Week 1 Eyes and Ears

The visual system contains 2 things, the eyes and the brain. the brain functions to 1) _______ and 2) ________ the information transmitted from the 3) _____ into 4) _______.

A: 1) process

2) interpret

3) receptors

4) images

The orbits are aka what?

A: eye sockets

Within the orbit are 3 main orbital opening which are the optic canal, the superior orbital fissure and inferior orbital fissure. The orbital canal is located at the 1) ____ of the socket and provides an entry point for the ____ nerve (CN 2). The superior orbital fissure is located in the 2) ______ orbit and provides entry point for several cranial nerves to enter the orbit form the brain such as the _____ nerve (CN 3), ___nerve (CN 4), ____nerve (CN 5) and ____ nerve (CN 6). The inferior orbital fissure is located at the 3) _____ of the orbit and hold the zygomatic branch of the ____ nerve.

A: 1) top of socket, optic nerve

2) posterior of orbit, oculomotor nerve, trochlear nerve, trigeminal nerve, abducens nerve

3) floor of orbit, maxillary nerve

There are 6 extra ocular muscles that attach to the eye and their role is to _____ and _____ the eye.

A: stabilize and move the eye

The ocular adnexa include the eyebrows, eyelids, eyelashes, and lacrimal system. The eyebrows. eyelids, and eyelashes are vital to 1) _____ the eye as they provide a physical barrier to dust and foreign particles. Blinking protects the eye from injury and distributes tears over the anterior surface of the eye and provides 2) _______ to surface cells.

A: 1) protect

2) nourishment

What is the thinnest skin on the body at 1mm thick?

eyelids

The lacrimal system includes the structure for tear production and drainage. The main and accessory lacrimal glands make 1) _____. the glands in supertemporal orbit are exocrine glands and make and secrete the aqueous layer of tear film (which moistens eye and supplies oxygen to cornea) and are responsible for 2) _____ tear production. The accessory glands are responsible for baseline tear production and are called the glands of 3) ____ and _____.

A: 1) tears

2) reflex tear production

3) Glands of Wolfring and Krause

The eye ball or globe is composed of 3 layers, the tough outer layer, the middle layer consisting of the uveal tract and the innermost layer. Match the following to their corresponding layer: iris, retina, cornea, conjunctiva, ciliary body, sclera, and choroid.

A: Outer Layer: cornea, conjunctiva, sclera

Middle layer: iris, choroid, ciliary body

Innermost layer: retina

The conjunctiva is a transparent mucous membrane that covers the inner surfaces of the eyelids and extends over the sclera. The glands in the conjunctiva secrete _____ and _____ (in conjunction to with the lacrimal system).

A: mucus and tears

The cornea allows light to enter the eye and _____ the light rays to help focus them on the retina.

A: bends/refracts

The sclera, the white part of eye, protects the eye and helps the eye to maintain its ___ and _____.

A: shape and structure

The iris gives the eye its color. At the center of the iris is the pupil which allows light to enter the eye and it constricts by action of sphincter muscles to control _____ that enters the eye.

A: the amount of light

The ciliary body is behind the iris and helps us ____ by changing the shape of the lens to refract light onto the retina.

A: focus

The aqueous humor fills the anterior chamber of the eye. It is composed of electrolytes, growth factors, and proteins which nourish the nonvascular structures of the anterior chamber such as the lens. Balanced secretion and excretion of aqueous humor is important as excess production or decreased outflow can increase 1) ______ greater than the normal 10 - 21 mm Hg. This is also known as 2) ___.

A: 1) Intraocular pressure (IOP)

2) glaucoma

The lens is behind the iris and is connected to the ciliary body. Its primary function is change shape to alter the 1) _______ of the eye. The ciliary body changes the lens shape as apart of 2) ______ which allows a person to focus.

A: 1) focal distance

2) accommodation

The vitreous humor is a transparent gel like substance that fills the posterior cavity of the orbit and it functions to ____ light passing through the vitreous.

A: block light

The retina lines the back of the eye. Its is mostly made up of neurons, meaning retinal cells are unable to 1) _______. The retina converts images into a form that the brain can understand and process as vision. It has 2 main parts the macula and fovea, the macula is responsible for the 2) ______ visual field and the fovea is responsible for our sharpest visual acuity which we need when detail is important like 3) ___ and ____. The retina contains light sensitive structures known as photoreceptor cells of which there are 2 types called rods and cones. Rods are most found in the 4) ______ retina and are responsible for our ___ and ____ vision, they perceive only light and dark and do not contribute to color vision. Cones are found in the 5) _____ retina and are responsible for ___ vision. The are 3 types of cone cells which are red, green, and blue.

