Term
|
Definition
| glands found in the eyelid that provide oils for the tear film |
|
|
Term
|
Definition
| found in the eyelid; provides a skeleton to the lid |
|
|
Term
|
Definition
| clear, thin mucous membrane |
|
|
Term
|
Definition
| part of the conjuctiva that coats the inside of the eyelids |
|
|
Term
| bulbar (ocular) conjunctiva |
|
Definition
| part of the conjunctiva that covers the outer surface of the eye; protects the anterior surface of the eye with the exception of the cornea and the surface of the eyelid in contact with the globe |
|
|
Term
|
Definition
location = temporal region of the superior eyelid
produces tears that moistent he eye |
|
|
Term
| levator palpebrae superioris |
|
Definition
| elevates and retracts the upper eyelid; innervated by CNIII |
|
|
Term
|
Definition
outer wall = sclera posteriorly and the cornea anteriorly
middle layer (uvea) = choroid posteriorly and the ciliary body and iris anteriorly
inner layer = retina (nerve fibers) |
|
|
Term
|
Definition
dense, avascular structure that appears anteriorly as the white of the eye
physically supports the internal structure of the eye |
|
|
Term
|
Definition
anteiror 1/6 of the globe and is continuous with the sclera
clear, has rich sensory innervation and is avascular
major part of the refractory power of the eye |
|
|
Term
|
Definition
middle part of eye
comprised of the iris, ciliary body and choroids |
|
|
Term
|
Definition
contractile muscular disk
contains pigment cells that produce the color of the eye
central aperture of the iris = pupil |
|
|
Term
|
Definition
| produces the aqueaous humor and contains the muscles controlling accommodation |
|
|
Term
|
Definition
| pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina |
|
|
Term
|
Definition
biconvex, transparent structure located immediately behind the iris
supported by fibers coming from the ciliary body
highly elastic and contraction or relaxation of the ciliary body changes its thickness (permitting accommodation) |
|
|
Term
|
Definition
| sensory network of the eye; transforms light impulses into electrical impulses, which are transmitted through the optic nerve, optic tract and optic radiation to the visual cortex and then cerebral cortex |
|
|
Term
|
Definition
| also called the fovea; site of central vision |
|
|
Term
| When does the eye develop during gestation? |
|
Definition
| during the first 8 weeks; development continues until the age of 4 years old |
|
|
Term
| Term infants have what kind of eye site (and what is their visual acuity)? |
|
Definition
they are hyperoptic
visual acuity of less than 20/400 |
|
|
Term
| when do the lacrimal glands start producing full volume tears? |
|
Definition
|
|
Term
| At what point is binocular vision complete in an infant? |
|
Definition
|
|
Term
| when can infants first differentiate colors? |
|
Definition
|
|
Term
| At what age is adult visual acuity achieved? |
|
Definition
|
|
Term
| Changes seen in the eye during pregnancy |
|
Definition
1. hypersensitivity
2. increased level of lysozyme in the tears = greasy sensation (problems with contact lenses)
3. worsening of diabetic retinopathy
4. mild corneal edema and thickening = blurred vision
5. intraocular pressure falls (during later 1/2 of pregnancy)
6. subconjunctival hemorrhages may occur spontaneously during pregnancy or labor but resolve spontanteously |
|
|
Term
| Changes in the lens in older adults |
|
Definition
lens becomes more rigid and the ciliary muscle becomes weaker = presbyopia
lens also continues to form fibers throughout life = lens becomes denser and cataracts develop |
|
|
Term
|
Definition
autosomal dominant disorder
embryonic malignant tumor arising from the retina
usually during the first 2 years of life
initial sign is leukocoria = white reflex rather than red reflex
ill-defined mass arising from retina on the fundoscopic exam; chalky white areas of calcification can be seen |
|
|
Term
|
Definition
autosomal recessive disorder in which the genetic defects cause cell death, predominantly in the rod photoreceptors
night blindness (early symptom)
tunnel vision
loss of vision is painless and progressive over years to decades
optic atrophy with waxy pallor and narrowing of arterioles are seen
peripheral bone spicule pigmentation are hallmarks of advanced disease |
|
|
Term
|
Definition
