Eye_Exam

Front 1

What are the 2 purposes of the eyelids

Back 1

Protect the eyeball and lublricate the ocular surface

Front 2

Where are the meibomian glands located?

Back 2

Within the tarsal plate in each eyelid (upper and lower)

Front 3

The lids come together at the medial and lateral _____.

Back 3

Canthi

Front 4

The space between the lids is called the ____.

Back 4

Palpebral fissure.

Front 5

The thick outer coat of the eye, normally white and opaque is called the ____.

Back 5

Sclera

Front 6

____ is the junction between the cornea and the sclera

Back 6

Limbus

Hint 6

None

Front 7

The Iris is the colored part of the eye that screens out light, primarily via the _____, which lines its ____ surface.

Back 7

pigmented epithelium, posterior

Front 8

The ___ is the ciruclar opening in the center of the iris that adjusts the amount of light entering the eye.

Back 8

pupil

Front 9

The size of the pupil is determinted by the ____ and ____ innervation of the ___.

Back 9

sympathetic, parasympathetic, iris.

Front 10

The thin, vascular tissue covering th inner aspect of the eyelids and sclera.

Back 10

Conjunctiva

Front 11

The ____ conjunctiva covers the inner aspect of the eyelids

Back 11

papebral cojunctiva

Front 12

The ____ conjunctiva covers the sclera

Back 12

bulbar conjunctiva

Front 13

CN IV innervates what muscle

Back 13

superior oblique

Front 14

CN VI innervates what muscle

Back 14

lateral rectus

Front 15

___ is the space that lies between the cornea anteriorly and the iris posteriorly. ____ fluid is found inside

Back 15

Anterior chamber, aqueous humor

Front 16

___ is the transparent, biconfex body suspended by zonules behind the pupil and iris; art of the refracting mechanism of the eye.

Back 16

Lens

Front 17

____ produces aqeous humor

Back 17

ciliary body

Front 18

Contraction of the ___ muscle changes tension on the zonular fibers that suspend the lens and allows the eye to focus from distant to near objects (accomodation)

Back 18

Ciliary body

Front 19

The _____ is the small space filled with aqueous humor behind the iris and in front of the vitreous.

Back 19

Posterior chamber

Front 20

____ is the relatively large space (4.5cc) behind the lens that extends to the retina. It is filled with transparent jelly-like material called the ____

Back 20

Viterous cavity, vitreous humor

Front 21

____ is the neural tissue lining the vitreous cavity posteriorly.

Back 21

Retina

Front 22

____ lie on the surface of the retina which is otherwise transparent.

Back 22

Blood vessels

Front 23

____ is the area of the retina at the posterior pole of the eye responsible for fine, central vision.

Front 24

The oval depression in the center of the maucla is called the ____

Back 24

fovea

Front 25

____ is the vascular, pigmented tissue layer between the sclera and the retina

Back 25

Choroid

Front 26

The choroid provides the blood supply for the ___ retinal layers

Back 26

outer

Front 27

____ is the portion of the optic nerve visible within the eye. It is comprised of axons whose cell beodies are located in the ___ cell layer of the retina

Back 27

Retina, ganglion

Front 28

What 2 structures make up the refractive surfaces of the eye

Back 28

cornea and lens

Front 29

The cornea provides ___ of the refractive power, while the lens provides.

Back 29

2/3 cornea, 1/3 lens

Front 30

An axial length of the eye that is too short will result in ___

Back 30

hyperopia

Front 31

An axial length of the eye that is too ong will result in ___

Back 31

myopia

Front 32

If the refracting power of the cornea and lens is different in one meridian than in another there will be a decrease in refractive power called ___

Back 32

Astigmatism

Front 33

A pinhold placed directly in front of the eye will narrow the effective ___(2 words)___ and thereby minimize the blurring induced by a refractive error

Back 33

pupillary aperture

Front 34

The ability of the ciliary muscle to contract and the lens to become more convex is called ____

Back 34

accommodation

Front 35

Loss of accommmodation due to lens hardening is manifested by a decreased ability to focus on near objects called ____, while corrected distance visual acuity remains normal

Back 35

presbyopia

Front 36

Some myopic patients with presbyopia can remove their distance glasses to read because _____?

