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189 Cards in this Set
- Front
- Back
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What are the objectives for developing and maintaining bionocular vision?
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Foveal centration and lens accommodation. To be able to fix the fovea centralis in each eye on the same target.
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The Fovea centralis si about how big?
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1.5 mm in diameter.
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What are the first things required to develop dinocular vision?
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Learning to use EOMs and ciliary muscles.
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Yoked eye movement and yoked vergence movements present by what age?
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yoked/ conjugate eye movments by about 4 months. Yoked vergence by about 6 months.
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What is the bilateral lens accomodation needed for?
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Near vision.
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What is the primary processing center for visual info in the brain?
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Lateral geniculate nuclei in the thalamus.
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How is binocular vision established with cortical mapping?
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These pathways are activity-driven sorting process.
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Complete / total deprivation of vision from one eye early in life will cause what to happen?
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It prevents side-to-side balance from developing and the non-deprived eye will assume control of nearly all cortical cells.
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What is emmetropia and amblyopia?
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Emmetropia- perfect vision. Amblyopia- Lazy eye.
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What is important in developing depth perception?
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Normal retinal correspondence (NRC).
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Convergence insufficiency can cause what?
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Eyestrain headaches.
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What is convergence insufficiency?
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Inability to maintain binocular alignment on near objects.
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When will Convergence insufficency be uncommon?
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In children under 10. More common in adolescents and young adults.
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Convergence insufficiency is associated with what?
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Prolonged periods of reading and computer use.
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What happens with convergence insufficiency?
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One eye usually deviates outward during convergence on a near object.
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Besides eyestrain headaches what can convergence insufficiency cause?
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Blurred vision for near objects, diplopia (double vision).
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What is a treatment for convergence insufficiency?
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Lifestyle changes.
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What is a potential problem with convergence insufficiency?
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The patient may be asymptomatic and may learn to suppress vision from the eye that deviates during near vision.
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What % of children experience some type of vision problems?
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5-10%.
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What % of children with vision problems show eye misalignment?
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1-4%.
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Of the children with eye misalignment problems what % will develop amblyopia?
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40%.
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What is the big question to ask when children have convergence insufficiency?
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Is the misalignment constant, intermittent, or alternating.
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What is Amblyopia and what is anisometropia?
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Amblyopia- Lay eye. Anisometropia- Not in the same measure of light the 2 eyes have an unequal refractive power/ unequality.
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What type of vision are infants born with?
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Farsightedness.
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Amblyopia most often manifests when?
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Between 6 months - 2 years.
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Amblyopia will most often be uni or bi lateral?
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Unilateral.
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What is the leading cause of monocular vision loss in those 20-70?
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Amblyopia.
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What is the likely outcome of constant, intermittent or alternating deviations?
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Constant- amblyopia/ vision loss. Intermittent or alternating- less likely to result in amblyopia.
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Most of the factors that lead to amblyopia involve what?
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Suppression of vision usually in one eye.
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What is strabismus?
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Latin for squinting, but is a generic term used for eyes that are not properly alligned with each other, and will not describe the circumstance under which the deviation occurs.
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What is Phoria?
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Latin for bearing, but is refering to a latent(it is there, but cant really be tell that it is there) deviation that occurs only when one eye is covered.
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Phoria is common in who?
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Children under 5 years of age.
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What is tropia?
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Latin for turning, but refers to a manifest(well seen) deviation that occurs when both eyes are open and uncovered.
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What type of tropias will and will not result in amblyopia?
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Constant- are more likely. Intermittent and alternating are less likely.
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How is the screening for phoria done?
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Cover-uncover test.
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What will surgery for eye deviation be like?
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Sometimes takes about 3 surgeries to fix.
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What can prolonged or unsupervised patching cause?
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Amblyopia.
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What are the most common types of deviations?
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Medial.
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Medial deviations are aka?
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Esotropias.
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Esodeviations account for what % of ocular deviations?
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50%.
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After medial (esotropias) what are the second most common eye deviations and they are aka?
