Nearsighted

Eyeball is too long, greater curvature of cornea

Rotate lens counterclockwise w/ myopic pt (negative diopters, red)

**Retinal structures look larger in myopic eye- WNL

Farsighted

Shorter eye; flat cornea

-rotate disc clockwise (+ diopters, green)

-Lens hardens, less pliable, cannot make lens rounder

-progressive loss of near vision, decreases accommodation

Loss of vision

Weakness/paralysis of extra ocular muscles

Excessive tearing

Blockage of tear drainage (puncta, lacrimal duct)

Dacrylitis?

Eye PAIN

Eye tenderness

Corneal abrasion, Narrow angle glaucoma, or Iritis

Conjunctivitis, iritis, blepharitis, hordeolum

Constriction of pupils

"My, oh so small"

Dilation of pupils

D

Unequal pupils

Normal in 20% of population (Adie's)

Retina/optic nerve defect

Oculomotor Nerve defect

Loss of horizontal vision in one eye

Optic disc lesion, CVA, Tumors, glaucoma, intracranial bleed

Not completely blocked from optic disc

• Marcus Gunn Pupil

Optic nerve is damaged (oculomotor nerve CNIII)

Affected eye: 1)no consensual reaction

2)dilates instead of constricting

3)decreased sensory input

4)sluggish response

Good eye is totally normal

CNIII

-complete ptosis

-impaired EOMs

MAP

-myosis, ptosis, anhydrosis

-BENIGN

-no reaction to light

-DOES constrict to near

-females

-Drugs (?glaucoma pts)

-Altered mental status/comatose

-Brainstem problem

-Argyll Robertson Pupil (syphilis)

-small, irregular pupils

-no rxn to light

-+accommodation(constrict w/ near)

-Common w/ syphilis

-eversion (turning out) of eyelid

-inadequate draining

-dry eyes

-Inversion of eyelid

-corneal abrasion

-Eyes appear swollen

- Skin infection vs. Allergy

-?renal problems

Hordeolum

vs.

Chalazion

-eyelid margin, obstructed Glands of Zeiss,PAIN

-Obstruction of Meibomian glands, painless

-soft, yellow plaques on eyelid

-Increased cholesterol?

-congenital

-bruising (ecchymosis)

-basilar skull or orbital floor fracture

-PAIN-->immediate referral

-no pain

-infection of cornea

-usually occurs when pt wears contact too long

-Blockage of Canal of Schlemm

-increase intraocular pressure (ant. chamber)

-Rock hard eye

-Blurriness, HA, halos, severe eye pain

-EMERGENCY

-mild increase of intraocular pressure

-geriatric

85% of cases, unknown etiology

-Glaucoma cupping-inc size of cup

-d/t increased pressure

-blood is btwn sclera & conjuntiva

-no pain

-opacity of lens

-no red reflex

-gray pupil, decreased visual acuity

-arc around cornea

-d/t increased cholesterol

->60

-error in focusing ability of eye

-d/t unequal curvature of front surface of cornea

-measures power of lens to converge & diverge

-corrects for refractive errors

-used to dilate eye

CONTRAINDICATIONS:

-head injury, coma, altered mental status(ruin exam, unable to check light rxn,etc),

narrow angle glaucoma(inc. pressure-->blindness)

-Cataract

-Eye prosthesis

-Vitreous opacity/hemorrhage

-Detached retina

-Retinoblastoma

-bleeding into vitreous humor 

-d/t trauma/disease

-Decreased/cloudy vision, rapid loss of vision

-Curtain comes down over eye

-preceded by flashing lights/floaters

-Retina becomes detached from blood supply

-Blunt trauma

-death of optic nerve fibers

-no physiological cup or vessels in disc

-bright white disc

-Benign

-bright white nerve fibers radiating from optic disc

-present at birth

-cotton wool patches, fluffy borders

-d/t infarcted nerve fibers of retina

-HTN, DM

-creamy/yellowish

-distinct borders, occur in clusters, linear, or starshaped patterns

-worsening HTN, DM

-undigested cellular debris

-occur around macula

-bilateral

-most common cause of blindness in >60

-associated w/ Macular Degeneration

-arteries become thickened, tortuous

-bright, coppery luster appears

-associated w/ HTN

-artery stenosis

-wall so thick you cannot see blood

-silvery appearance

-HTN

Nicking: vein appears to stop abruptly on either side of artery

Tapering:vein tapers down to small pt

Banking: vein is twisted on distal side of artery

-Blood & Thunder retina

-variable vision loss

-soft exudates (cotton wool spots)

-diffuse retinal hemorrhaging, disc edema

-DM, HTN, Glaucoma

-refer in 1-2 d

-Cherry red spot in macula

-edematous retina, narrowed arteries

-Sudden unilateral vision loss

-Common in early am, elderly men

-EMERGENGY

Lighter color around cherry red spot indicates pressure pushing  behind it.

-small, rounded spots

-dot or blot hemorrhages

-common w/ DM

*Microaneurysms: diabetic retinopathy

-Flame stitch hemorrhage,

-small, linear flame-shaped red streaks

-Severe HTN, papilledema, Central retinal vein occlusion

-blood gets into space btwn retina and vitreous

-causes sudden increase in intracranial pressure

-Asymptomatic

-AV nicking, tortuous vessels, cotton wool patches, hemorrhages, retinal edema, papilledema, leaky vessels, thickening arterioles (look like veins but lighter)

-Macular Stars (accumulation of edema)

-Nonproliferative

-microaneurysms, tortuous vessels, dilatation, hard exudates, macular edema, non-perfusion to affected areas

-Preproliferative

-cotton-wool patches