Back 36

They do not need to accommodate in the uncorrected state

Front 37

What are the 4 components of a minimal ocular exam

Back 37

visual acuity, pupillary reactions, extraocular movements and direct ophthalmoscopy the undilated pupils

Front 38

What are the 2 cases when pupillary dilation for ophthalmoscopy is required

Back 38

unexplained visual loss or suspected fundus pathology (DM)

Front 39

At what age should children have their distance visual acuity measured and why?

Back 39

3, to detect amblyopia

Front 40

If a patient has been diagnosed with glaucoma what test should be done?

Back 40

Tonometry

Front 41

If narrow-angle glaucoma is suspected what test should be done prior to pupillary dilation?

Back 41

Anterior chamber depth assessment

Front 42

What type of testing should be done if there is suspicion of a visual field defect?

Back 42

Confrontation field testing

Front 43

What test should be done in patients with retinal and optic nerve disorders?

Back 43

Color vision testing

Front 44

What test is done when a corneal epithelial defect or abnormality is suspected?

Back 44

Flourescein staining

Front 45

What should be done if the presence of a foreign body is suspected?

Back 45

Eversion of the upper lid

Front 46

Why is 20 feet used as the standard for distnace visual acuity testing

Back 46

For practical purposes this distance may be equated with optical infinity

Front 47

In what case should pinhole test be used?

Back 47

If the visual acuity is 20/40 or less in one or both eyes. It can be done over the subjects glasses

Front 48

What should be done if the patient cannot read the Snellen chart at 3 feet

Back 48

Finger counting test, must record finger distance accurately (CF 1ft)

Front 49

If the patient cannot count finger what test should be done?

Back 49

hand movement test, record distance at which pt can see hand move (HM 2ft)

Front 50

If the patient cannot see hand motion what test should be done?

Back 50

Penlight presense and direction (LP = light perception + projection, NLP = no light perception)

Front 51

Level of visual impairment that requires strong reading glasses, insufficient for driving

Back 51

Moderate low vision, 20/80 to 20/160

Front 52

Level of visual impariment that results in inability to read traffic signs, but allows adequate glorss orientation and mobility.

Back 52

Severe low vision, legal blindness in US, 20/200-20/400, or CF 10ft

Front 53

Level of visual impairment that results in increasing problems with visual orientation and mobility and makes longcane useful. Highly motivated pts can read with extreme magnification.

Back 53

Profound low vision, CF 8ft to 4ft

Front 54

What level of visual impairment results in vision that is unreliable except under ideal circumstances, pt must rely on nonvisual aids

Back 54

near-total blindness, less than CF 4ft

Front 55

What level of visual impairment results in no light perception at all

Back 55

Total blindness, NLP

Front 56

Under what circumstances is near visual acuity testing done?

Back 56

Complaint about near vision or inablity to test far vision (pt in bed)

Front 57

What reflex response suggests presense of vision?

Back 57

brisk pupillary response to light except in pts with cortical blindness

Front 58

What are the 2 components of pupillary reaction testing

Back 58

direct and consensual pupillary reaction to light while looking at a distant object

Front 59

What test is used to determine an afferent defect in the anterior visual pathway?

Back 59

swinging-flashlight test

Front 60

Name 2 causes of alteration in pupillary shape or size due to a local intraocular process

Back 60

damage to pupillary sphincter or adhesion of iris to lens

Front 61

What 2 muscles are being tested when the patient looks Right and Up

Back 61

Rt superior rectus and Lt inferior oblique

Front 62

What 2 muscles are being tested when the patient looks Right

Back 62

Rt lateral rectus and Lt medial rectus

Front 63

What 2 muscles are being tested when the patient looks Right and Down

Back 63

Rt inferior rectus and Lt superior oblique

Front 64

What 2 muscles are being tested when the patient looks Left and Up

Back 64

Lt superior rectus and Rt inferior oblique

Front 65

What 2 muscles are being tested when the patient looks Left

Back 65

Lt lateral rectus and Rt medial rectus

Front 66

What 2 muscles are being tested when the patient looks Left and Down

Back 66

Lt inferior rectus and Rt superior oblique

Front 67

What are 3 contraindications to pupillary dilation?

