Ch. 15 Eyes

Overall functions of cranial nerves

sensory, movement, or both

Cranial nerve III

Oculomotor nerve

Cranial nerve IV

Trochlear nerve

Cranial nerve VI

abducens nerve

What is the pupillary light reflex?

The normal constriction of pupils when bright light shines on the retina.

What is fixation in terms of visual reflexes?

The direction of the eye toward an object to maintain focus.

What is accommodation in terms of visual reflexes?

The adaptation of the eye for near vision, involving convergence of the eyes and constriction of the pupils.

How does tear production change in aging adults?

Tear production decreases with age, leading to dryness and irritation.

What is presbyopia?

Age-related loss of the eye's ability to focus on near objects due to decreased lens elasticity.

• lens is not flexible anymore

• lens hardens

• so they cannot see things close enough

At what age do cataracts typically begin to form?

Cataracts may begin forming around age 70.

How does visual acuity change with age?

Visual acuity may gradually diminish after age 50 and more significantly after age 70.

What causes the appearance of floaters in aging adults?

Floaters result from changes in the vitreous humor as it shrinks and forms clumps or strands.

What is cataract formation?

The clouding of the eye’s lens, leading to blurry vision and increased sensitivity to glare.

What are the most common causes of decreased visual functioning in older adults?

Cataract formation, glaucoma, macular degeneration, and diabetic retinopathy.

What is cataract formation?

A clouding of the eye's lens that leads to blurry vision and increased glare sensitivity.

What is glaucoma?

A condition caused by increased intraocular pressure, leading to optic nerve damage and potential vision loss.

What is macular degeneration?

A progressive disease affecting the macula, leading to central vision loss.

What is diabetic retinopathy?

A complication of diabetes that damages the blood vessels in the retina, leading to vision impairment or blindness.

• breaks down optic nerve

What is strabismus?

A misalignment of the eyes where they do not look in the same direction at the same time.

What is diplopia?

Double vision, where a person sees two images of a single object.

What can cause redness and swelling in the eyes?

Infection, allergies, irritation, or underlying conditions like conjunctivitis or blepharitis.

What are common causes of eye watering and discharge?

Allergies, infections (such as conjunctivitis), blocked tear ducts, or irritation.

Why is past eye history important in assessing vision health?

Previous eye conditions, surgeries, injuries, or family history can indicate risk factors for future issues.

What should be considered for contact lens care in self-care behaviors?

Proper hygiene, frequency of wear, cleaning routine, and any issues like dryness or irritation.

What vision tests should be discussed in self-care behaviors?

Last vision test, prescription updates, and whether the person has ever been tested for color blindness.

How do environmental hazards affect eye health?

• Exposure to dust, chemicals, bright lights, or workplace hazards can impact vision and increase the risk of eye conditions

How can medications affect vision and eye health?

Some medications may cause side effects such as dry eyes, blurred vision, or increased risk of cataracts and glaucoma.

How can vision problems impact daily life?

Difficulty reading, driving, recognizing faces, or performing daily tasks can affect independence and quality of life.

What visual difficulties might aging adults experience with mobility?

Difficulty climbing stairs or driving due to decreased visual acuity or depth perception.

What is a common vision problem aging adults experience at night?

Problems with night vision, making it harder to see in low-light conditions.

Why is glaucoma testing important for aging adults?

Glaucoma can lead to optic nerve damage and vision loss, so regular screening is essential for early detection.

Why is cataract history important in aging adults?

Cataracts can cause blurry vision, glare sensitivity, and vision impairment, affecting daily life.

What symptoms might aging adults experience related to eye discomfort?

• Dryness or burning sensations, often due to decreased tear production.

How can vision changes impact an aging adult’s daily activities?

A decrease in vision can make tasks like reading, sewing, or other close-up work more difficult.

How should a person be positioned for vision screening?

Standing for vision screening, then sitting up with their head at the examiner's eye level.

What equipment is needed for objective vision assessment?

A Snellen eye chart, handheld visual screener, opaque card or occluder, and a penlight.

What does the first number in a Snellen chart result represent?

The person's distance from the chart.

What does the second number in a Snellen chart result represent?

The distance at which a "normal" eye could read the same line.

What does 20/20 vision mean?

It means the person can read the line on the chart at 20 feet that a normal eye can also read at 20 feet.

What does the Jaeger card test?

It tests near vision by having the person read small print at a close distance.

What is considered a normal result for near vision on a Jaeger card?

A normal result is "14/14" in each eye, read without hesitancy and without moving the card closer or farther away.

What is the corneal light reflex also known as?

It is also known as the Hirschberg test.

What does the corneal light reflex assess?

It assesses the parallel alignment of the eye axes by shining a light toward the person’s eyes.

What should be noted when performing the corneal light reflex test?

The reflection of light on the corneas should be in exactly the same spot on each eye.

What does PERRLA stand for in eye assessment?

PERRLA stands for Pupils Equal, Round, React to Light, and Accommodation.

Dark

Dilates

Bright

Constricts

How do you test the pupillary light reflex?

Darken the room, ask the person to gaze into the distance, advance a light in from the side, and note the response.

What should you do before and after testing the pupil's reaction?

Measure the pupil size before and after testing the reaction to light and accommodation.

