Eyes

physiologic cup

-A smaller circular area that appears slightly depressed is referred to as the ____ _____. -This area is approximately one-third the size of the entire optic disc and appears somewhat lighter/whiter than the disc borders.

Conjuctiva

-A thin, transparent, continuous membrane that is divided into two portions: a palpebral and a bulbar portion.

allergies, foreign

-Burning or itching pain is usually associated with ____ or superficial irritation. -Throbbing, stabbing, or deep, aching pain suggests a _____ body in the eye or changes within the eye. -Therefore, immediately refer reports of eye pain.

Retinal Vessels

-Can be readily viewed with the aid of an ophthalmoscope -Four sets of arterioles and venules travel through the optic disc, bifurcate, and extend to the periphery of the fundus -Vessels are dark red and grow progressively narrower as they extend out to the peripheral areas -Arterioles carry oxygenated blood and appear brighter red and narrower than the veins

Corneal reflex

-Contact with a wisp of cotton stimulates a blink in both eyes -This reflex is supported by the trigeminal nerve, which carries the afferent sensation into the brain, and the facial nerve, which carries the efferent message that stimulates the blink.

Choroid layer

-Contains the vascularity necessary to provide nourishment to the inner aspect of the eye and prevents light from reflecting internally -Continuous with the ciliary body and the iris

Strabismus

-Cross Eyed -Disorder in which the eyes don't look in exactly the same direction at the same time.

vascular spasms, detachment

-Intermittent blind spots may be associated with _____ _____ (ophthalmic migraines) or pressure on the optic nerve by a tumor or intracranial pressure. -Consistent blind spots may indicate retinal _____. -Any report of a blind spot requires immediate attention and referral to a physician.

Vitreous chamber

-Located in the area behind the lens to the retina. -The largest of the chambers and is filled with a vitreous humor that is clear and gelatinous.

Myopia

-Nearsighted -A condition in which close objects appear clearly, but far ones don't.

Cornea

-Permits the entrance of light, which passes through the lens to the retina. -Well supplied with nerve endings, making it responsive to pain and touch.

Exophthalmos

-Protrusion of the eyeballs accompanied by retracted eyelid margins -A characteristic of Graves' disease

Confrontation

-Tests Peripheral Vision -Technique: Sit across from patient Patient will cover one eye Hold finger outside 180 º visual field move finger toward enter until seen. Repeat other side.

Swellen Chart

-Tests distant visual acuity -Normal vision 20/20 without correction -Technique: -20 feet away -Cover one eye -Read chart -Cover other eye -Repeat -Myopia (nearsighted) = impaired far vision

Positions test

-Tests extraocular muscle function -Observe for eye movement. -Eye movement should be smooth and symmetric throughout all six directions -Failure of eyes to follow movement symmetrically in any or all directions indicates a weakness in one or more extraocular muscles or dysfunction of the cranial nerve that innervates the particular muscle

Cover test

-Tests extraocular muscle function -Use opaque card to cover an eye to observe for eye movement. -The uncovered eye should remain fixed straight ahead. The covered eye should remain fixed straight ahead after being uncovered. -The uncovered eye will move to establish focus when the opposite eye is covered. When the covered eye is uncovered, movement to reestablish focus occurs. Either of these findings indicates a deviation in alignment of the eyes and muscle weakness

Corneal light reflex test

-Tests extraocular muscle function -Use penlight to observe parallel alignment of light reflection on corneas. -Reflection of light on the corneas should be in the exact same spot on each eye, which indicates parallel alignment -Asymmetric position of the light reflex indicates deviated alignment of the eyes. This may be due to muscle weakness or paralysis

Rosenbaum Chart

-Tests near visual acuity -Hold 14 inches from face -Read what is comfortable -Normal is 14/14 without correction -"+" diopter for magnification -Presbyopia (farsighted) = impaired close vision

rods, cones

-The ___ are highly sensitive to light, regulate black-and-white vision, and function in dim light. -The _____ function in bright light and are sensitive to color.

lacrimal gland, puncta, nasolacrimal sac, meatus

-The ____ ___ located in the upper outer corner of the orbital cavity just above the eye, produces tears. -As the lid blinks, tears wash across the eye then drain into the _____, which are visible on the upper and lower lids at the inner canthus. -Tears empty into the lacrimal canals and are then channeled into the ____ ___ through the nasolacrimal duct. They drain into the nasal ____.

palpebral, bulbar, movement

-The _____ conjunctiva lines the inside of the eyelids, and the ____ conjunctiva covers most of the anterior eye, merging with the cornea at the limbus. The point at which the palpebral and bulbar conjunctivae meet creates a folded recess that allows ____ of the eyeball.

pupil

-The central aperture of the iris -Muscles in the iris adjust to control the pupil's size, which controls the amount of light entering the eye. -The muscle fibers of the iris also decrease the size of the pupil to accommodate for near vision and dilate the pupil when far vision is needed.

medial, caruncle

-The eyelids join at two points: the lateral (outer) canthus and medial (inner) canthus. -The _____ canthus contains the puncta, two small openings that allow drainage of tears into the lacrimal system, and the ____, a small, fleshy mass that contains sebaceous glands.