| visual problem in which the eyes do not line up in the same direction |
|
|
Term
|
Definition
| "lazy eye"; disorder in which there is loss of central vision in a normally unaltered eye |
|
|
Term
| what type of problem is monocular diplopia? |
|
Definition
|
|
Term
| what type of problem is binocular diplopia |
|
Definition
|
|
Term
|
Definition
a sty; a localized infection of the eyelid involving the hair folicle
usually caused by a staphylococcal infection |
|
|
Term
|
Definition
| an area of diminished vision within the visual field |
|
|
Term
|
Definition
| vision loss or weakness that occurs without an apparent weakness within the eye |
|
|
Term
|
Definition
| used to measure visual acuity from far away (usually 20 feet/6 meters) |
|
|
Term
| visual acuity: numerator and denominator |
|
Definition
numerator = the distance of the patient from the chart
denominator = the distance at which the average eye can read the line
**smaller the fraction, the worse the vision |
|
|
Term
| visual acuity: numerator and denominator |
|
Definition
numerator = the distance of the patient from the chart
denominator = the distance at which the average eye can read the line
**smaller the fraction, the worse the vision |
|
|
Term
|
Definition
|
|
Term
|
Definition
to test if observed decreased visual acuity is caused by refractive error
**should result in an improvement in visual acuity by at least one line on the chart if refractive error is responsible for decreased acuity |
|
|
Term
|
Definition
used for near vision
should hold 14 in (35 cm) from eye |
|
|
Term
|
Definition
test peripheral vision
patient and physician should cover opposite eyes (eyes on the same side facing each other) |
|
|
Term
| lesions most likely to produce confrontation abnormalities |
|
Definition
| stroke, retinal detachment, optic neuropathy, pituitary tumor compression at the optic chiasm, and central retinal vascular occlusion |
|
|
Term
| what defect often coexists with a red defect (red colorblindness)? |
|
Definition
| afferent pupillary defect or subtle optic nerve disease |
|
|
Term
|
Definition
|
|
Term
| patient's eyebrows are coarse or do not extend beyond the temporal canthus |
|
Definition
|
|
Term
|
Definition
| always abnormal; can be caused by thyroid eye disease, allergies or nephrotic syndrome |
|
|
Term
|
Definition
| an elevated plaque of cholesterol deposited in macrophages most commonly in the nasal portion of the upper or lower eyelid |
|
|
Term
| fasciculations or tremors of the lids are a sign of what disease? |
|
Definition
|
|
Term
| average upper lid position |
|
Definition
| 2 mm below the limbus (border of the cornea and the sclera) |
|
|
Term
| average lower lid position |
|
Definition
|
|
Term
|
Definition
crusting along the eyelashes
can be caused by bacterial infection, seborrhea, psoriasis, a manifestation of rosacea or an allergic response |
|
|
Term
|
Definition
a condition in which the closed lids do not completely clover the globe
can caused the cornea to become dried and be at increased risk of infection
causes = thyroid eye disease, seventh nerve palsy, and overaggressive ptosis or blepharoplasty |
|
|
Term
| causes for pain on palpation of the eyelids |
|
Definition
| scleritis, orbital cellulitis and cavernous sinus thrombosis |
|
|
Term
| an eye that feels very firm and resists palpation may indicate________ |
|
Definition
| severe glaucoma or retrobulbar tumor |
|
|
Term
|
Definition
abnormal growth of conjunctiva that extends over the cornea from the limbus; occurs more commonly on the nasal side
more common in people heavily exposed to UV light; can interfere with vision if it advances over the pupil |
|
|
Term
| should blood vessels seen in a normal cornea? |
|
Definition
| no, the cornea is avascular |
|
|
Term
| which nerve controls corneal sensitivity? |
|
Definition
|
|
Term
| nerves involved in corneal blink reflex |
|
Definition
afferent = sensory from CN V (trigeminal)
efferent = motor from CN VII (facial) |
|
|
Term
| which disease is often associated with decreased corneal sensation? |
|
Definition
|
|
Term
|
Definition
corneal arcus; composed of lipids deposited in the periphery of the cornea
is normal in pts over the age of 60; if present before age 40, may indicated a lipid disorder |
|
|
Term
|
Definition
| corneal arcus that progresses to a complete circle |
|
|
Term
|
Definition
