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EYES
Anatomy and Landmarks of Eyes
<ul><li>The eye is the sensory organ that transmit visual stimuli to the brain for interpretation </li></ul><ul><li>It occ...
2 <ul><li>4 rectus & 2 </li></ul><ul><li>2 oblique muscles </li></ul><ul><li>are innervated </li></ul><ul><li>by CN 3 & CN...
<ul><li>1.EXTERNAL EYE </li></ul><ul><li>Eyelid  </li></ul><ul><li>Conjunctiva </li></ul><ul><li>Lacrimal gland </li></ul>...
<ul><li>Eyebrows </li></ul><ul><li>Eyelids </li></ul><ul><li>Eyelashes </li></ul>
 
<ul><li>2.INTERNAL EYE </li></ul><ul><li>3 layers  </li></ul><ul><li>1.Sclerotic coat </li></ul><ul><li>> this tough layer...
 
<ul><li>2. Choroid coat </li></ul><ul><li>> this middle layer is deeply pigmented with melanin </li></ul><ul><li>Reduces r...
 
<ul><li>3. Retina </li></ul><ul><li>> forms the inner layer of the eye  </li></ul><ul><li>> it contains the light receptor...
 
Eye Examination <ul><li>One of the best ways to protect vision- it can detect eye problems at their earliest stage </li></ul>
Who gives eye exam? <ul><li>Ophthalmologists- or any medical doctors who provide full eye care such as : </li></ul><ul><li...
<ul><li>Optometrists  </li></ul><ul><li>- diagnosing common eye disorders and treating selected eye diseases with drugs </...
<ul><li>Opticians  </li></ul><ul><li>- fill prescriptions for eyeglasses </li></ul><ul><li>- some opticians also sell and ...
<ul><li>A complete eye exam begins with your medical history: </li></ul><ul><li>- Are you having any eye problem now? </li...
<ul><li>What health problems have you had in recent years? </li></ul><ul><li>Are you taking any medications? </li></ul><ul...
<ul><li>Has anyone in the family had eye problems such as cataracts or glaucoma </li></ul><ul><li>Has anyone in your famil...
Eye Examination <ul><li>PROCEDURE… </li></ul>
<ul><li>Eyeball  </li></ul><ul><li>>Position and alignment of the eyes </li></ul><ul><li>a. Stand in front of the patient ...
<ul><li>The eyeball –observe the position within the confines of the bony orbit ( socket) </li></ul>
<ul><li>External examination </li></ul><ul><li>>Examination of the eyes is carried out in a systematic manner beginning wi...
<ul><li>Surrounding structures </li></ul><ul><li>Eyebrows  </li></ul><ul><li>> note for the amount , distribution </li></u...
<ul><li>Eyelids  </li></ul><ul><li>Assess the palpebral fissure with the patient looking straight ahead and observe the re...
<ul><li>Note for the ability to open and close the eyes completely </li></ul><ul><li>Observe for ptosis  </li></ul><ul><li...
<ul><li>Tremors  </li></ul><ul><li>Redness  </li></ul><ul><li>Swelling/edema of the lids </li></ul><ul><li>Note whether th...
<ul><li>Procedure for everting </li></ul><ul><li>the eyelid and removing </li></ul><ul><li>a foreign body </li></ul>
 
<ul><li>Eyeball tension </li></ul><ul><li>> apply gentle pressure from the fingertips </li></ul><ul><li>( L&R forefingers)...
<ul><li>Lacrimal apparatus </li></ul><ul><li>Inspect the regions of lacrimal gland and  </li></ul><ul><li>Lacrimal sac for...
<ul><li>Press on the lacrimal </li></ul><ul><li>sac; if fluid can be </li></ul><ul><li>expressed thru the </li></ul><ul><l...
<ul><li>INTERNAL EXAMINATION </li></ul>
<ul><li>Conjunctivae & Sclerae </li></ul><ul><li>Ask the patient to look </li></ul><ul><li>up as you depress both </li></u...
<ul><li>Cornea  </li></ul><ul><li>With oblique lighting </li></ul><ul><li>from a penlight </li></ul><ul><li>inspect for cl...
<ul><li>Iris, Pupils & Lens </li></ul><ul><li>> With the light shining  </li></ul><ul><li>directly from the temporal  </li...
<ul><li>Pupillary reaction </li></ul><ul><li>- Pupillary size changes in response to light and to the effort of focusing o...
<ul><li>a) The light reaction  </li></ul><ul><li>Direct light reflex: </li></ul><ul><li>> From the lateral side of each ey...
<ul><li>Indirect light reflex: </li></ul><ul><li>Ask the patient to rest the radial side of his L or R hand in between the...
<ul><li>b) The near reaction </li></ul><ul><li>- When a person shifts gaze fr. a far object to a near one, the pupils cons...
 
<ul><li>Eye muscle test </li></ul><ul><li>- This test examines the muscles that  </li></ul><ul><li>that control eye moveme...
<ul><li>EXTRAOCULAR  </li></ul><ul><li>MUSCLE TEST </li></ul><ul><li>>Position yourself 2 ft </li></ul><ul><li>in front of...
 