3, 5, anisocoria

-The iris is typically round, flat, and evenly colored. -The pupil, round with a regular border, is centered in the iris. -Pupils are normally equal in size (___ to ___ mm). -An inequality in pupil size of less than 0.5 mm occurs in 20% of clients. This condition, called _____, is normal.

Fundus

-Varies in color, depending on skin color

70, 50, 90, 60

-With normal peripheral vision, the client should see the examiner's finger at the same time the examiner sees it. Normal visual field degrees are approximately as follows: • Inferior: ____ degrees • Superior: ___ degrees • Temporal: ___ degrees • Nasal: ___ degrees -A delayed or absent perception of the examiner's finger indicates reduced peripheral vision. Refer client for further evaluation

scotoma

-a blind spot that is surrounded by either normal or slightly diminished peripheral vision. -may be from glaucoma

optic disc

-a cream-colored, circular area located on the retina toward the medial or nasal side of the eye -It is where the optic nerve enters the eyeball.

Sclera

-a dense, protective, white covering that physically supports the internal structures of the eye. -It is continuous anteriorly with the transparent cornea

Accommodation

-a functional reflex allowing the eyes to focus on near objects -accomplished through move- ment of the ciliary muscles, causing an increase in the curvature of the lens

Episcleritis

-a local, noninfectious inflamation of the sclera. -usually characterized by either a nodular appearance or by redness with dilated vessels

Lacrimal apparatus

-consists of glands and ducts that lubricate the eye

conjunctivitis

-generalized redness of the conjuctiva -also known as pink eye

Visual perception

-occurs as light rays strike the retina, where they are transformed into nerve impulses, conducted to the brain through the optic nerve, and interpreted

visual fields

-refers to what a person sees with one eye -divided into four quadrants: upper temporal, lower temporal, upper nasal, and lower nasal -The temporal quadrants of each visual field extend farther than the nasal quadrants. Thus, each eye sees a slightly different view but their visual fields overlap quite a bit. As a result of this, humans have binocular vision

visual acuity

-sharpness of vision, measured by the ability to discern letters or numbers at a given distance according to a fixed standard. -Normally 20/20 -The higher the second number, the poorer the vision

Binocular vision

-the visual cortex fuses the two slightly different images and provides depth perception, or three-dimensional vision.

eyelids

-two movable structures composed of skin and two types of muscle: striated and smooth -Purpose = to protect the eye from foreign bodies and limit the amount of light entering the eye -Serve to distribute tears that lubricate the surface of the eye

sunken

A _____ appearance of the eyes may be seen with severe dehydration or chronic wasting illnesses

20/200

A client is considered legally blind when vision in the better eye with corrective lenses is _____ ____ or less. Refer any client with vision worse than 20/30 for further evaluation.

fovea centralis

A retinal depression known as the ____ ____ is located adjacent to the optic disc in the temporal section of the fundus -This area is surrounded by the macula, which appears darker than the rest of the fundus. -Macula and this are highly concentrated with cones and form the area of highest visual resolution and color vision.

Hordeolum

A stye -a hair follicle infection, causes local redness, swelling, and pain

2, annually

A thorough eye examination is recommended for healthy clients without risk factors every ___ years, for ages 18 through 60; ____ for those age 61 and older

Entropion

An inverted lower lid -may cause pain and injure the cornea as the eyelash brushes against the conjunctiva and cornea. -interfere with normal tear drainage

cataracts

Areas of roughness or dryness on the cornea are often associated with injury or allergic responses. Opacities of the lens are seen with ______

optic chiasma

At the point where the optic nerves from each eyeball cross—the ____ ____—the nerve fibers from the nasal quadrant of each retina (from both temporal visual fields) cross over to the opposite side.

anterior chamber

Chamber that is located between the cornea and iris

eyeball

Composed of three separate coats or layers -External layer = sclera and cornea -Middle layer = iris and ciliary body -Posterior layer = choroid -contains several chambers that maintain structure, protect against injury, and transmit light rays

bacterial

Discharge other than tears from one or both eyes suggests a _____ or viral infection

diplopia

Double vision (_____) may indicate increased intracranial pressure due to injury or a tumor.

ptosis

Drooping of the upper lid -may be attributed to oculomotor nerve damage, myasthenia gravis, weakened muscle or tissue, or a congenital disorder

epiphora, Unilateral, Bilateral

Excessive tearing (______) is caused by exposure to irritants or obstruction of the lacrimal apparatus. -______ epiphora is often associated with foreign body or obstruction. -_____ epiphora is often associated with exposure to irritants, such as makeup or facial cleansers, or it may be a systemic response.

obstruction

Excessive tearing may indicate a nasolacrimal sac ____

cataracts

Exposure to ultraviolet radiation puts the client at risk for the development of _____

duct

Expressed drainage from the puncta on palpation occurs with ____ blockage

corneal

Failure of lids to close completely puts client at risk for ___ damage.

straight, diagonal

Four rectus muscles are responsible for ____ movement, and two oblique muscles are responsible for ____ movement.

blindness

Night _____ is associated with optic atrophy, glaucoma, and vitamin A deficiency.

palpebral

Palpation of the _____ conjunctiva is done if client complains of pain or something in the eye

aureus

Redness and crusting along the lid margins suggest seborrhea or blepharitis, an infection caused by Staphylococcus ____

hyperthyroidism

Retracted lid margins, which allow for viewing of the sclera when the eyes are open, suggest ____.

narrow-angle

Seeing halos around lights is associated with ______ ______ glaucoma.

