2/27 Ophthalmology History and Exam

Presbyopia:

Age-related vision loss

What is this finding called?

Chorioretinal inflammation

Retinoblastoma:

Embryonal malignant tumor arising from retina

Emmetropia:

Normal vision

What does the confrontation test assess?

Peripheral vision

Lipemia retinalis occurs when:

Serum triglycerides exceed 2000 mg/dL

What does the cover-uncover test check for?

Strabismus

Ophthalmology exam order (with CNs)

VA (CN 2) VF (CN 2) Inspection/palpation PERRLA (CN 2, 3) EOMs (CN 3, 4, 6) Fundoscopic exam

Where is the "blind spot" in our eyes?

Where optic nerve enters

After dropping fluorescein dye, we should use a _____ for assessment

Woods lamp/cobalt blue light

The optic disc/cup are about _____ degrees from midline

15

- No reaction to light/accommodation - Pupil doesn't constrict Which pathologic cause of anisocoria?

3rd nerve paralysis (CN 3)

During VF by confrontation, how many visual fields are we testing for?

4 or 6

If the patient misses _____% of the VA line, record the one above

50

Slit lamp: uses

Abrasion/laceration depth FB Uveitis (iritis)

- Large pupil - Sluggish or no reaction to light - Accommodation present but slowed What pathologic cause of anisocoria?

Adie's pupil

Before instilling dilating drops, you need to check:

Anterior chamber depth

What does tangential lighting test for?

Anterior chamber depth, cornea shadows

- Small, irregular pupils - Don't react to light - Do react to accommodation Which type of pupil?

Argyll-Robertson pupil

Types of visual field defects

Bitemporal hemianopsia "Anopsia" Homonymous hemianopsia

- Observe corneal abrasions and ulcers after fluorescein staining Which type of ophthalmoscope light?

Blue

Strabismus: definition

Both eyes don't focus on an object simultaneously

During an eye exam, you're more likely to induce nystagmus if you don't:

Bury the sclera when testing EOMs

During cotton wisp testing (neuro exam), what CNs are we testing?

CN 5 (sensory) CN 7 (motor)

Band keratopathy:

Calcium deposition in superficial cornea

Proparacaine: side effects (frequent use)

Corneal epithelial defects Opacifications Infiltrates

- Dot hemorrhages - Microaneurysms - Hard/soft exudates - Cotton wool spots Which condition?

DM retinopathy

- Tono-pen - Microscopic plunger applies pressure to cornea - Anesthetic must be used - Multiple readings are averaged - Avoid applying pressure to the globe with free hand Which type of tonometer?

Electronic indentation

Proptosis AKA

Exophthalmos

What does the corneal light reflex check for?

Extraoccular muscle balance

- Slit lamp findings - Seidel's sign - Rust ring Slit lamp findings for which condition?

FB assessment

What is this finding called?

Flame hemorrhage

- Assessment of corneal irregularities - Abrasion, laceration - Ulceration - Herpetic dendrites - Actinic (UV) keratitis Which assessment tool can be used to assist?

Fluorescein dye

Which type of ophthalmoscope light is best for eyes with cataracts?

Half light (so light doesn't bounce back at you)

Dendrites on fluorescein stain are indicative of:

Herpes simplex keratitis

- Pupil is small - Reacts to light and accommodation - Ptosis on affected side - Loss of sweating on affected side Which pathologic cause of anisocoria?

Horner's syndrome

Seidel sign: definition

If fluorescein stain applied to eye, stained vitreous fluid will be seen leaking from eye

- Schiotz Tonometer - Weighted plunger rests on cornea - Amount the plunger sinks into cornea translated onto scale at top of plunger - Conversion table used to change the scale reading into IOP in mmHg - Anesthetic must be used Which type of tonometer?

Impression/indentation

Tonometry (names)

Impression/indentation Electronic indentation Rebound tonometer Reboud transpalpebral tonometer

We should test the eyes (together/individually)

Individually

Horner syndrome is a triad of:

Ipsilateral miosis Mild ptosis Loss of hemifacial sweating

Which type of ophthalmoscope light is best for a dilated pupil with drops?

Large

What muscle does CN 6 supply?

Lateral rectus

"Anopsia" is caused by:

Lesion at the optic chiasm

Homonymous hemianopsia is caused by:

Lesion in optic tract on either side of brain

What is hemianopsia?

Less vision or blindness (anopsia) in half the visual field, usually on one side of the vertical midline

- Eye does not constrict in light - Monocular blindness - Afferent vs. efferent - Swinging flashlight sign Which type of pupil?

Marcus Gunn pupil

Pupils should constrict when focused on (near/far) objects

Near (we need less light to see up close)

- Decrease/distortion of central vision - Use of light to increase visual acuity - Complaints of glare - Difficulty in performing near work without lenses - Problems seeing medication labels Watch for these signs in which special population?

Older adults

- Excess tearing - Dry eyes - Nocturnal eye pain (sign of glaucoma) - Depth perception problems Watch for these signs in which special population?

Older adults

Paralytic vs. non-paralytic strabismus

Paralytic: ≥1 extraoccular muscle is impaired Non-paralytic: patient can focus with either eye but not both simultaneously

What does 20/200 vision mean?

Patient can read at 20' what a normal person can read at 200'

Bitemporal hemianopsia is caused by:

Pituitary tumor at optic chiasm

Keyser Fleischer rings are indicative of:

Poor copper metabolism

Topical anesthetic (names)

Proparacaine

- Ultra lightweight probe contacts cornea - Software analyzes deceleration and the contact time of the probe while it touches the cornea - The higher the pressure, the faster the probe decelerates and the shorter the contact time - No anesthetic required Which type of tonometer?

Rebound tonometer

- Diaton tonometer - Probe falls from a fixed height onto taught eyelid - Software analyzes rebound acceleration of the probe returning from impacting the lid - The higher the pressure, the faster the probe acceleration - No anesthetic required → no contact w/ cornea - Positioning of pt and probe more crucial Which type of tonometer?

Rebound transpalpebral

_____ reflex should be elicited in all newborns

Red

- Visualize the vessels/hemorrhages in better detail by improving contrast - Will make the retina look black and white Which type of ophthalmoscope light?

Red free

Victims of shaken baby syndrome will often have what ocular findings?

Retinal hemorrhages in infancy

- Sitting at front of classroom - Poor progress in school - Daily headaches Watch for these signs in which special population?

School age children

- Examine corneal abnormalities of cornea - Examine lens and retina Which type of ophthalmoscope light?

Slit beam

Which type of ophthalmoscope light is best for a constricted pupil?

Small

What muscle does CN 4 supply?

Superior oblique

Papilledema:

Swollen optic nerve head

Which ophtho diagnostic is best for a retinal detachment assessment?

Ultrasound

Anisocoria:

Unequal pupil size

Ptosis:

Upper eyelid droop

- Slit lamp findings - Cell (dust in a sunbeam), inflammatory cells - Flare (headlight in fog), cells/proteins cause light scatter Slit lamp findings for which condition?

Uveitis (iritis)

- Excessive rubbing of eyes - Frequent hordeola (styes) - Can't reach for small objects - Night vision difficulties Watch for these signs in which special population?

Young children