Notes in Eye exam

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Published	09/08/2024	{{c1::Sclera}} - the outermost covering of the eye which is {{c2::white/opaque}} in coloration.  Your {{c2::extraocular}} muscles (superior …
Published	09/08/2024	{{c1::Cornea}} - continuation of sclera over the anterior surface of the eye, which is {{c2::transparent}} and “{{c2::dome-shaped}}” over the iri…
Published	09/08/2024	{{c1::Choroid-}} richly vascularized layer between the sclera and retina.
Published	09/08/2024	{{c1::Anterior Chamber}} - Anatomical space between the {{c2::cornea}} and {{c2::lens}} which is filled with {{c2::aqueous humor}}.
Published	09/08/2024	Aqueous humor is produced by cells within the {{c1::ciliary body}} and establishes {{c1::pressure}} to maintain the shape and integrity of the ey…
Published	09/08/2024	{{c1::Posterior Chamber}} -  Anatomical space posterior to the anterior chamber also named the {{c2::vitreous body}} due to its composition …
Published	09/08/2024	Vitreous humor is transparent similar to aqueous humor but has a {{c1::thicker}} consistency to maintain the shape of the eye and exert {{c1…
Published	09/08/2024	{{c1::Iris}} – similarly to the cornea, it is the anterior continuation of the {{c2::choroid}}. Is an anatomically {{c3::circular ring}} with {{c…
Published	09/08/2024	{{c1::Ciliary muscles-}} - muscles which {{c2::bend}} the physiological lens to refract light at different angles on the {{c2::posterior retina}}…
Published	09/08/2024	Fun fact: when someone undergoes cataract surgery the physiologic lens is removed and replaced with an {{c1::intraocular lens implant (IOL)}}. Th…
Published	09/08/2024	{{c1::Suspensory ligaments (zonules)}} – suspend the physiologic lens in place and connect to ciliary body
Published	09/08/2024	{{c1::Lens}} – {{c2::biconvex}} transparent discus of {{c2::protein}} composition.
Published	09/08/2024	{{c1::Pupil}} – is an anatomical {{c2::absence}}, circular hole in the front of the iris which changes shape with {{c2::light exposure}} and {{c2…
Published	09/08/2024	{{c1::Retina}} -  {{c2::innermost}} lining of the posterior eye which makes direct contact with the {{c2::vitreous humor}}. Richly vasculari…
Published	09/08/2024	{{c1::Cones}} are responsible for color detection
Published	09/08/2024	{{c1::Fovea}} -  Retinal depression adjacent to the {{c2::optic disc}} which contains a higher concentration of {{c2::photoreceptors}} and i…
Published	09/08/2024	{{c1::Optic disc}}- physiologic {{c2::blind spot}}. Location of origination of {{c3::optic nerve}} and {{c3::vasculature supply. }}
Published	09/08/2024	{{c1::Optic nerve}} - axons of {{c2::retinal ganglion cells}} combine here to transmit signals from the retina.
Published	09/08/2024	{{c1::Rods}} are responsible for vision at {{c2::low light levels}} and do not mediate color vision.
Published	09/08/2024	Visual Pathway of light:1. {{c1::Light source}} 2. {{c2::Cornea}} 3. {{c3::Pupil}} 4. {{c4::Lens}} 5. {{c5::Retina}} 6. …
Published	09/08/2024	▫{{c1::Hyperopia}} = “farsighted”, difficulty with up-close vision
Published	09/08/2024	▫{{c1::Presbyopia}}= age-related hyperopia. Patient is extending arms to attempt to read up close text.
Published	09/08/2024	▫{{c1::Myopia}} = “nearsighted”, difficulty with distance vision. Increasing in prevalence in US and developed countries.
Published	09/08/2024	▫{{c1::Astigmatism }}=  irregularities in the lens or curvature of the cornea causing lens to not focus light evenly onto the retina
Published	09/08/2024	HISTORY•Basic questioning example: “{{c1::Any changes or difficulty in vision?”}} •“{{c2::Vision worse during up-close work or at a distance}}?”
