Eyes and head

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what 3 nerves innervate the eye muscles

Abducens: 6 Trochlear: 4 Oculomotor: 3

normal cup:disc ratio

1:2

how thick is the cornea?

1mm

what are you looking for in the vessels of the fundoscopic exam?

arteries vs veins, arteries are 2/3 size and lighter

imperfection of cornea or lens causing some distortion

astigmatism

where would you have the patient look when inspecting the fovea and macula?

directly into the light

what are the 3 layers of the internal eye?

external (fibrous), middle (vascular), internal

constriction of the pupils

miosis

dilation of the pupils

mydriasis

nearsighted vision

myopia

what do you check for at the end of EOMs?

near accommodation and convergence

are pulsations irregular or normal

normal, if they dont have them there is no clinical significance

what should you note for lacrimals?

note swelling, redness of the gland, sac, or puncta

what condition do you look for on far lateral gaze as you perform EOMs?

nystagmus

head of optic nerve where blood vessels enter and exit eye

optic disc

what is the optic disc?

origin of optic nerve

swelling of the optic disc

papilledema

what part of the nervous system controls pupillary constriction

parasympathetic

types of pathological facies

parkinsons, acromegaly, Cushing syndrome, nephrotic syndrome, myxedema

types of salivary glands

parotid, accessory parotid and submandibular

features of nephrotic syndrome

periorbital edema, puffy pale face, swollen lips

depression in the center of the disc

physiologic cup

age related, difficulty focusing near vision

presbyopia

what is the flow of the circulation of aqueous humor?

produced by ciliary body -> posterior chamber -> anterior chamber -> canal of schlemm -> venous circulation

features of acromegaly pathologic facies

prominent brow, enlarged soft tissues, prominent jaw

drooping

ptosis

what should you note for lids?

resting position, symmetry of palpebral fissures, edema, redness, lesions, adequate closure?

what is in the internal layer of the inner eye?

retina

what is the thin delicate layer of nervous tissue that contains photoreceptors (sensitive to light) and the optic disc (origin of optic nerve)

retina

what part of the nervous system controls pupillary dilation?

sympathetic

what is the name of the plate superficial to the meibomian gland of the external eye

tarsal plate

what do you palpate in a head exam?

temporal artery, contour of cranium, salivary ducts, temporomandibular joints (TMJ)

what are the 4 quadrants you should follow the vessels from the disc to the periphery

upper and lower temporal upper and lower nasal

what is the pigmented, vascular layer of the eye?

uveal tract

AV nicking

vein appears to stop abruptly on either side of the artery

most superior part of the skull

vertex

abnormal protrusion of the eyeball commonly seen with hypothyroidism

exophthalmos

outward turning of the eye

exotropia

what is included in the inspection of external soft tissue structures?

1. Lids 2. Lacrimals 3. Lashes

inspection of the eye

1. conjunctive and sclera 2. corneas: lesions, opacities, scars 3. depth of anterior chamber (shadows) 4. evaluate lens: opacities through pupil?

what are the steps for the fundoycopic exam?

1. darken room 2. turn focus to 0 3. hold out hand 4. tell patient to look at a spot on the wall 5. stand 15 inches away and 15 degrees lateral to the patient line of vision 6. shine light into pupil, initiate red reflex 7. move in towards pupil 8. inspect optic disc and retina, follow vessel into a disc

how do you test for near accommodation and convergence?

1. hold object 10 cm from patient eye 2. ask patient to look at object then to the distance 3. pupil shrinks with near gaze 4. eyes should converge when object gets closer to nose

what are you looking for in the fundoycopic exam?

1. red reflex (lens opacities) 2. optic disc 3. vessels 4. retinal background lesions 5. fovea and macula

steps for determining depth of anterior chamber

1. shine light from temporal side 2. look for shadow on nasal side of iris 3. normally won't cast a shadow

steps for corneal light reflex

1. stand 2 feet away 2. shine light, ask patient to look at the light 3. light reflex should be symmetric and slightly nasal from midline

steps for visual acuity

1. stand 20 feet from chart 2. cover 1 eye and read smallest line 3. visual acuity expressed as 2 numbers for both eyes 4. document glasses or contacts (corrected) 5. document missed letters (-2)

how to test visual fields by confrontation

1. stand arms length 2. wiggle and bring fingers forward to center view 3. ask patient to tell you when they see finger movement

what is the size of the optic disc?

1.5 mm

what is part of the head exam

Inspection: 1. position, tilt, tremor, tick, rotation 2. facial symmetry, pathological facies, edema, hirsutism 3. inspect and palpate hair 4. inspect and palpate salivary glands and ducts

what controls the amount of light reaching the retina, controls the size of the pupil, and produces eye color from the pigment

Iris

what is the structure directly deep to the tarsal plate in the eye?

