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Palpebral Fissure
open space between the eyelids
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Limbus
border between cornea and sclera
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Canthus
corner of the eye
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Caruncle
small fleshy mass at inner corner containing sebaceous glands
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Tarsal Plates
strips of connective tissue, contain the meibomian glands, secrete oily lubricating material
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Conjunctiva
- thin mucous membrane
- a. Palpebral Conjunctiva - lines the lids
- b. Bulbar Conjunctiva - overlays the eyeball with the white sclera showing through
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Lacrimal Apparatus
provides constant irrigation
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Puncta
absorb tear drainage (upper and lower lids at the inner canthus)
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Extraocular Muscles
- 6 muscles attach to the eyeball and give the eye
- movement
- a. Rectus Muscles - 4 straight
- b. Oblique Muscles - 2 slanting
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Internal Eye
- 1. Sclera - outer fibrous, protective white covering
- 2. Choroid - middle vascular, dark pigmented layer, delivers blood to the retina, prevents light from reflecting internally
- a. Pupil
- b. Lens - focus
- c. Anterior Chamber - continuous flow of fluid, serves to deliver, nutrients to surrounding tissues and drains metabolic waste
- 3. Retina - visual receptive layer of the eye, light waves are changed into nerve impulses (includes optic disc, retinal vessels)
- a. Optic Disc - retina fibers converge to form the optic nerve
- b. Macula - receives and transduces light from the center of the visual
- field
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Cultural Considerations
- A. Palpebral Fissures - narrowed in Asian population
- B. Glaucoma - more prevalent in African American population, and more severe
- which can lead to blindness
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History (Subjective)
- A. Vision difficulty, decreased visual acuity, blurring, blind spots
- B. Eye pain
- C. Hx Strabismus, diplopia (double vision)
- D. Redness and/or swelling
- E. Watering and/or eye d/c
- F. Past hx of eye problems (ie.injury or surgery to eye)
- G. Hx glaucoma
- H. Use of glasses and/or contacts
- I. Self care behaviors (date of last eye exam)
- J. Medications
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Physical Exam/Assessment (Objective)
- A. Snellen eye chart
- B. Near Vision
- C. Confrontation Test
- D. Corneal Light Reflex (Hirschberg Test) - shine light from distance approx. 12-14"
- –> at same spot both eyes
- E. Cover Test - test for lazy eye/strabismus
- F. Diagnostic Positions Test (H) and 6 cardinal positions of gaze - EOM function and test for nystagmus
- G. Inspection of External Eye
- 1. Eyebrows - symmetrical movement with facial expressions, no lesions, no scaling, etc.
- 2. Eyelids and Eye Lashes - upper lids overlap top of iris, skin intact without redness, swelling, d/c or lesions
- 3. Eyeballs - alignment
- 4. Conjunctiva and Sclera - color, discharge
- 5. Eversion of Upper Eyelid (not performed in lab)
- 6. Lacrimal Apparatus - palpate with thumb inner eye for lacrimal sac and brow area for lacrimal gland
- H. Anterior Eyeball Structures
- 1. Cornea and Lens - smoothness and clarity
- 2. Iris and Pupil - shape, PERRLA
- a. Pupillary light reflex
- b. Accommodation - distant object, shift to close object - pupils should constrict
- I. Ocular Fundus - ophthalmaloscope
- 1. Red Reflex
- 2. Optic disc
- 3. Retinal Vessels
- 4. General Color/Background, Lesions
- 5. Macula
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Esotropia
inward turning of eye
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Exotropia
outward turning of the eye
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Strabismus
eyes crossed (pseudostabismus - eyes look crossed secondary to epicanthal folds - normal for young children)
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Periorbital Edema
lids swollen, red, and puffy
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Ptosis
drooping upper eyelid
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Blepharitis
red scaly, flakey crusted lid margins (seborrhea)
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Hordeolum
(stye) - infection of the hair follicle
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Chalazion
(internal stye) - infection of internal glands of the eye
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Dacryocyctitis/Dacryoadenitis
inflammation of the lacrimal sac/gland
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Conjunctivitis
infection of the conjunctiva, “pink eye”
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Subconjunctival Hemorrhage
secondary to increased intraocular pressure
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Iritis
increased redness around iris only, usually need immediate referral
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Corneal Abrasion
scratch, irregular ridges, spot noted with fluorescein
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Mydriasis
dilated and fixed pupils
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Miosis
constricted and fixed pupils
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Diabetic Retinopathy
multiple microaneurysms or small red dots or dilations of the vessels noted on the fundiscopic exam
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