<ul><li>Convergence  </li></ul><ul><li>> Is the reflexive movement of the eyes medially when we view close objects causing...
<ul><li>Convergence test </li></ul><ul><li>- hold the target in the midline and at the eye level about 50 cm (20 inch) fro...
<ul><li>Lid lag </li></ul><ul><li>The inability of the upper eyelid to follow the eye’s downward movement </li></ul><ul><l...
<ul><li>Lid lag test </li></ul><ul><li>- hold the finger or a penlight as a target in the midline above the eye level 20 i...
Testing Vision <ul><li>Visual Acuity </li></ul><ul><li>- This test measures how clearly you can  </li></ul><ul><li>can see...
<ul><li>Snellen Chart </li></ul><ul><li>Done when gross visual acuity is fair </li></ul><ul><li>This is a test for far vis...
<ul><li>SNELLEN CHART  Pinhole test </li></ul>
<ul><li>Jaeger Test </li></ul><ul><li>> for  near vision  </li></ul><ul><li>> subject read at one </li></ul><ul><li>foot o...
<ul><li>Visual field test (perimetry) </li></ul><ul><li>- visual field is the area in front of you that you can see withou...
<ul><li>Confrontation test </li></ul>
<ul><li>Tangent screen exam </li></ul><ul><li>- sit a short distance from a screen and stare at a target at its center.  <...
<ul><li>Automated perimetry </li></ul><ul><li>- computer program is used that flashes small lights as you look into a spec...
<ul><li>Slit-lamp examination </li></ul><ul><li>- it uses a microscope that enlarges and illuminate the front of the eye w...
 
OPHTHALMOSCOPIC EXAM <ul><li>OPHTALMOSCOPY or FUNDOSCOPY </li></ul><ul><li>-  method of inspecting the eye grounds from a ...
 
<ul><li>Appertures of the ophthalmoscope </li></ul><ul><li>Small apperture – small pupils </li></ul><ul><li>Red free filte...
 
<ul><li>Optic disc </li></ul><ul><li>- note for its clarity, disc margin should be sharp and well defined </li></ul><ul><l...
<ul><li>-The physiologic cup if present is normally yellowish white. Its horizontal diameter is usually less than half the...
<ul><li>Identify the arterioles and veins </li></ul><ul><li>1) color  </li></ul><ul><li>A- light red  V- dark red </li></u...
<ul><li>The A:V ratio is generally 3:5 to 2:3 </li></ul>
<ul><li>Macula  </li></ul><ul><li>This is an avascular area, somewhat larger than the disc with no distinct margin </li></...
<ul><li>b. To bring it into your vision, ask the patient to look directly at the light </li></ul><ul><li>c. In the center ...
 
 
 
<ul><li>Glaucoma test ( tonometry)  </li></ul><ul><li>- measures intraocular pressure- pressure inside the eyes. </li></ul...
SIGNS
Eyeballs <ul><li>Exophthalmos  </li></ul><ul><li>- increase in the volume of the orbital content causing a protrusion of t...
 
<ul><li>Palpebral fissures </li></ul><ul><li>Widened palpebral fissures </li></ul><ul><li>- uncovers the upper border of t...
EYELIDS WIDENED PALPEBRAL FISSURE
<ul><li>(+) Lid lag test (Von Graefe sign) </li></ul><ul><li>- seen in hyperthyroidism </li></ul>
<ul><li>2. Narrowed palpebral fissure: </li></ul><ul><li>Enophthalmos </li></ul><ul><li>- the globe is recessed in the orb...
<ul><li>Failure of lid closure: </li></ul><ul><li>Paralysis of orbicularis muscle </li></ul><ul><li>- seen in Bell’s palsy...
BELL’S PALSY
<ul><li>2. Failure of lid opening: </li></ul><ul><li>Ptosis </li></ul><ul><li>- indicates a congenital or acquired weaknes...
<ul><li>Ptosis  </li></ul>
<ul><li>Lid swelling: palpebral edema </li></ul><ul><li>a) inflammatory edema  </li></ul><ul><li>- redness , warmth, pain ...
<ul><li>Swollen eyelids </li></ul>
<ul><li>Lid inversion ( Entropion ) </li></ul><ul><li>a) spastic </li></ul><ul><li>Occurs only in the lower lid </li></ul>...
<ul><li>b) Cicatricial  </li></ul><ul><li>- occurs in either lid </li></ul><ul><li>- due to contracture of scar tissue </l...
LID INVERSION (INTROPION)
<ul><li>Lid eversion ( Ectropion) </li></ul><ul><li>Lid turns outward </li></ul><ul><li>Both lids affected by spastic or c...
<ul><li>LID EVERSION (ECTROPION) </li></ul>
<ul><li>Xanthelasma </li></ul><ul><li>- yellow lid plaques </li></ul><ul><li>- painless, non pruritic occur in the upper a...
 
<ul><li>Chalazion or meibomian cyst </li></ul><ul><li>- a granulomatous inflammation of the meibomian gland in the upper a...
<ul><li>Chalazion  </li></ul>
<ul><li>Sty  </li></ul><ul><li>- lid pustule/external hordeolum </li></ul><ul><li>- acute suppurative inflammation of the ...
<ul><li>Sty  </li></ul>
<ul><li>Dacryoadenitis  </li></ul><ul><li>- obstruction of the lacrimal gland producing viral or bacterial infection </li>...
DACRYOADENITIS
Sclera
<ul><li>Icteric sclerae </li></ul>
Conjunctiva
<ul><li>Pale Palpebral Conjunctiva </li></ul>
<ul><li>Pterygium  </li></ul><ul><li>An abnormal growth of conjunctiva that extends over the cornea from the limbus. </li>...
 
