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eye external structure
- - conjunctiva
- - canthus
- - lacrimal apparatus
- - extraocular muscles
conjunctiva consists of what? how do they look like?
- - pink moist mucous membrane
- - clear transparent covering the eye ball
canthus consists of what?
and inner and outer canthus
function of lacrimal apparatus
cleanse the front of the eye, prevents microorganisms from entering the eye
extraocular muscles is controlled by which cranial nerves?
cranial nerves 1, 3, and 6
eye internal structures
- - outer layer
- - middle layer
outer layer consists of what?
middle layer consists of what?
- - chorioid
- - lens
- - iris
- - pupil
inner layer of the eye consists of
- - retina
- - optic disc
- - macula
- - fovea centralis
- - cones
- - rods
what does the red reflex tell you
it tells you the clarity of the lens itself
- sensory neurons in the retina
optic disc is made up of what two structures?
- - optic nerve
- - optic chiasm
eye health history is middle aged patient
presbyopia - impaired near vision (age 45)
retinopathy - HTN, diabetes mellitus
eye health history elderly patient
- cataract: increas UV exposure, more concentrated around the equator area where exposure to UV is high
- Glaucoma: increase interoculor pressure which can destroy the optic nerve (results in actual blindess)
- macular degeneration: decrease in central vision
eye history in children patients
amblyopia: brain partially/entirely ignore input from one eye - other eye wanders which is known as a lazy eye
treatment for this is patching the good eye which forces the brain to correct the bad eye
what can increase the chances of cataracts ?
how do we assess for macular degeneration ?
- we have to use a amplser grid
- - the person uses it to see how much distortion appears in the lines
- - records trend of disease
what are some common chief complaints when taking down eye history ?
- - changes in visual acuity
- - drainage
- - itching
- - dryness
what happens when changes in the visual acuity occur?
- - blurred vision
- - diplopia: double vision
- - visual field loss
- - blindness
- - floaters: clumps of vitreous humor
eye floaters occur more often when?
- happens as we age
- - they sit down in the bottom but as a person bends down, it floats up and blocks vision temporarily
what tyoe of past health history information should we collect when doing an eye examination
- - medical
- - eye surgeries
- - medications: eye drops
- - allergies
- - injuries: foreign bodies, trauma
- - family history of eye disease
- - social: work environment such as exposure to chemicals
- - health maintenance activities - such as the use of goggles, eye exams, glaucoma check
which cranial nerve affect visual acuity ?
cranial nerve II
how does visual acuity affect distance vision
- myopia: near-sighted, can be corrected
how can visual acuity affect near vision?
- hyperopia: far sighted
snellen eye chart tests for what?
- test for distant vision
- - should stand 20 ft away
- - the line that you record is the line they have completely
what is normal visual acuity ?
on the snellen chart, what does the red and green line test for?
what si the E chart use for?
used for individuals who do not know the alphabet
- - used for near sighted test
- - handheld
- - should hold 14 inches away from self
what happens if the person is wearing corrective lenses while doing eye tests
- - test with the corrective lenses on to see if there is any more deterioration of the eye
- - record this with corrective lenses
what does 20/80 vision mean?
it means that the patient can read at 20 feet what a patient with 20/20 vision can read at 80 feet
no light perception
- - varies from state to state
- - corrected vision is 20/200 or worse
- inherently recessive X-linked trait
color blindness is most common in who ?
color blondness: males
- - 8% white males
- - 4$ black males
ishihara plates test for what?
what technique is used to test visual field?
- confrontation technique
- - assess all visual fields
types of visual field defects
- - hemianopsia
- - circumferential blindness
- - unilateral blindness
abnormal findings of the eyelid include?
- - ptosis
- - exophthalmos
- - entropion (inverted) or ectropion (everted)
- - hordeolum
what should we check for when examining the lacrimal apparatus
- check for swelling, drainage (what color is it?), erythema, excessive tearing
- - drooping eyelid
- - cranial nerve III damage
- - bulging
- - bilateral = hyperthyroidism
what might be the concern with a patient who has exopthalamus
they might not be able to close their eye lid all the way which puts them at risk for dryness and infections
- infected hair follicle
- - common culprit is STAPH. A
- - treatment is warm soaks
- infection in the eyelid itself
- - treatment includes warm moist soaks if this doesn't work then the examiner had to lyse it
- - common culprit is STAPH. A
how do you test extraocular muscle function
- - corneal light reflex (Hirschberg test)
- - cardinal fields of gaze
- - cover and uncover test
corneal light reflex
- - also called Hirschberg test
- - you should focus the penlight 12-15 inches away from the eye right in the bridge of their nose
- - findings should be symmetrical and should see a the light reflect
cardinal fields of gaze
- - involves cranial nerves III, IV, VI
- - you are testing for muscle weakness
- - sometimes used for testing drunk drivers
- - focus in distance
- - cover one eye
- - note any movement in uncovered eye
- - remover cover
- - note any movement in the eye being uncovered
tranparent with small blood vessels
- - white with a few small superficial vessels
- - moist and shiny
- - moist, shiny
- - no discharge
- - no cloudiness
- - no opacities
loss of pigmentation of the eye is a process of what?
process of aging
- - controlled by cranial nerve III
- - normal size 2..-6mm
- - note the speed of constriction with light
- - not consensual response in other eye
pupil accommodation test
eyes will converge and the pupils constrict
PERRLA stand for what?
the pupils are equal in size, round, reactive to light, and accommodation
pupil dilates when?
when looking into the distance and in dark rooms
pupils constrict when ?
when looking at a near object and when in a well lit room
pinpoint or small and fixed pupils may indicate what?
- - opiates
- - miotic drops
- - brain lesion
dilated pupils may indicate what?
- - mydratric drops
- - head trauma
- - brain stem infarct
- - cardiac arrest after 4-6 min
how can you test for cranial III reflex
- - check for DOLLS EYES
- - hold eyes open
- - briskly turn head to one side
- - note the movements of the eye
- - positive = intact
- - negative = brain stem injury
what are some subjective data that can be collected from an ear examination
- - change or less of hearing (have they or anyone else noticed it?)
- - drainage ()
- - pain
- - tinnitus: ringing in the ears
types of ear drainage
- - purulent: infection
- - yellow waxy: cerumen and earwax build up
- - blood: rupture of the ear drum
- - clear fluid: make sure that it is not cerebral spinal fluid (to do this you would test it for glucose since cerebral spinal fluid has glucose)
the patient may be experiencing what with tinnitus?
- - vertigo or dizziness
- - you can ask the patient if the room is spinning around which is caused by vestibular issues
what are some objective data that can be collected during an ear examination?
- - position
- - color
- - size
- - shape
- - inflammation
- - pain/tenderness (tender nodules? gout? tofi?)
- - drainage
types of auditory screening
- - whisper test
- - weber test
- - rinne test
- - patient occludes on ear
- - examiner stands 2ft. behind patient
- - examiner whispers 2 syllable word
- - have patient repeat
- - place vibratory tuning fork on center of head
- - sounds lateralizes to both ears equally
- - plaing vibrating tuning fork on mastoid process to test for bone conduction
- - when patient no longer hears it, place it in front of the ear to test for air conduction
- - air conduction is 2x longer then bone conduction
dysfunction of sound transmission
- something not transmitting the sound to the tympanic membrane, can be caused by what?
- - build up of ear wax
- - tympanic membrane injury