Chapter 11 Seidel Eyes

Vision not correctable to 20/____ is legally blind:

200

Mrs. Howell brings her 13-year-old daughter for a routine well visit. Which of the following is relevant information for a history and examination of a child's eyes and vision? Immunization history Growth milestones Birth weight Academic performance

Academic performance

When testing the pupil for accommodation, which of the following results would be expected? As the individual focuses on a distant object, the pupils constrict. As the individual focuses on a close object, the pupils constrict. As the patient focuses on a distant object, the pupils diverge. As the patient focuses on a close object, the pupils converge.

As the individual focuses on a close object, the pupils constrict.

Mrs. Harold is a 36-year-old patient who presents to your office with a complaint of visual disturbances. As part of her eye examination, you assess for accommodation. Which method would you use? Shine a light into the pupil; note constriction. Ask the patient to shift her gaze from across the room to an object 6 inches away; note constriction. Ask the patient to follow an object through the six cardinal fields of gaze; note ocular movement. Cover one of the patient's eyes with a card; remove the card and note any deviation from a fixed gaze.

Ask the patient to shift her gaze from across the room to an object 6 inches away; note constriction.

Mrs. Delman brings her 1-month-old infant in for a routine examination. Which of the following is considered a routine part of a newborn examination? Assessing red reflex Assessing extraocular movements with six fields of gaze A fundoscopic examination Assessing visual acuity

Assessing red reflex

Pregnant women

Blurred vision for contact wearers due to increased level of lysozyme in tears. Mild corneal edema and thickening in third trimester. Intraocular pressure falls during latter half of pregnancy.

Mrs. Yates presents to your office with a 3-month-old infant for examination. During your examination, you note white specks scattered in a linear pattern around the circumference of the iris. Which of the following would best identify this condition? Lipemia, suggesting hyperlipidemia remaining from the mother after birth Enlarged corneas, suggesting congenital glaucoma Coloboma, suggesting congenital abnormalities Brushfield spots, suggesting Down syndrome or mental retardation

Brushfield spots, suggesting Down syndrome or mental retardation

Cranial nerve tested with visual acuity testing:

CN II (optic nerve)

Full eye movement is controlled by:

CN III (oculomotor) CN IV (trochlear) CN VI (abducens) six extraocular muscles

Mr. Black is a 66-year-old patient with a history of herpes simplex. He presents to your office with a concern of visual disturbances. Which of the following would explain why this individual may be unaware of an infection or injury to an eye? Decreased corneal sensitivity Diminished tearing Reduced visual acuity Increased density of the lens

Decreased corneal sensitivity

After examining a patient's eyes, you are documenting your findings. Which information would you include about a finding of ptosis? Severity of redness and injection of the lacrimal duct based on a range of 0 to 10 Number of millimeters separating the upper and lower lid when the eyes are closed Difference in millimeters between the position of the two upper lids relative to the limbus Degrees of eversion of the lower lid

Difference in millimeters between the position of the two upper lids relative to the limbus

Unexpected eye findings

Drusen bodies-small, discrete spots more yellow than retina. Consequence of aging but may be precursos to senile macular degeneration. Use Amsler grid for increasing drusen bodies. Hemorrhages at disc margin-poorly controlled glaucoma or undiagnosed. Flame-shaped hemorrhages occur in nerve fiber layers and blood spreads. Round hemorrhages appear dark. Dot hemorrhages-microaneurysms, common in diabetic retinopathy.

Opthalmoscope use:

Examine right eye with right eye. Start with lens on 0 setting. While looking at distant point, direct light at pupil 12 inches away. Visualize red reflex. (caused by light illuminating retina) Absence is usually improper position. Blood vessel will be first structure seen about 3-5cm away. If myopic, you will need to use minus (red)lnes. If hyperopic or lacks a lens (aphakic) you will need plus lens. When fundus is in focus, you will see branching of blood vessels. They branch away from optic disc so use as landmarks. Optic disc is where retina converges to optic nerve. Next, look at vascular supply of retina. Venous pulsation may be seen on disc and noted. Arterioles are smaller and reflext light brighter. Oxygenated blood is brighter red. Follow blood vessels distally far in each four quadrants. Note sites of crossing. May change with hypertension-narrowing of vessels, increased vascular tortuosity, copper wiring (red-brown reflex), arteriovenous nicking, retinal hemorrhages. Next, examine optic disc. Should be sharp and well defined especially in temporal region. Yllow to creamy pink but may be darker in dark skinned patients. 1.5mm in diameter and is the unit of measurement for lesion description. Next, examine macula. 2 disc diameters temporal to optic disc. Ask patient to look directly at light. Appears as lighter dot surrounded by avasuclar area.

