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health assessement
eyes ch 16
| Question | Answer |
|---|---|
| cranial nerves of extraocular movement (EOM) | CN 3, 4, 6 |
| external eye structure | eyelid w/ tarsal plate and meibomian gland lateral/medial canthi containing puncta/caruncle eyelashes conjunctiva (palpebral/bulbar) lacrimal apparatus |
| palpebral fissure | open space between upper/lower eyelid |
| limbus | border of the cornea and sclera where white and color meets |
| tarsal plates | upper lid connective tissue gives shape to the eye |
| conjunctiva | transparent protective cover over exposed part of eye kinda like plastic cover of remotes |
| lacrimal apparatus | constant irrigation to keep conjunctiva/cornea moist tear secretion |
| extraocular muscles | 6 muscles give rotation and straight movement |
| meibomian glands | located in tarsal plates sebaceous glands give oily lubricant to seal eye when closed |
| eye orbit | skull cavity where eye resides |
| eye developmental consideration in infants/children | fetal eye development @ 8 weeks of pregnancy infants born with peripheral vision w/o visual acuity visual acuity achieved by age 6 |
| eye developmental consideration in adults | farsightedness begin @ age 40 d/t loss of lens elasticitiy |
| eye developmental consideration in elderly | cataracts glaucoma macular degeneration (wet vs dry) |
| layers of eye | outer (sclera, cornea) middle (iris, pupil, lens, ciliary body, choroid) inner (retina, retinal vessels, optic disc, macula) |
| cornea | dome shaped part of eye focuses and allows light into eye |
| iris | works as a diaphragm -> controls light by regulating pupil size colored part of eye |
| pupil | size determined by CNS constriction vs dilation based on how much light there is |
| lens | disc shaped structure sitting behind pupil - controlled by ciliary movement bulges for focusing near object flatten for focusing far object |
| anterior chamber | continuously moves fluid protect/lubricate eye intraocular pressure measurement for glaucoma here |
| retina | melon colored light waves change into nerve impulse via cones/rods |
| retinal vessels | retinal arteries/veins |
| macula | located on temporal side darker pigment circular |
| vitreous/aqueous humor | maintain structure + intraocular pressure |
| optic disc | optic nerve entry point lighter, yellow orange/pink colored located on nasal side |
| visual field | what person sees with 1 eye, split into 4 quadrants upper/lower temporal quadrant upper/lower nasal quadrant |
| visual reflex | pupillary light reflex accommodation |
| direct pupillary light reflex | pupil in illuminated eye constricts with light |
| consensual pupillary response | opposite pupils also constricts |
| accommodation reflex | pupillary constriction and convergence when shifting focus from distant to near object |
| risk reduction for eye | sunglasses (block UV) EtOH/smoking cessation avoid eye injury -> treat prolonged eye inflammation/injury healthy weight regular eye exam |
| abnormal visual changes | spots floaters blind spots halos around lights double vision difficulty w/ night vision photophobia |
| other abnormal eye symptoms | eye pain/discomfort itching redness/swelling abnormal tearing/discharge |
| strabismus | cross eyed -> can cause amblyopia aka tropia |
| diplopia | seeing double |
| glaucoma | FHx risk factor halo around light/eye pain (closed angle) increased IOP DM |
| cataracts | clouding of lens impairing vision d/t age/injury/medication gradual onset w/ blurred + yellow vision + increased light sensitivity |
| cataract risk factor | age UV DM smoking/EtOH eye trauma FHx corticosteroids radiation eye surgery/inflammation |
| cataract screening | visual acuity test slit lamp exam regular eye exam after 65+ |
| glaucoma | increased IOP causing optic nerve damage gradual vision loss (open angle) sudden vision loss (closed angle) |
| angle closure glaucoma | closure/narrowing of anterior chamber angle d/t pupillary block preventing aqueous humor from exiting IOP spike -> acute optic nerve complication |
| open angle glaucoma | open drainage angle trabecular meshwork dysfunction -> impaired aqueous humor outflow gradual IOP increase -> chronic optic nerve damage |
| angle closure glaucoma symptoms | acute severe headache/ocular pain nausea blurred vision halos around eyes conjunctivitis |
| open angle glaucoma symptoms | gradual PERIPHERAL vision loss -> tunnel vision in advanced stage early stage asymptomatic |
| glaucoma screening | tonometry dilated eye exam high risk screens every 1-2 years recommended or as advised |
| glaucoma risk factor | all ages (more common in 60+) high eye pressure thin central cornea extreme refractive errors steroid medication hx eye injury |
| high risk glaucoma groups | african american/east asians/older hispanics w/ family Hx |
| macular degeneration | central vision loss d/t macular degeneration (wet vs dry) |
| wet macular degeneration | abnormal choroidal neovascularization below macula -> leakage + bleeding cause rapid/severe visual loss with central vision disturbance less common form 10-15% cases of MD |
| tx of wet macular degeneration | anti-VEGF injection laser photocoagulation other advanced tx |
| dry macular degeneration | drusen deposit formation cause slow/gradual central vision loss most common 85-90% case |
| dry macular degeneration tx | lifestyle modification + nutritional supplementation |
| macular degeneration screening | amsler grid for self monitoring eye exams reporting of visual changes |
