PET Exam 2 - Eye

Superior and inferior lacrimal puncta

What tiny openings at the medial margin of each eyelid drain tears into the lacrimal sac?

Lacrimal gland

Which glandular structure located in the superior lateral orbit produces the aqueous layer of tears?

Meibomian glands

Which sebaceous glands embedded in the tarsal plates produce the oily lipid layer of tears?

Bulbar conjunctiva

Which transparent mucous membrane covers the anterior sclera up to the corneal limbus?

Palpebral conjunctiva

Which transparent mucous membrane lines the inner surface of the upper and lower eyelids?

Medial canthus

What is the anatomical term for the inner nasal angle where the upper and lower eyelids meet?

Lateral canthus

What is the anatomical term for the outer temporal angle where the upper and lower eyelids meet?

Caruncle

What small pink globular nodule is located at the medial canthus containing sebaceous and sweat glands?

Tarsal plates

What firm strips of dense connective tissue give structural shape and support to the eyelids?

Limbus

What is the specific anatomical border or junction separating the clear cornea from the white sclera?

Protect conjunctiva and cornea from drying

What is one primary protective function of the tear film on the ocular surface?

Inhibit microbial growth

What antimicrobial role does the tear film serve for the anterior surface of the eye?

Make surface of cornea smooth

How do tears contribute to the optical quality and refractive power of the corneal surface?

Levator palpebrae superioris

Which muscle is primarily responsible for elevating the upper eyelid?

Cornea

What clear avascular anterior structure provides the majority of the refractive power of the eye?

Sclera

What tough white fibrous outer coat covers the posterior five-sixths of the eyeball?

Anterior chamber

What fluid-filled space lies directly behind the cornea and in front of the iris?

Posterior chamber

What narrow space containing aqueous humor lies behind the iris and in front of the lens?

Vitreous body

What transparent gel-filled structure fills the large posterior cavity of the eyeball behind the lens?

Choroid

What vascular pigmented layer lies between the sclera and the retina to nourish outer retinal layers?

Snellen chart

What standard visual chart is used to test distance visual acuity at 20 feet?

Jaeger or Rosenbaum pocket chart

What handheld card is used to test near visual acuity at a distance of 14 inches?

20 feet

What is the standard testing distance between the patient and a Snellen chart for distance vision?

14 inches

What is the standard distance held between the patient eye and a Rosenbaum card for near vision?

Test each eye separately

How should visual acuity be assessed regarding eye coverage during testing?

Do not press on the eye

What critical instruction must be given to the patient when using an occluder or hand to cover one eye?

Penlight

What basic optical illumination tool is needed to inspect pupils anterior chamber and external structures?

Ophthalmoscope or PanOptic

What specialized diagnostic instrument is required to perform a detailed funduscopic examination?

Ishihara plates

What color vision testing plates feature pseudoisochromatic dot patterns with embedded numbers?

Dim room lights

What environmental adjustment is made prior to funduscopy to promote natural pupillary dilation?

20 20 vision

What fractional visual acuity designation represents normal physiological distance vision?

20 200 vision

What visual acuity threshold defines legal blindness in the better eye with best correction?

20 10 vision

How is a visual acuity recorded if a patient sees at 20 feet what a normal eye sees at 10 feet?

Driver license requirement

Visual acuity between 20 30 and 20 100 is typically required for what everyday functional capability depending on state laws?

Reading newspaper print

What daily reading activity generally requires a minimum visual acuity of 20 50?

Reading large print Reader Digest

What reading task typically requires a visual acuity of at least 20 70?

Writing a check

What everyday financial documentation task typically requires a minimum visual acuity of 20 100?

Reading paper currency

What visual task requires an acuity threshold of at least 20 400?

Denominator

In the visual acuity fraction 20 40 what number indicates the distance at which a normal eye can read that line?

Numerator

In the visual acuity fraction 20 40 what number represents the physical distance in feet between the patient and the chart?

Red and green

Most congenital color perception deficiencies primarily involve difficulty distinguishing which two colors?

Confrontation testing

What bedside examination technique is used to screen for visual field defects in all four quadrants?

90 degrees temporally

What is the normal temporal extent of the peripheral visual field from central fixation?

50 degrees superiorly and nasally

What is the normal extent of the peripheral visual field superiorly and nasally?

60 degrees inferiorly

What is the normal extent of the peripheral visual field inferiorly?

Inverted

What orientation transformation occurs to the visual image projected onto the retina?

Optic chiasm

At what neural crossover structure do nerve fibers from the nasal half of each retina decussate?

Contralateral visual field

Each cerebral visual cortex receives encoded visual input from which side of the visual field?

Bitemporal hemianopsia

What visual field defect results from a lesion compressing the optic chiasm such as a pituitary adenoma?

Right homonymous hemianopsia

What visual field defect results from a complete lesion of the left optic tract or left optic radiation?

CN VI or Abducens nerve

Which cranial nerve innervates the lateral rectus muscle responsible for eye abduction?

CN IV or Trochlear nerve

Which cranial nerve innervates the superior oblique muscle responsible for intorsion and downward gaze in adduction?