A; 1) regenerate

2) central

3) reading and driving

4) peripheral, peripheral and night vision

5) central, color

The optic nerve, CN 2, transmits vision information from the retina to the ____.

A: brain

What are 4 important things to obtain from the patient when doing an assessment pertaining subjective data when it comes to assessing the visual system?

A: 1) health history

2) allergies

3) surgery history

4) medications

What are 2 things your looking for in health history that could be causing visual field defects?

A: 1) stroke

2) neurologic problems

Why is it that many cold medications dilate the pupil?

A: since they contain epinephrine which triggers dilation of pupils

Antihistamines and decongestants can cause what symptoms pertaining to the eyes?

A: dry eyes

Long term corticosteroid use can contribute to the development of what 2 eye disorders?

A; 1) glaucoma

2) cataracts

Hydroxychloroquine which is used to treat RA and other auto immune disease has the potential to lead to ___ toxicity (eyes)? They should be getting eye exams how often?

A: retinal toxicity, annual eye exams

Men are more likely to develop color ______ and women are more likely to have age-related _____ _____.

A; color blindness, age related macular degeneration

Why do many HCPs do not want patients to strain after eye surgery?

A: it can raise IOP (intraocular pressure)

You see a 65 year old with his right lower eye lid turned outward and away form the eye as well his left upper eye lid drooping down. He asks what this is and if he should be worried.

A: first is Ectropion and second is ptosis, its a normal finding in older people as there is a decrease of muscle tone and orbital fat and some tissue atrophies

What is the assessment finding for Pinguecula and what is due to?

A: small yellow do on medial aspect of conjunctiva, tissue damage caused by chronic exposure to UV light

You see a milky white gray ring encircling periphery of cornea in a 70 year old woman, what is it and what can cause it?

A: arcus senilis, cholesterol deposits in peripheral cornea

What is a thick, triangular bit of pale tissue that extends to inner canthus of eye to nasal border of cornea?

A: pterygium, tissue damage caused by chronic exposure

______ is the leading cause of blindness among blacks and Hispanics?

A: glaucoma

Hispanics, Blacks, Native Americans have the highest incidence of ____ retinopathy?

A: diabetic retinopathy

What have the highest incidence in what eye disorder?

A: AMD

When doing a physical assessment on the visual system, and patient has head skewed in an unusual position what could this mean?

A: has diplopia, and is trying to see a single image

When doing a physical assessment on the visual system, and patient is covering eyes with hands what could this mean?

A: corneal abrasion or photophobia

Your shadowing a nurse and they tell you they are going to measure something to do with the patients visual system, you have to figure what part. They go in and go to shake the patient's hand and the patient squints then goes to shake the nurse's hand. What were they measuring?

A: making a crude estimate of depth perception

To test a visual acuity 1) what would you use, and should keep glasses on, how far away to stand, how to do test. 2) patient go to 20/30 line but missed 2 letters with the right eye while wearing glasses, how to write this.

A: 1) Snellen chart, keep glasses on, 20 ft, one eye at a time without squinting

2) Right eye, 20/30-2, with glasses

A patient has near sighted vision problems, how to test near vision and what is perfect score?

A: Jager card, 14in away without moving card, 14/14

How to assess corneal light reflex and what does it evaluate?

A: in dark room ask patient to look straight ahead while shining pen light directly at cornea, the light should be in center of both corneas as patient faces light source, it evaluates weakness or imbalance of extra ocular muscles

What test can indicate weakness or paralysis in the extraocular muscles and cranial nerves 3, 4, and 6?

A: 6 cardinal position test

We measure IOP with a variety of methods but name one?, give me the normal range

A; tonometry, 10 - 21 mmHg

What tool is used to measure the retina and optic nerves?

A: ophthalmoscope

A pale blue cast on the sclera can be caused by ____ _____ which can be normal in older adults.

A; scleral thinning

The optic disc should be a ____ ____ with distinct margins. A central depression in the disc called the physiologic cup may be seen (this is exit site for the optic nerve), if seen it should be _____ the diameter of the disc.

A: creamy yellow, half the diameter

The Ishihara test assesses patient's ability to?

A: recognize a pattern of color in series of color plates

Stereoscopic vision allows a patient to see objects in ___ dimensions. Without it, the patient's ability to judge ____ or ___ is impaired.

A: 3 dimensions, distance or height

The patient reports seeing double vision, what is this called and what part of the eye is abnormal?

A: diplopia, extraocular muscle action

What is the persistent abnormal intolerance to light, and what is it caused by?

A: Photophobia, inflammation or infection of cornea or iris and ciliary body

Patient describes curtain, spider webs or floaters in field of vision, what is this called and what is it caused by?

