Questions and Answers
The distance visual acuity test is performed to screen for the presence of hyperopia.
False
Preschool children, non-English speaking people, and nonreaders are tested using a Snellen Big E chart.
True
The Snellen eye test is performed at a distance of 10 feet.
False
The center of the Snellen chart should be positioned at the patient's eye level.
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The patient should be instructed to wear his or her glasses or contact lenses for a distance visual acuity test unless they are for reading.
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The occluder should be placed over the eye being tested.
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Squinting in the eye being tested can temporarily improve vision leading to inaccurate test results.
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During the test, you should check for squinting, head tilting, and eye watering.
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If the patient misses more than three letters on a line, the previous line is recorded.
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Chart whether or not the patient is wearing corrective lenses during the test.
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The Ishihara test is a convenient and accurate method by which to detect congenital color blindness and red-green blindness.
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Patients with color vision defects see no number at all or a different number on the plates.
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Using natural lighting may change the shades of the colors on the plates, and this could cause an inaccurate reading.
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The first plate is a practice plate that is designed to be read correctly by everyone.
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Hold the first plate 60 inches away from the patient at a right angle to the patient's line of vision.
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The patient should be given 15 seconds to identify each plate.
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Do not allow the patient to touch the plate with his fingers, as any dirt or grime on the fingers can alter the colors over time.
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Chart an 'X' if the patient reads a plate correctly.
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Chart 'traceable' if the patient could correctly trace a winding line.
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Store the book in a closed position, to keep light from fading the colors on the plates.
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An eye irrigation involves washing the eye with a flowing solution.
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An eye irrigation may be performed to wash away foreign particles, ocular discharges, or harmful chemicals.
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If both eyes are to be irrigated, one set of equipment is used to prevent cross-infection from one eye to the other.
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Normal saline, also known as sodium chloride, usually is used to irrigate the eye.
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Check the solution label three times.
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If the solution is outdated, it may produce undesirable results.
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Warm the solution to room temperature.
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Palm the label of the container to prevent the solution from dripping on the label and obscuring or loosening the label.
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Ask the patient to tilt her head to the side in the direction of the unaffected eye.
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Before irrigating, cleanse the eyelids from the outer to the inner canthus.
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Instruct the patient to keep both eyes open during the procedure.
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Gently release the solution onto the eye at the inner canthus.
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Direct the solution toward the cornea of the eye.
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Do not allow the tip of the syringe to touch the eye, as this can cause an injury.
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Following the procedure, dry the eyelids with a gauze pad.
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An eye instillation involves the dropping of a liquid into the lower conjunctival sac of the eye.
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An eye instillation may be performed to treat infection, soothe irritation, dilate the pupil, or anesthetize the eye during examination or treatment.
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Medication for the eyes may come in the form of drops or ointment.
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Never place a medication in the eye unless it says 'otic' or 'eye' to avoid injury to the eye.
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If the patient wears contact lenses, they can be left in for the procedure.
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If the medication requires mixing, roll or shake the container.
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Ask the patient to look down, to keep the dropper from touching the cornea and to keep the patient from blinking when the drops are instilled.
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Invert the eye dropper container and hold the tip of the dropper approximately 2 inches above the eye sac.
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Placing the drops directly on the eyeball can be uncomfortable for the patient.
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Ask the patient to close his eyes gently and move the eyeballs to distribute the medication over the entire eye.
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Ear irrigation is washing of the inner ear with a flowing solution.
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Ear irrigations are performed to cleanse the external auditory canal, to remove cerumen, discharge, or a foreign body.
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Impacted cerumen can be softened by instilling warm saltwater into the ear.
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Normal saline, also known as sodium chloride, typically is used to irrigate the eye.
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Ear irrigation should never be performed if the tympanic membrane is perforated.
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If the irrigating solution is too hot or too cold, it might stimulate the inner ear and make the patient dizzy.
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Remove the cap of the irrigating solution container and place it on a flat surface with the open end facing downward to prevent contamination of the cap.
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Pour the solution into the basin at a height of approximately 12 inches, to reduce splashing.
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The patient should be asked to tilt her head toward the affected ear, to allow gravity to help the solution flow out of the ear and into the basin.
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Expel air from the syringe to avoid forcing air into the patient's ear, which can be uncomfortable for the patient.
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To straighten the ear canal of an adult or a child over the age of three, gently pull the ear downward and backward.