Pupillary Reaction

Size changes in response to light controlled by oculomotor never (III) -Darkened room -Have client focus on a distant object -Shine light obliquely into the pupil and observe the pupil's reaction to light -Normally, pupils constrict

myopia

Spots or floaters are common among clients with ___ or in clients over age 40. In most cases, they are due to normal physiologic changes in the eye associated with aging and require no intervention.

acute, hypertension

Sudden changes in vision are associated with _____ problems such as head trauma or increased intracranial pressure. Gradual changes in vision may be related to aging, diabetes, ____, or neurologic disorders.

cornea, lens

The ____ and ___ are the main eye components that refract (bend) light rays on the retina.

eye

The _____ transmits visual stimuli to the brain for interpretation and, in doing so, functions as the organ of vision

Oculomotor (III)

The inferior oblique is innervated by which nerve?

Oculomotor (III)

The inferior rectus is innervated by which nerve?

Retina

The innermost layer -Extends only to the ciliary body anteriorly -Receives visual stimuli and sends it to the brain. -Consists of numerous layers of nerve cells, including the cells commonly called rods and cones.

Abducens (VI)

The lateral rectus is innervated by which nerve?

bulges, flattens

The lens ____ to focus on close objects and ____ to focus on far objects.

Oculomotor (III)

The medial rectus is innervated by which nerve?

extraocular muscles

The six muscles attached to the outer surface of each eyeball

Trochlear (IV)

The superior oblique is innervated by which nerve?

Oculomotor (III)

The superior rectus is innervated by which nerve?

tarsal plates, meibomian

The upper eyelid is larger, more mobile, and contains ____ ____made up of connective tissue. These plates contain the _____ glands, which secrete an oily substance that lubricates the eyelid.

palpebral

The white space between open eyelids is called the ______ fissure.

Cyanosis

____ of the lower lid suggests a heart or lung disorder.

Redness

_____ or swelling of the eye is usually related to an inflammatory response caused by allergy, foreign body, or bacterial or viral infection

Xanthelasma

______, raised yellow plaques located most often near the inner canthus, are a normal variation associated with increasing age and high lipid levels.

Lens

a biconvex, transparent, avascular, encapsulated structure located immediately posterior to the iris -functions to refract (bend) light rays onto the retina

iris

a circular disc of muscle containing pigments that determine eye color

aqueous humor

a clear liquid substance produced by the ciliary body and fills up the anterior and posterior chamber -helps to cleanse and nourish the cornea and lens as well as maintain intraocular pressure -filters out of the eye from the posterior to the anterior chamber then into the canal of Schlemm through a filtering site called the trabecular meshwork

Scotoma

a partial loss of vision or a blind spot in an otherwise normal visual field.

Tropia

a specific type of misalignment: esotropia is an inward turn of the eye, and exotropia is an outward turn of the eye.

Phoria

a term used to describe misalignment that occurs only when fusion reflex is blocked

Ectropion

an everted lower eyelid, results in exposure and drying of the conjunctiva. -interfere with normal tear drainage

chalazion

an infection of the meibomian gland/ oil glands (located in the eyelid), may produce extreme swelling of the lid, moderate red- ness, but minimal pain

Nystagmus

an oscillating (shaking) movement of the eye—may be associated with an inner ear disorder, multiple sclerosis, brain lesions, or narcotics use.

pupillary light reflex

causes pupils immediately to constrict when exposed to bright light -This can be seen as a direct reflex, in which constriction occurs in the eye exposed to the light, or as an indirect or consensual reflex, in which exposure to light in one eye results in constriction of the pupil in the opposite eye -These protective reflexes, mediated by the oculomotor nerve, prevent damage to the delicate photoreceptors by excessive light.

posterior chamber

chamber that is the area between the iris and the lens

ciliary body

consists of muscle tissue that controls the thickness of the lens, which must be adapted to focus on objects near and far away. -Refractive ability of the lens can be changed by a change in shape of the lens (which is controlled by the ciliary body)

Strabismus

constant malalignment of the eyes.

Presbyopia (farsighted)

impaired close vision -indicated when the client moves the chart away from the eyes to focus on the print. It is caused by decreased accommodation. -Common condition in clients over 45 years of age

Myopia (nearsighted)

impaired far vision -present when the second number in the test result is larger than the first (20/40)

retina

light must pass through transparent media (cornea, aqueous humor, lens, and vitreous body) before reaching the ___

eyeball

located in the eye orbit, a round, bony hollow formed by several different bones of the skull. -In the orbit, a cushion of fat surrounds the eye -The bony orbit and fat cushion protect the eyeball.

Eyelashes

projections of stiff hair curving outward along the margins of the eyelids that filter dust and dirt from air entering the eye.