Which is the correct technique for performing a fundoscopic examination with a traditional ophthalmoscope? Examine the patient's right eye with your right eye, and the left eye with your left eye. Examine the patient's right eye with your left eye, and the left eye with your right eye. Examine the patient's right and left eyes with your dominant eye. Examine the patient's right and left eyes with your nondominant eye.

Examine the patient's right eye with your right eye, and the left eye with your left eye.

Which fact reported in a patient's history indicates increased risk for a pterygium? Recent episode of carotinemia Frequent sun bathing Ingestion of megadoses of vitamin C History of skin tags

Frequent sun bathing

You note when examining a 62-year-old patient that when she closes her eyes, the lids tremor. This finding would cause you to carefully assess for other symptoms of which disorder? Bell's palsy Pituitary tumor Acoustic neuroma Hyperthyroidism

Hyperthyroidism

Infants:

Inspect external eye structures. size of eyes, swelling, epicanthal folds (vertical fold of skin nasally that covers lacrimal caruncle). May suggest down syndrome but can be seen in different ethnicity. Sunsetting sign-rapidly lower from upright to supine. watch for sclera above iris. may be normal variant but can be seen with hydrocephalus and brainstem lesions. Distance between eyes-wide spacing with craniofacial defects and intellectual disability. Inspect sclera, conjunctiva, pupil, iris. Enlarged corneas-congenital gluaucoma. Brushfield spots-white specs in linear pattern around entire iris suggest down syndrome. coloboma-irregular pupil. seen in congenital anomalies.

rs. Jones brings her 5-year-old son in for a well visit. As part of the child's examination you check for nystagmus. How do you do this? Assess visual acuity. Inspect the macula of the eye with an ophthalmoscope. Inspect movement of the eyes to the six cardinal fields of gaze. Palpate the globe while the child holds eyelids closed.

Inspect movement of the eyes to the six cardinal fields of gaze.

Which of the following structures dilates or contracts to allow light into the eye? Pupil Iris Lens Rectus muscle

Iris

You are completing a fundoscopic examination on a 45-year-old patient. During the examination, you note a red light reflex. Which of the following is this indicative of? Normal hemoglobin content of the retina Light illuminating the retina Adequate dilation of the pupil A retinal hemorrhage

Light illuminating the retina

pregnant women:

Long-standing hypertension can have vascular tortuosity, angiosclerosis, hemorrhage, exudates. In PIH-segmental arteriolar narrowing with wet glistening appearance of edema.

An examiner is most likely to observe pseudostrabismus in which of the following groups? Older/frail adults Native American/American Indian infants Pregnant women Hispanic school children

Native American/American Indian infants

Which of the following cranial nerves directly connects the eye to the brain? Abducens Trochlear Optic Oculomotor

Optic

Fibers that originate on the nasal retina decussate (cross over) at what point in the optic pathway? Optic tract Optic chiasm Optic radiation Optic cortex

Optic chiasm

Pregnant women history

PIH, gestation diabetes topical eye meds

Mr. Lynch is a 46-year-old man who presents to your office for a routine examination. On examination of the corneal light reflex, you notice that there is asymmetry of the reflected light. What should your next step be? Perform the cover-uncover test. Test EOMs. Test for accommodation. Evaluate the depth of the anterior chamber.

Perform the cover-uncover test.

