Chapter 11: Eyes Assessment

Front 1

Function of the Eye.

Back 1

transmits visual stimuli to the brain for interpretation. It occupies orbitasl cavity/anterior aspect exposed. It attached by (4) rectus muscles, (2) oblique muscles. (total 6 muscles)

Front 2

What (3) cranial nreves helps the eye function?

Back 2

CN lll(oculomotor), lV(4-trochlear), and VI(6-abducens)

Front 3

What cranial nreve connects the eye to the brain?

Back 3

CN ll

Front 4

Function of the eyelid.

Back 4

1)distribute tears over eye surface.
2)limit amount of light entering the eye.
3)protect the eye from foreign bodies

Front 5

Function of the conjunctiva.

Back 5

protects the eye from foreign bodies and desiccation(drying up).

Front 6

Function of Lacrimal Gland

Back 6

produces tears that moisten the eye.

Front 7

How many layers do the internal eye have?

Back 7

3: inner, middle, outer

Front 8

What is the outer fibrous layer composed of?

Back 8

sclera posteriorly and cornea anteriorly

Front 9

What is the middle layer composed of?

Back 9

choroid posteriorly and ciliary body/iris anteriorly

Front 10

What is the inner layer composed of?

Back 10

Retina

Front 11

Function of the Sclera?

Back 11

"white of the eye," supports internal eye structures.

Front 12

Function of the Cornea?

Back 12

1)sensory innervation for pain.
2)Separates aqueous humor from external environment
3)Permits light transmission through lens to the retina.

Front 13

Function of the Iris?

Back 13

Contracts/Dilates to control amount of light traveling through the pupil to the retina.

Front 14

Function of the Lens?

Back 14

a biconvex, transparent structure located immediately behind the iris. Its changes in thickness allow images from varied distances to be focused on the retina.

Front 15

Function of the Retina?

Back 15

Is the sensory network of the eye. It transforms light impulses into electrical impulses that are sent to the cerebral cortex, which then interprets impulses as "visual " objects.

Front 16

When do eyes form?

Back 16

during the first 8 weeks of gestation

Front 17

What would be the reason for eyes becoming malformed?

Back 17

due to maternal drug ingestion or infection.

Front 18

Vision development depends on ____and occurs _____.

Back 18

nervous system maturation; and occurs over time

Front 19

Term infants are ____.

Back 19

hyperopic [20/200), 400

Front 20

When does Peripheral vision and Central vision fully developed?

Back 20

Peripheral vision fully developed at birth;
Central vision develops later

Front 21

Children develop ability to ____.

Back 21

accommodate(focusing power) and converge

Front 22

Young children are
_________.

Back 22

myopic

Front 23

Adult visual acuity is achieved by, what age?

Back 23

age 4 (book)
age 6 (notes)

Front 24

The eyes undergo several changes throughout pregnancy. name (7) changes.

Back 24

1)Corneal edema/thickening occurs.
2)Diabetic retinopathy may worsen.
3)Corneal epithelium pigmentation increases.
4)Tears have greasy feeling.
5)Intraocular pressure falls.
6)Ptosis may develop.
7)Subconjunctival hemorrhages may occur/resolve spontaneously.

Front 25

Pregnant Women tears contain an increased level of lysozyme, resulting in a greasy sensation and perhaps blurred vision for contact lens wearers, what is the best advice for patient who wears contact lenses?

Back 25

decide to discontinue their use during pregnancy. Because of the various changes in the eye, new lens prescriptions should not be obtained until several weeks after delivery.

Front 26

The major physiologic eye change in older adults, that occurs with aging is a--- progressive weakening of accommodation (focusing power) known as, what?

Back 26

presbyopia

Front 27

What age do the lens becomes more rigid and the ciliary muscle becomes weaker?

Back 27

Generally by 45 years of age

Front 28

In older adults, their old fibers are compressed centrally, forming a denser central region that may cause loss of clarity of the lens and contribute to, what?

Back 28

cataract formation.

Front 29

Blurred vision and diplopia are sometimes confused by the patient. Blurred vision represents, what?

Back 29

a problem with visual acuity and there are many causes.

Front 30

Diplopia vision?

Back 30

is the perception of two images and may be monocular or binocular.

Front 31

Monocular diplopia

Back 31

is an optical problem.

Front 32

Binocular diplopia

Back 32

is an alignment problem.

Front 33

prevent macular degeneration?

Back 33

antioxidant vitamins

Front 34

What medication cause cataract formation?

Back 34

Steroids

Front 35

Risk Factors for Cataract Formation

Back 35

•Steroid medication use
•Exposure to ultraviolet light
•Cigarette smoking
•Diabetes mellitus
•Aging

Front 36

What are (3) Chronic illness that can affect vision?

Back 36

•Hypertension
•Diabetes mellitus
•Glaucoma

Front 37

History of Present Illness: Eyes

Back 37

•Eyelids: recurrent hordeola, ptosis
•Vision correction
•Vision difficulties: color vision, halos, floaters, diplopia
•Cataracts
•Pain
•Secretions-color (clear or yellow), consistency (watery or purulent), duration, tears that run down the face, decreased tear formation with sensation of gritty eyes; presence of conjunctival redness
•Medications- eyedrops or ointments, antibiotics, artificial tears, mydriatics; glaucoma medications, antioxidant vitamins (to prevent macular degeneration), steroids (which cause cataract formation); prescription drugs, nonprescription drugs, complementary or alternative therapy)

Front 38

Past Medical History: Eyes

Back 38

•Trauma
•Eye surgery
•Chronic illness that can affect vision

Front 39

Family History: Eyes

Back 39

•Diabetes
•Retinal detachment
•Nearsightedness
•Farsightedness
•Strabismus
•Amblyopia
•Retinoblastoma(tumor affecting outer part)- "Optic Nurse care only"
•Glaucoma
•Macular degeneration
•Retinitis pigmentosa
•Allergies affecting eye
•Color blindness
•Cataract formation

Front 40

Personal and Social History: Eyes

Back 40

•Employment exposure
•Activities
•Allergies
•Corrective lenses
•Protective eyewear

Front 41

What type of Infants and Children related history should we reviewed?

