Pupillary Light Reflex
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Questions and Answers

What is the expected outcome when performing the Pupillary Light Reflex test?

  • Both pupils will dilate
  • The pupil exposed to light will constrict, and the opposite pupil will also constrict (correct)
  • Both pupils will remain unchanged
  • The pupil exposed to light will constrict, and the opposite pupil will dilate

    • What is the purpose of the Near Reaction test?

  • To evaluate the convergence and accommodation of the eyes (correct)
  • To test the direct and consensual reaction to light
  • To assess pupillary constriction to light
  • To assess the six cardinal positions of gaze

    • Which cranial nerve is responsible for innervating the superior oblique muscles?

  • Cranial nerve III (oculomotor)
  • Cranial nerve IV (trochlear) (correct)
  • Cranial nerve VI (abducens)
  • Cranial nerve II (optic)

    • What is the expected outcome when testing the Extraocular Muscles?

    <p>The patient's eyes will move together in parallel tracking</p> Signup and view all the answers

    What type of movement is typically checked for during the Extraocular Muscle test?

    <p>Nystagmus (fine oscillating movement)</p> Signup and view all the answers

    How is visual information transmitted from the eye to the brain?

    <p>Through the optic nerve, optic chiasm, optic tract, and optic radiation</p> Signup and view all the answers

    What is the purpose of assessing the Range of Peripheral Visual Fields?

    <p>To detect any defects or abnormalities in the visual field</p> Signup and view all the answers

    What is the primary purpose of assessing the corneal light reflex during a physical exam?

    <p>To assess the integrity of the cranial nerve pathway</p> Signup and view all the answers

    What is the purpose of the pupillary light reflex test?

    <p>To test the pupil's response to light and accommodation</p> Signup and view all the answers

    What is the primary purpose of assessing extraocular muscle function?

    <p>To test the range of motion and alignment of the eyes</p> Signup and view all the answers

    What is the purpose of visual field assessment?

    <p>To test the peripheral vision of the patient</p> Signup and view all the answers

    During the pupillary light reflex test, what is the normal response to light?

    <p>Pupil constriction only</p> Signup and view all the answers

    What is the purpose of assessing the direct and consensual reflex during the physical exam?

    <p>To assess the integrity of the cranial nerve pathway</p> Signup and view all the answers

    What is the purpose of the accommodation test during the physical exam?

    <p>To test the pupil's ability to focus on near objects</p> Signup and view all the answers

    What is the primary cause of Abnormal increase in IOP in Chronic-open angle Glaucoma?

    <p>Blockage preventing outflow of vitreous humor</p> Signup and view all the answers

    What is the most common symptom of Age Related Macular Degeneration?

    <p>Blurred vision</p> Signup and view all the answers

    What is the primary symptom of Wet (Neovascular) Age Related Macular Degeneration?

    <p>Straight lines appear wavy</p> Signup and view all the answers

    What is a common risk factor for Chronic-open angle Glaucoma?

    <p>Family history</p> Signup and view all the answers

    What is a symptom of Cataracts?

    <p>Glare and difficulty with night time driving</p> Signup and view all the answers

    What is a characteristic of Acute Closed Angle Glaucoma?

    <p>Rapid increase in IOP due to sudden blockage</p> Signup and view all the answers

    What is a symptom of Dry (Atrophic) Age Related Macular Degeneration?

    <p>Blurred vision</p> Signup and view all the answers

    What is the visual field defect that results from an optic chiasm cut?

    <p>Bitemporal hemianopsia</p> Signup and view all the answers

    Which of the following is a characteristic of a normal optic disc?

    <p>It has a sharp with distinct outline and is round or oval in shape</p> Signup and view all the answers

    What is the visual field defect that results from a right optic tract cut?

    <p>Left homonymous hemianopsia</p> Signup and view all the answers

    What is the part of the ophthalmoscope that allows the examiner to see the retinal vessels?

    <p>Retinal field or background</p> Signup and view all the answers

    What is the normal color of the retinal background?

    <p>Light red to dark brown-red</p> Signup and view all the answers

    What is the location of the macula in relation to the optic disc?

