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150 Cards in this Set
- Front
- Back
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accomodation
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when pupils/lens adjust to see objects at different depths (near/far)
ABILITY TO FOCUS AND REFOCUS |
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the leading causes of vision changes are associated with...
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AGING
-glaucoma -cataracts -macular degeneration |
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upper eyelid innervated by which CN
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CN III
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what forms tears
what are the 3 parts of tears |
lacrimal gland (outer/upper part)
1)lipiod 2)aqueous 3)mucoid |
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conjuctiva and it's 2 parts
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mucus membrane whose goblet cells secrete mucus
1) bulbar-covers sclera 2) palpebral-lines both lids |
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sclera and color
what covers it |
the white of the eye serves as protection
may be blue in children may be a dull white or kinda yellow in old covered by conjuctiva which contains the vessels |
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limbus
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part around iris where conjuctiva meets the cornea
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main refractory surface of eye
how many layers does it have |
cornea
avascular clear lens that has 5 layers -the endothelium replaces itself every 7 days |
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anterior chamber what is in it and why
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area behind cornea filled with aqueous humor that nourishes the cornea
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aqueous humor is made by .....
produced by it's relationship to.. |
ciliary body
IOP |
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normal IOP (intra ocular pressure)
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10-21 mm Hg
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what controls pupil constriction/dilation
are they the same size? |
sphinchter-parasympathetic
dilator pupillae-sympathetic only in 80% of us but should respond the same if normal |
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OD
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oculus dexter =RIGHT EYE
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OS
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oculus sinister =LEFT EYE
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OU
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oculus uterque= both eyes
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age and the lens
when do you start to see these s/s |
the lens retains ALL cells formed throughout life and GROWS throughout life forming rings (like a tree)
=loss of accomodation 5th decade |
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what fluid is anterior and posterior to lens
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anterior-aqueous humor
posterior-vitreous humor |
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posterior chamber
what is made here where does it go |
between vitreous and iris
ciliary body makes aqueous humor from here into anterior chamber then trabecular meshwork into the canal of Schlemm |
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ocular fundus
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largest chamber of eye contains vitreous humor
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vitreous humor
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clear, gelatinous substance, encased by hyaloid membrane that helps maintain the shape of the eye
BEHIND THE LENS it is attached to retina by scattered collagen filaments |
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what happens to vitreous humor with age
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loses gel-like quality
may see "floaters" d/t cells/casts loses shape and effects retina |
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retina
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innermost surface of ocular fundus
10 microscopic layers that are like "wet tissue paper NEURAL TISSUE EXTENSION OF THE OPTIC NERVE |
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optic disc
what does it look like |
where optic nerve enters retina
AKA optic nerve, optic head "PHYSIOLOGICAL BLIND SPOT" looks like a oval/circular opening w/sharp edges |
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macula
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part of retina used for central vision the rest of retina used for peripheral
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retinal pigment epithelium (RPE)
sensory retina |
many Fs including absorbing LIGHT
contain photoreceptor cells rods and cones |
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rods
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retina photoreceptor cells =night vision and low light
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cones
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retina photoreceptor cells=bright light, color, fine detail
everywhere in retina but MOST in fovea (Macula) *there are NO RODS in fovea |
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optic chiasm
if this does not function |
point at which the nasal fibers from the nasal retina of each eye cross to the opposite side of the brain
pt cannot see out of left side or right side of eye BUT OPPOSITE in both eyes=bitemporal hemainopsia |
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if pt cannot see out of one eye
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unilateral blindness d/t OPTIC NERVE on that side
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optic tract does not function
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homonymous hemianopsia =OPTIC TRACT
cannot see on on SAME SIDE of BOTH EYES -problem will be on opposite side of visual cortex |
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what if pt cannot read any letters on Shnellen chart at 20'
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move chart closer and record point when pt can read largest letter on chart
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what if pt can ONLY read 'E" on chart at 10'
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record as 10'/200
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what if pt cannot see "E" at any distance
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-count fingers
record as CF/X X=number of feet |
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what if pt cannot see to count fingers
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move arm up or down or side to side as pt which direction it is being moved
-HM-hand motion |
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LP
NLP |
light perception
no light perception (hand motion) |
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retinitis pigmentosa
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night blindness
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cellophane reflex
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apperance of macula in young person
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crazy stuff seen in eye with direct opthalmoscopy
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cup should be 1/3 size of disk
veins are bigger than arteries silver/cooper disc=arteriosclerosis red smuges/flames=HTN lipids=lipidemia or diabetes "cotton wool" red dots/nevi=microaneurysms DRUSEN |
