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N307 E2 Eyes
N307 Eyes Assessment [Ch 14]
| Question | Answer |
|---|---|
| Identify the function of the eyelids. (2) | protect eye, filter out dust and dirt |
| palpebral fissure | elliptical open space between the eyelids |
| limbus | border between cornea and sclera |
| canthus | corner of eye; medial and lateral |
| caruncle | small, fleshy mass at inner corner of eye containing sebaecous glands |
| tarsal plates | strips of connective tissue, contain the meibomian glands, secrete oily lubricating material |
| conjunctiva | thin, mucous membrane; palpebral and bulbar |
| Identify the function of the lacrimal apparatus. | Provide constant irrigation to keep the conjunctiva and cornea moist and lubricated |
| Which gland secretes tears and where is it located? | Lacrimal gland, located in upper outer corner over the eye, secretes tears |
| Identify the function of the 6 extraocular muscles. List them. | Attach eyeball and give eye movement; 4 rectus and 2 oblique |
| Identify the normal color of the sclera. | White |
| What population has narrowed palpebral fissures? | Asians |
| Glaucoma is more prevalent in this population: _______. It is also more likely to cause blindness in this population. | African-American |
| strabismus | abnormal alignment of the eyes; deviation from axis; "cross-eyed" |
| Halos around lights occur with _______. | acute narrow-angle glaucoma |
| Floaters are common with ________. | myopia or after middle age (due to condensed vitreous fibers) |
| scotoma | blind spot surrounded by area of normal or decreased vision, occurs with glaucoma and optic nerve disorders |
| Night blindness occurs with _______. (3) | Optic atrophy, glaucoma, or vitamin A deficiency |
| photophobia | inability to tolerate light |
| diplopia | perception of two images of a single object; double vision |
| What causes lacrimation or epiphora? | Irritants or obstruction in drainage of tears |
| lacrimation | tearing |
| epiphora | excessive tearing |
| Describe purulent discharge. | Thick, yellow, crusts form at night |
| Allergens, such as ______ (3), cause irritation of conjunctiva or cornea. | make-up, contact lens solution |
| How far away should you place the Snellen chart? | 20 feet |
| Snellen chart | chart used to measure visual acuity; has lines of letters arranged in decreasing size |
| What chart do you use for those that cannot read letters, ex. small children? | Snellen picture chart |
| The larger the denominator, the _____ the vision. [better/poorer] | poorer |
| Normal visual acuity is ______. | 20/20 |
| Identify the meanings of the numeric values in a patient's visual acuity score. | Top number indicates distance person is standing from chart; bottom number is the distance at which a normal eye could have read that particular line |
| How do you document visual acuity? | Right 20/30 -1 with glasses (right eye scored 20/30 missing one letter with glasses) |
| What do you do if the person is NOT able to see the largest letter? | Shorten the distance to the chart |
| For the near vision test, how far should the person hold the card? What does this distance mean? | 14" from the eye; distance quals print size on 20-foot chart |
| Identify normal result for near vision test. | 14/14 without hesitation and without moving card closer or further away |
| If you have no near vision screening card available, is it okay to ask the person to read from a magazine? | Yes |
| confrontation test | gross measure of peripheral vision; compare person's peripheral vision with examiners |
| Describe how to perform the confrontation test. | Stand 2 feet away from pt; Cover same eye as pt; look straight at each other; slowly advance flicking finger inward from several directions; tell pt to say now when they see it; repeat with other eye |
| The confrontation test screens for _____ in older adults. | glaucoma |
| Identify normal results for the confrontation test. | About 50 degrees upward, 90 degrees temporally, 70 degrees down, and 60 degrees nasally; "peripheral vision comparable to examiner's" |
| corneal light reflex test | assess the parallel alignment of eye axes by shining light toward person's eyes |
| Identify an abnormal result for the corneal light reflex test. | Asymmetry of light reflex indications deviation in alignment from eye muscle weakness or paralysis |
| Describe how to perform the corneal light reflex test. | Direct pt to stare straight; hold light about 12" away; note reflection of light on corneas, should be the same spot on each eye |
| cover test | detects small degrees of deviated alignment by interrupting the fusion reflex that normally keeps two eyes parallel |
| Describe how to perform the cover test. | Direct pt to stare at your nose; cover 1 eye with opaque card; assess uncovered eye; uncover eye & assess for movement; repeat w/ other eye |
| Identify a normal response for the cover test. | Uncovered eye is "steady, fixed gaze" |