    <p>Not mentioned in the content</p> Signup and view all the answers

    What is the purpose of the ophthalmoscope?

    <p>To examine the interior of the eye</p> Signup and view all the answers

    What is the result of the crossing of fibers in the optic chiasm?

    <p>Visual loss in the temporal half of each field</p> Signup and view all the answers

    What is the part of the retina that is responsible for central vision?

    <p>Macula</p> Signup and view all the answers

    Study Notes

    Pupillary Light Reflex

    • To test the pupillary light reflex, have the patient gaze into the distance and shine a pen light onto the eye from the side
    • Direct reaction: normally, the pupil exposed to bright light will constrict
    • Consensual reaction: normally, the opposite pupil will also constrict

    Assessing for Near Reaction: Convergence and Accommodation

    • Hold a finger in front of the patient's nose, 12 inches away, and have them focus on it
    • Pupils will normally dilate when focusing on a far object
    • Move the finger closer (3 inches from the face) and the pupils will normally constrict and converge as the finger moves closer

    Testing Extraocular Muscles

    • Hold a finger about 12 inches from the patient's face and have them follow it through the six cardinal positions of gaze
    • Should have parallel tracking of the eyes
    • Check for nystagmus (fine oscillating movement) and lid lag
    • Cranial nerve VI (abducens) innervates the lateral rectus muscles
    • Cranial nerve IV (trochlear) innervates the superior oblique muscles
    • Cranial nerve III (oculomotor) innervates all the rest: superior, inferior, medial rectus, and inferior oblique

    Assessing Range of Peripheral Visual Fields

    • Assess the range of peripheral visual fields

    Visual Fields and Visual Pathways

    • Visual fields: projected upside down and reversed right to left
    • Visual pathways: nerve impulses are conducted through the retina, optic nerve, optic chiasm, and optic tract on each side, and then through a curving tract called the optic radiation

    Subjective - History

    • PMH: history of ocular problems, strabismus, glaucoma, cataracts, eye trauma, macular degeneration, medications for eyes/eyedrops, diabetes, and hypertension
    • PSH: prior surgery involving the eyes (LASIK, cataract removal, etc.)
    • FMH: family history of genetic eye conditions, such as macular degeneration, retinitis pigmentosa, retinoblastoma, glaucoma, night blindness, etc.

    Review of Systems (ROS)

    • Ask about recent changes in vision, use of contacts/glasses, eye pain, blurred vision, double vision, photophobia, floaters, flashing lights, redness/swelling of eyes, watering/discharge, and date of last eye exam
    • Also, ask about self-care behaviors

    Objective - Physical Exam

    • Assess visual acuity
    • Inspect lids and lashes, conjunctiva, sclera, iris, cornea, and shape and size of pupils
    • Check corneal light reflex and direct and consensual reflex
    • Test accommodation: convergence
    • Test extraocular movements
    • Test visual fields
    • Perform a funduscopic examination

    Testing Visual Acuity - Snellen Test

    • Position the patient 20 feet from the chart
    • Leave glasses on/contacts in
    • Shield one eye and have them read the smallest line possible
    • Record the fraction noted at the last line read with more than half correct answers
    • Record for each eye separately (OD = patient's right eye, OS = patient's left eye)

    Abnormal - Impaired Vision

    • Myopia (nearsightedness): impaired far vision
    • Hyperopia (farsightedness): impaired close vision

    Inspect

    • Eyebrows: note fullness, hair distribution, and any scaliness of underlying skin
    • Eyelids: note width of palpebral fissures, edema, lid color, lesions, condition and direction of eyelashes, and adequacy of eyelid closure
    • Eyeball: note alignment in the socket and any protrusion or enophthalmos
    • Conjunctiva and sclera: note any swelling or nodules, and ask the patient to look up while using thumbs to lower the bottom lid
    • Lacrimal apparatus: note any swelling around the lacrimal gland and lacrimal sac

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    Description

    Assess your knowledge of the pupillary light reflex, including the direct and consensual reaction to light stimuli. Learn about the steps to test the reflex, including shining a pen light onto the eye.

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