EYES

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EYES

• Who would believe that so small a space could
  contain the images of all the universe. Oh might
  process.
• Leonardo Da Vinci 1452-1519

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• Experiments conducted in West Germany and at the
  University of Southampton in England show that
  even mild and incidental noises cause the pupils
  of the EYES to dilate. It is believed that this
  is why surgeons, watchmakers, and others who
  perform delicate manual operations are so
  bothered by uninvited noise the sound causes
  their pupils to change focus and blur their
  vision.

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Questions

• More focused
• Eye infections
• Injuries
• Surgery
• Blurred vision
• Eye pain
• Work situation
• Computer time
• Hobbies
• Sunglasses

• General
• Vision / changes
• Last exam (freq)
• Glasses / contacts
• FH DM, HTN, glaucoma

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Equipment

• Vision charts (Snellen, Rosenburg)
• Pen light
• Cotton tip applicator (NO!)
• Cover cards
• Ophthalmoscope

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Hints

• Ability to read will determine the chart to use
• Several types of lighting are required
• Need 20 for Snellen chart check
• Patient can sit / stand you follow.
• Directions slow and precise

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Video

• Head ck first on video

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Visual Acuity

• Test central vision
• Wear general reading glasses
• 20 distance from chart
• Cover one eye
• Read smallest possible
• Read down next
• Repeat on other eye read backwards in case
  photo
• Must read more than half to be correct
• 20/20 vs 20/200 (1st pt distance from chart)
• Rosenburg hand held chart hold 14 out

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Visual Fields by Confrontation

• Glass bowl
• 2 ft apart at ear level
• Wiggle fingers
• Upper lower temporal quad
• Your peripheral vision is best you can test
• Gross test limited test
• Defects need to be f/up blind spots glaucoma,
  optic neuritis, edema

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EOM function

• Check the 6 cardinal position
• H Pattern
• Parallel tracking pause during up and lateral
  movement
• nystagmus - can indicate neuro problems
• Sm amt oscillation is often nl

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External exam

• General appearance no bulging
• Eyebrows lids and lashes
• Conjunctiva sclera pink white
• Lacrimal apparatus no swelling tearing
• Cornea lens oblique lighting no opacities
• Ptosis? Droopy eye

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Pupillary response direct and consensual

• Dark room
• Observe pupils
• Bring penlight from side
• Watch for direct and consensual response
• Do other eye
• PERRLA or PERRL

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Accommodation

• Hold finger about 1- cm from patient nose
• Ask to alternately look into distance and at
  finger
• Look at Pupillary response

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OPHTHALMASCOPE

• Front
• Brow rest
• On off switch
• Lens selector clear, no cross hairs, sm light
  if eyes are dilated
• Lens indicator

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Using ophthalmoscope

• Right eye
• Stand R of patient
• Select 0 on the lens disc and small round
  aperture
• Dim lights
• Pt focus on distant object
• Scope 6 ahead and 25 degrees to R, direct light
  at eye
• Find RR (absent cataracts, detached retina,
  tumor in kids)
• Hand on head move in
• Vessles
• Pt can tell when you are on the eye
• Best to look w/ both your eyes
• Wheel up and down 2 clicks to ck clarity

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What you may see

• Disc round, yellow orange if you cant find
  it, follow a blood vessel centrally gets larger
  toward the disc
• Adjust lens to bring disc into focus start at 0
  diopter and rotate to correct your own refraction
  errors
• Central physiological cup --- yl white, ½ size of
  disc
• Papilledema swelling of optic disk
  meningitis, subarachnoid hemorrhage, lesions
• Retina Arteries, veins, fovea, macula

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Changes in Aging

• Eye lid skin is thinnest skin in body bags?
• Decreased tear production
• Excessive tearing r/t drainage
• Eye droop may incompletely close ? ulcers
• Presbyopia
• Cataracts
• Decrease in pupil size less ability to dilate
  in dark -- gt sensitive to glare

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Health Promotion

• Eye protection / work / occupation
• Sun glasses
• Freq of exam
• Decreased tear production