ryan clin skills exam two

orbit

what is the bony socket housing the eye?

sclera

what is the hard, outer white part of the eye?

extraocular eye muscles

what does the sclera connect to the orbit?

1. stand in front of pt and trace large H in air with finger

2. instruct pt to follow fingers with eyes only

3. note any deviation from normal in each direction

4. hold finger at each end-point to access for nystagmus

5.note any lid lag as eyes move up and down

6. test for convergence using pencil

how do you test for EOM?

pupillary restriction

the iris has eye color and controls...

allows light to enter

the pupil is the black center of the eye which...

transparent structure that covers both the iris and pupil

what is the cornea?

surface of the eyelids and eyes

what is the conjunctiva?

palpebral conjunctiva

what is the conjunctiva lining the eyelids called?

bulbar conjunctiva

what is the conjunctive lining the anterior eye?

junction of bulbar conjunctiva and cornea

what is the limbus?

tarsal plates

what are the eyelid margins?

meibomian glands, provide oily lubrication for eye surface

what do the tarsal plates contain? what is the function?

superolateral orbit

where are the lacrimal glands found?

lacrimal glands

what is found in the superolateral orbit which drains across the eye surface?

two tiny holes on superior and inferior medial eyelid margins that drain tears into lacrimal sac

what are lacrimal puncta?

nasolacrimal duct

after tears enter lacrimal sac, where do they drain?

behind the iris

where is the lens located?

to adjust thickness to focus on near or distant objects

what is the function of the lens?

changes size of lens for focusing

what is the function of the ciliary m?

posterior portion of the eye that includes the retina, choroid, vitreous, retinal vessels, macula, fovea, and optic disc

what is the optic fundus?

optic disc

what is the entry point of the optic nerve?

retina

what is the sensory part of the eye allowing for vision?

dark circular depressed area that is the point of central vision

what is the fovea?

macula

what surrounds the fovea?

anterior chamber, posterior chamber, vitreous chamber

what are the three chambers of the eye?

cornea and iris

the anterior chamber is between the ___ and ___

iris and lens

the posterior chamber is between the ___ and ___

posterior chamber

what chamber is filled with clear liquid called aqueous humor?

via canal of Schlemm

how does the aqueous humor drain?

intraocular pressure

what does the posterior chamber control?

lens and retina

the vitreous chamber is between the ___ and ___

more viscous fluid

the vitreous chamber is filled with ____ called vitreous humor

maintains eye shape

what is the function of the vitreous chamber?

photoreceptors of the retina

when light passes through the pupil, what is it focused on?

optic nerve to optic tract to visual cortex of occipital lobe

list the nerve impulse conduction of the visual pathway

direct reaction to light

(light reaction) when light shining through one pupil causes constriction of the affected pupil, what kind of reaction is it?

consensual reaction to light

(light reaction) when light shining through one pupil causes constriction of the unaffected pupil, what kind of reaction is it?

constriction

(near reaction) what happens to pupils when you shift from far objects to near objects?

bilateral medial rectus movement

the near reaction also tests for convergence of the eyes, which involves what kind of movement?

convergence and accommodation

besides pupil constriction, what else does the near reaction test for?

contraction of ciliary muscle to focus lens on object

what is accomodation?

moves eyes upward (elevation)

what is the action of the superior rectus muscle?

when reaction to light is impaired

when should you test the near reaction?

hold finger 10 cm from pt's eye and have pt alternate from looking at finger to point behind you

how do you perform the near reaction test?

moves eyes downward (depression)

what is the action of the inferior rectus muscle?

moves eyes inward toward nose (adduction)

what is the action of the medial rectus m?

moves eyes outward away from nose (abduction)

what is the action of the lateral rectus m?

rotates top of eye towards nose around long axis and downward

what is the action of superior oblique m?

rotates top of eye away from nose and moves eye upwards

what is the action of the inferior oblique m?

scotomas

what is the medical term for blind spot?

strabismus

what is the medical term for abnormal alignment aka crossed eyes?

one-sided visual field loss

what is hemiansopsia?

Snellen Eye Chart

what is used to test visual acuity?

hand-held vision chart, pen-light, and ophthalmoscope

what tools are needed for an eye exam?

central vision

what is Snellen eye chart used to test?

20 feet

how far from the snellen eye chart should you position the patient?

the distance of the patient from the chart

what is the first number in visual acuity?

distance at which a normal eye can read the line

what is the second number in visual acuity?

those who require reading glasses or are at bedside

for whom is a handheld card used to test vision?

14 inches

how far should a handheld chart be held from the pt's eyes?

static finger wiggle test

what is the screening tool for lesions in anterior and posterior visual pathways?

1. position self about an arm's length away from pt

2. cover own eye and have pt cover their mirroring eye

3. place your hand about 2 feet laterally bringing them slowly into patient's center of view

4. test in each quadrant or each clock hour

describe how to perform the static finger wiggle test

pseudoisochromatic color plate

color testing uses a ___ to determine if pt can detect color difference between the figure and background

1. have patient observe bright red object by covering left eye and then alternating to right

2. ask patient if color saturation is equal in both eyes

describe how to test contrast sensitivity

to describe percentage of brightness observed in less saturated eye

if pt does not see equal color saturation in both eyes when testing contrast sensitivity, what should you ask them?

drooping of upper lid

what is ptosis?

ptosis

name the eyelid abnormality

entropion

name the eyelid abnormality

inward turning of eyelid margin

what is entropion?

ectropion

name the eyelid abnormality

outward turning of eyelid margin

what is ectropion?

hordeolum

what is the medical term for stye?

painful, tender, red infection on eyelid margin

what is hordeolum?

S. aureus infection

what is hordeolum (stye) usually due to?

meibomian gland

what is obstructed if hordeolum is on inner eyelid margin?

eyelash follicle or tear gland

what is obstructed if hordeolum is on outer eyelid margin?

hordeolum (stye)

name the eyelid abnormality

chalazion

name the eyelid abnormality

subacute nontender nodule due to obstructed meibomian gland

what is chalazion?

inner eyelid margin

where is a chalazion usually found?

yellow growth on or near eyelids due to excessive deposits of lipids

what is xanthelasma?

xanthelasma

name the eyelid abnormality

cholesterol

patients with xanthelasma have severely elevated ____ levels

harmless, yellow triangular nodule on bulbar conjunctiva, does not affect cornea

what is pinguecula?

pinguecula

name the conjuctival abnormality

pterygium

name the conjunctival abnormality

triangular thickening of bulbar conjunctiva, grows slowly across cornea and can affect vision

what is pterygium

subconjunctival hemorrhage

name the conjunctival abnormality

sudden, painless, broken blood vessels of eye due to increased pressure such as coughing or trauma

what is subconjunctival hemorrhage?

thin gray-white arc near edge of cornea

what is corneal arcus?

corneal arcus

name the abnormality

Hyperlipoproteinemia

corneal arcus is benign but can indicate...

gold/brown ring around cornea due to condition of excess copper

what is Kayser-Fleischer rings?

Wilson disease

what is Kayser-Fleischer rings aka?

Kayser-Fleischer rings (wilson disease)

name the abnormality

opacity of the lenses visible through the pupil

what is cataract?

elderly

cataracts are common in...

cataract

name the abnormality

anisocoria

what is unequal pupils called?