in pregnancy
Intraocular pressure falls notably during latter half of pregnancy
163
What is the major physiologic eye change that occurs with aging
Progressive weakening of accommodation (focusing power) = presbyopia
164
When does the lens become more rigid usually and the ciliary muscle becomes weaker
Age 45
165
Old fibers of the lens are compressed _____ forming denser ____ region that may cause what to happen
Centrally; central region; cause loss of clarity of the lens contributing to cataract formation
166
What cranial nerve is tested for small visual details and is essentially a measurement of central vision
CN 2
167
In the eye exam the smaller the fraction indicates what
The worse the vision
168
When do you perform a pinhole test
If visual acuity is recorded at a fraction less than 20/20
169
Expect improvement in visual acuity by at least one line on the chart if ______ is responsible for diminished acuity
Refractive power
170
Monocular diplopia is a ______ problem, binocular diplopia is an _____ problem
Optical; alignment
171
Measurement of near vision should also be tested in each eye separately with handheld card such as what
The rosenbaum pocket vision screener
172
What fields are you testing in peripheral field vision test
Nasal, temporal, superior, inferior fields
173
_____ most likely to produce confrontation abnormalities include stroke, retinal detachement, optic neuropathy, pituitary tumor compression at the optic chiasm, and central retinal vascular occlusion
Lesions
174
What is the order you carry out external exam of the eyes
Begin with appendages and move inward
175
If patients eyebrows are coarse or do not extend beyond temporal canthus, the patient may have what
Hypothyroidism
176
What is an elevated plaque of cholesterol deposited in macrophages most commonly in the nasal portion of the upper or lower lid
Xanthelasma
177
When examining a patient you have them lightly close their eyes and notice tremors what does this indicate
Hyperthyroidism
178
If one superior eyelid covers more of the iris than the other or extends over the pupil then ____ of that lid is present
Ptosis
179
Ptosis indicates a ____ or _____ weakness of the ____ muscle or a paresis of a branch of the ____ CN
Congenital or acquired; levator muscle; 3rd CN
180
When the lower lid is turned away from the eye it is called what
Ectropion
181
When the lid is turned inward toward the globe the condition is known as what
Entropion
182
In the case of entropion the lids eyelashes can cause what
Corneal/conjuctiva irritation, increasing secondary infection chances reports of foreign body sensation
183
An acuute suppurative inflammation of the follicle of an eyelas can cause an erythamatous or yellow lump called what
Hordeolum caused by staph
184
What usually causes blepharitis
Bacterial infection, seborrhea, psoriasis, roascease, allergic response
185
If closed eyelids do not completely cover the globe then it is a condition called what and results in what
Lagophthalmos cornea can become dried/infx
186
Pain on palpation of closed eye is consistent with what
Scleritis, orbital cellulitis, and cavernous sinus thrombosis
187
An eye that feels very firm and resists palption can indicate what
Severe glaucoma or retrobulbar tumor
188
An erythematous or cobblestone appearance especially on the ____ conjunctiva may indicate an _____
Tarsal conjunctiva; allergic/infectious conjunctivitis
189
Subconjunctival hemorrhages can occuur spontaneously during what
Labor/pregnancy
190
A pterygium is more common in people heavily exposed to what
UV light
191
Corneal sensitivity is controlled by CN ____ and is tested by touching whisp of cotton to the cornea
CN V
192
Decreased corneal sensation is often associated with what
Diabetes, herpes simplex and herpes zoster viral infx, after trigeminal neuralgia surgery
193
Blinking after corneal sensitivity test indicates what sensory CN are intact
CN 5 and motor fibers of CN 7
194
If arcus senilis is present before age 40 what can this indicate
Lipid disorder
195
What is a pupillary constriction to less than 2 mm
Miosis
196
The miotic pupil fails to do what
Dialate in the dark
197
What can cause miosis
Drugs like morphine or glaucoma meds
198
Pupillary dilation of more than 6mm an failure of pupils to constrict with light characterization of what
Mydriasis
199
Mydriasis is an accompaniement of a what
A coma or eye drops
200
What is an inequality of pupillary size and is common variation but can occur in other disease states
Aniscoria
201
If a pupil continues to dilate rather than constrict then what is present
Afferent pupillary defect or marcis gunn pupil
202
Bilateral, miotic, iregularly shaped pupils that fail to constrict with light but retain constriction with convergence are what
Argyll robertson pupil
203
A failure to respond to direct light but retaining constriction during accomodation is sometimes seen in patients with what
Diabetes/syphilis
204
What happens that causes sclera to become pigmented and appear either yellow or green
Liver or hemolytic disease
205
What appears as a dark slate gray pigment just anterior to the insertion of the medial recuts muscle
Senile hyaline plaque
206
What do you use to test the balance of the extraocular muscles
Corneal light reflex
207
What can cause no initial red reflex
Improper placement, cataract, hemorrhage into vitreous humor
208
If your patient is myopic you will use what lens
Minus (red) lens
209
If a patient is hyperopic or lacks a lens (aphakic) you will use what ophthalmascope lens
You will need a plus lense
210
Characteristics during a ophthalmologic exam inclduing narrowing of vessels, increased vascular toruosity, copper wiring, arteriovenous nicking and retinal hemorrhage indicate what
HTN
211
Prominent epicanthal folds are expected in asian infants but can be suggestive of what
Down syndrome/ other congenital anomolies
212
Wide spacing of the eyes is known as what
Hypertelorism
213
What is the false appearance of strabismus
Pseudostrabismus
214
Brushfield spots strongly suggest what
Down syndrome
215
The anticipated visual acuity for children 3-5 is what
20/40
216
The anticipated visual acuity for children aged 6 and older is what
20/30 or better
217
What can help differentiate chronic htn and PIH in pregnant women
Retinal examinations
218
Vascular tortuosity, angiosclerosis, hemorrhage, and exudates may be seen in patients with what
Long standing history of HTN
219
Segmental arteriolar narrowing with wet, glistening appearance indicative of edem is in a patient with what
PIH
220
What is inflammation of the superficial layers of the sclera anterior to the insterion of the rectus muscles
Episcleritis
221
What is a deposition of calcium in the superficial cornea
Band keratopathy
222
What is a disruption of corneal epithelium and stroma
Corneal ulcer
223
What is it when both eyes do not focus on an object simultaneously but can focus with either eye
Strabismus e
224
What is it when there is interruption of sympathetic nerve innervation to the eye
Horner syndrome
225
What is it when there is dot hemorrhages or microaneurysms and the presence of hard/soft exudates
Non proliferative diabetic retinopathy
226
What is it with development of new vessels as result of anoxic stimulaiton
Proliferative diabetic retinopathy
227
What is it when there is a creamy white appearance of retinal vessels that occurs with excessively high serum triglyceride levels
Lipemia retinalis
228
What is an autosomal recessive disorder in which genetic defects cause cell death predominantly in the rod photoreceptors
Retinitis pigmentosa
229
What is a disease of the optic nerve where the nerve cells die usually due to high intraocular pressure
Glaucoma
230
What is an inflammatory process involving both choroid and the retina
Chorioretintitis
231
What is disruption of normal progression of retinal vascular development in preterm infant
Retinopathy of prematurity
232
What is it when part of the retina degenerates
Macular degeneration