A: Spots/floaters, common cause is vitreous liquefication which is benign but it can be caused by hemorrhage

Patient has redness, swelling, and crusting long lid margins, what is it called and cause?

A: blepharitis, bacterial invasion of lid margins (often chronic)

What is excess eyelid skin called?

A: dermatochalasis

What is outward turning of lower lid margin called and what is inward turning of upper of lower lid margin called?

A: Ectropion, Entropion

Patient has small, superficial white nodule along lid margin. what is it called and cause?

A: Hordeolum, infection of meibomian gland of eyelid

What is drooping of eyelid called and what can be caused by?

A: ptosis, excess skin or eye lid tumors

Patient has redness and swelling of conjunctiva, what is it called and what is cause?

A: conjunctivitis, bacterial or viral infection or allergic response

There is an appearance of a blood spot on sclera, what is it called and what is caused by?

A: subconjunctival hemorrhage, blood vessels in conjunctiva ruptured leaking blood into subconjunctival space

What can be cause of corneal abrasion?

A: trauma, or overwear or improper fit of contact lenses

The patients eye is abnormally protruding beyond its normal position, what it called and cause?

A: exophthalmos, intraocular tumors or hyperthyroidism

Patient responds asymmetrically to light stimulus or accommodation, cause?

A: CNS disorder or anesthesia

What is called when pupil size is different in each eye and what is cause?

A: anisocoria, CNS disorder or genetic if there is slight difference

If a patient's eye position is deviated in 1 or more directions it is called what, cause?

A: strabismus, overaction or under action of 1 or more extraocular muscles

Pupil appears cloudy or white and there is opacification of lens, what is it called and cause?

A: cataract, aging, trauma, diabetes, long term corticosteroid use

What is loss of central vision caused by?

A: macular disease

What is partial or complete loss of peripheral vision caused by?

A: glaucoma, migraine or stroke

What is the inability to accommodate objects at a distance called?

A: myopia (nearsightedness)

What is the inability to accommodate for near objects called?

A: Hyperopia (farsightedness)

What is the loss of accommodation associated with age called, what age start, harder to see object near or far?

A: Presbyopia, mid-40s, near

Vision distortion caused by uneven or irregular curvature of the cornea is called what?

astigmatism

What is the absence of the eye lens called?

A: aphakia

2 non surgical ways to correct a refractive error?

A; glasses, contacts

Contacts have the risk of causing microbial keratitis which is a sight threatening condition, what are 3 risk factors?

A: 1) poor hand cleaning

2) poor lens case hygiene

3) inadequate lens cleaning

What are 3 surgical procedures to correct refractive error?

A; 1) LASIK (cut flap in cornea and laser part of stoma and put back)

2) PRK (if cornea isn't thick enough for LASIK)

3) refractive IOL (implanted contacts)

Vision impairment is defined as vision that cannot be fully corrected by any kind of medical treatment or corrective lens. Legal blindness is one such case, what score does the better eye have to be to be considered legally blind?

A: 20/200

What are 4 eye care health promotion guidelines?

A: 1) regular hand washing

2) wear sunglasses

3) eat proper nutrition

4) wear safety glasses during hazardous work

Match the diagnostic study with purpose and description. Studies: 1) Amsler grid test 2) Fluorescein angiography 3) Perimetry testing 4) Refractometry 5) Ultrasonography Purpose: 1) Measures refractive error 2) associates size and structure of eye 3) monitors macular problems 4) Provides information about flow of blood through retinal vessels 5) Detects changes om central and peripheral vision Description: 1) Fluorescein injected IV into peripheral vein followed by serial photographs of retina through dilated pupils 2) Patient sits looking through Snellen acuity chart and lens are changed, patient chooses lenses that make acuity sharpest 3) Patient uses hand held card printed with a grid of lines using 1 eye at a time they focus on a point ad note any abnormalities of grid lines 4) Patient sits and looks inside bowel shaped instrument and presses button each time bowl flashes and computer records results 5) A scan de

A: 1) Amsler grid test - monitors macular problems - Patient uses hand held card printed with a grid of lines using 1 eye at a time they focus on a point ad note any abnormalities of grid lines

2) Fluorescein angiography - Fluorescein injected IV into peripheral vein followed by serial photographs of retina through dilated pupils

3) Perimetry testing - Detects changes om central and peripheral vision - Patient sits and looks inside bowel shaped instrument and presses button each time bowl flashes and computer records results

4) Refractometry -Measures refractive error - Patient sits looking through Snellen acuity chart and lens are changed, patient chooses lenses that make acuity sharpest