pupillary constriction of less than 2 mm in diameter
contributing factors = iridocyclitis, miotic eye drops, drub abuse |
|
|
Term
|
Definition
pupillary dilaltion usually more than 6 mm in diameter
contributing factors = iridocyclitis, mydriatic or cycloplegic drops (atropine), midbrain lesions or hypoxia, oculomotor damage, acute angle glaucoma, drug abuse |
|
|
Term
| pupillary failure to respond (constrict) with increased light stimulus |
|
Definition
| contributing factors = iridocyclitis, retinal degeneration, optic nerve destruction, midbrain synapses involving afferent pupillary fibers or oculomotor nerve, impairment of efferent (parasymp) that innervate sphincter pupillae muscle, mydriatics |
|
|
Term
|
Definition
bilateral, miotic irregularly shaped pupils that fail to constrict with light but retain constriction with convergence
pupils may or may not be equal in size
commonly caused by neuosyphilis or lesion in midbrain where afferent pupillary fibers synapse |
|
|
Term
|
Definition
unequal size of pupils
contributing factors = congenital or caused by local eye medication, or unilateral sympathetic or parasympathetic pupillary pathway destruction |
|
|
Term
| iritis constrictive response |
|
Definition
| acute uveitis is commonly unilateral; construction of pupil accompanied by pain and reddened eye, especially adjacent to the iris |
|
|
Term
| oculomotor nerve damage (pupil response seen) |
|
Definition
| pupil dilated and fixed; eye deviated laterally and downward; ptosis |
|
|
Term
|
Definition
affected pupil dilated and reacts slowly or fails to react to light; responds to convergence
caused by impairment of postganglionic parasympathetic innervation to sphincter pupillae muscle or cilliary malfunction; often accompanied by diminished tendon reflexes |
|
|
Term
| which abnormal pupil finding usually accompanies coma? |
|
Definition
|
|
Term
|
Definition
if the eye does not constrict during consensual light test and continues to dilate
caused by an afferent pupillary defect
important sign of optic nerve disease and can be present in severe retinal disease |
|
|
Term
| what is an important sign of optic nerve disease? |
|
Definition
|
|
Term
| what should happen to the pupils during the accommodation test? |
|
Definition
| they should constrict as they focus on the near object |
|
|
Term
| failure to constrict in the accommodation test is a sign of which diseases? |
|
Definition
|
|
Term
| mean protrusion of the eye for black males |
|
Definition
exceeds 2-4 mm
because they have a shallower orbit |
|
|
Term
| true or false: Asians have a shallow orbit |
|
Definition
| false; Asians have a rounder orbit, blacks have a rectangular, shallow orbit and whites are in the middle |
|
|
Term
| true or false: ocular protrusion is reduced with increasing age |
|
Definition
|
|
Term
|
Definition
dark, slate gray pigment just anterior to the insertion of the medial rectus muscle on the sclera
its presence does not imply disease but should be noted |
|
|
Term
|
Definition
| lacrimal caniculi; should be seen as slight elevations with a central depression on both the upper and lower lid margins nasally |
|
|
Term
| eye abnormality seen in Sjogren syndrome |
|
Definition
| decreased tear production and enlarged lacrimal glands |
|
|
Term
|
Definition
| horizontal, vertical, rotary, mixed pattern or jerking |
|
|
Term
|
Definition
exposure of the sclera above the iris when the patient is asked to follow your finger as you direct the eye in a smooth movement
my indicate thyroid eye disease |
|
|
Term
|
Definition
| eye points outward (away from midline) |
|
|
Term
|
Definition
| eye points inward (toward the nose) |
|
|
Term
| ophthalmoscope lens used for a myopic pt during fundoscopic exam |
|
Definition
|
|
Term
| ophthalmoscope lens used when the pt is hyperoptic or lacks a lens |
|
Definition
|
|
Term
|
Definition
| approximately 2 disc diameters temporal to the optic disc; have pt look directly into the light |
|
|
Term
|
Definition
small, discrete spots that are slightly more yellow than the retina
usually a consequence of the aging process |
|
|
Term
|
Definition
a grid that is used to evaluate central vision
should be used when drusen bodies are noted |
|
|
Term
| myelinated retinal nerve fibers seen on examination |
|
Definition
white area with soft, ill-defined peripheral margins usually continuous with the optic disc