<ul><li>Subconjunctival Hemorrhage </li></ul><ul><li>Bright red blood in a sharply defined are surrounded by a normal appe...
Subconjunctival Hemorrhage
<ul><li>Chemosis ( conjunctival edema) </li></ul><ul><li>- swelling of the eye surface membrane because of accumulation of...
 
<ul><li>Conjunctivitis  </li></ul><ul><li>- a condition in which the conjunctiva becomes inflamed or infected . </li></ul>...
<ul><li>Conjunctivitis  </li></ul>
Pupils
<ul><li>Mydriasis  </li></ul><ul><li>Pupillary dilatation </li></ul><ul><li>( > 5 mm diameter) </li></ul><ul><li>May be du...
<ul><li>Miosis  </li></ul><ul><li>- Pupillary constriction </li></ul><ul><li>( < 3 mm in diameter) </li></ul><ul><li>- may...
 
Cornea <ul><li>Cloudy cornea </li></ul><ul><li>- seen in congenital syphilis </li></ul><ul><li>- Hutchinson triangle : </l...
 
<ul><li>Arcus senilis </li></ul><ul><li>- gray band of opacity in the periphery of the cornea which is composed of lipid d...
 
<ul><li>Circus senilis </li></ul>
<ul><li>Corneal ulcer </li></ul><ul><li>- infective condition of the cornea involving disruption of its epithelial layer w...
 
Lens <ul><li>Cataract  </li></ul><ul><li>- opacity occuring in the lens due to denaturation of lens caused by aging </li><...
<ul><li>Cataract  </li></ul>
EOM muscles
<ul><li>Strabismus  </li></ul><ul><li>- a condition in which both eyes do not focus on an object simultaneously </li></ul>
<ul><li>2 kinds </li></ul><ul><li>a) paralytic </li></ul><ul><li>- caused by impairment of one or more  </li></ul><ul><li>...
<ul><li>b) Non paralytic strabismus </li></ul><ul><li>- has no primary muscle weakness </li></ul><ul><li>- patient can foc...
<ul><li>When one eye is covered, the other one will move to  focus on the object if the covered eye is the dominant one </...
<ul><li>Cranial nerve 3 palsy </li></ul>
Visual Field
 
 
<ul><li>A= total blindness </li></ul><ul><li>right eye </li></ul><ul><li>B= nasal hemianopsia </li></ul><ul><li>of the rig...
<ul><li>Hemianopsia  </li></ul><ul><li>-involves nerves projecting from both eyes </li></ul><ul><li>caused by lesion in th...
<ul><li>Homonymous hemianopsia </li></ul><ul><li>- defect on the same side of each field </li></ul><ul><li>e.g.  </li></ul...
<ul><li>(R) Homonymous Hemianopsia (L) </li></ul>
<ul><li>Bitemporal heteronymous hemianopsia </li></ul><ul><li>- caused by a lesion of the decussating fibers in  the optic...
Retina
<ul><li>Papilledema ( choked disc) </li></ul><ul><li>Due to inc.ICP </li></ul><ul><li>causes CSF to </li></ul><ul><li>comp...
<ul><li>Macula  </li></ul><ul><li>- common site for  </li></ul><ul><li>diabetes mellitus </li></ul><ul><li>- microaneurysm...
<ul><li>Retinal spots </li></ul>
Symptoms
<ul><li>Diplopia or double vision </li></ul><ul><li>- eyes not aligned </li></ul><ul><li>- perception of 2 visual images d...
<ul><li>Blurred vision </li></ul><ul><li>- loss of sharp focus of light on the retina </li></ul><ul><li>- may be due to op...
<ul><li>Visual loss </li></ul><ul><li>- injury or impairment to any portion of the visual pathway </li></ul><ul><li>Acute ...
<ul><li>Pain in the eye </li></ul><ul><li>Careful examination of the cornea, anterior chamber, iris, retina are mandatory ...
<ul><li>Causes: </li></ul><ul><li>endocrine – thyrotoxicosis </li></ul><ul><li>idiopathic – cluster headache </li></ul><ul...
Thank You
 
 
 
 
<ul><li>Corneal ulcer </li></ul>
<ul><li>Cataract </li></ul>
<ul><li>Eye Hemorrhage </li></ul>
Grades of Retinal Hypertension <ul><li>1 Narrowing in terminal branches of vessels </li></ul><ul><li>2 General narrowing o...
Grades of Retinal Sclerosis <ul><li>1 Thickening of vessels with slight depresion of veins at arteriolar- venular crossing...
 
 
<ul><li>(Lower) Homonymous Hemianopsia (Upper) </li></ul>
<ul><li>Diabetic Retinopathy </li></ul>
 
 
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Eyes (2)

