Terms in this set (77)
Visual receptive layer of eye where light waves changed into nerve impulses.
Retinal structures viewed through opthalmoscope
Optic disc, retinal vessels, general background, macula.
Area in which fibers from retina converge to form optic nerve. Located toward nasal side of retina. Color varies from creamy yellow-orange to pink; round or oval shape; margins that are distinct and sharply demarcated (esp. temporal); physiologic cup (smaller - diameter usually less than half the diameter of the disc -circular area inside disc where blood vessels exit and enter).
Normally include a paired artery and vein extending into each quadrant, straighter on nasal side. Arteries are brighter red and have arterial light reflex. Artery-to-vein width is 2:3 or 4:5. Regular decrease in caliber noted as they extend toward periphery. May cross paths - not significant if w/in 2DD of disc and no sign of interrupted blood flow. Mild tortuosity (twisting) not signifcant. Pulsations may be present in veins.
Slightly darker pigmented region surrounding fovea centralis, area of sharpest and keenest vision. Receives and transduces light from center of visual field. Located on temporal side of fundus.
Infant Eye Structure and Function
Peripheral vision is intact in newborn infant; macula is absent at birth but mature by 8 mos.; binocularity and fixation on single image w/ both eyes simultaneously possible at 3-4mos; lens is nearly spherical and of the consistency of soft plastic at birth.
Aging Adult Eye Structure and Function
Pupil size decreases; lens loses elasticity, becoming hard and glasslike (decreases ability to change shape to accommodate for near vision); transparent fibers of lens begin to thicken and yellow (beginning of cataracts) by age 70.
Loss of lens elasticity, resulting in hard and glasslike lens that is less able to change shape to accommodate near vision.
Most common causes of decreased visual function in older adults
1.) Cataract formation or lens opacity, resulting in clumping of proteins in lens
2.) Glaucoma, or increased intraocular pressure (chronic open-angle glaucoma is most common).
3) Macular degeneration, or breakdown of cells in macula or retina
4.) Loss of central vision (most common cause of blindness).
Opthalmologic Exam: Subjective Data
Vision difficulty (decreased acuity, blurring, blind spots); pain; strabismus; diplopia; redness, swelling; watering, discharge; hx ocular problems; glaucoma; use of glasses or contact lenses; self-care behaviors
Abnormal alignment of the eyes, the condition of having to squint. Deviation in the anteroposterior axis of the eye.
Double vision or perception of two images of a single object.
Common w/ myopia or after middle age as a result of condensed vitreous fibers. Usually not significant, but acute onset ("shade"/"cobwebs") may occur w/ retinal detachment.
Halos/Rainbows/Rings around Lights
Occur w/ acute narrow-angle glaucoma
Blind spot in the visual field surrounded by an area of normal or decreased vision, occurs with glaucoma, with optic nerve and visual pathway disorders.
Occurs with optip atrophy, glaucoma, vitamin A deficiency.
Sudden onset may be an emergency - refer immediately. Assess quality.
Lacrimation (tearing)/epiphora (excessive tearing)
Due to irritants or obstruction in drainage of tears
Characterized by increased intraocular pressure.
Medication that may cause cataracts or increased intraocular pressure.
Loss in central vision acuity
Opthalmoscope: Black Numbers
Indicate positive diopter - focus on nearer objects. Used for farsighted eyes.
Opthalmoscope: Red Numbers
Show negative diopter - focus on farther away. Used for nearsighted eyes.
"Plus" or "Positive" Lens
Biconvex; used to focus on objects that are closer to the examiner's eye (anterior structures).
"Negative" or "Minus" Lens
Bi-concave; used to focus on objects farther away from examiner's eye (vitreous humor and retina).
Neither convex nor concave; used if neither the examiner's nor the patient's eyes have refractive errors.
Cornea, anterior and posterior chambers (aqueous fluid), lens
Optic disc, retinal vessels, general background, macula
Undilated Opthalmoscopic Exam
View limited to posterior structures of the retina
Dilated Opthalmoscopic Exam
Assess more peripheral structures, macula, and unexplained visual loss
Infant eye examination
Deferred at birth d/t transient edema of lids from birth trauma or from instillation of silver nitrate at birth. Should be examined w/in a few days and again between 2-6 mos w/ infant lying on table.
