PE I Eye
-Visual acuity/Visual fields
-Inspection
-Extraocular movements (EOMs)
-Position and alignment
-Pupils
-Ophthalmoscopic exam - ANS-Eye exam
Perform routine eye exams
-Routine physical screening
-Diabetes, hypertension, other systemic disease f/u
Evaluate routine ocular complaints
-Blurry vision
-Eye drainage
Evaluate urgent eye complaints
-Trauma
-Periorbital cellulitis, etc
-Blindness - ANS-Eye Exam in Primary Care
-_____ is continuous with the sclera
- ________ _______: cornea to the iris, canal of Schlemm - ANS-Cornea
Anterior Chamber
-Ensure you have enough light and the proper equipment
-Do not press on or allow your patient to press on his globe
-Obtain appropriate history
--Last eye exam
--Wear glasses or contact lenses
--History of ocular disease
Get in the habit of assessing visual acuity with *ANY* eye complaint - ANS-Technique
points
What does the following stand for?
-OD (oculus _____) right eye
-OS (oculus _______) left eye
,-OU (oculus ______) both eyes - ANS-Dexter
Sinister
Uterque
Use wall chart or card:
-Snellen eye chart: stand __ ____ from chart
-Pocket card: should be __ _____ from eyes
-Test patient *with correction,* if worn (and note this)
-Test each eye separately, then together (OD/OS/OU)
Have patient read the smallest line in which they can identify more than half the letters -
ANS-20 feet
14 inches
Record as a notation, e.g. 20/20
-__: distance from chart (feet)
-__: distance a normal eye can read the line
-eg; 20/40 means the patient can read at 20 feet what a normal eye can at 40 feet -
ANS-N
D
If a visual acuity of 20/20 is achieved, then a refractive error is present. If not, _______
must be considered. Any child with a visual acuity in either eye of 20/__ or worse at
*age three to five* years or 20/__ or worse at *six years or older,* *or a two-line
difference in acuity between the two eyes,* should be referred to an ophthalmologist for
further evaluation - ANS-Amblyopia
20/40
20/30
What if patient cannot see largest letter?
What if they cannot see the big E at 3 feet? - ANS-Walk the patient toward the chart
until they see the big E.
Record as 10/200 (the 20/200 letter at 10 ft)
If patient unable to see big E at 3 feet, try:
, -Count fingers
-Hand motion
-Light perception
->20/200: legal blindness
-Purpose is to screen for visual field defect
-A visual field is the entire area seen by an eye when it looks at a central point
-Visual fields normally limited by the brows above, the cheeks below, and the nose
medially
-A lack of ______ _______ at the optic disc produces an oval blind spot in the normal
field of each eye, 15 degrees temporal to the line of gaze. - ANS-Visual Fields by
Confrontation, Retinal Receptors
-Imagine the patients visual fields projected onto a glass bowl that encircles the front of
the patients head
-Ask them to look with both eyes into your eyes.
-While you return the patients gaze, place your hands about 2 feet apart, lateral to the
patients ears
-Instruct the patient to point to your fingers as soon as they are seen
-Then slowly move the wiggling fingers of both your hands along the imaginary bowl
and toward the line of gaze until the patient identifies them
-Usually a person sees both sets of fingers at the same time - ANS-Visual Fields by
Confrontation
-If you find a defect, try to establish its boundaries
-Test one eye at a time several times and try to define the border of the defect
-Review different patterns of visual field defects (Table 6-4, pg. 212). Give three
examples: - ANS--Homonymous hemianopsia
-Bitemporal hemianopsia
-Quadratic defects
*A lesion at the Optic chiasm* may involve only fibers crossing over to the opposite
side. Since these fibers originate in the nasal half of each retina, visual loss involves the
temporal half of each field. - ANS-Bitemporal Hemianopsia
*A lesion of the optic tract* interrupts fibers originating on the same side of both eyes.