Absence of pigment, feathery margins, and full visual fields help distinguish this benign condition from chorioretinitis
No physiologic significance |
|
|
Term
|
Definition
loss of definition of optic disc margin, initially occurs superiorly and inferiorly, then nasally and temporally central vessels pushed forward, and veins are markedly dilated
caused by increased intracranial pressure transmitted along the optic nerve; initially vision is not altered |
|
|
Term
| Glaucomatous optic nerve head cupping |
|
Definition
physiologic disc margins are raised with a lowered central area; blood vessels may disappear over the edge of the physiologic disc and be seen again deep within the disc; may lead to optic atrophy = disc appears much whiter than usual
result of increased intraocular pressure with loss of nerve fibers and death of ganglion cells; peripheral visual fields are constricted |
|
|
Term
| types of retinal hemorrhages |
|
Definition
flame-shaped = occur in nerve fiber layers
round = occur in the deeper layers and may appear darker than flame hemorrhages
dot = may represent microaneurysms; common in diabetic retinopathy |
|
|
Term
| types of retinal hemorrhages |
|
Definition
flame-shaped = occur in nerve fiber layers
round = occur in the deeper layers and may appear darker than flame hemorrhages
dot = may represent microaneurysms; common in diabetic retinopathy |
|
|
Term
|
Definition
ill-defined, yellow areas caused by infarction of nerve layer of retina
caused by vascular disease secondary to hypertension or diabetes mellitus |
|
|
Term
|
Definition
when the lower lid is turned away from the eye
may result in excessive tearing because the inferior punctum is pulled outward and cannot collect the secretions of the lacrimal gland |
|
|
Term
|
Definition
| serves as the tear-collecting system in the eye |
|
|
Term
|
Definition
when the lid is turned inward toward the globe
may be caused by corneal and conjunctival irritation (increased risk of infection) |
|
|
Term
| common causes of lagophthalmos |
|
Definition
| thyroid eye disease, seventh nerve palsy (Bell's palsy) and overaggresive ptosis or blepharoplasty surgical repair |
|
|
Term
| common causes of pain on palpation of the orbit |
|
Definition
| scleritis, orbital cellulitis, and cavernous sinus thrombosis |
|
|
Term
| subconjunctival hemorrhage |
|
Definition
| bright red blood in a sharply defined area surround by healthy-appearing conjunctiva |
|
|
Term
| Which nerve controls corneal sensitivity? |
|
Definition
|
|
Term
| Which nerve controls the blink reflex (motor side)? |
|
Definition
|
|
Term
|
Definition
an arc on the cornea which is composed of lipids deposited in the periphery of the cornea
common in pts over age 60; if present before age 40, may indicate a lipid disorder |
|
|
Term
|
Definition
| arcus senilis that has formed a complete circle |
|
|
Term
| What does hemorrhage at the disc margins usually indicate? |
|
Definition
| poorly controlled glaucoma or undiagnosed glaucoma |
|
|
Term
|
Definition
bright red color
occur in the nerve fiver layers
blood spreads parallel to the nerve fibers |
|
|
Term
|
Definition
| tend to occur in the deeper layers and may appear as a dark color instead of the bright red that is characteristic of flame hemorrhages |
|
|
Term
|
Definition
| may represent microaneurysms (common in diabetic retinopathy) |
|
|
Term
|
Definition
vertical fold of skin nasally that cover the lacrimal caruncle
common in Asian infants, and also my suggestive of Down's syndrome |
|
|
Term
| what is the relationship between the medial and lateral canthi to each other? |
|
Definition
| they are usually horizontal (right across from each other) |
|
|
Term
|
Definition
| when the outer canthi are above the line made with the medial canthi (upward slant of the eye) |
|
|
Term
|
Definition
| when the outer canthi are below the line made with the medial canthi (downward slant of the eye) |
|
|
Term
| What is the arteriole-venule size ration in the retina? |
|
Definition
|
|
Term
| Four degrees of hypertensive retinopathy |
|
Definition
1. None = no detectable changes
2. Mild = retinal arteriolar narrowing, AV nicking, copper wiring = modest association with risk of stroke
3. Moderate = Hemorrhage, cotton wool spot, hard exudates and microaneurysms = strong association with stroke