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Published	09/08/2024	two important questions for vision loss hx are:{{c1::•“Vision loss in one or both eyes?” •“Pain associated with vision loss?”}}
Published	09/08/2024	•Acute unilateral vision loss: ▫Painless = 4 VMRR {{c1::Vitreous degeneration from diabetes or trauma Macular degeneration Retinal detachment Reti…
Published	09/08/2024	Bilateral vision loss: Painless = 2 {{c1::Meds (anticholinergics) can’t see, can’t pee, can’t spit, can’t poop Cataracts Macular Degeneration}} Pa…
Published	09/08/2024	Why do anticholinergics cause blurred vision? they can cause {{c1::relaxation of the ciliary muscle}} leading to {{c1::impairment}} of visual {{c1::ac…
Published	09/08/2024	Important Acute Vision Problem History: •Description of pain: ▫Itchy/scratchy/burning/sharp pain/FB sensation = generally {{c1::localized to…
Published	09/08/2024	•Eye pain does not always equal eye pathology. ▫Consider {{c1::soft tissue infections}} of surrounding tissues: orbital cellulitis, bacteri…
Published	09/08/2024	Vital Signs of the Eye: {{c1::VISION, PUPILS, PRESSURE}}
Published	09/08/2024	1.VISION: ▫most important function of the eye ▫Hard to measure, {{c1::subjective}} - what is clear for me might be blurry to you ▫To gather…
Published	09/08/2024	{{c1::Snellen Chart}}: documented as a ratio with 20/20 considered ‘normal’ If patient is standing at 20 feet away looking at the chart and they can…
Published	09/08/2024	{{c1::Rosenbaum chart}}: documented as {{c2::Jaeger 1+}} through {{c2::16}} Patient holds chart at distance they would to read (14-15…
Published	09/08/2024	OD = oculus dexter  or {{c1::RIGHT EYE}}
Published	09/08/2024	OS = oculus sinister  or {{c1::LEFT EYE}}
Published	09/08/2024	OU = oculus utro or {{c1::BOTH EYES}}
Published	09/08/2024	{{c1::Ishihara color}} test – color perception test for red-green color deficiencies
Published	09/08/2024	2.PUPILS •Pupillary reaction to {{c1::light}}: ▫{{c1::OBJECTIVE}} test that allows us to determine if the eyes can sense light. ▫{{c1::Great…
Published	09/08/2024	▫{{c1::DIRECT}} REACTION: pupillary constriction in the {{c2::SAME}} eye the light is pointed into the pupil
Published	09/08/2024	▫{{c1::CONSENSUAL}} REACTION: pupillary constriction in the {{c2::OPPOSITE}} eye the light is pointed into the pupil
Published	09/08/2024	{{c1::Anisocoria}} = difference in pupillary size of 0.04mm or greater. Visible in up to 35% of healthy individuals. Can also be associated with oculo…
Published	09/08/2024	{{c1::Swinging light}} test: ▫ allows you to determine the presence of an {{c2::afferent pupillary}} defect. Test allows you to look f…
Published	09/08/2024	3.PRESSURE •{{c1::OBJECTIVE}} measurement of the internal fluid pressure in the eye •Differential diagnosis for elevated intraocular pressure (IO…
Published	09/08/2024	▫{{c1::Tonometry pen “Tono pen”}} – common in ER - applanation “flattening” tonometry which converts surface tension into an {{c2::electrica…
Published	09/08/2024	▫{{c1::Schiotz tonometry}} –applanation tonometry which correlates indentation of corneal surface against a known weight of instrumentation to de…
Published	09/08/2024	▫{{c1::Goldmanns applanation}} tonometry – based on principle that force to flatten area of cornea divided by area of flattening equals IOP. (gol…
Published	09/08/2024	Visual Fields by Confrontation•Detection of lesions in the {{c1::anterior}} and {{c1::posterior}}visual pathway •Allows you to evaluate…
Published	09/08/2024	•{{c1::Anterior}} visual pathway: origin of the optic nerve to the lateral geniculate nucleus
Published	09/08/2024	•{{c1::Posterior}} visual pathway: from the lateral geniculate nucleus to the occipital lobe in the primary visual cortex
