Clinical Assessment - Eyes (2-1)

Front 1

Cranial nerves

Back 1

1. Olfactory

2. Optic

3. Occulomotor

4. Trochlear

5. Trigeminal

6. Abducens

7. Facial

8. Auditory

9. Glossopharangeal
10. Vagus

11. Spinal accessory

12. Hypoglossal

Front 2

How to inspect eyes (8)

Back 2

1. Position and alignment

2. Eyebrows

3. Eyelids

4. Lacrimal apparatus

5. Conjunctiva/ Sclerae

6. Cornea, Lens

7. Iris

8. Pupils

Front 3

How to test CNII (3 tests)

Back 3

1. Visual acuity

2. Visual fields - if defect, test one at a time

3. View retina

Front 4

Describe defects of CNII

Back 4

1. Hyperopia, Myopia (far/nearsighted)

2. Legally blind = 20/200

3. Anopsia - know lesion sites

Front 5

CN II/III tests + what do abnormals mean.

Back 5

1. Size and shape of pupils

2. Pupillary (concensual) reaction to light. If flashed only gets smaller = CNIII lesion. If opposite eye constricts, CNII lesion.

3. Near response

Front 6

Innervation of eye muscles. How to test??

Back 6

LR6, SO4

Rest are III

Hit 6 cardinal directions (H shape), lid elevation.

Front 7

Abnormals of occulomotor/CNIII

Back 7

1. Down and out = Superior oblique, Lateral rectus only left. CNIII paralysis.

2. Ptosis. (NOT lid lag)

3. Mydriasis.

Front 8

CN IV abnormalities

Back 8

Trochlear

1. Vertical diplopia, esp. when reading

2. "UP and IN" appearance - SO lesioned

Front 9

How to detect CN6 lesion

Back 9

Abducens

Lateral deviation

Front 10

How to inspect iris

Back 10

1. Shine light from temporal side

2. Look for crescentic shadow

3. If seen, indicates glaucoma

Front 11

Pupil - 3 abnormalities, clinical correlate

Back 11

1. Miosis: constricted

2. Mydriasis: prolonged dilation

3. Anisocoria : if >5mm, <3mm, or unequal. PS contricts, sympathetic dilates.

Argyll Roberson Pupils: Constricts w/focus on near object (near reaction) BUT not with light (concensual light reflex).

CAUSES: Neurosyphilis, brain trauma, mitral regurgitation, thiamine (B1) deficiency

Front 12

Horner's syndrome signs

Back 12

MUST HAVE ALL FOUR:

1. Miosis, anisicoria, ptosis, anhydrosis (decreased pupil size, pupil size difference, ptosis, sweating on one side)

Common causes: CVA, tumor/spinal cord injury, carotid,neck injury, LUNG CANCER, idiopathic, migraines, heterochromia if congenital

PANCOAST TUMOR: in apices of lung, can insult autonomic nervous system --> horner's.

Front 13

Marcus Gunn Pupil

Back 13

Change in pupillary reflex caused by unilateral optic nerve or retinal disease.

Use swinging flashlight test

Unhealthy eye will constrict less OR, if severe, dilate when shined on

Front 14

Adie's pupil (Tonic - presentation, cause)

Back 14

Affected pupil is larger than the other. Responsds to accommodation and convergence in slow fashion. Reacts to light only after prolonged exposure.

PARASYMP. denservation. Loss of knee/ankle DTRs.

Front 15

Describe types of strabismus (4) + How to test

Back 15

Cover affected eye. When uncovered, affected eye drifts back center.

Cover unaffected eye. Unaffected will drift.

Front 16

Nystagmus - presentation, meaning

Back 16

1. Fine rhythmic oscillation

2. Normal in extreme lateral gaze, slightly

3. Seen in neurological disorders

Front 17

Disorders seen under ophtalmoscope (2)

Back 17

1. Corneal arcus - normal aging, young African americans. Usually benign. White right.

2. Cataract: Clouded appearance in lens.

3. Diabetic retinopathy

4. Hypertensive retinopathy

Front 18

Hypertensive retinopathy presentation

Back 18

Front 19

Other abnormalities

Back 19

1. Herpes zoster near eye - refer to emergency opthalm. (may be blind by morning)

2. Subconjunctival hemorrhage - harmless

Front 20

Label normal fundus

Back 20