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Chapter 14 Eyes Barkley
Eyes for Health Assessment
39
Nursing
Graduate
07/05/2013

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Term
Eye Structure
Definition

Palpebral Fissure- open space between eyelids, lower lid is limbus, canthus is corner of eye where eyelids meet

 

Caruncle- Flesshy mass containing sebaceous glands

Meibomian glands- modified sebaceous glands, creates seal when lids are closed

Term
External Eye Structure Cont.
Definition
Conjunctiva- thin mucous membrane folded like envelope betwen eyelids
Term
Extraocular muscles
Definition

Six muscles attach eye to orbit 

4 of these are straight (rectus)- superior, lateral, medial and inferior

Movement of these muscles are stimulated by three cranial nerves; 

VI- abducens-innervates lateral rectus

IV- Trochlear0 innervates superior oblique 

III- oculomotor- innervates all the rest

Term
Internal Eye Anatomy
Definition

Outer layer- Sclera- tough protective white covering

Cornea- covers iris and pupil, bends (refracts) incoming light, transparent

Middle layer- Choriod- vascularized, delivers blood to retina,Ciliary body controls thickness of the lens. Iris-controls amount of light admitted to retina. Pupil- round, regular, stimulation thru nerve III causes constriction(parasympathetic), sympathetic branch stimulates dilation

Lens- bulges when focused on near objects, flattens for far objects

Inner Layer- Retina- visual receptive layer of eye, waves are changed into nerve impulses. Retinal vessels contain paired artery (bright red)

and vein

Macula- receives and transduces light

Fovea Centralis- Sharpest and keenest vision

Term
Visual Pathways
Definition
Objects Reflect Light through transparent media and strike the retina, which forms an upside down image , images cross over on optic chiasm. Rt side of brain looks at lft side of world.
Term
Visual Reflexes
Definition

Pupillary Light Reflex- normal constriction of pupils when bright light shines on retina. When one eye is exposed to light a direct light reflex occurs (constriction)  as well as consensual light reflex ( simultaneous constriction of the other pupil). 

 

 

Term
Accommodation
Definition
Adaptation of the eye for near vision
Term
Presbyopia
Definition
Lens looses elasticity, becoming hard, glasslike, decreases lens ability to change shape to accomodate for near vision. By 40 yrs of age 50% of people have this.
Term
Aging- Decreased Visual Functioning
Definition

1. Cataract-lens opacity, clumping of proteins

2. Glaucoma- Increased intraocular pressure, Scotoma is a blind spot surrounded by area of normal/decreased vision occurs w/t glaucoma

3. Macular Degeneration- cells in macula breakdown, loss of central vision, most common casue of blindness. Women more affected then men.

Term
Cover Test
Definition
Looking for fixation
Term
Floaters
Definition
Common with myopia, due to condensed vitreous fibers, usually not significant. However, acute rapid onset of floaters ( shade or cobwebs) associated with retinal detachment
Term
Eye Disorders
Definition

Photophobia- inability to tolerate light

Strabismus- deviation in axis of eye

Diplopia-perception of 2 images of single object

Term
Snellen Eye Chart
Definition

Tests for Visual Acuity

Normal is 20/20

The larger the denominator, the poorer the vision

20/30-1 means 20/30 missing one letter

20/30 means you can read at 20 feet what the normal eye can see from 30 ft away.

Term
Confrontation Test
Definition

A measure of peripheral vision. Compares patients peropheral vision with your own. You and patient cover opposite eye (looks same when facing eachother), slowly advance in their periphery in several directions.

Normal results are 50 degrees up, 90 temporally, 70 down and 60 nasally. Suggests peripheral field loss if patient doesn't see object as examiner does.

Term
Corneal Light Reflex (Hirschberg Test)
Definition
Assess the parallel alignment of the eye axes by  shining a light toward the person's eyes. Reflection of light should in same spot on each eye
Term
Cover Test
Definition
Asymmetry of light reflex indicates deviation in alignment from eye muscle weakness/paralysis, perform this test by covering one eye with a card while noting the uncovered eye. A normal response is a steady fixed gaze, if the eye jumps it was out of alignment.
Term

Diagnostics Position Test

 

Definition
Lead the eye through the 6 cardinal positions of gaze (draw whiskers), a normal response is parallel tracking of object with both eyes. If not parallel indicates weakness of extraocular muscles or cranial nerve dysfunction
Term
Nystagmus
Definition
Oscillating movement seen around iris (colored part of eye) Occurs with disease of semicircular canals in ears, paretic eye muscle, multiple sclerosis or brain lesions
Term
Eye Conditions
Definition

Sceral Icterus- a yellowing of the sclera, indicates jaundice

Ptosis- drooping of upper lid

Anisocoria- Pupils of two different sizes

Term
Pupillary Light Reflex
Definition
Darken the room and ask person to gaze into distance (dilates the pupils), advance a light from the side and note the response. Normally you will see constriction of same pupil (direct light reflex) and simultaneous constriction of the other (consensual light reflex)
Term
Accommodation
Definition
To test for this, ask person to focus on distant object, this dilates the pupils. Then have the person shift the gaze to a near object such as finger (3in) from their nose. A normal response shows pupillary constriction and convergence of the axes of eyes.
Term
PERRLA
Definition
Pupils Equal, Round React to Light and Accomodation
Term
Opthalmoscope
Definition