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Drusen
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seen in retina, made of hyaline globular deposits may be yellowish seen in macular degeneration
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slit lamp examination
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thing that sits on a table where the magnification can be changes like they did at school
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is color vision loss more a problem in central or peripheral conditions
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CENTRAL- because central vision identifies color
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most common test for color vision
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Ishihara polychromatic plates
uses "hidden images" using primary colors on background of secondary colors |
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Amsler Grid
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often used for those w/macular problems
grid of squares stare at center if changes are seen in peripheral this is not normal pt may be told to to this qd at home |
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color fundus photography
for what/ side effects |
to detect retinal lesions
pupil is dilated visual acuity diminished for about 30 minutes after d/t "retinal bleaching" from light |
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neovasculurization
test for it how/side effects |
growth of abnormal new blood vessels
(EX: macular degeneration ) Fluorescein Angiography dye injected into eye may turn skin yellow/urine yellow or orange |
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Indocyanine green angiography
for/ side effects |
to ID abnormalities of choroidal vasculature
injected IV may cause N/V NOT given if IODINE ALLERGY |
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applanate
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flatten
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Tonometry
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used to measure IOP
by amount needed to applanate globe |
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scotomas
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blind areas of visual field
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perimetry testing
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tests visual field an tests for scotomas
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average visual field when eye is in primary gaze
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65 upward
75 downward 95 outward (degrees) |
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refraction
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determination of the refractive errors of the eye and correction by lenses
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refractive errors
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eye is too long or short and light is not focused right
-may result in blurred vision -may be corrected by lenses/glasses |
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emmetropia
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no refraction errors=normal eye/vision
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myopia
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-deeper eyeball
-light focused before retina -NEARSIGHTED -things at distance are blurred |
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hyperopia
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-shorter eyeball
-light focused after retina -FARSIGHTED -things at up close are blurred |
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astigmatism
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-irregularly curved cornea
-can cause refractive errors -may have both problems -contacts/sx to correct -hard or conical lenses |
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BCVA
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best corrected vision at
best seen with glasses/etc |
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low vision
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needs more than just glasses/etc
BCVA 20/70 to 20/200 |
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blindness
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BCVA 20/400 or less
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clinical absolute blindness
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no light perception
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legal blindness
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BCVA 20/200 MAX in better eye
OR visual field diameter 20 degrees or less |
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travel vision
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person has some significant visual impairment but can manage without the use of aides
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glaucoma
patho AKA common s/s |
-condition causes optic nerve damage r/t increased IOP
1) direct mechanical=direct pressure to optic nerve 2) ishemic=pressure to vessels of nerve "silent thief of sight" blurred vision "halos" around lights difficulty focusing in low light loss of peripheral vision "tunnel vision" pain in eye and headache cupping of optic nerve disc pallor of optic nerve |
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how does aqueous humor drain
what does flow depend on |
1) Trabecular Network
normally aqueous humor flows between iris and lens then flows out of anterior chamber through the spongy trabecular meshwork into the canal of Schlemm and episceral veins 2) Uveoscleral route 10% from ciliary body into venous system open angle of 45 between iris and cornea |
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DX glaucoma
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tonometrey
opthalmoscopy gonioscopy=to view angle perimetry |
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miotics
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cause pupils to contstrict and trabecular network to open
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mydraitics
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medications that cause pupils to dilate
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open angle
and angle-closure glaucoma |
3 types-all have open anterior chamber
(Pupillary Block) 3 types-all obstruction of aqueous humor and increased IOP |
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risks for cataracts
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-smoking
-long term corticosteriod use -sunlight/ionizing radiation -diabetes -eye injury -obesity |
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3 most common types of senile cataracts -major differences
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-nuclear (center of lens/ myopia)
-cortical (little effect on vision/bright light) -posterior subcapsular (from posterior capsule/hyperopia/bright light and glares) |
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brunescens
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color value shifts to yellow-brown
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diplopia
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double vision
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major s/s of cataracts
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-clouding of lens (as it progresses)
-dimmer surroundings like "dirty lens" -light scattering=reduced contrast -sensitive to glare myopic shift (return of near vision) -astigmatism -monocular diplopia -color shift (more blue light absorbed) -brunescens -decreased visual acuity |
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aphakic
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without lens