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  1. 1. EYES
  2. 2. Anatomy and Landmarks of Eyes
  3. 3. <ul><li>The eye is the sensory organ that transmit visual stimuli to the brain for interpretation </li></ul><ul><li>It occupies the orbital cavity with only the anterior aspect exposed </li></ul>
  4. 4. 2 <ul><li>4 rectus & 2 </li></ul><ul><li>2 oblique muscles </li></ul><ul><li>are innervated </li></ul><ul><li>by CN 3 & CN 6 </li></ul><ul><li>The eye is </li></ul><ul><li>connected to the </li></ul><ul><li>brain by CN 2 </li></ul>
  5. 5. <ul><li>1.EXTERNAL EYE </li></ul><ul><li>Eyelid </li></ul><ul><li>Conjunctiva </li></ul><ul><li>Lacrimal gland </li></ul><ul><li>Eye muscles </li></ul><ul><li>Bony skull orbit </li></ul>
  6. 6. <ul><li>Eyebrows </li></ul><ul><li>Eyelids </li></ul><ul><li>Eyelashes </li></ul>
  7. 8. <ul><li>2.INTERNAL EYE </li></ul><ul><li>3 layers </li></ul><ul><li>1.Sclerotic coat </li></ul><ul><li>> this tough layer creates the “white” of the eye except in the front where it forms the transparent cornea </li></ul>
  8. 10. <ul><li>2. Choroid coat </li></ul><ul><li>> this middle layer is deeply pigmented with melanin </li></ul><ul><li>Reduces reflection of stray light within the eye </li></ul><ul><li>The choroid coat forms iris and ciliary body in the front of the eye and the choroid posteriorly </li></ul><ul><li>The size of its opening, the pupil, is variable and under the control of autonomic nervous system </li></ul>
  9. 12. <ul><li>3. Retina </li></ul><ul><li>> forms the inner layer of the eye </li></ul><ul><li>> it contains the light receptors, the rods and cones ( thus serve as the “film” of the eye) </li></ul>
  10. 14. Eye Examination <ul><li>One of the best ways to protect vision- it can detect eye problems at their earliest stage </li></ul>
  11. 15. Who gives eye exam? <ul><li>Ophthalmologists- or any medical doctors who provide full eye care such as : </li></ul><ul><li>- complete eye exam </li></ul><ul><li>- prescribing corrective lenses </li></ul><ul><li>- diagnosing and treating complex eye diseases </li></ul><ul><li>- performing surgery </li></ul>
  12. 16. <ul><li>Optometrists </li></ul><ul><li>- diagnosing common eye disorders and treating selected eye diseases with drugs </li></ul><ul><li>- evaluating vision </li></ul><ul><li>- prescribing corrective lenses </li></ul><ul><li>- can not perform surgery </li></ul>
  13. 17. <ul><li>Opticians </li></ul><ul><li>- fill prescriptions for eyeglasses </li></ul><ul><li>- some opticians also sell and fit contact lenses </li></ul>
  14. 18. <ul><li>A complete eye exam begins with your medical history: </li></ul><ul><li>- Are you having any eye problem now? </li></ul><ul><li>- have you had any eye problems in the past? </li></ul><ul><li>Do you wear glasses or contacts now? </li></ul><ul><li>if so, are you satisfied with them? </li></ul>
  15. 19. <ul><li>What health problems have you had in recent years? </li></ul><ul><li>Are you taking any medications? </li></ul><ul><li>Do you have any allergies to medications, food or other substances? </li></ul>
  16. 20. <ul><li>Has anyone in the family had eye problems such as cataracts or glaucoma </li></ul><ul><li>Has anyone in your family had diabetes , high blood pressure, heart disease or any health problems that can affect the whole body? </li></ul>
  17. 21. Eye Examination <ul><li>PROCEDURE… </li></ul>
  18. 22. <ul><li>Eyeball </li></ul><ul><li>>Position and alignment of the eyes </li></ul><ul><li>a. Stand in front of the patient and survey </li></ul><ul><li>the eyes for position and alignment with </li></ul><ul><li>each other . </li></ul><ul><li>b. If one or both eyes seem to protrude , </li></ul><ul><li>assess them from the profile and from </li></ul><ul><li>above </li></ul>
  19. 23. <ul><li>The eyeball –observe the position within the confines of the bony orbit ( socket) </li></ul>
  20. 24. <ul><li>External examination </li></ul><ul><li>>Examination of the eyes is carried out in a systematic manner beginning with the appendages that is, the eyebrows and surrounding tissues and moving inward </li></ul>
  21. 25. <ul><li>Surrounding structures </li></ul><ul><li>Eyebrows </li></ul><ul><li>> note for the amount , distribution </li></ul><ul><li>2. Inspect the orbital area </li></ul><ul><li>> edema </li></ul><ul><li>> sagging tissues or puffiness </li></ul><ul><li>> lesion </li></ul>
  22. 26. <ul><li>Eyelids </li></ul><ul><li>Assess the palpebral fissure with the patient looking straight ahead and observe the relationship of the lids to the limbus </li></ul><ul><li>Note for any widening or narrowing of the palpebral fissure </li></ul>
  23. 27. <ul><li>Note for the ability to open and close the eyes completely </li></ul><ul><li>Observe for ptosis </li></ul><ul><li>Note for the eyelashes </li></ul><ul><li>-Projecting from the border of each lid, should turn outward </li></ul>