Which abnormality found when examing the eyes of a 12-year-old can be indicative of nephrotic syndrome? Drusen spots Lid fasciculation Periorbital edema Xanthelasma

Periorbital edema

Which of the following is the function of the lens? Converts light impulses into electrical impulses for image formation Controls the amount of light entering the eye Coordinates eye movement Permits images from varied distances to be focused on the retina

Permits images from varied distances to be focused on the retina

Mr. French is a 67-year-old patient who presents to your office with the following complaint: "I have a loss of vision in the outer half of each eye." Which of the following underlying problems should the examiner consider? Diabetes Pituitary tumor Glaucoma Cytomegalovirus (CMV) infection

Pituitary tumor

Mrs. Jones presents to your office for a complaint of visual disturbances. On examination, you note an abnormal growth of conjunctiva from the limbus over the cornea. Which term best describes this condition? Pterygium Arcus limbus Xanthelasma Episcleritis

Pterygium

You are completing a fundoscopic examination on a 28-year-old patient. When examining the right eye with the ophthalmoscope, the examiner should use which hand to hold the ophthalmoscope? Right Left Dominant Nondominant

Right

Which of the following should be used to test for near vision in a 50-year-old patient? Rosenbaum Pocket Vision Screener Snellen "E" chart Confrontation test Landolt C

Rosenbaum Pocket Vision Screener

Sclera inspection:

Senile hyaline plaque-dark, slate gray pigment anterior to insertion of medial rectus muscle.

Infants continued:

Test CN II, III, IV, And VI: examine vision by infants preference to objects. focus and track light through 60 degrees. blink reflex-shine bright light at eyes. quick closure of eyes and dorsiflexion of head. corneal reflex same as adults. Assess red reflex-observe opacities, dark spots, white spots. may indicate congenital cataracts or retinoblastoma. fundus exam deferred for 2-6 months unless concern.

Mr. Green is a 63-year-old patient who is having a driver's physical examination completed. On examination, you note a senile hyaline plaque. Which of the following best describes this finding? This is a normal finding depending on the amount of melanin in the pigment epithelium. This is a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle. This is a small discrete spot slightly more yellow than the retina. This is a slightly raised, irregularly shaped yellow tinted lesion.

This is a dark, slate gray pigment just anterior to the insertion of the medial rectus muscle.

Which examination finding may be indicative of a retro-orbital tumor? Episcleritis Argyll Robertson pupil Unilateral exophthalmos Retinitis pigmentosa

Unilateral exophthalmos

Children:

Visual acuity about 3 years of age. Acuity for ages 3-5 years is 20/40 or better. acuity for ages 6 years-20/30 or better. Refer to specialist for difference between eyes by 2-line difference (such as 20/25 and 20/40).

Ms. Williams is a 21-year-old patient who presents to your office. On examination, you find a cobblestone appearance of the conjunctiva. This is most likely related to: subconjunctival hemorrhage. allergic or infectious conjunctivitis. lagophthalmos. cytomegalovirus infection.

allergic or infectious conjunctivitis.

Mr. Jeffries is a 37-year-old carpenter who presents to your office with a complaint of visual disturbances. On examination, you notice inequality in pupil size which you identify as: mydriasis. esotropia. anisocoria. meiosis.

anisocoria.

Internal eye: cornea

anterior 6th of globe and continuous with sclera. Optically clear, rich sensory innervation and avascular. Major part of refractive power of eye.

Visual acuity is essentially a measurement of: lens accommodation. central vision. depth perception. cranial nerve II, III, VI integrity.

central vision.

efore instilling a mydriatic eyedrop into a patient's eye for examination, the examiner should: assess the corneal reflex. check for a shallow anterior chamber. assess intraocular pressure. observe the eye for vascular changes.

check for a shallow anterior chamber.

Cornea inspection:

clarity-shining light tangentially on it. Because avascular, blood vessels should not be present. Corneal sensitivity-CN V (trigeminal nerve). Decreased corneal sensation-DM, herpes simplex, herpes zoster, and after trigeminal neuralgia surgery. Corneal arcus-composed of lipids deposited in periphery of cornea. May be seen in >60yrs old. If before 40, may be lipid disorder.

