Exam 2: Eyes

List the 3 visual reflexes.

1. pupillary light reflex

2. fixation

3. accommodation

ability to distinguish shapes/details at a given distance

Visual acuity (VA)

A normal accommodation response includes… (2)

1. bilateral pupillary constriction

2. convergence of eyes’ axes

open space bn eyelids (eye width)

Palpebral fissures

T or F: pupillary light reflex causes unilateral pupillary constriction when bright light shines on the retina.

F

normal bilateral constriction of pupils when bright light shines on retina

Pupillary light reflex

oflactory

CN I

smell

CN I

optic

CN II

vision

CN II

oculomotor

CN III

eye movement; pupil constriction

CN III

trochlear

CN IV

eye movement

CN IV

trigeminal

CN V

facial sensations; chewing (jaw)

CN V

abducens

CN VI

eye movement

CN VI

facial

CN VII

facial expressions; taste

CN VII

vestibulocochlear

CN VIII

hearing; balance

CN VIII

glossopharyngeal

CN IX

taste; swallowing

CN IX

vagus

CN X

digestion, HR, glands

CN X

spinal accessory

CN XI

shoulder and neck movement

CN XI

hypoglossal

CN XII

tongue movement

CN XII

Which of the following nerves are involved in the pupillary light reflex? (Select all that apply.)

A. CN I

B. CN II

C. CN III

D. CN IV

E. CN III

B, C

reflex direction of eye toward an object that attracts attention

Fixation

Which of the following may affect the effectiveness of the fixation relfex? (Select all that apply.)

A. fatigue

B. loud noises

C. substance abuse

D. hyperfixation

E. anxiety

F. old age

A, C, D

adaptation of eye for near vision (and vice versa)

accommodation

T or F: the pupil constricts when looking at objects farther away and dilates when looking at objects close up.

F (both)

What subjective data should you NOT ask your pt about their eyes? (Select all that apply.)

A. erythema

B. ophthalmalgia

C. central vision

D. near vision

E. vision difficulty

F. edema

G. corrective lens use

H. discharge

I. peripheral vision

J. lacrimation

K. history of ocular problems

L. pupillary light reflex

M. self-care

N. last eye exam

C, D, I, L

eye pain

Ophthalmalgia

cross eye

Strabismus

double vision

Diplopia

peripheral vision loss due to CN II damage from intraocular pressure

Glaucoma

What are 5 examples of red eye emergencies?

1. sudden vision loss

2. trauma to eye

3. herpes zoster that impairs CN II

4. corneal damage

5. sudden distorted pupil

herpes zoster

Shingles

light sensitivity

Photophobia

unilateral black dot in vision

Scotoma

tearing up

Lacrimation

nearsightedness

Myopia

farsightedness

Hyperopia

T or F: hyperopia means that you can’t see far away.

F (myopia)

one eye lid doesn’t open symmetrically to other

Ptosis

______ is to eye as hypertension is to heart.

red eye emergency

What are the two acceptable positions for a pt to be in to collect objective data about their eyes?

1. standing up (vision screening)

2. sitting up with head at eye level (inspection)

List the 3 types of equipment needed for an eye exam.

1. Snellen eye chart

2. handheld visual screener

3. penlight

Which of the following tests for far vision?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostics positions test

E

Which of the following tests for near vision?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostic positions test

A

Which of the following tests for peripheral vision?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostic positions test

C

Which of the following tests for the corneal light reflex?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostic positions test

D

Which of the following tests for weakness in a particular eye?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostic positions test

F

Which of the following tests for weakness in a parallel tracking?

A. Visual Screener

B. Romberg test

C. Confrontation test

D. Hirschberg test

E. Snellen test

F. Cover test

G. Diagnostic positions test

G

The Snellen chart should be placed at _____ level, about _______ (measurement) away from pt.

1. eye

2. 20 ft

Corrective vision scores refer to Snellen eye chart scores that are done with…

glasses/contacts in use

T or F: in the Snellen eye test, start with the largest lines (font).

F

Label whether the following are for central (C) or peripheral (P) vision.

1. Confrontation test

2. Snellen eye chart

3. Visual Screener

1. P

2. C

3. C

What does 20/20 vision mean?

20: distance you are standing away from chart

20: distance away from chart that people with perfect vision can still read the font size

You can read at 20 ft what the normal eye can read at 20 ft away

In the visual screener test, the card must be ______ (distance) away.