Enlarges your view of the eye to inspect the media and ocular fundus (internal surface of retina) Look through hole and adjust to focus. Unit of strength in each lens is diopter. Black numbers indicate positive, focus on objects nearer to opthalmoscope, Red numbers show a negative diopter and are for far away objects. Aperture is where you view eye

Normal vision diopter is at 0, moving it compensates for near/farsightedness (red=near) (black=far)

Term
Red Reflex
Definition

Red glow filling person's pupil, this is a reflection of opthalmoscope light off inner retina. Adjust lens to 6+ to note any opacities in media (should be none)

Cataracts appear as opaque black areas against red reflex. 

Term
Myopia vs. Hyperopia
Definition

Myopia- nearsighted, light rays focus in front of retina

Hyperopia- Farsighted, light rays would focus behind retina

Term
Foveal Light Reflex
Definition
A tiny white glistening dot that reflects opthalmoscope light
Term
Newborn Assessment
Definition

Absent pupillary light reflex (blinking) after 3 weeks indicates blindness

Criteria for Blindness 

1. Age 3 yrs- vision 20/50 or greater

2.Age 4yrs- 20/40 or greater

3. Difference between 2 eyes is one line or more

Many infants have an epicanthal fold (excess skinfold on inner corner of eye)- give a false sign of malalignment termed pseudostrabismus

Lacrimal glands not functional at birth

 

Term
Aging Adult
Definition

Ectropian- lower lid dropping away

Entropian- lower lid turning in

Pingueculae- show on sclera as yellow, elevated nodules

Pseudoptosis- upper lid is elongated as to rest of lashes

Arcus Senilis- Seen around cornea, gray white arc around limbusm due to lipid buildup, no effect on vision

Xanthelasma- raised yellow plaques on lids at inner canthus, more in women (50's)

Term
Glaucoma
Definition

Involves optic nerve damage and visual field changes

Open Angle- drainage channels become clogged, leads to inocular pressure buildup.

Closed Angle- drainage canals are blocked or covered by outer edge of iris, comes on suddenly

Term
Strabismus
Definition

True disparity of eye axes, Constant malalignment is termed tropia

Estropia- inward turning of the eye

Exotropia- Outward turning of eye

Term
Phoria
Definition

Phoria- mild weakness, 

Esophoria- nasal (inward) drift

Exophoria- temporal (outward) drift

Term
Eye Abnormalities
Definition

Periorbital Edema- lids are swollen and puffy, occurs with local infections, crying, congestive/renal failure, allergy

Exophthalmos- protruding eyes

Enophthalmos- sunken eyes- loss of fat in orbits and dehydration

Term
Abnormalities in eyelid
Definition

Ptosis- drooping of upper lid from neuromuscular weakness ,oculomotor cranial 3 nerve damage or sym nerve damage

Upward Palpebral Slant- normal is asians, indicates down syndrome in caucasian

Term
Lesions on eyelid
Definition

Blepharitis- inflammation on eyelids

Chalazion- beady nodule protruding on lid, infection or retnetion of cyst on meibomian gland

Hordeolum- Stye, localized staph infection in hair follicles

Daryocystitis- inflammation of lacrimal sac- infection of lacrimal gland

Term
Abnormalities in pupil
Definition

Monocular Blindness- when light is directed to blind eye no response, when light is directed to normal eye both eyes constrict

Mydriasis- Dilated and fixed pupils, stimulation of sym system

Miosis- Constricted and fixed pupils

Horner's Syndrome- small, regular pupil that doesn't react to light and accommodation, lesion of sym nerve.

Cranial Never 3 Damage- dilated pupil with no reaction to light or accommodation with oculomotor nerve damage

Term
Visual Field Loss
Definition

Lesion in globe or optic nerve- yields one blind eye or unilateral blindness

Retinal Damage- Macula- central blind area (diabetes)

Term
Vascular Disorders of External Eye
Definition

Subconjunctival Hemorrhage- red patch on sclera

Iritis- Circumcorneal redness-deep dull halo around iris and cornea

Term
Abnormalities in Cornia and Iris
Definition

Pterygium- triangular opaque wing of bulbar conjunctiva overgrows toward center of cornea.

Corneal Abrasion- blunt eye injury-top layer of corneal epithelium removed

Hyphema-blood in anterior chamber is a result of herpes zoster infection, also occurs with blunt trauma

Hypopyon- Purulent matter in anterior chamber occurs with iritis and inflammation

Term
Papilledema
Definition
Choked Disc- sign of intracranial pressure , by tumor or hematoma, visual acuity not affected, ishows redness, congestions and elevation of optic disc
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