External eye: conjunctiva

clear thin mucous membrane. palpebral conjuctiva-coats inside of eyelid bulbar conjuctiva-covers outer surface of eye. protects anterior surface of eye with exception of cornea and surface of eyelid in contact with globe.

Internal eye: Uvea

composed of iris, ciliary body, and choroids. Iris-circular contractile muscle disc with pigment cells. controls amount of light reaching retina. Ciliary body-produces aqueous humor and muscles for acommodation. Choroid-pigmented, richly vascular layer that supplies oxygen to outer layer of retina.

The outer layer of the eye is composed of the sclera posteriorly and the _______________anteriorly. choroid lens conjunctiva cornea

cornea

Ptosis is a condition in which the eyelid: does not cover any portion of the iris. covers a portion of the iris and sometimes a portion of the pupil. is unable to cover any portion of the eyeball. is turned inward toward the globe.

covers a portion of the iris and sometimes a portion of the pupil.

Internal eye: sclera

dense, avascular structure "white of the eye". supports internal structure.

Infants and children

develop during first 8 weeks gestation. Can become malformed from maternal drug ingestion or infection. Term infants-hyperopic with acuity <20/400. Lacrimal glands produce full volume tears and interest in large objects by 2-3 weeks. Binocular vision-complete by 3-4 months. differentiate colors by 6 months. Adult visual acuity by 4 years of age.

Personal/Social History

employment activities protective devices corrective lenses cigarette smoking

Inspection external: eyelids

examine closed for fasciculations or tremors (hyperthyroidism). Ability to close and open, flakiness, redness, swelling. When open, should cover portion of iris but not pupil. Ptosis-when eyelid covers more than other or over the pupil. Congenital or acquired weakness of levator muscle or a paresis of branch of third cranial nerve. Ectropion-when lower lid is turned away from the eye. can cause excessive tearing. Entropion-lower lid is turned inward toward globe. Eyelashes may cause corneal and conjunctival irritation, or infection. Hordeolum or stye-acute suppurative inflammation of follicle of eyelash can cause erythema or yellow lump. Usually staphylococcal. Blepharitis-crusing along eyelashes from bacterial infection, seborrhea, psoriasis, manifestation or rosacea, allergic response. Lagophthalmos-lids do not close completely. Increased risk of infection and dried cornea.

Lid lag:

exposure of sclera above iris when following finger from ceiling to floor. may indicate thyroid eye disease.

PMH

eye surgery chronic illness affecting vision medications

Inspection external: surrounding structures

eyebrows-size, extension, texture. coarse and do not extend beyond temporal canthus, may have hypothyroidism. orbital and periorbital area-edema, puffiness, redundant tissue below orbit. Periorbital edema is always abnormal-thyroid disease, allergies, renal disease. Flat/slightly raised, oval, irrgularly shaped yellow tinted lesions on periorbital tissues due to abnormal lipid metabolism (xanthelasma). Most common in nasal portion of upper and lower lid.

Palpation

eyelids for nodules. Palpation of orbit for intraocular pressure. Pain on palpation-scleritis, orbital cellulitis, cavernous sinus thrombosis. Eye that is firm or resists palpation-severe glaucoma or retrobulbar tumor.

Esotropic

inward (toward the nose)

Older adults:

lacrimal glands involute and decreased tear production. Decreased visual function-glaucoma, cataracts, macular degeneration.

Mrs. Carter has vision that at best is 20/210. Mrs. Carter is considered: legally blind. mildly myopic. moderately hyperopic. unilaterally anisocoric.

legally blind.

External eye: lacrimal gland

located in temporal region of superior eyelid and produces tears to moisten eye. Flow over cornea and drain by canliculi to lacrimal sac and duct then to nasal meatus.

Mr. Jones is a 55-year-old gentleman with diabetes. In order to visualize his macula, the examiner should ask Mr. Jones to: blink the eye several times quickly. lie in a supine position. look directly into the light of the ophthalmoscope. direct eye gaze on an object to the left and then to the right.

look directly into the light of the ophthalmoscope.