| amsler grid | grid with black square in center people with abnormal MD vision will see distortion in center of grid |
| macular degen risk factors | advancing age FHx (genetic) smoking poor nutrition UV HTN/cardiovascular disease |
| macular degeneration patient teaching | nutrient rich diet w/ leafy green + antioxidants avoid UV exposure smoking cessation eye exams amsler grid for self exam |
| conjunctiva inspection | inspect lower portion, pull down lower eyelid redness/exudate upperlid only if foreign body in eye |
| exophthalamos | eyeballs bulging out |
| opthalmoscope | visualize red reflex/optic disc and retinal vessels diopter settings for refractive error |
| central visual acuity test | snellen eye chart (CN 2) near vision |
| visual field tests | confrontation test - check peripheral vision |
| EOM function test | corneal light reflex (hirschberg test) cover test 6 cardinal gaze test (CN 3, 4, 6) |
| hirschberg test | corneal light reflex assess parallel alignment of eye axis reflection of light on cornea should be on same exact spot |
| cover test | for children one eye forcus on uncovered eye to see normal response being steady fixed gaze if covered eye moves after uncovering = misalignment |
| E chart | snellen chart for nonverbal individuals |
| jaeger eye chart/card | visual acuity at normal reading distance (14 inches) match with corresponding jaeger number for smallest line |
| nystagmus | involuntary eye movement (oscillations) d/t inner ear disorder, MS, brain lesion, narcotic use |
| pupillary reaction to light | PERRLA (pupils are equal, round, reactive to light and accommodation) |
| accommodation test | shifting gaze from far to near -> pupils should constrict |
| diopter value | positive values (green or black) - focus on closer objects; helpful with viewing lens/cornea in hyperopia negative values (red) - focus on more distant objects; helpful w/ myopia |
| opthalmoscope tips | use opposite eye to look into client eye to prevent nose bumping client should look into light to view fovea/macula start @ 10-15" at 15 degree angle |
| different type of eye trauma | foreign bodies/globe perforation eyelid swelling corneal abrasion anterior chamber blood blunt vs penetrating trauma |
| ptosis | drooping eyelid |
| entropion | inwardly turned lower eyelid |
| ectropion | outwardly turned lower eyelid |
| chalazion | ruptured pore from meibomian gland |
| hordeolum | stye in sweat gland |
| blepharitis | infection/inflammation of eyelid |
| conjunctivitis | inflammation of conjunctiva subconjunctival hemorrhage (bright red area of sclera) |
| scleritis | inflammation of sclera -> painful d/t autoimmune disease |
| chalazion vs stye | same thing (blocked gland) has different presentation |
| phoria | mild weakness of EOM |
| paralytic strabismus | d/t weakness/paralysis of 1 or more EOM muscle nerve affected on same side of eye infected |
| pseudostrabismus | pupil appears at inner canthus normal in young children |
| corneal scar | grayish white d/t old injury or inflammation |
| pterygium | thickening of bulbar conjunctiva extending to corneal edge |
| nucleus cataract | gray when seen with flashlight black spot against red reflex in ophthalmoscope |
| peripheral cateract | appears like gray spokes pointing inward with flashlight appears like black spokes with ophthalmoscope against red reflex |
| anisocoria | unequal pupillary size can be seen in trauma |
| irregular iris shape | can cause shallow anterior chamber -> increase closed angle glaucoma risk |
| miosis | pinpoint pupils d/t medication/narcotics/brain damage |
| mydriasis | dilated pupils d/t CNS injury, medication, circulatory collapse, deep anesthesia |
| tonic pupil | caused by impaired parasympathetic nerve supply to iris |
| bitemporal hemaniopia | loss of vision in outer (temporal) halves of both visual field dt optic chiasm issue |
| visual quadrant defects | visual loss in 1/4 visual field d/t localized damage |
| abnormal corneal light reflex sugest | possible strabismus normal should be 5:00 (R) and 7:00 (L) alignment |
| entropion | inward turning of eyelid -> cause irritation from lashes rubbing against eye |
| diffuse episcleritis | inflammation of episclera localized redness/discomfort |
| episclera | tissue between conjunctiva and sclera |
| scleral jaundice | yellow discoloration of sclera due to liver dysfunction (elevated bilirubin) |
| glaucomatous cupping | excavation of optic disc resulting in loss of nerve fibers in glaucoma |
| optic atropihy | degeneration/pallor of optic disc from chronic optic nerve damage |
| constricted (retinal) vessels | narrowing of retinal blood vessel typically d/t systemic HTN |
| silver/copper wire arterioles | sclerotic change in retinal arterioles and appears silver/copper colored d/t chronic HTN |
| cotton wool patches | fluffy white retinal lesions d/t localized ischema/microinfarctions |
| hard exudates (retina) | yellowish deposits of lipid residue from leaky retinal vessel |
| flame/dot shaped hemorrhages | nerve fiber layer bleeds (flame shaped) deeper retinal layer bleeds (dot shaped) suggestive of vascular conditions like HTN or DM retinopathy |
| microaneurysm (retina) | tiny out pouching in retinal capillaries sign of early DM retinopathy |
| papilledema (optic disc) | swelling of optic disc d/t increased ICP |
| pinguecula | yellowish nodules on bulbar conjunctiva harmless |
| arcus senilis | normal condition in older client white arc around limbus |
Created by:
sleepingbear