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Make sure the tip of the syringe does not obstruct the canal to prevent patient discomfort and possible injury to the tympanic membrane.
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Inject the irrigating solution directly onto the tympanic membrane.
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The patient may experience a minimal amount of dizziness, fullness, and warmth as the ear solution comes in contact with the tympanic membrane.
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After the procedure, ask the patient to lie with the affected side downward, to allow any remaining solution to drain out.
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An ear instillation involves the dropping of a liquid into the middle ear.
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Ear instillations are performed to soften impacted cerumen, to combat infection with the use of antibiotic ear drops, and to relieve pain.
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The medication label must bear the word 'otic' or 'ear drops', indicating that it is for the ear.
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Position the patient in a prone position.
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Warm the ear drops to body temperature by placing the medication container in hot water.
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If the drops are too cold or too warm, they may stimulate the inner ear, causing the patient to become dizzy.
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If the medication requires mixing, shake the container well.
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Tilt the patient's head in the direction of the unaffected ear, to allow gravity to help the medication flow into the ear canal.
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Straighten the external ear canal to permit the medication to reach all areas of the canal.
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After the procedure, instruct the patient to keep her head tilted toward the unaffected side for 2 to 3 minutes, to prevent the medication from running out of the ear.
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Study Notes
Visual Acuity Testing
- Distance visual acuity tests do not specifically screen for hyperopia.
- Snellen Big E chart is suitable for preschool children, non-English speakers, and non-readers.
- The standard Snellen eye test is performed at 20 feet, not 10.
- Position the center of the Snellen chart at the patient's eye level for accurate testing.
- Patients should wear corrective lenses during the test unless prescribed for reading only.
Testing Procedures
- An occluder is used correctly over the unaffected eye during testing.
- Squinting can temporarily enhance vision, potentially skewing results.
- Monitor for squinting, head tilting, and eye watering during the test.
- If a patient misses more than three letters on a line, record the previous line's result.
Color Vision Testing
- Ishihara test effectively detects congenital color blindness and red-green blindness.
- Patients with color vision defects may see no number at all on certain plates.
- Using natural lighting does not affect color shades on Ishihara plates.
- The first plate serves as a practice plate and should be accurately read by all.
Eye Irrigation
- Eye irrigation involves washing the eye with a flowing solution to remove particles or discharge.
- If both eyes need irrigation, use separate equipment to prevent cross-infection.
- Normal saline (sodium chloride) is typically used for eye irrigation.
- Always check the solution label multiple times for accuracy, especially regarding expiration.
Eye Care Procedure
- Solution container should not warm to room temperature; it should be used at appropriate temperatures.
- The patient should tilt their head toward the unaffected eye during the irrigation.
- Cleanse eyelids from inner to outer canthus before irrigation, contrary to common procedures.
- Release solution gently toward the inner canthus of the eye to avoid direct corneal contact.
Eye Instillation
- Eye instillation involves dropping medication into the lower conjunctival sac for various treatments.
- Medication may come as drops or ointments; verify medication labels for otic indications.
- Never leave contact lenses in during eye medication application.
- To prevent irritation, do not place the dropper on the eyeball or allow contact with the cornea.
Ear Irrigation
- Ear irrigation is used to cleanse the external auditory canal, particularly for cerumen removal.
- An impacted cerumen cannot be softened with warm saltwater; normal saline is preferred.
- Never perform ear irrigation if the tympanic membrane is perforated.
- Dizziness may occur from temperature of the solution; optimal temperature should be maintained.
Ear Care Procedure
- Tilt patient's head toward the affected ear to facilitate drainage.
- Ensure the syringe tip does not obstruct the ear canal to avoid discomfort.
- Avoid injecting solution directly onto the tympanic membrane to prevent injury.
- After ear procedures, patients should lie with the affected side downward to aid in drainage.
Medication Application
- Eye and ear medications intended for instillation must be clearly marked to avoid errors.
- Warm solutions to body temperature but do not shake excessively post-mixing.
- Keep the patient's head tilted to allow gravity to assist with medication distribution.
- Patients should be instructed to remain tilted for a few minutes post-application to retain medication.
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Description
This quiz focuses on the principles and procedures of visual acuity and color vision testing. It covers various tests, including the Snellen chart and Ishihara plates, and the proper methods for conducting assessments. Ideal for anyone studying optometry or ophthalmology.