Fundus pale, vessels not fully developed; no foveal light reflection d/t immature macula until 1 yo.
Eye Exams: Children
Done at every WCC
Complete exam may be difficult - check red reflex, note any interruption.
Allow child to handle equipment and assure them that procedure will not hurt. Direct them to look at an appealing picture or toy during exam.
Eye Exam: Aging Adult
Retinal structures shine less
Blood vessels look paler, narrower, attenuated
Arterioles appear paler, straighter
Light reflex narrower
Benign degenerative hyaline deposits, often symmetrical
Normal development on retinal surface in the aged
No effect on vision
Findings: yellowish round spots, edges may be soft or hard, may concentrate in posterior pole.
Common in: normal aging, age-related macular degeneration.
Fundi: Normal Findings
Red reflex present bilaterally
Discs flat w/ sharp margins
Vessels present in all quadrants w/o crossing defects
Retinal background even color w/o hemorrhages/exudates
Macula has even color
Physiologic Cupping: Central
Small whitish depression in the optic disc, from which retinal vessels appear to emerge
May be visible centrally or toward temporal side of disc
Grayish spots seen at base
Physiologic Cupping: Temporal
May be visible either centrally or toward temporal side of disc
Rings & Cresents
Seen often around the optic disc
Not part of disc itself, should not be included in estimates of disc diameter
Medullated Nerve Fibers
Irregular white patches with feathered margins obscuring disc edge, retinal vessels
No pathologic significance
Venous stasis leading to engorgement and swelling 2/2 to increase ICP (meningitis, subarachnoid hemorrhage, trauma, mass lesion)
Findings: pink, hyperemic color; loss of venous pulsations; disc vessels more visible, numerous, curving over borders of disc; swollen disc w/ blurred margins; physiologic cup invisible
Increased pressure w/in the eye leading to increased cupping (backward depression of disc) and atrophy.
Findings: physiologic cup enlarged, occupying more than half of disc's diameter. Retinal vessels sink in and under, may be displaced nasally.
Death of optic nerve fibers lead to loss of tiny disc vessels.
Findings: color white, absence of vessels
Superficial Retinal Hemorrhage
Findings: small linear flame-shaped, red streaks in the fundi, shaped by the superficial bundles of nerve fibers that radiate from the optic disc; may be in clusters or streaking at edges.
Common in: severe htn, papilledema; occlusion of retinal vein
Findings: develops when blood escapes into the potential space between the retina and vitreous; larger than retinal hemorrhages; obscures any underlying vessels since it is anterior to the retina
Common in: sudden increase in intracranial pressure
Deep Retinal Hemorrhage
Findings: small, rounded, slightly irregular read spots ("dot" or "blot" hemorrhage). Occur in deep layer of retina.
Common in: diabetes
Findings: Tiny, round red spots seen commonly in and around macular area. Minute dilations of small retinal vessels, too small to be seen opthalmoscopically
Common in: diabetic retinopathy
Formation of new blood vessels
Findings: more numerous, more tortuous, narrower; grow into vitreous, retinal detachment or hemorrhage and loss of vision.
Common in late, proliferative stages of diabetic retinopathy.
Soft exudates: cotton wool patches
Infarcted nerve fibers
Findings: white or grayish, ovoid lesions w/ irregular "soft" borders. Usually smaller than disc.
Common in hypertension
Findings: creamy or yellowish, often bright lesions w/ well-defined "hard" borders. Small, round, may coalesce into larger irregular spots. Clusters, circular or star-shaped patterns.
Common in: diabetes, htn
Normal Retinal and Arteriovenous (A-V) Crossing
Normal arterial wall is transparent
Only column of blood w/in it can be seen, w/ light reflex
Vein crossing beneath can be seen up to column of blood on other side
Ocular changes, including atherosclerosis and arteriosclerosis, d/t acute and chronic hypertension. Arteries may show areas of focal or generalized narrowing. Light reflex narrows. Arterial wall thickens and becomes less transparent.