How do you test accommodation in the eyes?

Ask the person to focus on a distant object, then on your finger to observe the change in pupil size.

• distance dilates

• close constricts

What are the cardinal fields of gaze?

The cardinal fields of gaze refer to six positions that assess the movement of the eyes and check for alignment, smoothness, and coordination as the person follows a target (usually a finger or pen) in various directions.

What should you inspect about the eyebrows during a general eye examination?

Check for symmetry, hair distribution, and any abnormalities such as hair loss or excessive hair growth.

What should you inspect about the eyelids and lashes?

Observe for symmetry, position, redness, swelling, or any abnormalities such as ptosis (drooping) or missing lashes.

What should you inspect about the eyeballs?

Check for alignment, any visible lesions, and abnormalities in color or shape.

What color is the sclera typically in lighter-skinned patients?

The sclera is usually white in lighter-skinned patients.

What variations might be seen in the sclera of persons of color?

Persons of color may have a grey-blue sclera, macules on the sclera, or yellowish fatty deposits beneath the lids away from the cornea.

What should be noted about the cornea and lens during an eye examination?

• There should be no opacities (cloudiness) in the cornea or lens.

What is arcus senilis, and how does it differ from an opacity?

Arcus senilis is a normal finding in aging persons, characterized by a gray or white arc around the cornea, and should not be confused with opacity, which indicates cloudiness.

How should visual acuity be assessed in aging adults?

Perform the same examination as described in the adult section, but be aware that central acuity may decrease, particularly after 70 years of age.

How might the pupillary light reflex change in aging adults?

The pupillary light reflex may be slowed in aging adults.

What ocular structure changes may occur in aging adults?

Eyebrows may show loss of the outer one-third to one-half of hair, and wrinkles or crow's feet may develop.

What is pseudoptosis, and how does it relate to aging?

1. Pseudoptosis is a condition where the eyelid appears droopy due to loss of skin elasticity, common in aging adults.

What ocular structure changes are common in aging adults?

Aging adults may experience sunken eyes, decreased tear production, and yellowish elevated nodules called pingueculae at the 3 and 9 o'clock positions.

What are pingueculae?

Pingueculae are yellowish elevated nodules that appear at the 3 and 9 o'clock positions on the sclera.

How does the pupillary light reflex change in aging adults?

The pupillary light reflex may be slowed in aging adults.

How might the cornea change with age?

The cornea may appear cloudy with age.

What is arcus senilis, and does it affect vision?

Arcus senilis is a gray-white arc or circle around the cornea and has no effect on vision.

What is xanthelasma, and where does it occur?

Xanthelasma is soft, raised yellow plaques that occur on the lids at the inner canthus.

What is strabismus?

Strabismus is a condition where the eyes are not properly aligned with each other.

What is esotropia?

• Esotropia is a type of strabismus where one or both eyes turn inward (toward the nose).

What is exotropia?

Exotropia is a type of strabismus where one or both eyes turn outward (away from the nose).

What does paralysis of the extraocular muscles result in?

Paralysis of the extraocular muscles can result in an inability to move the eyes properly, affecting eye alignment and movement.

What is periorbital edema?

Periorbital edema is swelling around the eyes, often indicating fluid retention or inflammation.

What is exophthalmos?

• Exophthalmos is the abnormal protrusion of one or both eyes, often seen in conditions like hyperthyroidism.

What is enophthalmos?

Enophthalmos is the inward sinking of the eyeball into the orbit, which can occur due to trauma or certain medical conditions.

What is ptosis?

Ptosis is the drooping of the upper eyelid, which can affect vision and is often associated with aging or neurological conditions.

What is an upward palpebral slant?

• An upward palpebral slant is when the upper eyelid has a slight upward angle, which can be a normal anatomical variation or linked to certain syndromes.

What is ectropion?

Ectropion is a condition where the lower eyelid turns outward, which can cause irritation and exposure of the inner eyelid surface.

What is entropion?

Entropion is a condition where the lower eyelid turns inward, causing the eyelashes to rub against the cornea, leading to irritation and potential damage.

What is anisocoria?

Anisocoria is the condition where the pupils are of unequal size.

What can monocular blindness lead to in terms of pupil response?

Monocular blindness may result in a lack of pupillary response in one eye, causing abnormal reactions when light is shined into that eye.

What does constricted and fixed pupils (miosis) indicate?

Constricted and fixed pupils, also known as miosis, can indicate drug use, neurological issues, or certain medical conditions.

What does dilated and fixed pupils (mydriasis) indicate?

Dilated and fixed pupils, or mydriasis, can indicate cranial nerve damage, drug use, or brain injury.

What can damage to cranial nerve III cause in the pupils?

Damage to cranial nerve III can result in ptosis, eye movement abnormalities, and pupil dilation or abnormal reaction to light.

What is the first step in the eye examination?

Test visual acuity using the Snellen eye chart.

How do you test visual fields?

Perform the confrontation test to assess the visual fields.

How do you inspect extraocular muscle (EOM) function?

• Inspect EOM function using the corneal light reflex, cover test, and diagnostic positions test.

What external eye structures should be inspected?

Inspect the external eye structures, including the eyelids, lashes, conjunctiva, sclera, and cornea.