Visual loss in the eyes is therefore similar (homonymous) and involves half of each field
(hemianopsia). - ANS-Homonymous Hemianopsia (Right Optic tract)
-Visual acuity/Visual fields
-Inspection
-Extraocular movements (EOMs)
-Position and alignment
-Pupils
-Ophthalmoscopic exam - ANS-Eye exam
Perform routine eye exams
-Routine physical screening
-Diabetes, hypertension, other systemic disease f/u
Evaluate routine ocular complaints
-Blurry vision
-Eye drainage
Evaluate urgent eye complaints
-Trauma
-Periorbital cellulitis, etc
-Blindness - ANS-Eye Exam in Primary Care
-_____ is continuous with the sclera
- ________ _______: cornea to the iris, canal of Schlemm - ANS-Cornea
Anterior Chamber
-Ensure you have enough light and the proper equipment
-Do not press on or allow your patient to press on his globe
-Obtain appropriate history
--Last eye exam
--Wear glasses or contact lenses
--History of ocular disease
Get in the habit of assessing visual acuity with *ANY* eye complaint - ANS-Technique
points
What does the following stand for?
-OD (oculus _____) right eye
-OS (oculus _______) left eye
,-OU (oculus ______) both eyes - ANS-Dexter
Sinister
Uterque
Use wall chart or card:
-Snellen eye chart: stand __ ____ from chart
-Pocket card: should be __ _____ from eyes
-Test patient *with correction,* if worn (and note this)
-Test each eye separately, then together (OD/OS/OU)
Have patient read the smallest line in which they can identify more than half the letters -
ANS-20 feet
14 inches
Record as a notation, e.g. 20/20
-__: distance from chart (feet)
-__: distance a normal eye can read the line
-eg; 20/40 means the patient can read at 20 feet what a normal eye can at 40 feet -
ANS-N
D
If a visual acuity of 20/20 is achieved, then a refractive error is present. If not, _______
must be considered. Any child with a visual acuity in either eye of 20/__ or worse at
*age three to five* years or 20/__ or worse at *six years or older,* *or a two-line
difference in acuity between the two eyes,* should be referred to an ophthalmologist for
further evaluation - ANS-Amblyopia
20/40
20/30
What if patient cannot see largest letter?
What if they cannot see the big E at 3 feet? - ANS-Walk the patient toward the chart
until they see the big E.
Record as 10/200 (the 20/200 letter at 10 ft)
If patient unable to see big E at 3 feet, try:
, -Count fingers
-Hand motion
-Light perception
->20/200: legal blindness
-Purpose is to screen for visual field defect
-A visual field is the entire area seen by an eye when it looks at a central point
-Visual fields normally limited by the brows above, the cheeks below, and the nose
medially
-A lack of ______ _______ at the optic disc produces an oval blind spot in the normal
field of each eye, 15 degrees temporal to the line of gaze. - ANS-Visual Fields by
Confrontation, Retinal Receptors
-Imagine the patients visual fields projected onto a glass bowl that encircles the front of
the patients head
-Ask them to look with both eyes into your eyes.
-While you return the patients gaze, place your hands about 2 feet apart, lateral to the
patients ears
-Instruct the patient to point to your fingers as soon as they are seen
-Then slowly move the wiggling fingers of both your hands along the imaginary bowl
and toward the line of gaze until the patient identifies them
-Usually a person sees both sets of fingers at the same time - ANS-Visual Fields by
Confrontation
-If you find a defect, try to establish its boundaries
-Test one eye at a time several times and try to define the border of the defect
-Review different patterns of visual field defects (Table 6-4, pg. 212). Give three
examples: - ANS--Homonymous hemianopsia
-Bitemporal hemianopsia
-Quadratic defects
*A lesion at the Optic chiasm* may involve only fibers crossing over to the opposite
side. Since these fibers originate in the nasal half of each retina, visual loss involves the
temporal half of each field. - ANS-Bitemporal Hemianopsia
*A lesion of the optic tract* interrupts fibers originating on the same side of both eyes.
Visual loss in the eyes is therefore similar (homonymous) and involves half of each field
(hemianopsia). - ANS-Homonymous Hemianopsia (Right Optic tract)