Arteriolar Sclerosis: Grade 1
Thickening of the vessels w/ slight depression of veins at AV crossings
Arteriolar Sclerosis: Grade II
Definite AV crossing changes and moderate local sclerosis
Arteriolar Sclerosis: Grade III
Venule beneath the arterioles is invisible
Arteriolar Sclerosis: Grade IV
Venous obstruction and arteriolar obliteration
Arteriolar Changes: Copper Wiring
Findings: full and tortuous, develop and increased light reflex w/ bright coppery luster
Arteriolar Changes: Silver Wiring
Findings: portion of a narrowed artery develops such an opaque wall that not blood is visible within it.
Arteriovenous Crossing/A-V Nicking
Chronic hypertension stiffens and thickens arteries.
Findings: vein appears to stop abruptly on either side of arter.
At AV crossing points, arteries indent and displace veins.
Findings: vein apears to taper down on side of artery.
Findings: Vein is twisted on distal side of the artery and forms a dark, wide knuckle
Hypertensive Retinopathy: Keith-Wagener-Barker Classification: Group 1
Slight narrowing, sclerosis, tortuosity of retinal arterioles.
Mild, aysmptomatic hypertenion.
Hypertensive Retinopathy: Keith-Wagener-Barker Classification: Group 2
Definite narrowing, focal constriction, sclerosis, AV nicking.
Blood pressure higher, sustained.
Few s/s referable to blood pressure.
Hypertensive Retinopathy: Keith-Wagener-Barker Classification: Group 3
Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages).
BP high, sustained.
Clinical manifestations of headaches, vertigo, nervousness
Mild impairment of cardiac, cerebral, renal function
Hypertensive Retinopathy: Keith-Wagener-Barker Classification: Group 4
Neuro-retinal edema, including pailledema
Siegrist streaks, Elschnig spots
BP persistently elevated
Clinical manifestations: headaches, asthenia, loss of weight, dyspnea, visual disturbances
Impairment of cardiac, cerebral, renal function
Branch retinal artery occlusion
Branch retinal vein occlusion
Central retinal artery occlusion
Central retinal vein occlusion
Ocular manifestations of HIV
Optic neuropathy, anterior ischemic
leading cause of new blindness in persons aged 25-74 years in the United States
Microaneurysms are earliest clinical sign
Diabetic Retinopathy: Common Findings
Dot and blot hemorrhages
Retinal edema and hard exudates
Venous loops and venous beading
Intraretinal microvascular abnormalities
Mild Nonproliferative Retinopathy
Earliest stage, microaneurysms occur (at least one plus hemorrhage in all four fundus quadrants)
Small areas of balloon-like swelling in the retina's tiny blood vessels
Moderate Nonproliferative Retinopathy
Presence of hemorrhages, microaneurysms, hard exudates
Intraretinal microaneurysms, dot and blot hemorrhages of greater severity in 1-3 quadrants. Cotton wool spots, venous caliber changes including venous beading, intraretinal microvascular abnormalities present but mild.
Severe Nonproliferative Retinopathy
Severe hemorrhages and microaneurysms in all four quadrants
Venous beading more marked in at least two quadrants
Intraretinal microvascular abnormalities, more severe in at least one quadrant.
Neovascularization is hallmark
Microvascular pathology w/ capillary closure in retina leads to hypoxia of tissue, leading to release of vasoproliferative factors which stimulate new blood vessel formation.
New vessles in retina and on optic disc may produce hemorrhage and bleed into vitreous.
Diabetic Retinopthay: DDx
Branch Retinal Vein Occlusion
Central Retinal Vein Occlusion
Macular edema, Diabetic
Ocular Ischemic Syndrome
Retinopathy, Diabetic (nonproliferative)
Sickle Cell Disease
Age-related is leading cause of irreversible vision loss
Degenerative retinal disease caused by genetic and environmental factors
-Dry Atrophic (more common, less severe)
Macular Degeneration: DDx
Chorioretinopathy, Central Serous
Multifocal Choroidopathy Syndromes
Neovascular Membranes, Subretinal
Presumed Ocular Histoplasmosis Syndrome
Retinal Detachment, Exudative
Anterior Chamber, Lens, Vitreous Humor
Internal Surface of the Retina
Optic Disc, retinal vessels, general background, macula
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