  24. 28. <ul><li>Tremors </li></ul><ul><li>Redness </li></ul><ul><li>Swelling/edema of the lids </li></ul><ul><li>Note whether there is lid eversion or lid inversion </li></ul>
  25. 29. <ul><li>Procedure for everting </li></ul><ul><li>the eyelid and removing </li></ul><ul><li>a foreign body </li></ul>
  26. 31. <ul><li>Eyeball tension </li></ul><ul><li>> apply gentle pressure from the fingertips </li></ul><ul><li>( L&R forefingers) with the middle finger in </li></ul><ul><li>anchor on the eyeball </li></ul><ul><li>> Tonometer for accurate measurement of eyeball tension </li></ul>
  27. 32. <ul><li>Lacrimal apparatus </li></ul><ul><li>Inspect the regions of lacrimal gland and </li></ul><ul><li>Lacrimal sac for swelling </li></ul><ul><li>Look for excessive tearing or dryness of the eyes </li></ul><ul><li>Do nasolacrimal duct obstruction test </li></ul>
  28. 33. <ul><li>Press on the lacrimal </li></ul><ul><li>sac; if fluid can be </li></ul><ul><li>expressed thru the </li></ul><ul><li>punctum, the tear </li></ul><ul><li>duct is obstructed </li></ul>
  29. 34. <ul><li>INTERNAL EXAMINATION </li></ul>
  30. 35. <ul><li>Conjunctivae & Sclerae </li></ul><ul><li>Ask the patient to look </li></ul><ul><li>up as you depress both </li></ul><ul><li>lower lids with your </li></ul><ul><li>thumbs </li></ul><ul><li>Ask the patient to look </li></ul><ul><li>down as you pull the </li></ul><ul><li>upper lids upward </li></ul>
  31. 36. <ul><li>Cornea </li></ul><ul><li>With oblique lighting </li></ul><ul><li>from a penlight </li></ul><ul><li>inspect for clarity or </li></ul><ul><li>transparency, scars </li></ul><ul><li>abrasions and ulcers </li></ul><ul><li>of the cornea </li></ul>
  32. 37. <ul><li>Iris, Pupils & Lens </li></ul><ul><li>> With the light shining </li></ul><ul><li>directly from the temporal </li></ul><ul><li>side, note the ff: </li></ul><ul><li>a. iris –color </li></ul><ul><li>b. pupils- size, shape, </li></ul><ul><li>equality </li></ul><ul><li>c. lens – transparency, </li></ul><ul><li>opacity </li></ul>
  33. 38. <ul><li>Pupillary reaction </li></ul><ul><li>- Pupillary size changes in response to light and to the effort of focusing on a near object </li></ul>
  34. 39. <ul><li>a) The light reaction </li></ul><ul><li>Direct light reflex: </li></ul><ul><li>> From the lateral side of each eye, flash the penlight swiftly into the eye being examined. </li></ul><ul><li>>Observe for immediate constriction of the pupil </li></ul>
  35. 40. <ul><li>Indirect light reflex: </li></ul><ul><li>Ask the patient to rest the radial side of his L or R hand in between the eyes. </li></ul><ul><li>From the lateral side flash the penlight into one eye </li></ul><ul><li>Observe for the pupillary constriction of the opposite eye </li></ul>
  36. 41. <ul><li>b) The near reaction </li></ul><ul><li>- When a person shifts gaze fr. a far object to a near one, the pupils constrict. This response is mediated by the oculomotor nerve. </li></ul><ul><li>- This is pupillary response to acommodation </li></ul><ul><li>- This is done if there is defect in the pupillary response to light </li></ul>
  37. 43. <ul><li>Eye muscle test </li></ul><ul><li>- This test examines the muscles that </li></ul><ul><li>that control eye movement </li></ul><ul><li>- The movement of each eye is controlled </li></ul><ul><li>by the coordinated action of 6 muscles, </li></ul><ul><li>4 rectus and 2 oblique muscles and </li></ul><ul><li>integrated function of CN 3,4,6 </li></ul>
  38. 44. <ul><li>EXTRAOCULAR </li></ul><ul><li>MUSCLE TEST </li></ul><ul><li>>Position yourself 2 ft </li></ul><ul><li>in front of the patient </li></ul><ul><li>>Ask the patient to follow </li></ul><ul><li>your finger or pencil </li></ul><ul><li>in 6 cardinal direction of </li></ul><ul><li>gaze </li></ul><ul><li>Observe for normal </li></ul><ul><li>conjugate movements </li></ul><ul><li>of the eyes in all 6 fields </li></ul><ul><li>Observe for nystagmus </li></ul>
  39. 46. <ul><li>Convergence </li></ul><ul><li>> Is the reflexive movement of the eyes medially when we view close objects causing a cross - eye </li></ul>
  40. 47. <ul><li>Convergence test </li></ul><ul><li>- hold the target in the midline and at the eye level about 50 cm (20 inch) from the face gradually moving the target toward the bridge of the nose </li></ul><ul><li>- convergence is normally maintained until 2-3 inches ( 50 mm) from the bridge of the nose </li></ul>
  41. 48. <ul><li>Lid lag </li></ul><ul><li>The inability of the upper eyelid to follow the eye’s downward movement </li></ul><ul><li>A cardinal sign of thyrotoxicosis (Von Graefe’s sign) </li></ul>
  42. 49. <ul><li>Lid lag test </li></ul><ul><li>- hold the finger or a penlight as a target in the midline above the eye level 20 inches </li></ul><ul><li>(50 cm ) away. Move the target rapidly downward in the midline </li></ul><ul><li>Watch for the appearance of white sclera </li></ul><ul><li>between the iris and the upper lid margin </li></ul>