Published	09/08/2024	•Anterior pathway defects: {{c1::glaucoma, optic neuropathy, optic neuritis, and glioma}}
Published	09/08/2024	•Posterior pathway defects:{{c1:: stroke, chiasmal tumors }}
Published	09/08/2024	•Patients with visual field defects ALWAYS require further evaluation. {{c1::REFERAL, REFERRAL, REFERRAL}}
Published	09/08/2024	•{{c1::Homonymous Hemianopsia}} = a lesion of the optic tract interrupts fibers originating on the same side of BOTH eyes
Published	09/08/2024	•{{c1::Bitemporal}} Hemianopsia = a lesion at the optic chiasm interrupts fibers crossing over to the opposite side
Published	09/08/2024	{{c1::•Homonymous quadrantic defect}} = partial lesion of the optic radiation in the temporal lobe
Published	09/08/2024	Inspection of the Eye•Develop a systematic approach so that you don’t miss sight-threatening pathology! ▫“Start from the {{c1::outside}} and…
Published	09/08/2024	•Eyebrows: ▫inspection noting {{c1::quantity}} and {{c1::distribution}} of brows and any {{c1::scaliness}} of the skin.…
Published	09/08/2024	▫Face the patient to survey the eyes for {{c1::position}} and {{c1::alignment}}
Published	09/08/2024	•Lashes-inspect for {{c1::condition}} and {{c1 ::direction}}
Published	09/08/2024	▫ {{c1::ECTROPION}} – margin of lower lid is turned outward “eyelashes EXCIT” – dry eyes
Published	09/08/2024	▫{{c1::ENTROPION}} – margin of lid is turning inward “eyelashes ENWARD”- scratchy irritated eyes
Published	09/08/2024	•Eyelids inspected for: ▫{{c1::Width of palpebral fissures}} – upstarting palpebral fissures in Down Syndrome▫{{c1::Edema}} ▫{{c1::Color}} →…
Published	09/08/2024	•{{c1::Hordeolum (Stye)}}: painful, tender, red +/- yellow/white pimple infection in a gland at the margin of the eyelid
Published	09/08/2024	•{{c1::Chalazion}}: subacute, nontender, non-infectious usually painless nodule caused by a blocked meibomian gland, styes after being treated but gla…
Published	09/08/2024	•{{c1::Blepharitis}} ▫Causes: Anterior: most commonly {{c2::staph aureus}} or {{c2::epidermidis}}. Can also occur with {{c2::sebo…
Published	09/08/2024	•{{c1::Ptosis}}: ▫{{c2::Drooping}} of the upper lid ▫Caused by {{c3::myasthenia gravis}}, {{c3::oculomotor nerve}} injury, {{…
Published	09/08/2024	•{{c1::Xanthelasma}} ▫Slightly {{c2::raised}}, {{c2::yellowish}}, well circumcised {{c2::plaques}} that appear along the {{c3…
Published	09/08/2024	•Inspect lacrimal gland and lacrimal sac for {{c1::swelling}} •Assess for excessive {{c1::tearing}} or {{c1::dryness}} ▫Excessive …
Published	09/08/2024	{{c1::Dacrocystitis}} which is infection of the lacrimal sac commonly precipitated by a blockage in the nasolacrimal duct. Antibiotic/steroid and +/-d…
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Published	09/08/2024	ALLERGIC CONJUNCTIVITIS•Etiology:▫Frequently associated with {{c1::seasonal allergic rhinitis.}}•Clinical presentation:▫Conjunctival {{c2::e…
Published	09/08/2024	Subconjunctival hemorrhage•Etiology: ▫Rupture of {{c1::small blood vessel}} of conjunctiva ▫Common in patients {{c2::> 80}} yea…
Published	09/08/2024	•{{c1::Pinguecula}}: ▫yellowish triangular node in the bulbar conjunctiva on either side of the iris ▫Frequently appears with age
Published	09/08/2024	{{c1::Pterygium}}: Triangular thickening of the bulbar conjunctiva that slowly grows across the cornea May encroach on pupil
Published	09/08/2024	•Use {{c1::oblique lighting}}, {{c1::45}} degree angle, to inspect the cornea for any {{c1::opacities}} that could be visuali…
Published	09/08/2024	1.{{c1::Corneal Arcus}} – thin gray/white circle around edge of cornea. Normal in aging, can indicate hyperlipoproteinemia in younger individuals…
Published	09/08/2024	1.{{c1::Kayser-Fleischer ring}} – golden/red/brown ring from copper deposition in individuals with Wilsons disease.
