what color is the pupil?
Black
What part of the eye gives it its color?
Iris
When assessing the Yoke Muscles, what are we checking?
Assessing the 6 fields of gaze, and the ability of the muscles to move the eye to see in those fields of gaze.
What is the function of the bony orbit?
It helps protect the eye
What is accommodation?
It is the pupil's ability to dilate for far away sight, and constrict when looking at up close objects.
What is a side effect of Lasik Surgery
can lead to dry eyes
What is glaucoma
An increase in the intraocular pressure (test for this is a poof of air)
What is diplopia
It is seeing double
What does PERRLA stand for?
P=Pupils
E=Equal
R=Round
R=Reactive to Light
L=Reactive to light
A=Accommodation
When you shine a light in the patient's pupil, what is the response?
The pupil will constrict
When you are in a dark room, what is the response of the pupil?
The pupil will dilate in this scenario
What is the definition of the Eyes consensual response?
Both eyes should respond the same way, at the same time.
What are characteristics of cataracts?
1. Lens of the eye gets cloudy, and it is a bluish color.
Glaucome
- Hight pressure in the eye, causes blindness, treatment is eye drops.
What is a palpable fissure?
Distance between upper eyelid and lower eyelid. They should be of equal distance. (May be different if the pt has had a stroke)
Objective data - the physical exam
1. Preparation - position - sitting or semi fowlers, dangling at side of the bed
2. Equipment needed
- Snellen eye chart - 20 feet away
- Handheld visual screener 14 inches from the face
- Opaque card or occluder
- Opthalmoscope
What is normal vision?
20/20
Steps of the eye assessment
Evaluating Vision
1. visual acuity
- distant using snellen eye chart
- near vision - middle aged patient who complains of difficulty reading - hand held vision chart.
2. Visual Fields
- Confrontation Test (range of peripheral visual fields)
Testing extraocular muscle function
1. Corneal Light Reflex (The Hirshberg Test)
- Shining light on the eyes.
--- Reflection from the light is in the same spot on both eyes.
Right Estropia
Inward turning of the eye
Right Extropia
Outward turning of the eye
How do you treat Estropia, and Extropia
You put a patch over the GOOD eye, this will make the muscle in the eye that are not working, work correctly.
Testing Extraocular Muscle Function
2. Cover/Uncover Test - you cover 1 eye, then take off the cover. If it is a lazy eye, while eye is covered, it will drift off.
If you cover the stung eye, the weaker eye will move.
Testing Extraocular Muscle Function
3. Diagnostic Positions Test - Assess eye muscle strength and cranial nerve function. You make the muscle go in the 6 cardinal fields of gaze.
External Eye Structures
- General
- Eyebrows
- Eyelids and lashes
- Eyeballs
- Bulbar Conjunctiva and Sclera
- Palpebral Conjunctiva (stressful and uncomfortable - usually done only if a complaint) -Eversion of the Upper Lid
- Lacrimal Apparatus
What is exothalamus, and when is it seen?
It is seen in hypothyroidism and it is the bulging out of the eyes.
Cornea and Lens (anterior chamber)
- Face the patient, shine light in obliquely through the anterior chamber from the lateral side.
- Observe the distribution of light in anterior chamber.
Iris and Pupil
- Pupillary light reflex
- Assess for consensual response - shine a light obliquely into one eye and observe pupil reaction in opposite eye (normal=opposite eye will constrict)
- Test for accomodation
Internal Eye Structures
- Inspect the media - anterior chamber, lens, vitreous and the ocular funds.
How to use the opthalmoscope
Red Reflex - the reflection from the back edge of the eye. In pictures it is called "red eye
When using the opthalmoscope, and assessing the right eye, which eye do you hold the opthalmoscope up to on yourself?
The right eye. You always hold the opthalmoscope up to the same eye that you are examining.
Normal ocular fundus
1. Optic Disc - Vessels, clear distinct edges, yellowish color.
2. Retinal vessels
3. General background of the funds
4. Macula - extremely sensitive to light. - macula should be located 2 Disc Diameters (2DDs) from the optic disc.
macula
- extremely sensitive to light.
- Should be located 2 DD's from the optic disc
Optic Disc
- Most Prominent landmark
- Located on nasal side of the retina
- Color is creamy yellow-orange to pink
- Shape is round or oval
- Margins are distinct, sharply demarcated
- Cup-disc-ration - cup may be brighter yellow white than rest of disc.
Retinal vessels
Follow a paired artery & vein out to periphery in the 4 quadrants and not these points:
- Number - (paired artery & veinpass to each quadrant
- Color - arteries brighter than veins
- Turtuosity - mild vessel twisting when present in both eyes = usually co
General Background of the Fundus
- Color varies: Light red to dark brown red (corresponding to person's skin color)
- No lesions should obstruct the retinal structures.
Macula
-1DD in size
- Located 2DD temporal to the optic disc
- Last area to inspect in fundoscopic exam.
- Normal color of area is somewhat darker than the rest of the fundus
Abnormalities in the Eyelids
- Periorbital Edema - swelling around edge caused by allergies or hit by something.
- Exopthalmos - protruding eyes
- Enopthalmos - sunken eyes
- Ptosis - drooping upper lid (lazy eye)
- upward palpebral slant
- ectropion - lower lid is outward
- entropio
Abnormalities of the external eye
- Conjunctivitis - Pink eye
- Subconjunctival Hemmorhage - leakage of blood outside vessels. (anything that may increase intraabdominal pressure can cause these)
- Iritis - inflammation of the iris.
- Acute glaucoma - pressure on inside of the eye.
- Pter
Abnormalities In the Pupil
- Anisocoria - unequal pupils
- Monocular Blindness
- Miosis - Constricted Pupil
- Mydriasis - Dilated pupil
** miosis and mydriasis are opposits of each other.
- Argyll Robertson Pupil
- Tonic Pupil
- Cranial nerve III damage
- Horner's syndrome
Abnormalities in the optic fundus
- Optic atrophy
- Papilledema - edema in the funds
- Excessive cup-disc ratio
- arteriovenous crossing
- narrowed arteries
- microaneurysms
- dot shaped hemmorhages
- flame shaped hemmorhages
- soft exudates
- hard exudates
Common variations of assessment: Geriatric
1. Eyes appear sunken
2. Ectropion - lower lid drops away from the globe
3. Entropion - turning of the lower lid
4. Acrus Senilis - around cornea - gray white arc
5. Xanthelasma - soft, raised yellow plaques on lids of inner canthus (yellowish color means