Exotropid

outward (away from midline)

Lacrimal apparatus inspection:

palpate lower orbital rim near inner canthus. Puncta should be slight elevations with central depression on upper and lower lid. Enlarged lacriam glands-tumors, lymphoid infiltration, sarcoid disease, Sjogren syndrome.

Macular degeneration:

patho: Dry(atrophic)-from gradual breakdown of cells. gradual blurring of central vision. Wet(exudative or neovascular)-new vessels grow under center of retina. leak, bleed, scar retina destroying central vision. vision loss may be rapid. leading cause of blindness in US >55yrs of age subjective: blurred or decreased central vision blind spots straight lines look irregular or bent different colored objects in each eye objects smaller in one eye objective: dry-drusen (multiple spots in macular region) thinning of retina and loss, and choroid wet-exudates, blood, scaring, new blood vessels below retina.

retinal hemorrhages in infance:

patho: accerleration-deceleration abuse impact head injury from shaken baby usually bilat other causes-HTN, bleeding problems, meningitis, vasculitis, retinal disease, anemia, hypoxia subjective: altered response w/o good explanation objective: dilated fundo exam shows retinal hemorrhage

Glaucoma: disease of optic nerve wherein the nerve cells die due to increased pressure

patho: acute angle may occur if iris blocks exit of aqueous humor open angle cuased by decreased absorption leads to increased resistance and painless buildup of pressure in eye congenital subjective: chronic-more common-symptoms absent except gradual loss of peripheral vision acute glaucoma with intense ocular pain, blurred vision, halo around lights, red eye, dilated pupil stomach pain, NV objective: seen during dilated eye exam visual field tests

Retinitis Pigmentosa: autosomal recessive disorder where genetic defects cause cell death, mainly in rod photoreceptors

patho: associated with deafness, paralysis of extraocular muscles, dysphasia, ataxia, cardiac conduction defects subjective: early symptom night blindness tunnel vision or bumping in to furniture loss of vision painless and progresses over years to decades objective: normal exam early on optic atrophy with waxy pallor, narrowing of arterioles, and peripheral "bone spicule" pigmentation

Chorioretinitis (chorioretinal inflammation): inflammatory process involving both the choroid and retina

patho: common cause-laster therapy for diabetic retinopathy but also histoplasmosis, cytomegalovirus, toxoplasmosis, congenital rubella subjective: cleaning cat litter box, laser surgery pain reduced visual acuity floaters photophobia objective: sharply defined lesion, whitish-yellow then dark pigmentation later visual defect with large lesion scar; whitish lesions single or multiple

Horner syndrome: interruption of sympathetic nerve innervation to eye

patho: congenital, acquired or hereditary (autosomal dominant) result from lesion of primary neuron, stroke, trauma to brachial plexus, tumors, dissecting carotid aneurysm, operative trauma results in traid of ipsilateral miosis, mild ptosis, and loss of hemifacial sweating subjective: depend on cause objective: subtle ptosis pupil on affected side round and constricted. anisocoria greater in darkness affected pupil dilates more slowly dry skin is on same side as affected pupil.

visual field defects:

patho: degenerative changes common cause-vascular supply to optic nerve interrupted. bitemporal hemianopa caused by lesion, usually pituitary tumor Homonymous hemianopa caused by lesions on optic nerve radiation on either side of breain

Diabetic retinopathy (Background or Non-Proliferative) dot hemorrhages or microaneurysms and presence of soft and hard exudates

patho: hard-lipid transudation through incompetent capillaries soft-infarction of nerve layer subjective: asymptomatic initially blurrd vision, distortion, visual acuity loss later on objective: blood vessels with ballon-like sacs blots of hemorrhages on retina itself tiny yellow patches of hard exudate

Exophthalmos: bulging of eye anteriorly out of orbit

patho: increased volume of orbital contents most common, Graves Disease-abnormal connective tissue deposition in orbit and extraocular muscles. bilat or unilat. when unilat, consider tumor subjective: trauma objective: eye protrusion, lids do not reach iris.

