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PCM - eye exam
Terms in this set (78)
When taking history, what might be some good open ended questions?
how is your vision?
are you having any trouble with your vision?
is your vision blurred?
any difficulty seeing near or far objects?
Is there a change in your vision?
What types of vision changes could you have?
What are some examples of visual disturbances?
blurred vision/ cloudy vision, tunnel vision, visual field loss, loss of central vision, flashes of light or spots, floaters, vail or curtain coming down
what may be some associated symptoms you should be concerned about regarding vision?
headaches, dizziness, vertigo, pain, discharge, photophobia (sensitivity to light)
Visual changes might be a prodrome. What is a prodrome?
an early symptom indicating the onset of a disease or illness. ex. migranes!
Which is more concerning: gradual or sudden loss of vision?
sudden! it is a medical emergency!
What may lead to a gradual loss of vision?
what may lead to a sudden loss of vision?
central retinal artery occlusion
far-sightedness - difficulty seeing near objects
near-sightedness - difficulty seeing distant objects
aging vision - progressive difficulty seeing near objects
failure of the visual axes to remain parallel - lazy eye
one eye deviates inward
one eye deviates outward
what structure seals the eye in the eye socket?
what is the border between the iris and the sclera? How is it clinically relevant?
limbus - if you see redness, it might be indicative of a corneal epithelium neoplasm
What produces tears?
lacrimal apparatus of the eye
where are you trying to center your view of the internal eye?
What is the most important thing to document during an eye exam?
the patient's visual acuity - both near and far!
How do you test far vision?
Snellen eye chart 20ft away, mechanical vision tester/titmus vision tester
How do you test near vision?
hand held card, 14 inches away, or mechanical vision tester/titmus vision tester
what does a visual acuity score of 20/20 mean?
what does a visual acuity score of 20/100 mean?
the patient sees at 20 feet what a normal visual acuity person can see at 100 feet.
How should you examine both eyes? What about if your patient has corrected vision?
each eye separately, then together.
repeat with uncorrected vision.
What is O.D. short for?
oculus dexter (right eye!)
what is O.S. short for?
oculus sinister (left eye!)
what is O.U. short for?
oculus uterque (both eyes!)
What test do you use to check for color blindness?
ishihara color blindness test
bad or absent visual field on one side
bitemporal hemianopsia (
: what is the cause?)
bad or absent visual field on each temporal side of the body.
usually due to a pituitary tumor that presses on the optic chiasm!
bad or absent vision in a quadrant
: what is a likely cause?)
protrusion of the eyes
most common cause: Grave's disease aka hyperthyroidism. excess fat deposition behind the eye causes protrusion
How can you check for eye alignment?
if your light reflects in the pupils evenly
eyelid turns inward
eyelid turns outward
clear mucus membrane which covers the eye
covers the anterior eye
lines the eyelids
yellow eye - indicative of liver issues
aka brittle bone syndrome, patient has blue sclera
How do you inspect for opacities of the cornea and lens?
inspect with oblique lighting
unequal pupils greater than .5mm
What does PERRLA stand for?
Pupils Equal Round & Reactive to Light and Accomodation
what is a direct reaction?
constriction of the same pupil
what is a consensual reaction?
constriction of the opposite pupil
what is accomodation?
change in pupil and lens for near and far objects
what is convergence?
eyes look inward to focus on a near object
What is an Argyll Robertson pupil?
a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed ("light-near dissociation").
what is nystagmus?
fine rhythmic oscillation of the eyes at the extreme lateral gaze
What are you generally looking at when you look into a patient's eyes with an opthalmoscope?
optic disc and cup
should the optic disc be lateral or medial?
what 3 things do you identify when looking at the optic disc?
1. CLARITY of DISC MARGIN
3. CENTRAL PHYSIOLOGIC CUP (aka the small white-ish depression within the optic disc)
Where do you want to check the retina last?
the macula/ fovea....
patient will probably close their eyes if you shine at it
lump, swelling - small nodule on the bulbar conjunctiva, does not cross over to the cornea
lump, swelling - thickening of the bulbar conjunctiva which grows across the cornea
lump, swelling - infection at the margin of the eyelid
lump, swelling - painless nodule involving the Meibomian gland
- what is a likely cause?)
flat yellow plaques found under the eye
this is associated with hyperlipidemia! there is no treatment, but you might want to try to investigate lipids and cholesterol
drooping of the upper eyelid
ptosis, miosis and anhydrosis
due to issues with sympathetic innervation
CN VII nerve issue, temporary face paralysis caused by a virus, usually
infection or inflammation of the conjunctiva. discomfort, discharge.
treat with topical antibiotics
leakage of blood under the conjunctiva. painless, sharply demarcated, resolves on its own
inflammation of the radiating vessels around the limbus.
very painful, vision is affected. can be an ocular emergency
blood present in the anterior chamber.
due to trauma
optic disc is swollen, blurred margins. physiologic cup not visible. increased intracranial pressure
increased intraoccular pressure. causes increased disc cupping. physiologic cup is enlarged, occupying more than half of the disc's diameter
may lead to focal or generalized narrowing of the artery!
AKA thick arterial wall
narrow light reflex
What is A-V nicking?
arterial walls become thickened and lose transparency due to atherosclerotic changes. the veins appear to taper as the artery crosses
possesses cotton wool patches - infarcted nerve fibers. can be seen in patients with hypertension and diabetes
usual pigment changes on the retina
What happens to the visual field if you injure nerves within the eye?
you'll probably find a horizontal defect
What happens to the visual field if you cut an optic nerve?
you will be blind in one eye
What happens to the visual field if you cut the optic chiasm?
you will have bitemporal hemianopsia
what happens when you slice the RIGHT optic tract?
the LEFT optic tract?
If you slice the RIGHT optic tract, you will have LEFT homonymous hemianopsia
If you slice the LEFT optic tract, you will have RIGHT homonymous hemianopsia
What happens when you slice the LEFT optic radiation?
Homonymous Left superior quadratic defect
What happens if you have a lesion in the RIGHT visual cortex?
LEFT homonymous hemianopsia
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