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Monday, April 28, 2008


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Eyes Slide Transcript
Slide 1: Eyes

Slide 2: External Anatomy  Sensory Organ for vision -Situated in bony, orbital cavity for protection – Eyelids= shades that add protection form injury, strong light , dust – Eyelashes= hairs to filter dust & dirt

Slide 3: External External Anatomy Anatomy

Slide 4:  Limbus – border b/t the cornea & sclera  Palpebral fissures – elliptical open space b/t lids  Canthus- corners of the eye where the lids meet, inner & outer  Caruncle – sm. Fleshy mass containing sebaceous glands at inner canthus

Slide 5:  Within the upper eyelid – Tarsal plates, connective tissue gives upper lid shape – Meibomian glands, in the plates, lubricate the lids, stops overflow of tears, airtight seal when lids closed

Slide 6:  Exposed part of the eye – Conjunctiva, folded envelope b/t eyelids & eyeball  thin mucous membrane, transparent protective covering of the exposed part of the eye.  Palpebral conjunctiva lines the lids, is clear but has sm .bld. Vessels  Bulbar conjunctiva is over eyeball, white sclera show through, merges at limbus with cornea

Slide 7:  Cornea – clear, covers & protects iris & pupil

Slide 9:  Lacrimal apparatus – irrigates conjunctiva & cornea – 3 parts A. Lacrimal gland, upper, outer corner of eye = tears B. Puncta= inner canthus, tear drainage C. Nasolacrimal duct= allows tears to drain from puncta to nasolacrimal sac. Tears then empty into the inferior meatus of the nose

Slide 11: Extraoccular muscles  6 muscles – Attach eyeball to orbit – Straight and rotary movement – Four straight muscles 1. Superior rectus 2. Inferior rectus 3. Lateral rectus 4. Medial rectus

Slide 12:  Two slanting/ oblique muscles 1. Superior 2. Inferior Humans have a Binocular, single – image visual system – Eyes normally move as a pair

Slide 13: • Eye movement stimulated by Cranial Nerves • III Oculomotor • IV Trochlear • VI Abducens

Slide 16: Internal Anatomy  The eye has 3 layers, the outer & inner layer can be viewed using opthalmascope 1. Sclera (outer layer) tough, protective, white covering connects with the -  Cornea – transparent, protects pupil & iris – helps focus light on retina

Slide 17: 1. Middle layer  Choroid – dark pigmentation to prevent internal light reflection, supplies bld. to retina  Pupil – PERRLA  Lens – biconvex disc, transparent, thickness controlled by ciliary body, bulges = near; flattens = distant  Anterior chamber – posterior to cornea, anterior to iris & lens, has aqueous humor supplies nutrients & drains wastes

Slide 18: 1. Inner layer – Retina – visual receptive layer – light waves changed to nerve impulses  Retinal structures  Optic disc – retinal fibers meet & form optic nerve, nasal side of retina, creamy yellow orange to pink, round or oval shape, physiologic cup inside the disc for bld.vessels to enter & exit  Retina vessels – paired arteries & veins

Slide 19:  Macula – temporal side of fundus, darker pigmented region, surround the fovea centralis  Fovea Centralis- area of sharpest & keenest vision, Very sensitive to light

Slide 21: Visual Pathways & Fields  Objects reflect light  Rays refracted by cornea, aqueous humor, lens, vitreous body and onto retina.  Light stimulus is changed to nerve impulses, travel thru optic nerve to visual cortex in occipital lobe  Image on retina is upside down & reversed. At the optic chiasm retinal fibers cross over. Right side of brain looks at left side of world.

Slide 23: Visual reflexes  Pupillary light reflex – bright light = constriction – Direct light reflex – Consensual light reflex  Fixation – ability to track an object & keep image on the fovea, can be impaired by drugs, alcohol, fatigue & inattention  Accomodation – for near vision = pupil constriction & convergence of eyes

Slide 26: Subjective data  Vision difficulty  Pain  Strabismus, diplopia  Redness, swelling  Watering, discharge  Past history ocular problems  Glaucoma

Slide 27:  Glasses/ contacts  Medications  Vision loss- coping mechanisms  Self–care behaviors

Slide 28: Objective data The Physical Exam  Preparation – Position- sitting, head at eye level  Equipment – Snellen eye chart- visual acuity – Handheld visual screener-near vision – Opaque card – Penlight – Applicator stick – Ophthalmoscope

Slide 29: Test visual acuity Snellen eye chart  Stand 20 ft. from chart  Glasses / contacts (Document )  Remove eye wear, retest  Normal visual acuity is 20/20 – top # is distance person is standing from the chart  Vision 20/30 refer to opthalmologist or optometrist  If unable to see largest letters, move to 10 feet – record as 10/200

Slide 30: Test for near vision  Vision screener  People > 40yrs or difficulty reading  Test each eye with glasses  Hold card 14in. from eyes  Normal result 14 / 14  Test using any available reading material if no card available

Slide 31:  Presbyopia is a normal physiological change in near vision occurs with aging = note if the person moves the card farther away

