Podcast
Questions and Answers
When inspecting the sclera of a dark-skinned patient, what is an expected finding?
When inspecting the sclera of a dark-skinned patient, what is an expected finding?
Small, brown macules on the sclera
What does anisocoria indicate?
What does anisocoria indicate?
Normal presence of pupils with two different sizes
What color do you expect Mr. Sternberg's optic discs to be on examination?
What color do you expect Mr. Sternberg's optic discs to be on examination?
Creamy yellow-orange to pink
How do you interpret findings of blinking and pupillary constriction in a newborn?
How do you interpret findings of blinking and pupillary constriction in a newborn?
What are you checking when you ask a patient to focus on a distant object and then on your finger held 7 to 8 cm from their nose?
What are you checking when you ask a patient to focus on a distant object and then on your finger held 7 to 8 cm from their nose?
What direction should a patient be told to look during an ophthalmoscope examination?
What direction should a patient be told to look during an ophthalmoscope examination?
What is meant by accommodation in the notation 'PERRLA'?
What is meant by accommodation in the notation 'PERRLA'?
Which phrases describe the optic disc? (Select all that apply)
Which phrases describe the optic disc? (Select all that apply)
How should you document a patient's pupil size before and after the light reflex if before it is 4 mm and after it is 2 mm?
How should you document a patient's pupil size before and after the light reflex if before it is 4 mm and after it is 2 mm?
Why should the room be darkened before an ophthalmic examination?
Why should the room be darkened before an ophthalmic examination?
What should you tell Mr. and Mrs. Green about their newborn's vision?
What should you tell Mr. and Mrs. Green about their newborn's vision?
What term might you use to document an abnormal growth of conjunctiva over the cornea?
What term might you use to document an abnormal growth of conjunctiva over the cornea?
What is arcus senilis?
What is arcus senilis?
What are xanthelasma?
What are xanthelasma?
What are pingueculae?
What are pingueculae?
What finding is expected in an individual with very dark irises?
What finding is expected in an individual with very dark irises?
What condition is caused by a generalized decrease in the diameter of the arteries?
What condition is caused by a generalized decrease in the diameter of the arteries?
What does photophobia mean?
What does photophobia mean?
What does the confrontation test assess?
What does the confrontation test assess?
Who should be tested for color blindness?
Who should be tested for color blindness?
What does the Hirschberg test assess?
What does the Hirschberg test assess?
What meaning do you attach to a gray-white circle around the limbus in an elderly patient?
What meaning do you attach to a gray-white circle around the limbus in an elderly patient?
What does the disappearance of the red reflex while using the ophthalmoscope indicate?
What does the disappearance of the red reflex while using the ophthalmoscope indicate?
What condition might you find alongside epicanthal folds in a child of Irish descent?
What condition might you find alongside epicanthal folds in a child of Irish descent?
What is the likely cause of a slight blue tinge to a newborn's sclera?
What is the likely cause of a slight blue tinge to a newborn's sclera?
What is papilledema?
What is papilledema?
What are congenital cataracts associated with?
What are congenital cataracts associated with?
What does bilateral miosis occur with?
What does bilateral miosis occur with?
What does a unilateral dilated pupil with no reaction to light or accommodation suggest?
What does a unilateral dilated pupil with no reaction to light or accommodation suggest?
The six pairs of extraocular muscles maintain parallel or ___________ movement.
The six pairs of extraocular muscles maintain parallel or ___________ movement.
The elliptical opening between the eyelids is known as the ________ fissure.
The elliptical opening between the eyelids is known as the ________ fissure.
Which part of the ocular fundus should be examined last?
Which part of the ocular fundus should be examined last?
What are normal findings when examining retinal blood vessels?
What are normal findings when examining retinal blood vessels?
What is a normal finding on an Allen test?
What is a normal finding on an Allen test?
What pattern of vision loss is associated with homonymous hemianopsia?
What pattern of vision loss is associated with homonymous hemianopsia?
What is a physiologic function of the retina?
What is a physiologic function of the retina?
What occurs at the optic chiasm?
What occurs at the optic chiasm?
In the Snellen chart, what does the numerator of 20 represent?
In the Snellen chart, what does the numerator of 20 represent?
What are you assessing when you perform the confrontation test?
What are you assessing when you perform the confrontation test?
What is the diagnostic positions test an indicator of?
What is the diagnostic positions test an indicator of?
What is an expected finding when performing the cover test on a 5-year-old?
What is an expected finding when performing the cover test on a 5-year-old?
Study Notes
Eye Examination Overview
- Expected finding for African-American patients: Small brown macules on the sclera are common and should not be mistaken for foreign bodies; may also observe a gray-blue or muddy sclera.
- Anisocoria is a normal condition where pupils are of different sizes.
- Optic discs should appear creamy yellow-orange to pink during routine exams.
Eye Reflexes and Functions
- In newborns, blinking and pupillary constriction in response to bright light indicate intact lower visual pathways, but do not confirm visual capability.
- Accommodation is tested by asking patients to focus on distant objects and shift gaze to near objects, leading to pupil constriction.
- For an ophthalmoscopic exam, patients should keep their gaze fixed on a distant point to aid pupil dilation.
Pupil Reactions
- PERRLA: Pupils are equal, round, and reactive to light and accommodation, indicating proper eye function.
- Documenting pupil size should indicate the size before and after testing, e.g. Right 4/2 = 4/2 Left.
Age-Related and Normal Findings
- Arcus senilis: A gray-white arc due to lipid deposition, generally harmless to vision.
- Normal changes with age include increased visibility of a gray-white circle around the limbus in older adults.
- The macula develops steadily after birth, with binocularity established by 3 to 4 months.
Abnormal Conditions
- Pterygium involves abnormal conjunctival growth over the cornea, potentially obstructing vision.
- Pingueculae are yellowish nodules caused by environmental exposure and are differentiated from pterygium.
- Papilledema indicates increased intracranial pressure, characterized by disc elevation and redness.
Vision Testing and Conditions
- Color blindness testing is essential for young white males, particularly ages 4 to 8.
- Conditions like Horner's syndrome are indicated by unilateral small pupils that react normally to light.
- Homonymous hemianopsia results in loss of the same half of the visual field in both eyes.
Specialized Eye Tests
- Hirschberg test assesses eye alignment through light reflection on corneas.
- Confrontation tests measure peripheral vision effectively.
- The cover test should demonstrate that a covered eye retains its position upon uncovering.
Retinal Examination Insights
- Retinal blood vessels should show a normal artery-to-vein width ratio of 2:3 with potential venous pulsation.
- The optic chiasm is where fibers from the nasal retina cross, forming optic tracts.
Snellen Chart and Visual Assessment
- The numerator of 20 in the Snellen chart measures distance from the chart, indicating the visual acuity assessment.
- Peripheral vision is assessed through confrontation tests, and the diagnostic positions test evaluates extraocular muscle function.
Important Definitions
- Photophobia: Intolerance to light.
- Bilateral mydriasis results from sympathetic activation or drug use.
- Congenital cataracts present with an absent red reflex, indicating serious vision issues.
Newborn Considerations
- Newborns may exhibit a slight blue tinge to the sclera due to scleral thinness at birth.
- Eye movements are often uncoordinated in neonates, but vision develops significantly within the first year.
Studying That Suits You
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Description
Test your knowledge with these flashcards focused on Chapter 14 of the eye review. Explore important observations and expected findings during eye examinations, particularly for diverse populations. Perfect for medical students and professionals aiming to enhance their understanding of eye health.
