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25 Cards in this Set

  • Front
  • Back
Hyperopic
- far-sighted
- axial length too short for the power of the cornea and lens
Myopic
- near sighed
- An eye that is too long for the power of the cornea and lens will be myopic
Miosis vs Mydriasis
Miosis = pupillary constriction
Mydriasis = pupillary dilation
Using the Opthalmascope - how far to stand away from patient? from what direction? red reflex?
Start approximately 1 foot from the patient, and look at the patient’s pupil from an angle slightly lateral to the patient’s line of vision. Shine the light at the pupil, and you will note a red-orange reflection from the pupil, similar to “red eye” often seen in photographs. This is the red reflex.
- Focusing on the red reflex, slowly move closer to the patient, remaining at an angle
- 7. Once you spot a retinal vessel, focus on it and track it to the optic disc. If the vessel becomes smaller, it may be leading away from the optic disc; track it in the opposite direction until you find the disc
which has higher refractory index, cornea or lens?
most of focus is done by the cornea
Measure visual acuity
- what are you measuring?
- how?
- why measure?
- Distance and near vision (with corrective lenses, if patient uses them)
- use wall chart or count fingers
- assess for presence/monitor progression of decreased vision
Anisocoria
- if pathological?
- aniscoaria is _____ in disease of CN II
difference in size/shape of pupils - 3% of population
- pathological --> disease of iris, CNIII (efferent)
- aniscoria is absent in disease of CN II (afferent)
Pupillary light reflex
function of Cranial Nerves II and III
- Cranial Nerve II is the afferent loop, receiving and transmitting the light signal
-Cranial Nerve III is the efferent loop- motor nerve to the iris, causing miosis (pupillary constriction)
Presbyopia
difficulty focusing at near because of reduced accomodation
Confrontation testing
have patient cover eye, and examiner holds hand out and flashes fingers in all 4 quadrants of visual field
--> asesses for subtle areas of vision loss

simultaneous test of right left visual fields
- flash two hands at same time and ask patient number of fingers
- (detects for homonymous hemianopias)
Direct pupillary response
shine light at each eye individually, watch for constrction
consensual pupillary response
shine light at one eye and watch for constriction of opposite pupil.
Accommodation Reflex
Ask the patient to focus on a distant, non-lighted object, such as a pen held in your hand. Slowly move the object towards the patients nose. As the object moves closer, the patient’s eyes will converge, and the pupils will constrict.
Swinging Flashlight Test
- relative afferent pupillary defect?
Tests for relative afferent pupillary defect (Marcus Gunn pupil) - decreased function of Cranial Nerve II (or retina)
- If there is decreased function of CN II, the light signal received will not be as intense, and the pupil will constrict less.
o In a room with dim light, ask the patient to look at a distant object.
o Shine the penlight in one eye; both eyes should constrict (direct and consensual papillary responses.)
o Quickly swing the penlight to the opposite eye; both pupils should constrict to the same degree.
o If, when you swing the light quickly to the opposite eye, both eyes dilate slightly and remain dilated, there is a relative afferent pupillary defect in the eye that results in dilation.
why perform swinging flashlight test?
A relative afferent papillary defect is 92-98% sensitive in detecting asymmetrical optic nerve disease (optic neuritis, etc.)
why examine lids and surrounding structures?
infection, trauma
difference between palpebral and bulbar conjuctiva?
- what should conjuctiva look like?
1. palepbral conjunctiva: on inside of lids
2. bulbar conjunctiva: convers the surface of the eye
- The conjunctivae should be smooth, pink, and moist, without discharge.
Movements uf superior oblique? movements of inferior oblique?
o Superior Oblique (CN IV)- Intorsion, depression, abduction; downward inward gaze
o Inferior Oblique (CN III)- Extorsion, elevation, abduction; upward outward gaze
Ocular alignment (strabismus) test
- First, have the patient focus on a pinpoint light source, and note the location of the light reflex on the cornea.
- Next, cover one of the patient’s eyes, while watching the light reflex on the other eye. If you see the light reflex change position on the cornea, you know that this eye is moving to focus on the light source. This indicates strabismus (lack of coordination between the eyes,) with the covered eye being the dominant eye.
Inspection of cornea and iris:
- fluorescein staining
- anterior chamber depth
- fluorescein staining: staining of cornea to detect epithelial defects - areas of denuded corneal epithelium will stain bright green
- anterior chamber depth: shine penlight on the cornea from the side and note shadow that is cast - shadow of iris should not be greater than one-half of the iris on opposite side
what part of the eye are fluorescein staining and anterior chamber depth testing?
cornea
Tonometry
- detect ocular pressure
•Schiotz tonometer: an older, but commonly used analog technique for measuring IOP.
•Tonopen: a digital pressure measuring device
•Applanation tonometry: performed by the Ophthalmologist using a slit-lamp machine
Red reflex
- shine light in pupil
- Evaluates for integrity of retina or cornea
- rays coming out of retina are so defocused --> poor red reflex
- can detect cancer (retinoblastoma)
Examining retina:
- red spots?
- dot, blot shaped red spots?
- new vessles?
-soft white, feathery patches
- discrete yellow retinal spots
- red spots = hemorrhages
- dot, blot shaped red spots = deeper intraretinal hemorrhages
- new vessels: fine, tortuous (diabetes)
- soft white feathery patches = cotton wool spots (sings of retinal ischemia)
- yellow spots: hard exudates, usually cholesterol deposits
Why examine retina?
pathology, signs of elevated intracranial pressure (papilledema), secondary signs of systemic disease