5) Ultrasonography - associates size and structure of eye - A scan determines right power of a lens implant before surgery and B scan used to diagnose pathologic conditions

Description: 1) Fluorescein injected IV into peripheral vein followed by serial photographs of retina through dilated pupils 2) Patient sits looking through Snellen acuity chart and lens are changed, patient chooses lenses that make acuity sharpest 3) Patient uses hand held card printed with a grid of lines using 1 eye at a time they focus on a point ad note any abnormalities of grid lines 4) Patient sits and looks inside bowel shaped instrument and presses button each time bowl flashes and computer records results 5) A scan determines right power of a lens implant before surgery and B scan used to diagnose pathologic conditions

4) Refractometry -Measures refractive error - Patient sits looking through Snellen acuity chart and lens are changed, patient chooses lenses that make acuity sharpest

5) Ultrasonography - associates size and structure of eye - A scan determines right power of a lens implant before surgery and B scan used to diagnose pathologic conditions

With fluorescein angiography the fluorescein can cause what color of skin and urine, can cause nausea and vomiting and if extravasation occurs this means what?

A: yellow orange, its toxic to tissue

Non 24 hour sleep/wake disorder is a common issue for blind people (where their biologic clock is not synchronized to to a 24 hour day) what can help with this?

A: melatonin

What are 9 steps of emergency management of eye injury and what 2 things not to do?

A: 1) determine mechanism of injury

2) ensure ABC

3) begin eye irrigation immediately with saline or water if saline not available and do not stop until emergency personnel arrive

4) assess visual acuity

5) tell them not to blow nose

6) stabilize foreign object

7) cover eye(s) with dry sterile patches and protective shield

8) do not give food or fluids

9) elevate head of bed 45 degrees

1) do not try treat injury

2) do not put pressure on eye

A ____ lens may be used to provide continuous irrigation of an injured eye.

A: Morgan lens

What is an infection of the meibomian glands in the lid margin (red, swollen, circumscribed and acutely tender area)?

A: an external hordeum

Palliative care for inflammation or infection eye lids include what?

A: Apply warm moist compress at least 4 times a day

Chronic inflammation or glaucoma of the meibomian glands in the lid is what?

A: chalazion

What condition has lids are red rimmed with many scales or crusts on the lid margins and lashes and has a main symptom of itching?

A: blepharitis

For blepharitis, what can effectively soften and remove crusting?

A: gentle cleansing with baby shampoo

Conjunctivitis is aka what and caused by?

A: pink eye, infection or inflammation of conjunctiva

Treatment of conjunctivitis usually includes what and teaching what?

A: antibiotic drops, teaching hand washing and avoiding contact with an infected person

Chronic conjunctivitis caused by chlamydia is called what and it is mostly seen in what countries?

A: trachoma, undeveloped countries

The defining symptom of allergic conjunctivitis is?

A: itching

Inflammation or infection of the cornea is called?

A: keratitis

The most common cause of corneal blindness in developed countries is herpes simples virus keratitis (HSK) and characteristic symptom of? treatment?

A: dendritic appearance (tree branching), ganciclovir or other -vir

Protruding eyeball is also known as?

A: exophthalmos

Tissue loss caused by a corneal infection produces a corneal ulcer which requires aggressive treatment to prevent vision loss. What is treatment?

A: antibiotic, antifungal, or antiviral eyedrops may be giving every hour for first 24 hours

Keratoconjunctivitis sicca also known as dry eyes often report what?

A: sand in eye

A condition in which a person cannot consistently focus both eyes simultaneously on the same object is called? Primary problem is?

A: strabismus, double vision

In keratoconus, the anterior cornea thins and bulges forward taking on a cone shape. The main symptom is blurred vision and early treatment includes what?

A: glasses or rigid contact lens

Corneal transplants (keratoplasty) are most commonly indicated for corneal problems or eye injuries. Match the 2 types with their definitions. Surgeries: 1) Penetrating cornea transplant 2) lamellar cornea transplant Definitions: 1) transplanting all 3 layers of the cornea 2) only some layers of the cornea are replaced with the transplant

A: 1) Penetrating cornea transplant - transplanting all 3 layers of the cornea

2) lamellar cornea transplant - only some layers of the cornea are replaced with the transplant

An opacity within the lens is called?

A: cataract

Opacity in the eye lens can be seen using what instrument, and a totally opaque lens creates the appearance of a ____ pupil.

A: ophthalmoscope or slit lamp microscopy, white pupil

Besides routine antibiotics, for cataract surgery what are 3 types of medications for preop care?

A: 1) mydriatic and cycloplegic agents

2) NSAID eye drops

3) anti anxiety