  43. 50. Testing Vision <ul><li>Visual Acuity </li></ul><ul><li>- This test measures how clearly you can </li></ul><ul><li>can see from distance </li></ul><ul><li>- Gross test for visual acuity can be made </li></ul><ul><li>without special equipment. Test a single </li></ul><ul><li>eye at a time. </li></ul>
  44. 51. <ul><li>Snellen Chart </li></ul><ul><li>Done when gross visual acuity is fair </li></ul><ul><li>This is a test for far vision </li></ul><ul><li>Express the reading as: 20/20 </li></ul><ul><li>20= distance at which the test is </li></ul><ul><li>conducted </li></ul><ul><li>20= distance at which line of letters should </li></ul><ul><li>be read by a normal eye </li></ul>
  45. 52. <ul><li>SNELLEN CHART Pinhole test </li></ul>
  46. 53. <ul><li>Jaeger Test </li></ul><ul><li>> for near vision </li></ul><ul><li>> subject read at one </li></ul><ul><li>foot or 14” distance </li></ul><ul><li>Acuity of near vision </li></ul><ul><li>is expressed </li></ul><ul><li>as J1,J2,J3 </li></ul><ul><li>A reading of J1 is </li></ul><ul><li>considered normal </li></ul>
  47. 54. <ul><li>Visual field test (perimetry) </li></ul><ul><li>- visual field is the area in front of you that you can see without moving your eyes </li></ul><ul><li>- This test determines whether you have difficulty seeing any areas of your peripheral vision- the areas on the side of your visual field </li></ul>
  48. 55. <ul><li>Confrontation test </li></ul>
  49. 56. <ul><li>Tangent screen exam </li></ul><ul><li>- sit a short distance from a screen and stare at a target at its center. </li></ul><ul><li>- tell examiner if you see an object move into your peripheral vision </li></ul>
  50. 57. <ul><li>Automated perimetry </li></ul><ul><li>- computer program is used that flashes small lights as you look into a special instrument. </li></ul><ul><li>- press the button when you see the lights </li></ul>
  51. 58. <ul><li>Slit-lamp examination </li></ul><ul><li>- it uses a microscope that enlarges and illuminate the front of the eye with an intense line of light </li></ul><ul><li>- this is use to examine the cornea, iris , lens and anterior chamber of the eye </li></ul>
  52. 60. OPHTHALMOSCOPIC EXAM <ul><li>OPHTALMOSCOPY or FUNDOSCOPY </li></ul><ul><li>- method of inspecting the eye grounds from a light source using ophthalmoscope </li></ul><ul><li>- best done in a semi-darkened or a completely darkened room </li></ul><ul><li>- most useful in conditions like diabetes mellitus, HPN and increased intraocular pressures </li></ul>
  53. 62. <ul><li>Appertures of the ophthalmoscope </li></ul><ul><li>Small apperture – small pupils </li></ul><ul><li>Red free filter- produces a green beam for examination of the optic disc ( pallor, hemorrhages) </li></ul><ul><li>Slit – examination of the anterior eye determination of elevation of lesions </li></ul><ul><li>Grid –examination of the size of fundal lesion </li></ul>
  54. 64. <ul><li>Optic disc </li></ul><ul><li>- note for its clarity, disc margin should be sharp and well defined </li></ul><ul><li>- round or oval vertically </li></ul><ul><li>- color is yellowish- orange to creamy pink oval </li></ul>
  55. 65. <ul><li>-The physiologic cup if present is normally yellowish white. Its horizontal diameter is usually less than half the horizontal diameter of the disc </li></ul><ul><li>- Measures about 1.5 mm in diameter and 3 diopters of elevation = 1mm </li></ul>
  56. 66. <ul><li>Identify the arterioles and veins </li></ul><ul><li>1) color </li></ul><ul><li>A- light red V- dark red </li></ul><ul><li>2) Size </li></ul><ul><li>A- smaller(2/3 to 4/5 of vein) V- larger </li></ul><ul><li>3) Light reflex </li></ul><ul><li>A- bright V- absent </li></ul>
  57. 67. <ul><li>The A:V ratio is generally 3:5 to 2:3 </li></ul>
  58. 68. <ul><li>Macula </li></ul><ul><li>This is an avascular area, somewhat larger than the disc with no distinct margin </li></ul><ul><li>To locate the macula, focus on the disc, then move the light temporally about 2 discs diameter </li></ul>
  59. 69. <ul><li>b. To bring it into your vision, ask the patient to look directly at the light </li></ul><ul><li>c. In the center of the macula the fovea appears as a small darker red area in the retina </li></ul>
  60. 73. <ul><li>Glaucoma test ( tonometry) </li></ul><ul><li>- measures intraocular pressure- pressure inside the eyes. </li></ul><ul><li>- it can detect glaucoma , a disease that causes pressure to build inside the eyes and can cause blindness </li></ul>
  61. 74. SIGNS
  62. 75. Eyeballs <ul><li>Exophthalmos </li></ul><ul><li>- increase in the volume of the orbital content causing a protrusion of the globes forward </li></ul><ul><li>- Due to Grave’s disease if bilateral and retroorbital tumor if unilateral </li></ul>
  63. 77. <ul><li>Palpebral fissures </li></ul><ul><li>Widened palpebral fissures </li></ul><ul><li>- uncovers the upper border of the limbus </li></ul><ul><li>to expose white sclera superiorly </li></ul><ul><li>- fissures maybe widened by retractions </li></ul><ul><li>of the lids or by protrusion of the </li></ul><ul><li>eyeballs </li></ul>