Meibomian gland

what does PERRLA mean?

Pupils are equal, round, and reactive to light accommodation

another name for submandibular duct

Wharton's duct

change in lens caused by contraction of the ciliary muscles that brings the near object into focus

accommodation

difference in pupil size (can be benign)

anisocoria

Is the cornea vascular or avascular?

avascular

is the sclera avascular or vascular?

avascular

most inferior part of the skull

base

inflammation of the eyelid

blepharitis

what are the different conjunctive?

bulbar conjunctive palpebral conjunctiva

if there were opacities of the pupil what is that an indication of?

cataract

what supplies the retina of the eye?

central arteries and veins

a nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland

chalazion

arteries vs veins -diameter -color -light reflex

diameter: artery smaller than vein (2:3 ratio) artery is light red, veins are dark red arteries are brighter

what nourishes adjacent layers of the retina?

choroid

what circumferentially supports the lens, aiding in focusing?

ciliary muscle

if you are farsighted (hyperopic) which side would you move the wheel?

clockwise (to the plus/green

what are you looking for with the optic disc?

color, borders, size of physiologic cup, cup/disc ratio

what should you note for lashes?

condition and direction

what test is done for the pupils?

direct and consensual light responses

eyes coming together

convergence

continuous with the sclera and covers the pupil and iris

cornea

if you are nearsighted (myopic) which side would you rotate the focusing wheel?

counterclockwise (to minus/red)

what are you looking for when testing the visual fields?

defects

what is the physiologic cup?

depression in disc

features of myxedema

dry, coarse, sparse hair, lateral eyebrows are thin, peri orbital edema, puffy dull face with dry skin

what is the sclera continuous with?

dura of the CNS which surrounds the optic nerve

outward turning of the rim of the eyelid

ectropion

inward turning of the rim of the eyelid

entropion

inward turning of the eye

esotropia

how do you test extra ocular movements?

follow your finger in the 6 cardinal directions of gaze

tiny bright reflection at center of macula

fovea

posterior, inner part of the eye

fundus

what muscles are innervated by the oculomotor nerve?

superior rectus muscle medial rectus muscle inferior rectus muscle inferior oblique muscle

what is disc cupping a sign of

glaucoma (glaucomatous cupping)

stye

hordeolum

farsightedness

hyperopia

when would you have to document the size of the pupils?

if they are unequal to one another, greater than 5mm, or less than 3 mm

if there is a shadow when checking the depth of the anterior chamber what could this indicate?

increased risk of angle closure glaucoma

what muscle rotates the eye away from the nose around the long axis (extorsion) and moves the eye upward? (elevation)?

inferior oblique

what muscle moves the eye downward (depression)?

inferior rectus

what is part of the middle layer (vascular) of the inner eye?

iris, ciliary body and choroid (uveal tract)

what makes up the uveal tract?

iris, ciliary body, choroid

name the ducts associated with the eye

lacrimal gland, lacrimal sac, canaliculi, puncta, nasolacrimal duct

what muscle moves the eye outward away from the nose? (abduction)

lateral rectus

what muscles are innervated by the abducens nerve?

lateral rectus muscle

what allows for near/distant focus under the control of the ciliary muscle and is subject to osmotic influences

lens

what is the normal size of the cup

less than 1/2 of disc

what is the normal finding for anterior chamber depth?

light illuminates both sides of iris

what is examined last?

macula

what is the area of central vision located lateral to the disc; darker area?

macula

what is the area of central vision in the retina?

macula/fovea

what muscle moves the eye inward toward the nose? (adduction)

medial rectus

tough outer white covering covered by the conjunctiva that provides support

sclera

what is part of the external (fibrous) layer of the inner eye?

sclera and cornea

what should you note about the optic disc?

shape, margins, color, disc abnormalities, pigmented rings or crescents

how would you test direct and consensual light responses

shine light and observe in both eyes

what are you inspecting for the pupils?

size and symmetry

what tests are used for visual acuity?

snellen chart (distant) pocket screener (near)

features of parkinson's pathologic facies

stare, decreased mobility

how does the cornea perform most of the refraction of incoming light?

steep curvature

another name for parotid duct

stensen's duct

what is the name of the artery you can palpate in the temporal region of the head?

superficial temporal artery

what muscle rotates the top of the eye toward the nose around the long axis (intorsion) and moves the eye down (depression)

superior oblique

what muscles are innervated by the trochlear nerve?

superior oblique muscle

what muscle moves the eye upward (elevation)?

superior rectus

what prevents corneal scarring?

tough Bowman's membrane

what should you identify in the retina?

vessels, venous pulsations

term for the entire area seen by the eye when it looks at a central point

visual field

types of humours in the eye

vitreous humour and aqueous humour

what is the normal color of the physiologic cup?

yellowish white, appears brighter than the disc


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