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binocular vision
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ability for both eyes to focus on an object and fuse the two images into one
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keratoconus
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conical growth that sticks out of cornea
more commonly seen in younger lens used to flatten it out |
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strabismus
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"lazy eye"
deviation in ocular alignment |
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retinal detachment
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seperation of retinal pigment epithelium (RPE) from sensory layer (rods,cones,photoreceptors)
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4 types of retinal detachment
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rhegmatogenous
traction COMBO: rhegmatogenous/traction exudative |
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rhegmatogenous retinal detachment
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-most common
-hole or tear allows fluid to move between layers -risks include myopia or aphakia, also trauma and retinopathy associated w/diabetes |
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traction retinal detachment
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is d/t a pulling force or tension
-often d/t scar tissue |
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exudative retinal detachment
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production of serous fluid under retina from choroid from uveitis or macular degeneration, etc
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s/s retinal detachment
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-shade/curtain coming across vision
-cobwebs/floaters -bright/flashing lights -NO PAIN |
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scleral buckle
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-type of sx
-band placed around eye -brings layers of retina together -used for retinal detachment |
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age related macular degeneration
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-most common cause of vision loss >60
-drusen -central vision loss -2 types (dry and wet) |
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age related macular degeneration
DRY |
(nonneovascular,nonexudative)
-outer layers of retina break down -drusen occur outside of macular area -drusen outside macular=NO vision LOSS -drusen inside=vision loss gradual blurring when pt tries to read often a slow onset |
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age related macular degeneration
WET |
(neovasular, exudative)
-may have abrupt onset -blood vessels grow under retina -choriodal neovascularization -straight lines look crooked/distorted -letter/words look brocken |
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orbital trauma
s/s assessment |
tenderness, bruising, proptosis
check for signs of HEAD injury first then get at least a basic vision assessment |
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proptosis
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downward displacement of eye ball
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enopthalmos
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eye ball deeper is socket
opposite is exopthalmus when it is popping out |
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worst type of material to get stuck in eye d/t purulent infection
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-iron
-copper -vegetable matter |
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chemosis
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edema of conjunctiva
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hyphema
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hemorrhage within eye chamber
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enucleation
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removal of eye
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sympathetic opthalmia
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inflammation in UNIJURED eye d/t injury of AFFECTED eye
may be cause for enucleation |
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irrigating an eye after chemical contact until pH is....
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7.3-7.6
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dry eye syndrome
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AKA keratoconjunctivitis sicca
tears or part of tears not right scratchy, burning, itching, redness, pain, corneal erosion, infection TX: artificial tears/punctal plug |
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Schirmer's test
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filter paper used to measure tear production
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Hordeolum and tx
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AKA stye
abscess caused by Staph aureus warm compress 10-15 min x4/day may need to drain if more than 48hrs |
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Blepharitis
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inflammation of the eye lid(s)
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Conjunctivitis
must evaluate the type of .... type of ...... and type of..... |
AKA pink eye
discharge: 1) watery 2) mucoid 3) purulent 4) mucopurulent conjunctival reaction: 1) follicular-lesions with vessels (RICE) 2) papillary-fine mosiac pattern Membranes: 1) psuedomembranes-exudate sticks 2) true membranes-removal causes bleeding |
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Evisceration
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removal of contents within the eye
allows for movement |
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exenteration
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removal of eyelids, eye, and others
-most often with cancers/etc |
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when pt loses an eye what else is lost
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depth perception
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papilledema
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swelling of optic nerve d/t increased IOP
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function of auricle
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transmits sound waves to ear
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external auditory canal ends at
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tympanic membrane
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eustachian tube fucntions
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drains stuff from middle ear
equalizes pressure |
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tympanic membranes
layers and fucntion |
AKA eardrum
has three layers pars flaccida lacks middle layers pars tensa has all the layers amplifies sound x22 |
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ossicles
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3 smallest bones in body
malleus, incus, and stapes |
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organ of hearing and location
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cochlea -inner ear
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organ of balance and location
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semicircular canals -inner ear
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end organ for hearing
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organ of Corti
snail shaped structure in cochlea transforms mech energy to neural |