CN III or Oculomotor nerve

Which cranial nerve innervates the superior rectus inferior rectus medial rectus and inferior oblique muscles?

Superior rectus

Which extraocular muscle innervated by CN III elevates the eye when looking outward?

Inferior rectus

Which extraocular muscle innervated by CN III depress the eye when looking outward?

Medial rectus

Which extraocular muscle innervated by CN III adducts the eye toward the nose?

Lateral rectus

Which extraocular muscle innervated by CN VI abducts the eye temporally?

Superior oblique

Which extraocular muscle innervated by CN IV moves the eye downward when adducted toward the nose?

Inferior oblique

Which extraocular muscle innervated by CN III moves the eye upward when adducted toward the nose?

H-pattern test

What geometric movement pattern is followed by the clinician finger to test all six extraocular muscles?

Nystagmus

What term describes involuntary rhythmic fine oscillatory movements of the eyes during EOM testing?

Cover uncover test

What physical exam test identifies ocular misalignments like tropias and phorias?

Corneal light reflex or Hirschberg test

What test evaluates ocular alignment by observing symmetrical light reflections on both corneas?

Direct light reflex

What is the term for pupillary constriction in the eye directly exposed to a light beam?

Consensual light reflex

What is the term for pupillary constriction in the unilluminated opposite eye when light is shone into one eye?

Accommodation or near reaction

What pupillary response includes convergence of the eyes and pupillary constriction when shifting gaze from far to near?

Anisocoria

What is the medical term for a defect characterized by unequal pupil sizes?

PERRLA

What common medical acronym documents normal pupillary inspection and reflex findings?

Tangential lighting

What lighting technique uses a beam cast across the cornea to inspect anterior chamber depth and look for shadows?

Narrow angle or glaucoma risk

What clinical concern is raised if tangential lighting casts a crescentic shadow on the medial side of the iris?

Start at zero diopters

At what diopter lens setting should the ophthalmoscope dial initially be set before starting the fundus exam?

Examine right eye with right eye

Which eye should the clinician use when examining the patient right eye with an ophthalmoscope?

Examine left eye with left eye

Which eye should the clinician use when examining the patient left eye with an ophthalmoscope?

Start 12 inches away at 15 degree angle

At what distance and angle from the line of sight should the clinician begin approaching the patient for funduscopy?

Red reflex

What bright orange-red glow should immediately be visualized through the pupil when starting funduscopy 12 inches away?

Opacity in lens or vitreous

Absence or interruption of the red reflex suggests what underlying ocular pathology like cataracts?

Lowest comfortable brightness

What brightness setting should be selected on the ophthalmoscope to maximize patient comfort and visualization?

Follow a vessel centrally

How can the clinician navigate toward the optic disc if it is not immediately visible in the fundus field?

Optic disc

What yellowish orange or pink oval structure with sharp margins marks the entry of the optic nerve and central retinal vessels?

Optic cup

What pale central depression within the optic disc normally measures less than half the disc diameter?

0.3 to 0.5

What is the normal ratio of the optic cup diameter to the total optic disc diameter?

Arteries are brighter red and narrower

How do retinal arteries visually differ from retinal veins on funduscopic exam?

Veins are darker red and wider

How do retinal veins visually differ from retinal arteries on funduscopic exam?

Macula

What small dark avascular circular area is located temporal to the optic disc for central vision?

Fovea centralis

What tiny bright pinpoint light reflection marks the center of the macula with the highest concentration of cones?

Order of funduscopic exam

What sequence follows red reflex to cornea to lens to background to vessels to optic disc and finally macula?

Macula is examined last

Why is the macula examined last during funduscopy?

Choroid crescent

What benign normal fundus variant appears as a dark pigmented arc along the margin of the optic disc?

AV nicking

What hypertensive vascular finding presents as a vein appearing stopped or indented on either side of an overlying artery?

Copper wiring

What hypertensive retinal arteriolar change causes the vessel wall to broaden and take on a bright coppery luster?

Silver wiring

What severe hypertensive change causes the arteriolar wall to become opaque so no blood column is visible?

Superficial flame-shaped hemorrhages

What type of small linear retinal hemorrhages occur in the superficial nerve fiber layer in hypertension or CRVO?

Deep dot and blot hemorrhages

What type of small round dark retinal hemorrhages occur in deeper layers in diabetic retinopathy?

Preretinal hemorrhage

What large boat-shaped hemorrhage develops in the space between the retina and vitreous body with a horizontal fluid line?

Neovascularization

What process of delicate thin fragile new blood vessel formation is a hallmark of proliferative diabetic retinopathy?

Cotton wool spots

What soft white fluffy cotton-like retinal lesions represent microinfarcts of the nerve fiber layer?

Hard exudates

What bright yellow waxy lesions with well-defined margins represent lipid deposits leaking from damaged capillaries?

Drusen

What tiny yellowish round extracellular lipid deposits accumulate under the retinal pigment epithelium in macular degeneration?

Macular degeneration

Which age-related retinal disease is characterized by central vision loss drusen accumulation and macular atrophy or neovascularization?

Diabetic retinopathy

Which microvascular metabolic disease of the retina features microaneurysms hemorrhages cotton wool spots exudates and neovascularization?