Back 41

*Retinopathy of prematurity
*Failure of infant to gaze or blink
*White area in pupil on a photo
*Excessive tearing
*Strabismus
*Excessive rubbing of eyes, hordeola
*Bring objects up close for examination
*Poor school performance

Front 42

What type of Preganancy related history should we reviewed?

Back 42

*Weeks of gestation or postpartum
*History of diabetes mellitus or eye disorders
*Pregnancy-induced hypertension or diabetes
*Use of topical eye medications that may cross placenta

Front 43

What type of older adult related history should we reviewed?

Back 43

*Decrease in central vision
*Use of dim light to increase visual acuity
*Complaints of glare
*Production of excess tears
*Blurred vision
*Dry eyes
*Scleral brown spots
*Difficulty performing near work without lenses
*Nocturnal eye pain

Front 44

EXAMINATION AND FINDINGS EQUIPMENT

Back 44

•Snellen chart
•Rosenbaum/Jaeger near vision card
•Penlight
•Cotton wisp
•Ophthalmoscope
•Eye cover, gauze, or opaque card

Front 45

What does Visual Testing test for?

Back 45

•Central vision
•Near vision
•Peripheral vision

Front 46

Measurement of visual acuity-the discrimination of small details-tests cranial nerve II (optic nerve) and is essentially a measurement of___.

Back 46

central vision

Front 47

This is the most important What vision test can be performed by the examiner who is not an ophthalmologist; it is also one that is often neglected.

Back 47

central vision

Front 48

Do you test both eyes together?

Back 48

No!! Each eye tested individually

Front 49

Can you test vision in patients with corrective lenses on?

Back 49

Test with and without corrective lenses. However, record the readings separately. Always test vision without glasses first.

Front 50

While testing a patient vision if you notice, their vision less than 20/20, what should you do?

Back 50

conduct pinhole test

Front 51

Inspect eyebrows for?

Back 51

size, extension, and hair texture.

Front 52

What should you Inspect orbital area for?

Back 52

edema, puffiness, sagging tissue below orbit

Front 53

Eyelid inspection

Back 53

1)Inspect closed lid for fasciculations and tremors.
2)Check ability to close completely/open widely.
3)Observe margin for flakiness, redness, swelling.
4)Look for eyelashes.
5)Note eye opening.
6)Note any eversion or inversion of lids.

Front 54

Fasciculations and tremors of eyelids, may indicate?

Back 54

a sign of hyperthyroidism

Front 55

If one superior eyelid covers more of the iris than the other or extends over the pupil, then ____ of that lid is present.

Back 55

ptosis; Ptosis indicates a congenital or acquired weakness of the levator muscle or a paresis of a branch of the lll cranial nerve. Record the difference between the two lids in millimeters. (Note: Average upper lid position is 2 mm below the limbus. Average lower lid position is at the lower limbus).

Front 56

When the lower lid is turned away from the eye,____is present and may result in excessive tearing

Back 56

ectropion

Front 57

When the lid is turned inward toward the globe, a condition known as____.

Back 57

entropion, the lid's eyelashes may cause corneal and conjunctival irritation, increasing the risk of a secondary infection. The patient often complains of a foreign body sensation.

Front 58

An acute suppurative inflammation of the follicle of an eyelash can cause an erythematous or yellow lump, called?

Back 58

A hordeolum or sty

Front 59

Crusting along the eyelashes may represent____.

Back 59

Blepharitis---- caused by bacterial infection, seborrhea, psoriasis, a manifestation of rosacea, or an allergic response

Front 60

Ask the patient to close the eyes, and note whether the eyelids meet completely. If the closed lids do not completely cover the globe (a condition called?

Back 60

Lagophthalmos--- the cornea may become dried and be at increased risk of infection.

Front 61

Palpate the eyelids for nodules. Next palpate the eye itself. Determine whether it feels hard or can be gently pushed into the orbit without causing discomfort. An eye that feels very firm and resists palpation may indicate, what?

Back 61

glaucoma, hyperthyroidism, or the presence of a retrobulbar tumor.

Front 62

How do you inspect the Conjunctiva?

Back 62

*1st-Inspect lower portion by pulling down lower lid.
*Note:Upper lid is inspected only if foreign body is in the eye.

Front 63

When inspecting the Conjunctiva, what should you look for?

Back 63

1)Look for redness/exudate.
2)Look for pterygium(abnormal growth of conjunctiva that extends over the cornea from the limbus)

Front 64

How do you examine the Cornea for clarity?

Back 64

1)Examine clarity of the cornea by shining light on it.
2) Inspect for corneal arcus.

An arcus is seen in many individuals older than 60 years of age. If present before 40 years of age, arcus senilis may indicate a lipid disorder, most commonly type II hyperlipidemia.

Front 65

How do you test for cornea sensitivity?

Back 65

Test sensitivity by touching the cornea with a cotton wisp to elicit blink.

Front 66

Corneal sensitivity is controlled by which Cranial nerve?

Back 66

controlled by cranial nerve V (trigeminal nerve)

Front 67

Inspect iris for____.

Back 67

pattern, color, shape.

Front 68

Test the Iris for___.

Back 68

direct/consensual light response.

Front 69

Test pupils for____.

Back 69

*accommodation.

Note:Estimate pupil size and compare for equality.

Front 70

Inspect Lens for____.

Back 70

Inspect for transparency/clarity