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36 Cards in this Set
- Front
- Back
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8 parts of eye exam
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Visual acuity
External exam Pupils Motility Visual fields Slit lamp/penlight IOP Fundus |
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Visual acuity
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Snellen chart
20 ft (optical infinity) Test w/ correction Right eye first 18g needle pin hole Check color, polarized light, presbyopia (if > 40yo) Snellen near motion light |
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3 common refractory dz
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Myopia
Hyperopia Presbyopia |
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Extrinsic Eye muscles/Innervation
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LR – VI
SO – IV MR, SR, IR, IO – III |
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Pupil pathway
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Retina W ganglion cells
-temporal hemiretina ipsi -nasal hemiretina contra (commissural cross talk Pretectal Superior Colliculus (commissural cross talk) EWN CN III PSNS Ciliary muscles |
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Confrontation
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1 at a time – neglect
2 at a time – field defect Face – ARMD |
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Ocular Motility
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Goal posts
Convergence |
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Fundoscopic Exam
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3-5 yrs, 1 yr if DM
Don’t dilate square pupil Don’t dilate ACG Retina – orange/red/white/yellow Optic Nerve – color, cupping |
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LOV
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CRAO – APD (after 90 min?)
CRVO DR RD AION GCA ACG – painful ON – painful, APD |
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Retina life-span
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90 min
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LOV associated w/ arteritis
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CRAO
AION GCA |
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See halos
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ACG
Viral conjunctivitis |
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4 mgmt goals
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Evaluation
Further testing Confounding factors w/ Tx – i.e. DM Plan w/ milestones |
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Causes of low/high Pressure
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Low – ruptured sclera
High – ACG |
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4 Ocular emergencies
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Alkalai burn
Ruptured globe ACG CRAO |
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3 alignment tests
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Gross observation (sclera)
Light reflex (pen light) Cover test – does eye move to focus on object +/- prism – angle of misalignment |
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4 types of eye mvmts
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Vergence – opposite directions, i.e. convergence
Voluntary – self-explanatory Version – same direction Duction – 1 eye at a time? |
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5 reasons to go to OR for strabismus
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Diplopia
Abnl head position Cosmetic/appearance Maintain binocular vision Ocular asthanopia (eye strain Sx) |
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Causes of Amblyopia
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Unilateral – Tx w/ patch, drops
-strabismus < 7yo -anisometropia < 7yo -deprivation < 70 Bilateral -Bilateral ametropia (significant refractive error) – Tx w/ glasses -Bilateral deprivation – Tx w/ contact/IOL |
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Causes of abnl Bruckner Test/Red reflex
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Strabismus
Anisometropia Opacity in ocular media/fundus (RD, RB) |
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Carotid-Cavernous Sinus Fistula
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Unilateral exophthalamos
?Erythematous conjunctiva ?swollen ?bruit Tx w/ embolization/angiography |
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CRAO
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Painless LOV
APD Vision < 20/200 Retina – pale/swollen nerve, cherry red spot Cause – embolization, Temporal arteritis Tx only RF search – Carotid US, echo, ESR, Bx Tx if embolus – pressure on globe, anterior chamber paracentesis |
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CRVO
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Painless LOV
Venous dilation, 4 quadrant hemorrhage, swollen nerve Causes – HTN, DM, hypercoagulable |
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Diabetic Retinopathy
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Hemorrhages, exudates, cotton-wool, neovascularization
Acute LOV – vitreous hemorrhage (VEGF), traction RD Dx – flourescein angiogram Tx – avastin, laser (focal, PRP) |
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Retinal Detachment
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RF – FHx, PMHx, eye surgery, very myopic
Floaters, flashes, field defect Mech – vitreous fluid causes break |
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Anterior Ischemic Optic Neuropathy
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Mech - ?poor flow? Of short posterior ciliary Aa.
Altitudinal scotoma Optic N. swell Causes – HTN, DM, vasculitis |
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Temporal Arteritis
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???jaw/scalp pain, eye pain, HA…???
Steroids, vascular Bx ↑ESR |
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ACG
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Mech – lens grows/presses against iris fluid trapped in posterior chamber
Context – matinee movie, evening Eye pain, N/V, redness, blurred vision, cloudy cornea, hard eye, halos Tx w/ lasered iris (shunt) |
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Optic Neuritis
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Def – inflammation of CN II
Asssoc – MS (also TB, syphilis, cat scratch) Acute Unilateral LOV, unilateral pain w/ eye mvmt (meninges) 20-50yo WF Mgmt – MRI, IV steroids, vision will recover |
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Chemical Burn
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Alkalai (cleaners) > acid (battery)
Eval – airway, pH, IOP Tx – IRRIGATE -5L over 20 min -topical anesthetic -lid speculum …??what mason said -hair missing = alkalai -fornix swab – pH test, remove material |
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Open Globe/Lacerated Cornea
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Pres – abnl pupil (not round or not central)
Tx – shield and call ophtho... -call ophtho -no pressure -cup/patch -no cleaning, cutting, Rx, anesthetic -NPO -no bending, valsalva |
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Hyphema
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Def – bleed into anterior chamber
Complications -↑IOP -rebleed -corneal blood staining |
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CN III palsy
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Eye is lateral, slightly down (EOM)
Blown pupil (pupil sphincter) No accommodation (ciliary body) Causes – PCA aneurysm, microvascular DM, tumor, MG |
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CN IV palsy
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CC – double vision
Tilted head to opposite side of lesion Eye turned out Causes – congenital, trauma, pedi?, MG |
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CN VI palsy
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Face turned to eliminate diplopia
Eye turned in Causes - ↑IOP, DM, trauma, MG |
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Accomodation Isotropia
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?
Eyes crossed, hyperopia, no Sx Glasses nl alignment |