Back 67

shallow anterior chamber and narrow angle, neuro observation for pupillary signs (post head injury) and s/p cataract extraction with implantation of an IRIS supported intraocular lens (pupil looks square)

Front 68

What are the 4 things in order that should be examined on ophthalmoscopy

Back 68

optic disc, retinal blood vesselss, retinal background and macula

Front 69

The ____ is a central depression in the surface of the optic disc

Back 69

physiologic cup

Front 70

What is the normal disc diameter?

Back 70

1.5mm

Front 71

What causes a hypopigmted crescent of the optic disc

Back 71

If the retinal pigment epithelium and/or choroid fail to reach the disc margin

Front 72

Which patients frequently have a hypopigmented temporal crescent

Back 72

myopic pts

Front 73

What can cause a dense white superficial opacification with feathery edges of the optic disc?

Back 73

If myelination of the optic nerve extends onto the surface of the disc

Front 74

In what layer are the divisions of the retinal artery found?

Back 74

Superficially in the nerve fiber layer

Front 75

What % of normal eyes will have spontaneous pulsation of vessels at optic disc?

Back 75

80%

Front 76

What is the ratio of normal vein to artery diameter?

Back 76

3:02

Front 77

How should the arteries and veins of the retina be examined?

Back 77

Arteries followed away from the disc, veins toward the disc for each quadrant

Front 78

Where is the macula found and how can it be recognized

Back 78

Darkly pigmented area temporal to the optic disc (specialized retinal pigment epithelial cells of the macula are taller and more heavily pigmented)

Front 79

What causes the foveal reflex

Back 79

Light reflecting off the concave surface of the fovea

Front 80

What determines the intraocular pressure

Back 80

Outflow of aqeous humor and amount produced

Front 81

What is the mean IOP in a normal , what is the normal range

Back 81

15mm Hg, 10 to 21.5

Front 82

What type of tonometer is used by ophthalmologists

Back 82

Goldmann applanantion tonometry

Front 83

The iris becomes convex as it is bowed over the lens in what circumstance

Back 83

shallow anterior chamber, nasal iris is seen in a shaddow when light is shined from opposite side

Front 84

Who do you assess for shallow anterior chamber?

Back 84

Shine light from temporal side across front of eye and look at nasal aspect of iris, if 2/3+ is in shadow the chamber is shallow

Front 85

What is the reference in confrontation field testing?

Back 85

The visual field of the examiner, pt counts fingers held up by examiner

Front 86

What method is used to evaluate the macula

Back 86

Amsler grid testing

Front 87

What are the 3 color sensitive pigments of the retina

Back 87

red, green and blue

Front 88

What is used for color testing

Back 88

Pseudoisochoromatic plates (Ishihara plates)

Front 89

What maneuver is used to return the eye to its normal position after upper eyelid eversion

Back 89

examiner releases the lid margin and instructs pt to look up

Front 90

In flourescein testing what denotes absent or decreased epithelium

Back 90

areas stained bright green

Front 91

What enhances the visibility of flourescein?

Back 91

cobalt blue light

Front 92

2 precautions in flourescein testing

Back 92

use strips not solution (suseptible to psuedomonas) and remove contacts to avoid discoloration of the contacts

Front 93

11 steps of eye exam in summery

Back 93

measure visual acuity
peform confrontation field testing
inspect eyelids and surrounding tissues
test extraocular movements
test the pupils for direct and consensual responses
inspect the cornea and iris
assess the anterior chamber for depth and clarity
assess the lens for clarity through direct ophthalmoscope
use ophthalmoscope to study fundus, disc vessels and macula
perform tonometry when indicated

Hint 93

None

Front 94

6 indications for referal to ophthalmologist

Back 94

visual acuity less that 20/20 in either eye with complaints
visual acuity less that 20/40 without complaints
Assymetry: difference in visual acuity of 2+ lines on Snellen chart
Presbyopia
Abnomal fundus
IOP > 22mm

Hint 94

None