4. Malignant = some or all of the above plus optic disc edema (papilledema) = strong association with death |
|
|
Term
|
Definition
| when the sclera is seen above the iris (infant appears to be looking downward); may be an expected sign in infants but may also indicate hydrocephalus and brainstem lesions |
|
|
Term
|
Definition
wide spacing of the eyes
may be seen in infants with mental retardation or cranifacial deficits |
|
|
Term
|
Definition
the false appearance of strabismus caused by a flattened nasal bridge or epicatnthal fold
expected variant in Asian and Native American/American Indian infants as well as in some whites
usually disappears by about 1 year
**use the corneal light reflex to distinguish pseudostrabismus from stabismus = an asymmetric light reflex may indicate true stabismus or hypertelorism |
|
|
Term
| Enlarged corneas in an infant may be sign of which disease? |
|
Definition
|
|
Term
|
Definition
neonatal bacterial conjunctivitis
seen when a newborn's eyelids are swollen or edematous AND are accompanied by conjunctival inflammation and drainage |
|
|
Term
|
Definition
keyhole pupil
often associated with other congenital anomalies |
|
|
Term
|
Definition
white specks scattered in a linear pattern around the entire circumference of the iris
strongly suggests Down syndrome |
|
|
Term
| What is the expected focus of an infant? |
|
Definition
| focus and track a light or face through 60 degrees |
|
|
Term
| opacities or interruption of the red reflex in infants may indicated which diseases? |
|
Definition
| congenital cataracts or retinoblastoma |
|
|
Term
| What is a popular mydriatic? |
|
Definition
| cyclopentolate hydrochloride 0.5% |
|
|
Term
| anticipated visual acuity for 3-5 year-olds |
|
Definition
|
|
Term
| visual acuity for 6 year-olds |
|
Definition
|
|
Term
| How do you differentiate between chronic hypertension and PIH in pregnant women? |
|
Definition
long-standing hypertension = vascular tortuosity, angiosclerosis, hemorrhage, and exudates
PIH = segmental arteriolar narrowing with a wet, glistening appearance indicative of edema (hemorrhages and exudates are rare) |
|
|
Term
| Can you use mydriatic agents on pregnant women? |
|
Definition
| No, the should be avoided due to their systemic absorption |
|
|
Term
|
Definition
bulging of the eye anteriorly out of the orbit
causes = Graves' disease (bilateral), retro-orbital tumor (unilateral) |
|
|
Term
|
Definition
Inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles
Causes = idiopathic, may be autoimmune
seen with photophobia, painless injection and or watery discharge |
|
|
Term
|
Definition
deposition of calcium in the superficial cornea
Causes = chronic corneal disease, also occurs in pts with hypocalcemia, hyperparathyoridism, and occasionally with renal failure or syphilis
S/O data = decrease in vision, line just below the pupil that passes over the cornea, horizontal gray bands interspersed with dark areas that look like holes (where the corneal nerves pass over the Bowman membrane) |
|
|
Term
|
Definition
Disruption of the corneal epithelium and stroma
causes = connective tissue disorder (sjogren syndrome, lupus, etc.) or viral or bacterial infection desiccuation
S/O data = visual acuity affected and purulent exudates may be seen |
|
|
Term
|
Definition
Both eyes do not focus on an object simultaneously, but can focus with either eye
Causes = may be a sign of increased intracranial pressure or CN III problems
S/O data = poor vision |
|
|
Term
|
Definition
Interruption of sympathetic nerve supply to the eye
Causes = congenital, acquired or herediatry
S/O data = seen as a triad of ipsilateral miosis, mild ptosis, and loss of hemifacial sweating; anisocoria (difference in pupil size) is greater in darkness; dry skin and flushing on the same side of the face as affected pupil |
|
|
Term
|
Definition
opacity in lens
causes = denaturation of lens protein caused by aging (central cataracts), hypoparathyroidism (peripheral cataracts), steriods, and maternal rubella, genetic defects or other fetal insults during first trimester of pregnancy (congenital cataracts) |
|
|
Term
| Diabetic retinopathy (background) |
|
Definition
dot hemorrhages or microaneuysms and the presence of hard and soft exudates
hard exudates = result of lipid transudation through incompetent capillaries
soft exudates = caused by infarction or the nerve