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Lateral deviations aka exotropias.
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Exodeviations are often ____.
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Hereditary.
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Constant exodeviation could be caused by what?
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CN III damage.
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Vertical eye deviations are often accompanied by what?
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Characterisitic head tilt.
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Vertical eye deviations are associated with what (besides characterisitic head tilt)?
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CN IV paresis.
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What % of males and females will have vision problems after whiplash accidents?
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males- 11.5%. Females- 13%.
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What % of males and females will have dizziness/ unsteadiness after whiplash accidents?
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males- 41.4%. Females- 48.3%.
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What is the test done for visual acuity?
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Snellen chart.
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What is the snellen chart test of visual acuity like?
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A rough estimate.
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What is the easiest and hardest letters to read on the snellen chart?
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Easiset is L and hardest is B.
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How is visual acuity determined from a snellen chart test?
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The smallest line on which the patient can distinguish more than one-half the letters is the visual acuity.
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What is legal blindness?
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A distant vision of 20/200 or less in the better eye when the best possible correction has been applied and or a visual field that subtends an angle of less than 20 degrees.
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Why is the near visual acuity not routinely assessed in a screening exam?
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This exam is notoriously imprecise.
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What is presbyopia?
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Old vision. Age-related loss of elasticity in the lense that leads to a far-sightedness for near vision.
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Presbyopia is an inability to _____?
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Accommodate and leads to far-sightedness for near vision.
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What % of refraction occurs in the cornea and what % happens in the lens?
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80% in the cornea. 20% in the lens.
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How common is true emmetropia?
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rare.
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What is myopia and yperopia?
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Myopia- near-sightedness. Hyperopia- far-sightedness.
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What is the difference of refractive myopia and axial myopia?
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Refractive- lense is too great. Axial- eyeball is too long.
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What is the difference of refractive and axial hyperopia?
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Refractive- lense is insufficient. Axial- eyeball is too short.
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What type of error is more common refractive or axial?
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Refractive.
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Axial errors are more likely to have what?
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Complications.
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What is astigmatism?
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Unequal refraction in different meridians of the eyeball that cause difficulties in seeing fine detail.
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Astigmatisms affect what % of people?
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1 in 3 people.
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What is more common a regular or irregular astigmatism?
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Regular is much more common.
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What should be done when testing peripheral vision with the confrontation method?
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Make eye contact with patient.
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What is the difference between negative and positive defects?
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Negative- objective blind spots so patient sees nothing. Positive- perceived blind spots so patient sees flashes of light.
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What is a hemianopia and a quadrantinopia?
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Hemianopia- blindness in one half of the visual field of noe or both eyes. Quadrantinopia- Blindness in one quarter on the visual field of one or both eyes.
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A lesion to the midline optic chiasm will cause what type of problem with vision?
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Bitemporal hemianopia this leads to a loss of peripheral vision since it is bilateral.
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A bitemporal hemianopia is commonly caused by what?
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Pituitary tumor.
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A lesion to the right optic radiation will cause what type of problem with vision?
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Left homonymous hemianopia. Which will be a loss of vision in the left visual field in both eyes.
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A lesion in the optic radiation is commonly caused by what?
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Vertebrobasilar artery insufficiency.
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When might a patient not be awar that they have a homonymous hemianopia caused by a lesion to the optic radiation?
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If macular vision is preserved.
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What is a scotoma, scotomata?
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scotoma- blind island. Scotomata- blind islands.
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Scatomas can by what type of visual problems?
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Positive or negative.
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What is the cause of floaters in the vision?
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Vitreous substance between the lense and retina can become detached and this is called posterior virteous detachment PVD.
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When should floaters be taken very serious?
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Sudden shower of floaters, new light flashes, a veil or curtain obstructing your vision should be refered to the ER.
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Sudden showers of floaters is a warning of what?
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Retinal detachment and this is one of the 3 most time sensitive opthalmic emergincies.
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What are the first components of the eye exam?
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PERRLA. P-pupils, E-equal size, R-round, R-reactive to, L-light, A-accomidates to near vision.