Band Keratopathy: deposition of calcium in superficial cornea.

patho: most common w/chronic corneal disease. may occur in-hypercalcemia, hyperparathyroidism, trauma, RF, sarcoidosis, syphilis. subjective: decrease in vision foreign body sensation objective: line just below pupil; passes over cornea rather than around iris. horizontal gray bands interspersed with dark areas that look like holes.

Cataracts: opacity in lens

patho: most commonly from denaturation of lens protein with aging. generally central. may be peripheral with hyperparathyroidism steroid use congenital such as maternal rubella during first trimester subjective: cloudy or blurred vision faded colors headlight, lamps, sunlight too bright halo around lights poor night vision or double vision frequent RX changes objective: cloudiness of lens without special equipment

Strabismus: both eyes do not focus on object simultaneously but can focus with either eye

patho: paralytic-extraocular muscle impairment nonparalytic-no muscle weakness may be sign of increased ICP CN III is vulnerable to damage from brain swelling subjective: poor vision sudden onset of double vision eye deviation reported objective: eye will not move in direction of impaired muscle. detected by cover-uncover test

Episcleritis: inflammation of superficial layers of sclera anterior to insertion of rectus muscles.

patho: poorly understood. simple-intermittent, 1-3 month intervals lasting 7-10 days and resolving in 2-3 weeks. nodular-prolonged and more painful. most are idiopathic. subjective: acute onset mild-moderate discomfort or photophobia. painless injection (redness) and/or watery discharge w/o crusting. objective: diffuse or localized injection of bulbar conjunctiva. purplish elevation of few mm. watery discharge.

retinopathy of prematurity (ROP): disruption of normal progression of retinal vascular development in preterm infant

patho: results in abnormal proliferation of blood vessels more common with birth weight <1500g or gestational age <30 weeks subjective: prematurity high oxygen concentration, blood transfusion, respiratory distress, breathing difficulties objective: straight, temporally diverted blood vessels on fundo exam. mild with no visual defects or progress to retinal detachment and blindness

Corneal ulcer: disruption of corneal epithelium and stroma:

patho: rheumatologic: connective disease (RA, lupus) infection (viral, bacterial) extreme dryness (incomplete lid closure) subjective: pain photophobia contact lenses blurry vision foreign body sensation objective: visual acuity affected variably inflammation and erythema of lids and conjunctiva purulent exudates ulcer round or oval, border sharply demarcated with base ragged and gray.

Lipemia Retinalis: creamy white appearance of retinal vessels with high serum triglyceride levels

patho: serum triglyceride >2000 subjective: elevated serum triglycerides no vision symptoms objective: peripheral fundus changes in early stages appear salmon pink then become whitish can resolve with normal triglyceride levels

retinoblastoma: embryonic malignant tumor arising from retina

patho: usually develops during first 2 years of life autosomal dominant or chromosomal mutation most common retinal tumor in children subjective: family history white reflex on photos objective: initial sign-leukocoria, white reflex ill-defined mass arising from retina on fundo exam.

Diabetic Retinopathy (Proliferative): development of new vessels as result of anoxic stimulation

patho: vessels grow out up retina toward vitreous humor occur in peripheral retina or on optic nerve itself lack supporting structure and may hemorrhage bleeding is major cause of blindness laser therapy subjective: generally asymptomatic floaters, blurred vision, progressive visual acuity loss objective: may require change in lens setting vitreous hemorrhage may be seen and can obstruct view

Infants and children history

preterm maternal STI congenital eye abnormalities symptoms of congenital eye abnormalities white area in pupil in photos excessive tearing strabismum excessive rubbing sitting at front of classroom

Older adults

progressive weakening of accomodation (focusing power) known as presbyopia. by age 45, lens is more rigid and ciliary muscle weaker. loss of lens clarity and catarct formation from old fibers forming a condensed central region.

External eye: eyelid

provide oils to tear film. distributes tears over surface of eye, limits amount of light entering, protects from foreign bodies.

HPI

red eye vision problem

Family history

retinoblastoma (autosomal dominant) glaucoma, macular degenration, DM, HTN cataracts color blindness, retinal detachment, retinis pigmentosa, allergies nearsighted, farsighted, strabismus, amblyopia

Mrs. Young has brought her 2-year-old son in for a routine examination. On examination, you are unable to elicit a red reflex in her son. This may indicate: congenital glaucoma. myosis. retinopathy. retinoblastoma.

retinoblastoma.