Published	09/08/2024	{{c1::Wilsons disease}} – rare autosomal recessive mutation of a gene on chromosome 13  causing abnormal accumulation of copper in the tissues th…
Published	09/08/2024	{{c1::Corneal Light Reflex}} Test: •Objective assessment of {{c2::ocular alignment}} •Patient is directed to look at a penlight held directl…
Published	09/08/2024	{{c1::Esotropia}} = strabismus in which one or both eyes turn inward
Published	09/08/2024	{{c1::Exotropia}} = strabismus in which one or both eyes turn outward
Published	09/08/2024	{{c1::Esophoria}} = tendency of one eye to turn inward when focusing on an object at a distance
Published	09/08/2024	{{c1::Exophoria}} = tendency of one eye to turn outward when focusing on an object at a distance
Published	09/08/2024	{{c1::Anterior Chamber Depth}} test: •Shine pen light from temporal side of each eye, 90-degree angle •Evaluate for a {{c2::crescentic shado…
Published	09/08/2024	Acute Narrow Angle-Closure Glaucoma•Etiology: ▫Often precipitated by {{c1::pupillary dilation}} which further closes the angle of {{c1:…
Published	09/08/2024	{{c1::Acute Narrow Angle-Closure Glaucoma}}
Published	09/08/2024	Hyphema•Etiology: ▫Result of {{c1::blunt or penetrating injury}} to the eye Children: sports injuries, Teenagers & Adults: assault, ai…
Published	09/08/2024	{{c1::Hyphema}}
Published	09/08/2024	{{c1::Cover-Uncover}} Test: •Evaluates for a {{c2::latent strabismus}} – meaning a deviation that is only present after normal binocula…
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Published	09/08/2024	{{c1::Six Cardinal fields of gaze}}: •Tests to evaluate the function of the {{c2::six extraocular muscle}}s and cranial nerves {{c2::III, IV…
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Published	09/08/2024	Convergence: •Evaluates for {{c1::convergence insufficiency disorder}}. Which can cause symptoms such as: {{c2::eyestrain, headaches, double…
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Published	09/08/2024	•All evaluated as a part of the fundoscopic exam! ▫Evaluate clarity of the {{c1::lens}} – {{c2::cataracts}} ▫{{c3::Retina}} &&…
Published	09/08/2024	Steps for using the Ophthalmoscope1.{{c1::Dim}} room lights, have patient focus straight ahead behind you 2.Turn lens to the {{c2::0 diopter…
Published	09/08/2024	Examining the optic disc:•Locate the optic disc ({{c1::round/orange}} structure) by tracing a blood vessel {{c1::centrally.}} •Gently {…
Published	09/08/2024	Evaluating the Retina – arteries/veins/fovea/macula•Inspect the arteries and veins following them out into the {{c1::periphery}} ▫Arteries =&nbsp…
Published	09/08/2024	{{c1::papilledema}}
Published	09/08/2024	•Normal arteries have a wall that is {{c1::transparent}} allowing only the column of blood to be seen with a light reflex that is about 1/4th the…
Published	09/08/2024	•Retinal arteries in {{c1::hypertension}} ▫Arteries show areas of {{c2::narrowing}} with a narrow light reflex
Published	09/08/2024	•{{c1::Copper wiring}} ▫Arteries close to the optic disc become {{c2::full}} and {{c2::tortuous}} developing an increased light reflex …
Published	09/08/2024	•{{c1::Silver wiring}} ▫Portion of a narrowed artery develops an {{c2::opaque wall}} where no blood is visible within it
Published	09/08/2024	•In hypertensive patients where arterial walls lose transparency, changes at {{c1::arteriovenous crossing}} can consist of AV nicking and ta…
Published	09/08/2024	▫{{c1::AV nicking}} – vein appears to stop abruptly on either side of the artery
Published	09/08/2024	{{c1::▫AV tapering}} – vein appears to taper down in diameter on either side of the artery
Published	09/08/2024	•{{c1::Retinal Hemorrhages}} – small, flame shaped, red streaks in the fundi. Seen in severe HTN, papilledema, occlusion of the retinal vein
Published	09/08/2024	•{{c1::Soft exudates or cotton wool patches}} – white/gray ovoid lesions with soft borders. Caused by infarcted nerve fibers seen mostly in HTN
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