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What is the second component of the eye exam?
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Corneal reflection test. Assesses the alignemtn of the eyes in the neutral position.
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What is the third component of the eye exam?
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Cardinal field of gaze. This is done in neutral position and in conjugate pursuit movements of paired EOMS.
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What is EOMs?
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Exraocular muscle movements.
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What is Ptosis?
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Drooping of the upper eyelid.
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With ptosis what is the question that should be asked?
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Is it of new onset or an existing problem.
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What are the 2 general types of ptosis?
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Congenital and acquired.
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What are the 2 causes of congenital ptosis and which one is most common?
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1. Localiezed myogenic dysgenesis and this is the most common. 2. Congenital horners syndrome or congential CN III palsy.
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Wich cause of congenital ptosis will there be abnormalities in pupil size?
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Just congenital horners syndrome or congenitla CN III palsy.
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What are the 3 causes of acquired ptosis?
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1. Acquired aponeurotic ptosis- from aging, surgery or inflammation. 2. acquired horners syndrome or acquired CN III palsy. 3. Acquired myogenic ptosis.
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Of the causes of acquired ptosis which one(s) will cause abnormal pupils?
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Just horners and CN III palsy.
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What should be done with lumps on the eye lid?
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squeexing them is ill-advised.
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What is acquired myogenic ptosis?
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acquired weakness of the superior rectus and or medial rectus muscles with concurrent weakness of the levator palpebrae supeioris is common.
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What are 2 ways to say abnormalites in the shape of the pupil?
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Pupillary dyscoria, coloboma.
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What is synechia?
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Adhesion of the iris to the cornea or the lense.
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Synechia are uncommon complications of what?
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Acute iritis.
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Acute iritis is often confused with what?
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Conjunctivitis aka pink eye.
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What is anisocoria?
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an inequality in pupil size.
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How common is anisocoria?
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seen in up to 20% of the population.
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What is the pupilary refelx like with anisocoria?
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It is intact.
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What drugs are used to dialate the pupils?
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Mydriatic agents.
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What is adie's tonic pupil/ adies pupillotonia?
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Sluggish and delayed reactions of the pupil.
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What is associated with argyll robertson pupil?
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Tabes dorsalis, and syphilis.
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If there is a picture on the midterm of eyes with different pupil sizes which one will be the affected or problem pupil the large or small one?
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The one that is bloodshot.
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What is acute iritis?
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A painful, aching, bloodshot eye and small pupil.
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What is acute glaucoma?
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a very painful, bloodshot eye and a large pupil.
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Which condition is a true medical emergency acute iritis or acute glaucoma?
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Acute glaucoma.
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What is the key difference between conjunctivitis vs. acute iritis/ glaucoma?
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pink eye is not an intra-ocular inflammation and does not change pupil size or shape.
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Do you need good vision to have a direct and a consensual pupil response to light?
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No you can even be blind and have both direct and consensual pupil responses to light.
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What is hippus?
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Normal variant in the pupillary reaction to light.
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What is miosis of the eye?
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Excessive constrictino of the pupil. This is abnormal when the pupil will not dilate in the dark.
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What is mydriasis?
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Excessive dilation of the pupil. This is abnormal when the pupil will not constrict in bright light.
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What is the second step in an eye exam after PERRLA?
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Assessing ocular alignment in the primary (neutral position).
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How is the assessment of ocular alignment in a neutral position done?
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Have patient stare at an object and look for the corenal reflection.
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Will the corneal reflex test determine if there is a phoria?
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No. A phoria is an eye deviation that occurs only when one eye is closed or covered.
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What % of population will have some degree of eye deviation?
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1-4%.
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What is the third step in the eye exam (after PERRLA and ocular alignment)?
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Cardinal field of gaze.
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What is concomitant strabismus? AKA?
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Abnormal cardinal gaze, A noticeable deviation of the eye. AKA non-parylitic strabismus.
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Will concomitant strabismus involve muscle weakness?
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No.
