PD II eyes

The cornea is ____ to the sclera

The cornea is ____ to the sclera

anterior

What is the thin membrane that lines the sclera anterior?

conjunctiva

What is the inside layer of the sclera called?

uvea

What does the conjunctiva NOT cover?

cornea

What does the anterior chamber contain?

lens, iris, ciliary body

How does the blood flow from the ophthalmic artery?

deep to peripheral

How does the blood flow from the choroid plexus?

peripheral to deep

What is the site where all vessels terminate?

macula

What supplies blood to the macula and fovea?

choroid plexus

What CN provides sensory to cornea and conjunctiva?

CN V

Which CN is for vision?

CN II

What CN controls opening of the eye, eye movement, sympathetic pupil dilation, and parasympathetic pupil constriction?

CN III

What is OD?

oculus dexter; right eye

What is OS?

oculus sinistral; left eye

What is OU?

oculus uterus; both eyes

What is emmetropic?

no vision correction needed

What is myopic?

nearsighted

What is hyperopic?

farsighted

What is presbyopia?

age related farsightedness

What is amblyopia?

poor vision of eye that is other wise physically normal; “lazy eye”

What is a scotoma?

blind spot

What is entropion?

eyelid folds inward

What is ectropion?

eyelid folds outward

what is hypopyon?

pus in anterior chamber

What is epiphora?

overflow of tears

What is synechiae?

iris adheres to cornea or lens

What is ptosis?

drooping of upper eyelid margin

What is hyperemia?

congestion of blood in any part of eye

What is stroma?

connective tissue framework

What is heterochromia?

different colored eyes

What is aphakia?

no lens in the eye

What is dyschromatopsia?

acquired color blindness which occurs due to CN disease or degenerative disease of macula

What is a slit lamp used for?

measure depth of an abrasion or of an infection

What should you use if slit lamp is unavailable?

ophthalmoscope

what would you use to differentiate between ulcer and abrasion?

fluorescein stain

What is a tono-pen / tonometer?

measures the intraocular pressure; anesthetize w/ tetracaine and compare 3 measurements

What is normal intraocular pressure?

10-21 mmHG

What is the intraocular pressure for chronic open angle glaucoma?

20-30 mmHg

What is the intraocular pressure for acute angle closure glaucoma?

> 40 mmHg

How do you measure setting in the orbit?

place a flat object over eyebrow and maxilla and note the distance between the closed eye and flat object

When the patient is looking forward, the upper lid should cover …

the upper portion of the cornea

What is exophthalmos?

bulging of eye anterior out of orbit

What is bilateral exophthalmos due to?

abnormal connective tissue deposition in the orbit and extraocular muscle that can be visualized on CT or MRI

What is bilateral exophthalmos associated with?

graves disease

What is unilateral exophthalmos associated with?

orbital tumor

What are findings you might see with exophthalmos?

stare on frontal gaze, lid lag up and down, anxiety, heat intolerance, palpitations

What is this?

enophthalmos

What type of enopthalmos is congenital?

primary

Which enopthalmos is acquired change in volumetric relationship b/t rigid bone cavity, the orbit, and it’s contents?

secondary

What is Horner’s syndrome?

damage to pathway in SNS that regulates HR, pupil size, perspiration, BP, etc; results in ptosis, miosis, anhidrosis

what would CN III palsy result in?

ptosis

What is an internal hordeolum?

acute infection of meibomian gland deep to the eyelid surface

What is an external hordeolum?

pustule in an eyelash gland (moll or zeis)

What is a chalazion?

chronic enlargement of meibomian gland due to obstruction

What is xanthelasma?

yellow plaque or patch on eyelid or periorbital skin

What are causes of xanthelasma?

familial hyperlipidemia, DM, hypothyroidism

What might patients with xanthelasma also present with?

abdominal pain from pancreatitis or eruptive xanthomas

What is dacryostenosis?

blocked tear duct

What is special about newborns with dacryostenosis?

usually gets better without treatment

What is a marker for elevated lipids?

xanthelasma

How often should patients aged 40-65 years have a visual acuity examination?

every 2-4 years

How often should patients over 65 have a visual acuity examination?

every 1-2 years

What can you use to exam a child’s visual acuity after the age of 3 instead of snellen?

tumbling E chart or picture chart

What visual acuity is considered legally blind?

20/200 or worse

What do you do when testing for visual acuity if patient is legally blind?

test again at 15 and 10 feet, then assess with fingers, hand movement, and a light source

Which conditions improve with lenses- refractory or nonrefractory?

refractory

When no light is perceived (NLP), that is considered ____

total blindness

How do you differentiate between nonrefractory and refractory?

have patient read snellen chart through a pinhole to see if there is improvement

What chart is used to test color vision?

ishihara

What is the only part of the retina with cones?

fovea centralis

What is the earliest detectable clinical feature of macular degeneration?

drusen

What is used to asses macular degeneration and gross scotoma?

amsler visual grid

What is macular degeneration?

acute or chronic deterioration of central vision characterized by drusen and no pain or redness

What CN keeps eyes open?

CN III

What CN closes eyelid?

CN VII

How would visual acuity present in a patient with an optic chiasm tumor?

loss of entire half of temporal field bilaterally

How would a normal patient see the amsler visual grid?

not wavy and central point through visual fields; absolute scotoma 10 degrees on temporal midline

How would a patient with macular degeneration see the amsler visual grid?

wavy and decreased ability to see central dot

How would a patient with chronic glaucoma see the amsler visual grid?

multiple scotomas on periphery and scotoma on an arc extending from blind spot to superior nasal area

At what visual acuity, with visual sx, would you refer to ophthalmologist?

less than 20/50 in one or both eyes

At what visual acuity, without visual sx, would you refer to ophthalmologist?

less than 20/40 in one or both eyes

When do you evaluate visual fields?

after visual acuity has been done

When testing visual fields by confrontation, what do you do if there is a temporal defect on one eye?

have patient cover opposite eye and slowly move object from defective area to the better vision in order to define the border

Where is the lesion location in horizontal (altitudinal) visual field defects and how does the VF loss present?

branch of central retinal after or ischemia of optic nerve

unable to see below a horizontal point on the same eye

Where is the lesion location in a blind eye? How does VF loss present?

optic nerve; unilateral blindness

Where is the lesion location in bitemporal hemianopsia? How does VF present?

optic chiasm; temporal half of each field

Where is the lesion location for left homonymous hemianopsia? How does VF present?

right optic tract;

affects temporal visual field on the left and nasal visual field on the left

Where is the lesion location in homonymous left superior quadratic defect? How does VF loss present?

partial right optic radiation;

homonymous quadratic defect “pie in the sky”

What is nystagmus?

repetitive, oscillatory, jerky movements of eyes

What 3 disorders are associated with Horner’s syndrome?

partial ptosis, anhidrosis, miosis

What muscles does CN III innervate?

superior rectus, inferior rectus, inferior oblique, medial rectus

what is seen with CN III?

ptosis and inability to elevate and adduct eye

What is normal motion of superior oblique?

look down and medially

What would defects with the superior oblique be caused by?

trauma to orbit or uncle herniation

What does CN IV innervate?

superior oblique

What are deficits seen with the superior oblique muscle?

moderate exotropia or slight deviation upward

What does CN VI innervate?

lateral rectus muscle

What is the normal movement of the lateral rectus muscle?

move eyes laterally

What is a deficit with the lateral rectus muscle?

esotropia

What causes deficits with the lateral rectus?

congenital weakness, trauma