| Identify an abnormal response for the cover test. | Eye jumps to fixate on designated point mean it was out of alignment before |
| diagnostic positions test | leading the eyes through the 6 cardinal positions of gaze will elicit any muscle weakness during movement |
| Describe how to perform the diagnostic positions test. | Ask pt to hold the head steady & to follow the movement of your finger with eyes only. Hold the target back 12". Move it to each of the six positions, hold, then back to center. Progress clockwise. |
| Identify a normal response in the diagnostic positions test. | Parallel tracking of object with both eyes |
| Identify an abnormal response in the diagnostic positions test. | Eye movement is not parallel. Failure to follow in a certain direction indicates weakness of an extraocular muscle (EOM) or dysfunction of cranial nerve innervating it. |
| nystagmus | a fine, oscillating movement best seen around the iris |
| Nystagmus occurs with _______. (4) | disease of the semicircular canals in the ears, a paretic eye muscle, multiple sclerosis (MS), or brain lesions |
| Lid lag occurs with _______. | hyperthyroidism |
| Identify the cause for unequal/asymmetrical or absent eyebrow movement. | Nerve damage |
| ptosis | drooping of upper eyelid; asymmetrical |
| exophthalmos | protruding eyes |
| enophthalmos | sunken eyes |
| Pallor near the outer canthus of the lower lid may indicate _____. | anemia |
| scleral icterus | an even yellowing of the sclera extending up to the cornea, indicating jaundice |
| Is eversion of the upper eyelid part of the normal examination? | No |
| arcus senilis | gray, white arc or circle around the limbus due to deposits of lipid material; no effect on vision |
| How does a corneal abrasion present? | Causes irregular ridges and reflected light, producing a shattered look to light rays |
| Identify the normal size of pupils in resting adult. | 3-5 mm |
| TRUE/FALSE: Small number of people have 2 different sized pupils. | TRUE. This is called anisocoria. |
| How do you document the pupillary light reflex? | PERRLA direct and consensual |
| Constriction of the same-side pupil ______. | direct light reflex |
| Constriction of the other-side pupil ______. | consensual light reflex |
| esotropia | inward turning of eye |
| exotropia | outward turning of the eye |
| Identify how the following disease/condition would present: periorbital edema (3). What does this occur with? (3) | lids swollen, red, and puffy; occurs with crying, local infections, and systemic conditions (CHF, renal failure, allergy, hypothyroidism) |
| Identify how the following disease/condition would present: blepharitis. (3) s/s: (4) | red scaly, flakey, crusted lid margins (seborrhea); s/s burning, itching, tearing, foreign body sensation |
| hordeolum | infection of the hair follicle that is painful, red, and swollen; stye |
| chalazion | infection of internal glands of the eye; internal stye |
| dacryocyctitis/dacryoadenitis | inflammation of the lacrimal sac/gland |
| conjunctivitis | infection of the conjunctiva, “pink eye” |
| Describe the discharge associated with conjunctivitis. | infectious, yellow to green, thick, eyes will be matted shut |
| subconjunctival hemorrhage; cause(s): 6 | secondary to increased intraocular pressure (from coughing, vomiting, lifting weights, giving birth, straining with stool, trauma); sclera will be bloody |
| iritis | increased redness around iris only, "ring of redness"; usually needs immediate referral |
| Why does iritis need immediate referal? | It can cause blindness. |
| corneal abrasion | scratch, irregular ridges, spot noted with fluorescein |
| fluorescein | orange dye, C20H12O5, with a yellowish-green fluorescence, used as an indicator and tracer. |
| anisocoria | unequal pupils; pupils not symmetrical |
| mydriasis | dilated and fixed pupils |
| miosis | constricted and fixed pupils |
| Are fixed pupils normal or abnormal? What are they associated with? | Fixed is abnormal, associated with trauma |
| myopia | nearsightedness; can see near, but not far |
| hyperopia | farsightedness; can see far, but not near |
| cataract | congenital; round, circular black dot, occluding red reflex aging |
| diabetic retinopathy | multiple microaneurysms or small red dots or dilations of the vessels noted on the fundiscopic exam |
| Which lymph node is commonly swollen with conjunctivitis and a hx of URI? | Preauricular lymph nodes |
| The red reflex seen during an ophthalmoscope examination is the result of ______. | light from scope reflecting back from choroid |
| A 9 y/o pt complains of his eye itching and tearing up. Upon examination, his sclera is reddened. Why eye abnormality is suggested? | Conjunctivitis |
| A nurse is inspecting a 10 y/o child's pupils. Shining indirect light into right eye causes what normal response? | Both eyes constrict |
Created by:
nikkirosety
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