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air and bone conduction
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air is BETTER -vibration of tympanic membrane and ossicles
bone-travel through bone bypasses middle and external ear |
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balance and equilibrium
what part of brain what 3 systems are needed |
cerebellar (cerebral cortex)
1)body (proprioceptive system) 2) eyes (visual system) 3) labyrinth (vestibular system) |
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Weber test
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-tests bone conduction
-placed on head or forehead -normal=hears sound in head -conductive loss=better in affected -sensorineural=better in good ear |
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Rinne Test (rin-ay)
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-mastoid until nothing then air
normal=air is louder conductive loss=bone is longer sensorineural=air is longer |
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best test for hearing loss
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audiometry
2 types- tone and voice |
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3 parts to hearing evaluation
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-frequency
-pitch -intensity |
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frequency
how is it measured what is normal range |
-number of sound waves from source per second
-measured in Hertz (Hz) normal 20-20,000 speech range 500-2000 |
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pitch
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used to describe frequency
100 Hz=low pitch 10000 Hz=high pitch |
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intensity
how is it measured what is normal range what is the corrected goal |
AKA loudness or pressure exerted from sound
-measured in decibal (dB) low conversation 40 dB harsh and damaging 80 dB goal is 30 db for tx/sx of loss |
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measuring hearing loss by dB
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0-15 normal
15-25 slight 25-40 mild 40-55 moderate 55-70 moderate to severe 70-90 severe >90 profound |
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presbycusis
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progressive hearing loss associated with aging
loss ability to hear high pitched "ch", "f", "p", "t", "k", "st" |
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otalgia
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sense of fullness or pain in the hear with or without loss of hearing
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external otitis (otitis externa)
s/s teaching |
AKA swimmers ear
-pain /aural tenderness -discharge (yellow/green bacterial)(black fungal) -swelling redness wick may be inserted to keep dry dry ears protect from wetness/cotton/jelly |
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malignant external otitis
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AKA temporal bone osteomyelitis
infection gets into the bone |
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exostoses
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-small,hard,bony growths in external ear canal
-may be caused by cold water -must be sx removed |
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clear watery drainage from nose or ear after head trauma may be...
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cerebrospinal fluid
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tympanic membrane perforation
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-often will heal on own
-must protect it until then -tmpanoplasty=sx to fix |
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acute otitis media
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-middle ear infection lasting less than 6wks
-most common in children -PAIN-relieved if rupture of eardrum -fever, runny nose -bulging red eardrum -may need to drain it |
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myringotomy
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AKA tympanotomy
sx incision to tympanic membrane |
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serous otitis media
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AKA middle ear effusion
-no infection (often) -fluid stuck d/t blocked tubes -fullness/air bubbles |
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cholesteatoma
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skin from eardrum grows into middle ear
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chronic otitis media
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reccurent AOM
may cause damage to eardrum and cholesteatoma may also lead to other more serious infections sx may be needed to correct it |
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ossiculoplasty
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sx reconstruction of middle ear bones to restore hearing for conduction loss
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pt teaching after middle ear or mastoid sx
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-don't blow nose for 2-3 weeks
-sneeze/cough with mouth open -avoid lifting/straining -may hear popping/cracking 3-5wks -temporary hearing loss is normal -protect ear from water |
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otosclerosis
s/s |
-involves the stapes (fixation)
-bone conduction better than air -may have tinnitus -low frequency loss -tx with sx |
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dizziness
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altered sensation of orientation
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vertigo
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illusion of motion of person/surroundings
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Meniere's disease
s/s dietary changes sx |
-inner ear fluid imbalance
-too much endolymph -endolymphatic hydrops=space gets big -sensorineural loss (fluctuation) -tinnitus or roaring sound -VERTIGO -loss of low frequencies low Na/diuretics/ increased K -sac decompression -vesicular nerve cutting |
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Labyrinthitis
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-inflammation of inner ear
-ACUTE SEVERE VERTIGO -N/V -tinnitus -hearing loss |
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ototoxic medications=most common
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aspirin, quinine
aminoglycosides (-MICIN or -MYCIN) |
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acoustic neuroma
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slow growing benign tumor of CN VIII
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furuncle
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bacterial infection of hair follicle
(often seen in ear) |
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Romberg's test
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-tests vestibular function
-close eyes while standing -some sway is normal |
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random stuff about hearing
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-brain processes sound 1000x faster than images even during sleep
-B/P wil increase 5-8% in loud places -loud noise=pupil dilation SURVIVAL |
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microbial vs allergic conjunctivitis
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microbial may start in one eye then spread and drainage is often cloudy/purulent
allergic often both eyes with clear drainage |
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otorrhea
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drainage from ear
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