Chapter 15: Eyes Physical Examination
2022
Eyelids - -two rapid window shades that further protect the eye from injury, strong
light, and
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-upper eyelid is larger and more mobile
Palpebral Fissure - elliptical open space between eyelids
Canthus - corner of the eye, the angle where the lids meet
Caruncle - -at the inner canthus
-small, fleshy mass containing sebaceous glands
Tarsal Plates - strips of connective tissue that gives upper eye lid its shape
Meibomian Glands - -in the tarsal plates
-modified sebaceous glands that secrete an oily lubricating material onto the lids
-this stops the tears from overflowing and helps form an airtight seal when lids are
closed
Conjunctiva - -transparent covering on the exposed part of the eye
-thin mucous membrane folded like an envelope between the eyelids and the eyeball
Lacrimal Apparatus - -provides constant irrigation to keep conjunctiva and cornea
moist and lubricated
Extraocular Muscles - give the eye both straight and rotary movement
What are the four straight (rectus) muscles? - -superior
-inferior
-lateral
-medial
What 3 cranial nerves stimulate the movement of the EOM (extraocular muscles)? -
-abducens nerve (VI): innervates the lateral rectus muscle (which abducts the eye)
-trochlear nerve (IV): innervates the superior oblique muscle
-oculomotor nerve (III): innervates all the rest- the superior, inferior, and medial
rectus and the inferior oblique muscles
Three concentric coats of the eye - -outer fibrous sclera
-middle vascular choroid
-inner nervous retina
Scelra - -tough, protective white covering
-continuous anteriorly with the smooth, transparent cornea, which covers the iris and
pupil
Cornea - -thin, transparent, and very sensitive to touch
Corneal Reflex - -blinking in response to corneal stimulation
Choroid - has a dark pigment to prevent light from reflecting internally and is heavily
vascularized to deliver blood to the retina
Pupil - -is round and regular
-its size is determined by a balance between the parasympathetic and sympathetic
chains of the ANS
-stimulation of the parasympathetic branch, through cranial nerve III, causes
constriction of the pupil
-stimulation of the sympathetic branch dilates and elevates the eyelids
Retina - -visual receptive layer of the eye in which light waves are changed into
nerve impulses
-surrounds soft, gelatinous vitreous body
What are the retinal structures viewed through ophthalmoscope? - -optic disc
-retinal vessels
-general background
-macula
Pupillary light reflex (PLR) - -normal constriction of pupils when bright light shines on
retina
Direct light reflex - when one eye is exposed to bright light --> constriction of that
pupil
Consensual light reflex - stimulation of other pupil occurs
Fixation - -reflex direction of the eye toward an object attracting our attention
Accomodation - -adaptation of the eye for near vision
What happens in the aging adult? - -distinct facial changes
-lacrimal glands involute --> decreased tear production, feeling of dryness and
burning
Presbyopia - impaired vision as a result of aging
Common causes of decreased visual functioning in older adults - -cataracts
-glaucoma
-age-related macular degeneration (AMD)
-diabetic retinopathy
Cataracts - -a clouding of the crystalline lens partly due to UV radiation
-curable with lens replacement surgery
Glaucoma - -optic nerve neuropathy characterized by loss of peripheral vision,
caused by increased intraocular pressure
-primary risk= age
Age-related Macular Degeneration (AMD) - -a loss of central vision caused by
yellow deposits (drusen) and neovascularity in macula
-AMD prevalence rises sharply with older age
-person is unable to read books, or papers, sew, or do fine work and has difficulty
distinguishing faces
Diabetic Retinopathy - -leading cause of blindness in adults 25-47
-vision impairment results in difficulty driving, reading, managing diabetes treatment,
and other self care
-prevalence has decreased slightly as a result of intensified prevention measures
and newer treatments, such as injection of steroids into the vitreous and anti-growth
factor drugs
Subjective Data: What to ask patients about - -vision difficulty (decreased acuity,
blurring, blind spots)
-pain
-strabismus, diplopia
-redness, swelling
-watering, discharge
-history of ocular problems
-glaucoma
-use of glasses or contact lenses
-patient-centered care
Scotoma - -blind spot inside an area of normal or decreased vision, occurs with
glaucoma and optic nerve disorders
Photophobia - -inability to tolerate light
Strabismus - -deviation in the parallel axes of the eyes
Diplopia - -perception of two images of a single object
-one eye is caused by dry eyes, uncorrected refractive error, cataract
Lacrimation - tearing
Epiphora - excessive tearing
Snellen Eye Chart - -most commonly used and accurate measure
-lines of letters arranged in decreasing size
-place pt 20 ft from chart
-leave on glasses and contacts (only remove reading glasses)
-shield one eye at a time
-top number= how far you are from chart (always 20)
-bottom number= how far a normal person can see that line
-the larger the bottom, the poorer the vision [Show Less]