EENT Eye Exam and Pathology Notes

Consensual light reflex tests Cranial nerves:

II and III

T/F: BOTH pupils should constrict when light is shone into only one side

True

Which cranial nerve carried light towards the brain?

CN II

Which cranial nerve carried the response from the brain to constrict the pupil?

CN III

If the direct eye does not constrict but the consensual eye does , there is a CN ____ lesion in which eye?

CN III lesion in the direct eye

If the direct eye constricts and the consensual eye does not, there is a CN ____ lesion in which eye?

CN III lesion is the consensual eye

Term for when pupils are not equal in size

Anisocoria

Term for dilated pupils

Mydriasis

Term for constricted pupils

Miosis

P.E.R.R.L.A. stands for:

pupils equal, round, react to light and accommodate

Accommodation

When patient can change focus from far to near

When looking far, the lens shape is

Flat

When looking near, the lens shape is

Round

T/F: When looking close the ciliary body tenses

False

Ciliary body is innervated by CN ____

CN III

Term for inability to accommodate (usually associated with people >40)

Presbyopia

What do the eyes do while looking near?

Converge and pupils constrict

Convergence is controlled by CN ____

CN III

Term for when a strip of sclera is visible when patient looks down:

Lid Lag

Lid lag AKA

con Graef's sign

Term for protruding eyeballs

Exophthalmos

Exophthalmos is associated with:

Graves disease or tumor

Causes for ptosis:

Horner's syndrome, CN III lesion, Myasthenia gravis

Repetitive, jerky eye movements

Nystagmus

When eyes are not facing the same direction/ lazy eye

Strabismus

Tests for Strabismus

Cardinal fields and cover/uncover

Paralysis of the ocular muscles is called

Ophthalmoplegia

Weakness of the ocular muscles is called

Ophthalmoparesis

With homonymous hemianopsia, the lesion is on the ________ side of the vision loss

Contralateral

Pupillary reflex is ______ when loss of vision is due to a tract lesion

Absent

Pupillary reflex is ______ when loss of vision is due to a cortical lesion

Present

When the eyelid is turned outward

Ectropion

Risk with ectropion

none

When the eyelid is turned inward

Entropion

Risk with entropion

Corneal abrasion

Fatty yellow plaques due to increased cholesterol:

Xanthelasmas

Inflamed hair follicle on the eyelid (Stye)

Hordeolum

Plugged meibomian gland

Chalazion

Lacrimal duct inflammation on medial side of the eye:

dacryocystitis

Lacrimal duct inflammation on lateral side of the eye:

dacryoadenitis

Well-demarcated, often liver-shaped area of redness seen on the sclera of the eye

Subconjunctival hemorrhage

T/F: Subconjunctival hemorrhage is clinically significant

False

Subconjunctival hemorrhage is caused by

Idiopathic or increased intrathecal pressure

Slightly raised, benign, fatty structure under the conjunctiva

Pinguecula

Excessive growth of eye tissue that can obstruct vision

Pterygium

Excessive growth of Pterygium is caused by:

Environmental trauma

The findings associated with Keratoconjunctiva Sicca

Dry eyes, dry mouth, joint pain

Keratoconjunctiva Sicca AKA

Sjogren's Syndrome

Pale grey-blue discoloration around iris

Arcus senilis

When is Arcus senilis clinically significant?

If patient is under 40

Circular golden brown band found on the posterior surface of the cornea

Kayser-Fleischer ring

Kayser-Fleischer ring indicates

Wilson's disease

Wilson's disease associated finding

Blue lunulas

Blue sclera cause

Osteogenesis imperfecta

Osteogenesis imperfecta associated findings

brittle bones and diminished hearing

Miotic pupils associated with syphilis

Argyll Robertson

Shape of Argyll Robertson pupils

Irregular

Reaction to light in Argyll Robertson pupils

Absent

Reaction to painful stimulus in Argyll Robertson pupils

Intact

Reaction to near objects in Argyll Robertson pupils

Diminished but intact

Pupils with sluggish response to light

Adie's pupil

Adie's pupil AKA

Tonic pupil

Pupil size for Adie's pupil

Large

Glaucoma risk factors

older than 65 y/o, family history, African American descent, diabetes, myopia, prolongued corticosteroid use

Glaucoma screening tests

Tonometry, ophthalmoscopy, visual field test

Signs and symptoms of open angle glaucoma

Painless

Loss of peripheral vision

Cupping of the disc

(-) shadow test

Gradual onset/progression

Signs and symptoms of narrow angle glaucoma

Painful

Blurred vision

Cupping of disc

(+) shadow test

Sudden onset

Eye hard to palpation

Eye redness

Pupil dilation

T/F: For Narrow angle glaucoma, you refer to the ER

True

Glaucoma causes loss of _______ vision

Peripheral

Causes for an absent red reflex when doing a fundoscopic exam

Cataracts, detached retina, retinoblastoma

Clouding/opacity of the lens that interferes with vision

Cataracts

Primary complaint of patients with the senile form of cataracts

Difficulty driving at night

How long does it take for cataracts to develop after diabetes diagnoses

10-20 years

Marfan's syndrome may predispose an individual to develop

Lens subluxation

Benign myelination of optic nerve fibers appears as:

Fluffy white fibers

Increased intracranial pressure can causes

Papilledema

Papilledema AKA

Choked disc

How would papilledema look on a fundoscopic exam?

Bulging, inverted disc

Chalky white disc suggests

Optic atrophy

Optic atrophy is indicative of

Increased intracranial pressure

Flame hemorrhages are associated with

Hypertension

Dot/blot hemorrhages are associated with

Diabetic retinopathy

Microaneurysms are pathognomonic for

Diabetic retinopathy

What suggests diabetic retinopathy

Neovascularization

Drusen bodies can result from

Macular degeneration, atherosclerosis, hypertension

Where are Drusen bodies often seen?

Near the fovea

Cherry red macula is seen with

Central artery occlusion and Tay Sach's disease

Microinfarctions causing swelling of the terminal nerve fibers are called

Cotton wool patches

Cotton wool patches are caused by

Hypertension

Macular degeneration causes painless loss of

Central Vision

Before losing vision, the patient with macular degeneration may report

Blurred central vision, words missing letters when reading, straight lines look wavy

Which type of macular degeneration has a slow, insidious onset?

Dry

Which type of macular degeneration has a rapid onset?

Wet

What causes wet macular degeneration

Abnormal blood vessels that leak under the macula

What grid is used in the diagnosis of macular degeneration?

Amsler

What does a patient experience with retinal detachment

Sparks of light, sudden onset of floaters, vision loss like a curtain

What does complete retinal detachment look like on a fundoscopic exam?

Absent red reflex

What does a partial retinal detachment look like on a fundoscopic exam?

Gray wrinkled section of the retina

What kind of referral is required for retinal detatchment

Emergency

Dark colored pigment deposits in the retina that initially cause loss of peripheral vision

and night vision in a young person suggest

Retinitis pigmentosa