  64. 78. EYELIDS WIDENED PALPEBRAL FISSURE
  65. 79. <ul><li>(+) Lid lag test (Von Graefe sign) </li></ul><ul><li>- seen in hyperthyroidism </li></ul>
  66. 80. <ul><li>2. Narrowed palpebral fissure: </li></ul><ul><li>Enophthalmos </li></ul><ul><li>- the globe is recessed in the orbit </li></ul><ul><li>- bilateral cause: decrease orbital fat </li></ul><ul><li>( dehydration,inanition) </li></ul><ul><li>congenital microphthalmos </li></ul><ul><li>- unilateral cause: trauma or inflammation </li></ul>
  67. 81. <ul><li>Failure of lid closure: </li></ul><ul><li>Paralysis of orbicularis muscle </li></ul><ul><li>- seen in Bell’s palsy due to disorder of the facial nerve (CN 7) causing partial </li></ul><ul><li>or complete paralysis of the orbicularis </li></ul><ul><li>muscle </li></ul>
  68. 82. BELL’S PALSY
  69. 83. <ul><li>2. Failure of lid opening: </li></ul><ul><li>Ptosis </li></ul><ul><li>- indicates a congenital or acquired weakness of the levator muscle or paresis </li></ul><ul><li>of the 3 rd CN </li></ul><ul><li>- Superior eyelids covers more than the iris </li></ul>
  70. 84. <ul><li>Ptosis </li></ul>
  71. 85. <ul><li>Lid swelling: palpebral edema </li></ul><ul><li>a) inflammatory edema </li></ul><ul><li>- redness , warmth, pain </li></ul><ul><li>b) non inflammatory edema </li></ul><ul><li>- acute nephritis </li></ul><ul><li>- myxedema </li></ul><ul><li>- exophthalmos of grave’s dse. </li></ul><ul><li>- contact dermatitis </li></ul>
  72. 86. <ul><li>Swollen eyelids </li></ul>
  73. 87. <ul><li>Lid inversion ( Entropion ) </li></ul><ul><li>a) spastic </li></ul><ul><li>Occurs only in the lower lid </li></ul><ul><li>Due to increase tone of the orbicularis oculi usually from inflammation of an eye </li></ul>
  74. 88. <ul><li>b) Cicatricial </li></ul><ul><li>- occurs in either lid </li></ul><ul><li>- due to contracture of scar tissue </li></ul><ul><li>- eg. Trachoma </li></ul><ul><li>> Entropion from any cause maybe acc. by blepharospasm from irritation of the inverted eyelashes </li></ul>
  75. 89. LID INVERSION (INTROPION)
  76. 90. <ul><li>Lid eversion ( Ectropion) </li></ul><ul><li>Lid turns outward </li></ul><ul><li>Both lids affected by spastic or cicatricial ectropion </li></ul><ul><li>Paralytic ectropion involves only the lower </li></ul><ul><li>lid </li></ul><ul><li>- Senile atrophy of tissues sometimes result in ectropion </li></ul>
  77. 91. <ul><li>LID EVERSION (ECTROPION) </li></ul>
  78. 92. <ul><li>Xanthelasma </li></ul><ul><li>- yellow lid plaques </li></ul><ul><li>- painless, non pruritic occur in the upper and lower lids near the inner canthus </li></ul><ul><li>- ass. with hypercholesterolemia </li></ul>
  79. 94. <ul><li>Chalazion or meibomian cyst </li></ul><ul><li>- a granulomatous inflammation of the meibomian gland in the upper and lower eyelid </li></ul><ul><li>- lesions of the internal sebaceous glands is characterized by localized swelling and usually develop slowly over several weeks </li></ul>
  80. 95. <ul><li>Chalazion </li></ul>
  81. 96. <ul><li>Sty </li></ul><ul><li>- lid pustule/external hordeolum </li></ul><ul><li>- acute suppurative inflammation of the sebaceous gland near the follicle of an eyelash </li></ul>
  82. 97. <ul><li>Sty </li></ul>
  83. 98. <ul><li>Dacryoadenitis </li></ul><ul><li>- obstruction of the lacrimal gland producing viral or bacterial infection </li></ul><ul><li>- swelling within lateral brim of the orbit </li></ul>
  84. 99. DACRYOADENITIS
  85. 100. Sclera
  86. 101. <ul><li>Icteric sclerae </li></ul>
  87. 102. Conjunctiva
  88. 103. <ul><li>Pale Palpebral Conjunctiva </li></ul>
  89. 104. <ul><li>Pterygium </li></ul><ul><li>An abnormal growth of conjunctiva that extends over the cornea from the limbus. </li></ul><ul><li>More common to people heavily exposed to ultraviolet light </li></ul><ul><li>Chronic irritation due to wind/dust exposure </li></ul><ul><li>May interfere vision if it advances over the pupil </li></ul>
  90. 106. <ul><li>Subconjunctival Hemorrhage </li></ul><ul><li>Bright red blood in a sharply defined are surrounded by a normal appearing conjunctiva </li></ul><ul><li>Bleeding maybe due to coughing, sneezing, weight lifting </li></ul>
  91. 107. Subconjunctival Hemorrhage
  92. 108. <ul><li>Chemosis ( conjunctival edema) </li></ul><ul><li>- swelling of the eye surface membrane because of accumulation of fluid </li></ul><ul><li>- ass. with grave’s disease </li></ul>
  93. 110. <ul><li>Conjunctivitis </li></ul><ul><li>- a condition in which the conjunctiva becomes inflamed or infected . </li></ul><ul><li>- maybe due to viral/bacterial infections </li></ul><ul><li>- foreign body reaction </li></ul><ul><li>- allergy </li></ul>
  94. 111. <ul><li>Conjunctivitis </li></ul>
  95. 112. Pupils