Internal eye: Retina

sensory network. Transforms light impulses into electrical impulses which are transmitted through optic nerve, optic tract, and optic radiation to visual cortex in brain and then interpretation in cerebral cortex. Major landmarks-optic disc (optic nerve originates, together with central retinal artery and vein). Macula, or fovea, is site of central vision.

Iris and pupil inspection:

should be round, regular, and equal. Miosis-constriction <2mm. fails to dilate in dark. Caused by narcotics, or drugs for glaucoma. Mydriasis-dilation >6mm and failure to constrict with light. Caused by coma (DM, alcohol, uremia, epilepsy, brain trauma), eye drops. Anisocoria-inequality in pupil size Marcus-Gunn pupil-Afferent pupillary defect. Shine light in one eye then rapidly to the other. Expect slight dilation in second eye while light is crossing bridge of nose but should constrict equally to first eye. If pupil constinues to dilate rather than constrict, it is Marcus-Gunn pupil. Important sign of optic nerve disease. Causes-optic neuritis, glaucoma, optic nerve tumor, MS.

Lens inspection:

should be transparent.

Confrontation test for peripheral vision:

sit opposite and eye level with patient about 3 feet away. Cover opposite eyes so the open eyes are across from each other. Fully extend arm and move slowly centrally. Compare patients response to seeing arm as yours. Test- nasal, temporal, superior, and inferior fields. Lesions most likely to produce abnormalities: stroke, retinal detachment, optic neuropathy, pituitary tumor compression at optic chiasm, central retinal vascular occlusion.

External eye: muscles

six muscles-superior, inferior, medial and lateral rectus, superior and infrior oblique. Innervated by CN III (oculomotor), IV (trochlear), VI (abducens). Superior oblique-only muscle innervated by trochlear nerve. Lateral rectus-only muscle innervated by abducens nerve.

A hordeolum (stye) is best described as a(n): an infection of the eyelid. irritation and eversion of the eyelid. suppurative inflammation of the follicle of an eyelash. overgrowth of a Meibomian gland.

suppurative inflammation of the follicle of an eyelash.

Mrs. Allen is a 45-year-old patient who presents to your office with complaints of visual disturbances. On examination her visual acuity is recorded as 20/60. This can be interpreted to mean that: the person can read at 60 feet what an average person can read at 20 feet. the person can read at 20 feet what an average person can read at 60 feet. 20% of individuals tested can read 60% of the letters in this particular line. out of 100 individuals, 20% can read all the letters and 60% can read half of the letters in this particular line.

the person can read at 20 feet what an average person can read at 60 feet.

Mrs. Starman is a 68-year-old patient who presents to your office for a routine follow-up. On examination, you notice a ring of white in the periphery of the cornea. Your assessment of the condition is that: the individual needs to be screened for glaucoma. this is a normal age-related change in the eye. the individual has a potentially serious complication of diabetes. with early intervention the progression of the deposition can be stopped.

this is a normal age-related change in the eye.

conjunctiva inspection:

usually translucent and free of erythema. Have patient look up while pulling lid down. Should be translucent and vascular pattern. Inspect upper tarsal conjunctiva only with foreign body complaint. Erythema or cobblestone may be allergic or infectious conjunctivitis. Bright red in sharply defined area-subconjunctival hemorrhage. May occur spontaneously during pregnancy or labor.Resolve spontaneously. Pterygium-abnormal growth of conjunctiva extends over cornea from limbus. Common in people heavily exposed to UV light. Can interfere with vision.

Older adults history

visual acuity excess tearing dry eyes nocturnal eye pain difficulty with depth perception

Mr. Davids is a 48-year-old patient with high cholesterol and diabetes. Individuals with abnormal lipid metabolism are prone to deposition of flat, slightly raised, irregularly shaped, yellow tinted lesions on the periorbital tissues that are called: xanthelasma. xanthophose. xanthophylls. xanthosis.

xanthelasma.