S/O data = asymptomatic in early stages, blurred vision, distortion or loss of visual acuity in advanced stages, balloon-like sacs (microaneurysms), blots of hemorrhage on retina, tiny yellow patches of hard exudates |
|
|
Term
| Diabetic retinopathy (proliferative) |
|
Definition
development of new vessels as result of anoxic stimulation = vessels grow out of the retina toward the vitreous humor (in peripheral retina or optic nerve)
new vessels lack structure and are likely to hemorrhage = bleeding is major cause of blindness in pts with diabetes
S/O data = generally asymptomatic, floaters, blurred vision or progressive visual acuity loss in advanced stages, vitreous hemorrhage may also be seen |
|
|
Term
|
Definition
occurs when the serum triglyceride level exceeds 2000 mg/dL
seen in diabetic ketoacidosis and in some hyperlipidemic states
S/O data = elevated serum triglyceride levels, no vision complaints, peripheral fundus changes in early stages, vessels appear salmon-pink initially and then become whitish
abnormalities improve as the triglyceride levels return to normal |
|
|
Term
|
Definition
autosomal recessive disorder in which the genetic defects cause cell death, predominantly in the rod photoreceptors
S/O data = earliest symptom is night blindness, tunnel vision, loss of vision is painless and progressive over years or decades, advanced disease shows optic atrophy with waxy pallor and periperhal "bone spicule"pigmentation with narrowing of the arterioles in the eye |
|
|
Term
|
Definition
disease of the optic nerve wherein the nerve cells die, producing characteristic appearance of the optic nerve (increased cupping)
cause = dramatically elevated intraocular pressure
S/O data = chronic and acute glaucoma, optic nerve damage can be clearly seen during a dilated eye exam, may see loss of peripheral vision |
|
|
Term
|
Definition
most common
symptoms are absent except for gradual loss of peripheral vision over period of years
may only be recognized when it is already quite advanced |
|
|
Term
|
Definition
less common
accompanied by intense ocular pain, blurred vision, halos around lights, a red eye and a dilated pupil
pts complain of stomach pain, nausea and vomiting |
|
|
Term
| chorioretinal inflammation |
|
Definition
inflammatory process involving both the choroid and the retina
cause = laser therapy for diabetic retinopathy (most common), also seen in histoplasmosis, cytomegalovirus, toxoplasmosis, or congenital rubella infections
S/O data = sharply defined lesion, generally whitish yellow and becomes tippled with dark pigment in later stages ending with chorioretinal scar, visual field defects with larger lesions |
|
|
Term
| Which eye disease can you get from cleaning a cat litter box? |
|
Definition
| histoplasmosis infection leading to chorioretinal inflammation |
|
|
Term
| How can you tell the difference between chorioretinal scars and myelin sheath persistence? |
|
Definition
| the whitish pigment looks the same but myelin sheath persistence does causes no visual field defect |
|
|
Term
|
Definition
lesion that interrupts the optic chiasm
most commonly caused by a pituitary tumor
causes tunnel vision (lateral half of each eye is knocked out) |
|
|
Term
|
Definition
caused by lesion of the optic nerve radiation on either side of the brain before the optic chiasm
causes hemianopia in each eye on the same side |
|
|
Term
|
Definition
embryonic malignant tumor arising from the retina
usually seen in first 2 years of life
transmitted either by autosomal dominant trait or by chromosomal mutation
S/O data = initial sign is leukocoria (white reflex), ill-defined mass arising from retina on fundoscopic exam, chalky-white areas of calcification can be seen |
|
|
Term
| retinopathy of prematurity (ROP) |
|
Definition
disruption of normal progression of retinal vascular development in preterm infant
cause = abnormal proliferation of blood vessels, preterm labor
S/O data = very common in premature infants, can be mild with no visual defects or can progress to retinal detachment and blindness; straight, temporally diverted blood vessels on fundoscopic exam |
|
|
Term
| Retinal hemorrhages in infancy |
|
Definition
occurs in infant victims of shaken-baby syndrome
usually bilaterally
S/O data = dilated fundoscopic exam is necessary to look for retinal hemorrhages |
|
|