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What 3 things will a concomitnat strabismus imply?
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abnormal origin or insertion of a muscle. Abnormallity in muscle length. Abnormallity associated amblyopia.
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What is non-concomitant strabismus?
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Abnormla cardinal gaze with paralysis and or restrictions to movement of the extra-ocular muscles.
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When will the worst deviation and double vision occur with extraocular muscle palsy?
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When the patient looks in the direction of the weak muscle.
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What will it suggest when the patient looks in the direction of a weak muscle with extraocular muscle palsy?
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Lesion of the cranial nerve nucleus, the cranial nerve, the neuromuscular junction, or the muscle itself.
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CN III palsy is aka?
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Oculomotor palsy.
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CN IV palsy is aka?
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trochlear palsy.
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CN VI palsy is aka?
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Abducens palsy.
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Kera refers to what?
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Cornea.
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What is ectropion and endtropion?
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Ectropion- eversion of the eyelid margin. Endtropion- inversion of the eyelid margin.
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How will ectropion happen?
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Acquired- age related or paralytic like bells palsy
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What are the complications of ectropion?
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inadequate tear drainage which leads to excessive tearing.
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Bleph means what?
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eye lid.
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What are the 2 types of blepharitis?
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Anterior- an inflammation around the eyelashes and follicles. Posterior- involves the meibomian gland.
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Posterior blepharitis is aka?
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Internal hordeolum.
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Hordeolums will be what?
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H for hurt or painful.
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What is an external hordeolum?
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A stye, a painful inflammation of an eyelash follice.
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What are external hordeolums like?
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Painful self-limiting, usually don’t result in problems, recurrences are common.
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What is an internal hordeolum?
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A painful meibomian gland.
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What are the internal hordeolums like?
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self limiting, can result in compliations and recurrences are common.
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What is a chalzaion?
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Painless retention cysts associated with the meibomian gland.
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What should be considered with a recurrent chalazia?
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sebaceous carcinoma, squamous cell carcinoma, microcystic adnexal carcinoma or TB.
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What is xantheisma?
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Subcutaneous lipid deposition and it is the most common cutaneous xanthoma.
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What is the possible correlation with xanthelasma's?
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elevated plasma lipid levels in 50% of people.
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Dacryo refers to what?
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Lacrimal.
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What is dacryoadenitis?
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Painful inflammation and swelling of the lacrimal gland.
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What is keratoconjunctivitis sicca and what is it aka?
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aka KS and it is dry eyes due to insufficient tear production.
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What is sjogren syndrome?
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Dry mouth dry eye.
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What is dacryocystitis?
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Infection of the lacrimal sac.
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Where is the palpebral conjunctiva?
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It lines the inner surface of the eyelids.
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Where is the conjunctiva at?
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The transparent modified mucous membrane of the eye.
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What is the cornea?
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A transparent multi-layered avascular structure of the eye.
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What will provide 85% of the refractive power of the eye?
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The cornea.
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What is the pain like for the conjunctiva and the cornea?
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Conjunctiva- much less pain-sensitive than the cornea- which is VERY pain sensitive.
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What is found in the iridocorneal angle?
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The canal of schlemm.
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What is the normal intra-ocular pressure?
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14-20 mmHg.
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What is pinguecula and pterygium?
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Pinguecula- elevated, benign, yellow fibrovascular connective tissue mass. Pterygium- a benign, fleshy wing like fibrovascular connective tissue growth.
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Injection means what?
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Bloodshot eyes.
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What is worse conjunctiva injection or ciliary injection?
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Conjunctiva not so bad, but ciliary is bad.
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What are the general signs and symptoms of conjunctivitis?
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red eye, discomfort, discharge, not overtly painful, not photophobic, vision unchanged, pupillary reactions are normal.
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What is the most important clinical feature of acute allergic conjunctivitis?
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Ocular itching.
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What else is possible with acute allergic conjunctivitis?
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Lymphoid follicular response.
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What is a lymphoid follicular response?