14 in

_____/_____ is to visual screener test as ____/_____ is to Snellen eye test.

1. 14/14

2. 20/20

List the steps of the confrontation test.

1. stand 2 ft away from pt

2. have pt stare straight

3. cover one eye of the PT

4. cover YOUR opposite eye (mirror)

5. slowly advance penlight from periphery in several directions to medial

6. ask person to say “now” when they see object

7. repeat for opposite eye

What is the goal for the confrontation test?

peripheral vision intact: pt sees object when examiner does

The goal of the Hirschberg test is to test the ________ and to assess ________.

1. corneal light reflex

2. eye muscle strength/control

How do you perform the Hirschberg test?

1. have pt stare straight

2. hold light 1 foot away from nose bridge

3. note reflection of light on corneas

What is the “normal” result of the Hirschberg test?

light reflects on the same spot in each eye

What are the 4 abnormal eye conditions seen during a Hirschberg test? Define them.

1. Esotropia: eye turns in

2. Exotropia: eye turns out

3. Hypertropia: eye turns up

4. Hypotropia: eye turns down

This is a picture of the following condition:

exotropia

This is a picture of the following condition:

esotropia

This is a picture of the following condition:

hypertropia

This is a picture of the following condition:

hypotropia

T or F: as long as light is in the same place during corneal light reflex, its ok for the pt.

T

How do you peform a cover test?

1. have pt stare straight

2. cover one eye at at ime

3. note gaze

What is “normal” for the cover test?

steady fixed gaze

How do you perform a diagnostic positions test?

1. object held 1 foot in front of pt

2. you move penlight (OFF) in 6 directions (upper, eye level, and lower left and right)

3. progress clockwise

4. pt should follow movements with eyes ONLY

What is the goal for diagnostic positions testing?

bilateral parallel tracking (eyes move together in each direction)

What 8 things should you make note of during an objective inspection of the eye?

1. eyebrows

2. eyelids

3. eyelashes

4. conjunctive

5. sclera

6. lacrimal apparatus

7. protrusion/sunken eyeballs

8. light reflexes

What 3 things should you make note of for objective data about eyebrows?

1. present bilaterally?

2. symmetrical?

3. moves with expression changes?

What 4 things should you make note of for objective data about eyelids/lashes?

1. present bilaterally?

2. symmetrical?

3. normal overlap?

4. evenly distributed eyelashes?

What 3 things should you make note of for objective data about the conjunctiva?

1. clear?

2. shiny?

3. fatty deposits?

What 1 thing should you make note of for objective data about the sclera?

1. white

tough, fibrous, opaque part of eye that focuses light rays into the retina

Sclera

mucous membrane that covers outer sclera and lines eyelids that is very sensitive

Conjunctiva

where light waves are changed into nerve impulses for visual perception

Retina

Which is a “normal” factor that causes fatty deposits in conjunctiva? abnormal?

1. being black/AA

2. having high cholesterol levels

What 2 things should you make note of for objective data about the lacrimal apparatus?

1. no pain?

2. normal tears?

What 2 things should you make note of for objective data about the pupillary light reflex?

1. size (equal)

2. shape (round)

How do you test for pupillary light reflex?

1. darken environment

2. have pt gaze at a distance

3. shine light in one eye from side

4. take note of pupillary size of BOTH eyes

5. repeat for other eye

What are the 2 types of pupillary light reflexes? Define them.

1. direct: light-receiving pupil constricts

2. consensual: other pupil constricts

What do you document a “normal” pupillary light reflex as?

pupils equal, round, reactive to light, and accommodation (PERLLA)

What 2 things should you make note for inspecting of the ocular fundus?

1. red reflex

2. pt should see flash of orange with red vessels

when light passes through pupil and reflects off retina, you can see a reddish orange glow from pt’s eye

Red reflex

How do you test for accommodation?

1. have pt focus on distant object

2. have pt gaze at objecct 3 inches from nose (penlight)

T or F: accommodation is an automatic reflex.

T

Another name for the inner lining of the eye (includes retina) is…

ocular fundus

In which of the following conditions might a pt have ruptured blood vessels in their ocular fundus? (Select all that apply.)

A. substance abuse

B. epilepsy

C. MS

D. diabetes

E. URIs

F. head trauma

D, F