Slide 32: Test visual fields Confrontation test  Compares peripheral vision with a tester who has normal peripheral vision  2 ft. apart, eye level  Tester & client cover opposite eyes  Tester advances finger in the periphery – Superiorly ( 50 degrees ) – Inferiorly ( 70 degrees ) – Temporally ( 90 degrees )

Slide 34: Inspect Extraoccular Muscle Function  Corneal light reflex  Cover test  Diagnostic positions test – 6 Cardinal Positions of Gaze

Slide 35: Inspect Extraocular Muscle Function  Corneal Light Reflex ( The Hirschberg Test) assesses parallel eye alignment – Shine light toward person’s eyes – Tell to stare directly ahead – Hold light 12 in. away – Light should reflect on both corneas in same spot

Slide 36:  Cover Test- detects deviated alignment – Stare straight at examiner’s nose – Cover 1 eye of the person being examined with opaque card – Normally the uncovered eye should maintain a steady, fixed gaze – Covered eye- should stare straight ahead when covered & then uncovered. If muscle weakness exists the covered eye will relax and then jump to fixed position when uncovered..

Slide 37: Diagnostic Positions Test  6 cardinal positions of gaze – – Determines muscle weakness during movement – Person must hold head steady – Follow movement of object (examiner’s finger, pen etc) only with eyes – Hold object 12 in. from person – Move thru each position, clockwise, hold , then back to center – Normal response= parallel tracking with both eyes

Slide 39:  During this test be aware of Nystagmus-fine jerky movement seen around the iris  Mild nystagmus in extreme lateral gaze is normal but not normal in any other position

Slide 40: Inspect External Structures  General – movement & facial expression (squinting?)  Eyebrows – 2(bilateral), symmetrical (look the same; move the same)  Eyelids & Lashes – present, approximate when closed, no redness, swelling, discharge, lesions?  Eyeballs- alignment, ? Protrusion? Sunken?  Conjunctiva & Sclera – moist, glossy, clear, white sclera

Slide 41:  Eversion of the upper eyelid FYI – we will not do this examine in lab see pg. 312 for technique – usually done for complaint of eye pain due to foreign body

Slide 44:  Lacrimal Apparatus – Person looks down – Using thumbs, slide outer part of upper lid along bony orbit – Note redness or swelling – Press index finger against lacrimal sac at inner canthus – Normal response is slight eversion of lower lid, no tearing or discharge

Slide 46: Anterior Eyeball Structures  Cornea & lens  Iris & pupil – Size & shape – Pupillary light reflex – Accommodation

Slide 47: Cornea & Lens  Shine light from side across cornea  Check smoothness, clarity  Normally no opacities

Slide 48: Iris and Pupil  Iris = flat, round, regular, even color bilaterally.  Pupils = PERRLA – Resting size norm = 3-5mm – 5% population have pupils of 2 diff. Sizes called Anisocoria

Slide 49:  Pupillary Light Reflex – Darken room – Person gazes straight ahead – Advance light from the side  Direct light reflex  Consensual light reflex – Measure pupil size before & after light reflex – Measurement R3/1 L3/1 =both pupils measure 3mm in resting state & 1mm with light

Slide 50:  Accomodation – focus on distant object -dilatation of pupils – Shift gaze to near object – pupils constrict & converge  Record the normal response to these tests as  PERRLA = Pupils Equal, Round, React to Light and Accomodation

Slide 51: Ocular Fundus (internal surface of retina)  Use Opthalmoscope- try keeping both eyes open- practice looking at a ring on your finger. Become familiar with the instrument before you examine your partner’s eyes

Slide 52:  Diopter of opthalmoscope – Black numbers = +diopter, focus on near objects – Red numbers = - diopter, focus on further objects  Use ophthalmoscope in darkened room = dilates pupils

Slide 53:  Remove examiner’s and person’s eyeglasses but contact lenses may be left in.  Select lg. White aperture light  Person should focus on a distant object and try & remain still  Examiner hold ophthalmoscope in Right hand to right eye to eamine person’s right eye

Slide 54:  Begin 10in away at 150 lateral angle & advance  Keep sight of red reflex  Adjust lens to +6 as you advance till your foreheads almost touch. Adjust diopter to focus. – Normal vision set at 0. Nearsighted use red #s. Farsighted use black.

Slide 56: Retinal background  Light – dark red normally  Note Lesions – Size, shape, color, distribution

Slide 57: Macula & Fovea Centralis  Last in Funduscopic exam – 1 DD in size – Darker than rest of fundus – Foveal light reflex – Exam last

Slide 59: Retinal Vessels Arteries Veins COLOR Light red Dark red SIZE Smaller 2/3 to Larger 4/5 diam. Of veins LIGHT Bright Inconspicuous REFLEX absent

Slide 60: Read Aging & Developmental Considerations Review Abnormalities of the Eyes

Slide 61: 3 most common causes of decreased visual functioning in the older adult  Cataract (lens opacity)  Glaucoma (increased ocular pressure) = loss of peripheral vision  Macular degeneration (breakdown of cells in the macula lutea) = loss of central vision

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