Lecture 2: VISUAL DISORDERS AND INTRODUCTION TO THE EYE EXAM

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Lecture 2: VISUAL DISORDERS AND INTRODUCTION TO THE EYE EXAM
updated 9 years ago by bolip888
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Graduate school, Professional
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1

Describe how to obtain an appropriate history and perform an ophthalmic physical exam given a patient with visual complaints.

I. Eye H & P
a. CC- patient’s words
b. HPI- One or both? When? Modifying factors? Character? Associations?
c. Vitals and Physical Exam- CHECK THE VISION! Check one eye at a time.
d. Eye Exam
-Vision with correction, one eye at time, distance or near
-Intraocular pressure (unless laceration is expected)
-Pupils
-EOM
-Lids/lashes/orbit
-Conjunctiva/sclera
-Cornea
-Anterior chamber/iris
-Lens
-Vitreous
-Optic nerve
-Vasculature
-Macula
-Peripheral retina

2

Understand the appropriate use of an ophthalmoscope.

a. Bunch of mirrors to help you see the eye better
b. Diopter dial- one thing you may have to manipulate during eye exam
i. Negative= red numerals= near sighted
ii. Positive= green numerals= far sighted
c. Apeture
i. Changes size, shape, color
ii. Slit beam to gauge depth
iii. Cobalt filter = wood’s lamp (for fluorescein stain)

3

Describe the principles of optics.

a. Light needs to be focused to a point to see clearly
b. Light rays enter eye and begin to converge to a point of focus
c. If they come together too soon, the convergence needs to be slowed
d. If they come together too late, convergence needs to be sped up
e. Light rays travels parallel when source is far away
f. When source is near, divergence must be overcome by eye with additional refractive power

4

Describe accommodation.

g. Accommodation= ability of eye to adjust focal length
i. Near objects= ciliary muscles contract, allow lens to take more convex shape, shorter focal length, more refractive power
ii. Far objects= ciliary muscles relax away from lens, pulling it into a flatter shape, longer focal length, less refractive power

5

Myopia

i. Myopia- near sighted
1. Eye is too long
2. Most common visually significant refractive error
3. Light comes together too soon
4. Correct with minus or concave lens (glasses will minimize appearance of eyes)

6

Hyperopia
Presentation and History, key physical exam findings, treatment plan

ii. Hyperopia- far sighted
1. Eye is too short
2. Natural focus point is behind retina
3. Correct with plus or convex lens (glasses with magnify eyes)

7

Astigmatism
Presentation and History, key physical exam findings

iii. Astigmatism
1. When cornea has imperfect curvature (like a football)
2. Can distort vision- like looking into a distorted, wavy mirror

8

Presbyopia
Presentation and History, key physical exam findings, treatment plan

iv. Presbyopia
1. Intraocular lenses get stiffer and fatter with age
2. Makes eye incapable of accommodation= fixed focus
3. Occurs gradually, around 40 yrs
4. Corrected with reading glasses or bifocals

9

Strabismus

a. Disorders of ocular alignment (eye crossing)
i. congenital (infantile)
ii. refractive
iii. acquired

10

Tropias
4 types

i. esotropia- medial movement
ii. exotropia- lateral movement
iii. hypertropia- superior movement
iv. hypotropia- inferior movement

11

Define amblyopia and list possible causes and treatments.

i. One of the MOST COMMON causes of visual loss in children
ii. Caused by abnormal visual input to one or both eyes
1. Anything that causes limitation of vision disproportionately in one eye
iii. Preventable and treatable if caught before age 8
iv. Brain ignores bad eye’s vision
1. Treatment= improve vision in weaker eye by covering stronger eye, so that the weaker one’s optic center has a chance to develop