Eyes HA Exam #2

normal constriction of pupils when bright light shines on retina
unconscious
stimulation of the blind eye causes no response

a reflex direction of eye toward an object attracting person's attention
very rapid ocular movement, eyes dart
can be impaired by drugs, alcohol, fatigue, and inattention

a water bottle drops in class and you look to see where the sound is coming from

adaptation of eye for near vision
pupils are BIG looking at things FARTHER away
pupils are SMALL looking at things CLOSER

Vision difficulty
Pain
Cross eye (Strabismus)
Double Vision (diplopia)
Redness, swelling
Watering, discharge
History of ocular problems (eye infection or retina issues)
Glaucoma -> involves pressure in the eyes
Use of glasses or contacts lenses
Last eye exam (every 12 months esp w diabetics)
Prescription changes
Self-care behaviors (makeup, eyelashes)

Sudden vision loss
Trauma to eyeball
Herpes zoster (shingles) infection on face
Corneal damage
Sudden distorted pupil (both are not round)

sensitivity to light

black/ blurry spots in the vision
associated with migraines
can be caused by glaucoma or nerve disorders

tearing
irritants or obstruction in drainage of tears

nearsighted, trouble seeing objects far away
globe is longer than normal and light rays focus in front of retina

farsighted, trouble seeing up close
globe is shorter than normal and light rays would focus behind the retina

drooping of upper eyelid

No

thick and yellow
crusts form at night

blood thinners

standing for vision screening
sitting with head at eye level

Snellen eye chart
Handheld visual screener
Penlight

Snellen Eye chart -> well lit and at eye level
20 feet from chart
hand person opaque card to shield one eye at a time during test -> so person can't memorize
leave glasses/contacts on
start with smallest line
move patient closer to chart until they can see

Top # distance of patient from the chart
OVER
Bottom # distance normal eye could have read the line
Patient/perfect

Visual Screener (handheld) (use magazine if needed)
hold card 14 inches away = 20/20 on Snellen distance
test each eye separately
normal result is 14/14 bilaterally
should be read without hesitancy and without moving card closer or farther away

decrease in power of accommodation with aging
suggested when person moves card farther away

Confrontation test
Distance 2 feet -> personal distance
Cover one eye (patient) examiner covers OPPOSITE eye -> to know when they should be seeing it
Use object and slowly advance from periphery in several directions
Repeat for opposite eye
Normal: peripheral vision intact

person sees object when examiner does

assess the parallel alignment of the eye axes by shining a light towards the person's eye

Hirschberg Test -> checking light reflex with muscle function
Assess strength of eye muscles
Patient to stare straight ahead
Hold light 12 inches away
Note reflection of light on corneas

reflection same spot on each eye

deterioration in alignment from eye muscle weakness or paralysis

eye turned inward
light will reflect on outer pupil

eye turned outward
light will reflect on inner eye

eye turned upward
light will reflect on bottom of pupil

eye turned downward
light will reflect on upper of pupil

detects weakness in a particular eye
patient stares straight ahead
cover one eye at a time
note uncovered eye
eye should not be jumping after uncovering

response is a steady fixed gaze

examiner guides patient
object held at 12 inches
patient to follow examiner movement with eyes only, hold head still
go through 6 cardinal positions

examines for muscle weakness during movements

a fine, oscillating movement best seen around the iris

occurs with disease of semicircular canals in ears, paretic eye muscle, multiple sclerosis or brain lesions

parallel tracking with both eyes

symmetrical, present bilaterally
don't makes assumptions and ask why
scaling with seborrhea
moves with expression changes (unless they've had botox)

normal overlap
eyelashes are evenly distributed
intact without redness

hyperthyroidism

no pain
normal tears, nose runs
pay attention to one eye tearing up more than the other
swelling visible bulge in outer part of upper lid

the white, tough, opaque, fibrous part of the eye
China white

yellow fatty deposits
this is normal

the mucous membrane covering the outer part of the sclera and lines the lids

clear
moist and glossy

protruding eyes

suken eyes

even yellowing of the sclera extending up to the corner
indicating jaundice

size/shape -> symmetrical
normally pupils appear round, regular and of equal size

side to side comparison
person gazes at a distance
light shining in eye -> constrict and both eyes should be the same

constriction of pupil shining the light on

simultaneous constriction of the other pupil not having light shined into it

person focuses on distant object
shift gaze with your finger
should have pupillary constriction and convergence of axes of eyes

PERRLA

Pupils Equal, Round, Reactive to Light and Accommodation

inspection of internal surface of retina

red reflex -> red, orangey color fills pupil
uses ophthalmoscope
should see flash of orange with red vessels
may complete in lab but not on exam