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Bumbs of lymphoid tissue aggregate in the palpebral conjunctiva giving it a cobblestone appearance.
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Pink eye is aka?
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Adenoviral conjunctivitis.
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Adenoviral conjunctivitis is the most common cause of what?
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Viral conjunctivitis.
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What is pink eye like?
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sudden onset and can last 2-4 weeks with redness, mild itching, tearing, chemosis, and pseudomembranous.
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What is the clinical concern with adenoviral conjunctiva?
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differentiating it from conjunctivitis due to herpes simplex infection.
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What are the common pathogens that cause acute bacterial conjunctivitis?
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Staphylococcus pneumoniae and haemophilus influenza.
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What is the stronges perdictor that one might have an acute bacterial conjunctivitis?
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Awakening with one or both eyes glued shut. Also a mucopurulent discharge that crusts on eyelashes.
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What is the clinical concern with acute bacterial conjunctivitis?
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The concern would be if the infection was caused by bacteria that is very aggressive to the conjunctivia like N. Gonorrhoeae or chlamydia.
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What are signs of corneal diseases?
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Localized pain, photophobia, reduced visual acutiy, lacrimation, blepharospasm (spasm of the eyelids), iridescent vision, and ciliary injection.
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What is the most important (for the test) sign of corneal disease and what is it?
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Iridescent vision. Breaking down of halo into light specturms.
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How will adenovirus, herpes simplex, and chlamydia affect the cornea?
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Adenovirus- rarely results in complications. Herpes and chlamydia often result in complications.
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Adenviral keratoconjunctivitis manifests how?
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minimal pain, some photophobia, pre-auricular lymphadenopathy, lymphoid follicular response.
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What type of herpes simplex virus affects the ocular area?
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HSV-1. HSV-1 is genital infection.
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What are the important patient presentations with HSV-1?
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Vesicular eruptions on eyelids or face (like chicken pox), Photophobia, blurred vision.
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What is the most common cause of blindness in the USA and the world?
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USA- HSV-1 keratitis. World- Chlamydial keratitis.
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Why is chlamydial keratitis the most common cause of blindness in the world?
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Poor sanittation and poor public heatlth.
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What type of medical emergency will chlamydial keratitis be?
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A ophthalmologic emergency since the cornea may rapidly lead to perforation of the cornea.
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What is Episcleritis?
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Inflammation of the Episcleral tissue found between the conjunctiva and the sclera.
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What is scleritis?
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Diffuse or localized inflammation of the anterior sclera with necrosis.
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What is a common cause of scleritis?
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48% are associated with autoimmune disorders.
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What is scleritis like?
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Almost always painful.
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What is anterior uveitis?
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Inflammation of the anterior chamber.
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What are the classic indications of anterior uveitis?
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Direct eye pain, redness, small pupil that reacts poorly to light.
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What type of medical emergency is anterior uveitis?
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A true medical urgency not a true medical emergency.
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What is angle-closure glaucoma like?
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a less common type of glaucoma and is usually unilateral and symptoms are present form onset of angle closure.
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What are the diagnostic critera for a angle-closure glaucoma?
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at leaste 2 of these; ocular pain, intermittent blurring of vision with halos, nausea/vomiting. At leaste 3 of these; nonreactive pupil in mid-dilation, ciliary injection, corneal epithelial edema, intraocular pressure that is > 21 mm Hg, a shallow anterior chamber.
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What type of a medical emergency is acute angle-closure glaucoma?
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A true medical emergency that can result in permanent vision loss in a matter of hours.
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What is a subconjunctival hemorrhage?
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Rupture of conjunctival and or episcleral blood vessels, with bleeding inot the potential space between the conjunctiva and sclera.
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What causes a subconjunctival hemorrhage?
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Trauma, may be idiopathic, may be due to coughing, vomiting, straining, etc.
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What happens to someone with subconjunctival hemorrhage?
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Usually asymptomatic and resolves completely within 2 weeks.
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What is traumatic hyphema?
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Accumulation of blood in the anterior chamber following trauma to the eye.
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