30 Questions
What is the expected outcome when performing the Pupillary Light Reflex test?
The pupil exposed to light will constrict, and the opposite pupil will also constrict
What is the purpose of the Near Reaction test?
To evaluate the convergence and accommodation of the eyes
Which cranial nerve is responsible for innervating the superior oblique muscles?
Cranial nerve IV (trochlear)
What is the expected outcome when testing the Extraocular Muscles?
The patient's eyes will move together in parallel tracking
What type of movement is typically checked for during the Extraocular Muscle test?
Nystagmus (fine oscillating movement)
How is visual information transmitted from the eye to the brain?
Through the optic nerve, optic chiasm, optic tract, and optic radiation
What is the purpose of assessing the Range of Peripheral Visual Fields?
To detect any defects or abnormalities in the visual field
What is the primary purpose of assessing the corneal light reflex during a physical exam?
To assess the integrity of the cranial nerve pathway
What is the purpose of the pupillary light reflex test?
To test the pupil's response to light and accommodation
What is the primary purpose of assessing extraocular muscle function?
To test the range of motion and alignment of the eyes
What is the purpose of visual field assessment?
To test the peripheral vision of the patient
During the pupillary light reflex test, what is the normal response to light?
Pupil constriction only
What is the purpose of assessing the direct and consensual reflex during the physical exam?
To assess the integrity of the cranial nerve pathway
What is the purpose of the accommodation test during the physical exam?
To test the pupil's ability to focus on near objects
What is the primary cause of Abnormal increase in IOP in Chronic-open angle Glaucoma?
Blockage preventing outflow of vitreous humor
What is the most common symptom of Age Related Macular Degeneration?
Blurred vision
What is the primary symptom of Wet (Neovascular) Age Related Macular Degeneration?
Straight lines appear wavy
What is a common risk factor for Chronic-open angle Glaucoma?
Family history
What is a symptom of Cataracts?
Glare and difficulty with night time driving
What is a characteristic of Acute Closed Angle Glaucoma?
Rapid increase in IOP due to sudden blockage
What is a symptom of Dry (Atrophic) Age Related Macular Degeneration?
Blurred vision
What is the visual field defect that results from an optic chiasm cut?
Bitemporal hemianopsia
Which of the following is a characteristic of a normal optic disc?
It has a sharp with distinct outline and is round or oval in shape
What is the visual field defect that results from a right optic tract cut?
Left homonymous hemianopsia
What is the part of the ophthalmoscope that allows the examiner to see the retinal vessels?
Retinal field or background
What is the normal color of the retinal background?
Light red to dark brown-red
What is the location of the macula in relation to the optic disc?
Not mentioned in the content
What is the purpose of the ophthalmoscope?
To examine the interior of the eye
What is the result of the crossing of fibers in the optic chiasm?
Visual loss in the temporal half of each field
What is the part of the retina that is responsible for central vision?
Macula
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
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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