  96. 113. <ul><li>Mydriasis </li></ul><ul><li>Pupillary dilatation </li></ul><ul><li>( > 5 mm diameter) </li></ul><ul><li>May be due to uremia </li></ul><ul><li>diabetes mellitus,coma </li></ul><ul><li>atrophine, alcohol, </li></ul><ul><li>head trauma, CN 3 damage </li></ul><ul><li>epilepsy </li></ul>
  97. 114. <ul><li>Miosis </li></ul><ul><li>- Pupillary constriction </li></ul><ul><li>( < 3 mm in diameter) </li></ul><ul><li>- maybe due to morphine, </li></ul><ul><li>pilocarpine, glaucoma </li></ul>
  98. 116. Cornea <ul><li>Cloudy cornea </li></ul><ul><li>- seen in congenital syphilis </li></ul><ul><li>- Hutchinson triangle : </li></ul><ul><li>interstitial keratitis </li></ul><ul><li>deafness </li></ul><ul><li>notched teeth </li></ul>
  99. 118. <ul><li>Arcus senilis </li></ul><ul><li>- gray band of opacity in the periphery of the cornea which is composed of lipid deposits </li></ul><ul><li>If seen before 40 yrs old, it may indicate type 2 hyperlipidemia </li></ul><ul><li>It may in time form complete circle (circus senilis) </li></ul>
  100. 120. <ul><li>Circus senilis </li></ul>
  101. 121. <ul><li>Corneal ulcer </li></ul><ul><li>- infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma </li></ul><ul><li>- this involves damage of the cornea as a result of injury, foreign body or excessive or inappropriate wearing of contact lens </li></ul>
  102. 123. Lens <ul><li>Cataract </li></ul><ul><li>- opacity occuring in the lens due to denaturation of lens caused by aging </li></ul><ul><li>- It may cause vision to become impaired and hazy eventually cause blindness in the affected eye. </li></ul>
  103. 124. <ul><li>Cataract </li></ul>
  104. 125. EOM muscles
  105. 126. <ul><li>Strabismus </li></ul><ul><li>- a condition in which both eyes do not focus on an object simultaneously </li></ul>
  106. 127. <ul><li>2 kinds </li></ul><ul><li>a) paralytic </li></ul><ul><li>- caused by impairment of one or more </li></ul><ul><li>EOM or their nerve supply </li></ul><ul><li>- limited eye movement , the eye will fail </li></ul><ul><li>to move in the direction controlled by </li></ul><ul><li>the damaged muscle </li></ul><ul><li>e.g ® lateral rectus paralysis, the ® eye can not move temporally or laterally </li></ul>
  107. 128. <ul><li>b) Non paralytic strabismus </li></ul><ul><li>- has no primary muscle weakness </li></ul><ul><li>- patient can focus with either eye but not with both simultaneously </li></ul><ul><li>- detected by having a patient observe a near object </li></ul><ul><li>- </li></ul>
  108. 129. <ul><li>When one eye is covered, the other one will move to focus on the object if the covered eye is the dominant one </li></ul><ul><li>This is cover-uncover test </li></ul>
  109. 130. <ul><li>Cranial nerve 3 palsy </li></ul>
  110. 131. Visual Field
  111. 134. <ul><li>A= total blindness </li></ul><ul><li>right eye </li></ul><ul><li>B= nasal hemianopsia </li></ul><ul><li>of the right eye </li></ul><ul><li>C= left homonymous </li></ul><ul><li>hemianopsia </li></ul><ul><li>D = bitemporal </li></ul><ul><li>heteronymous hemianopsia </li></ul>
  112. 135. <ul><li>Hemianopsia </li></ul><ul><li>-involves nerves projecting from both eyes </li></ul><ul><li>caused by lesion in the optic chiasm, optic </li></ul><ul><li>tract and brain </li></ul>
  113. 136. <ul><li>Homonymous hemianopsia </li></ul><ul><li>- defect on the same side of each field </li></ul><ul><li>e.g. </li></ul><ul><li>(L) homonymous hemianopsia can be </li></ul><ul><li>caused by a lesion in the ® optic tract </li></ul><ul><li>or the ® side of the brain </li></ul>
  114. 137. <ul><li>(R) Homonymous Hemianopsia (L) </li></ul>
  115. 138. <ul><li>Bitemporal heteronymous hemianopsia </li></ul><ul><li>- caused by a lesion of the decussating fibers in the optic chiasm injuring both </li></ul><ul><li>nasal retinae </li></ul><ul><li>- commonly due to pituitary gland tumor </li></ul>
  116. 139. Retina
  117. 140. <ul><li>Papilledema ( choked disc) </li></ul><ul><li>Due to inc.ICP </li></ul><ul><li>causes CSF to </li></ul><ul><li>compress optic </li></ul><ul><li>nerve </li></ul><ul><li>-central vision not </li></ul><ul><li>impaired, there is </li></ul><ul><li>peripheral loss </li></ul>
  118. 141. <ul><li>Macula </li></ul><ul><li>- common site for </li></ul><ul><li>diabetes mellitus </li></ul><ul><li>- microaneurysm </li></ul><ul><li>occur around the </li></ul><ul><li>macula </li></ul>
  119. 142. <ul><li>Retinal spots </li></ul>
  120. 143. Symptoms
  121. 144. <ul><li>Diplopia or double vision </li></ul><ul><li>- eyes not aligned </li></ul><ul><li>- perception of 2 visual images due: </li></ul><ul><li>a) abnormalities of refraction </li></ul><ul><li>b) impairment of the 3 rd ,4 th , 6 th CN or </li></ul><ul><li>c) weakness of one of the 6 EOMs that move the eye or of the myoneural junction </li></ul><ul><li>- ass. With myasthenia gravis, grave’s ophthalmopathy </li></ul>
  122. 145. <ul><li>Blurred vision </li></ul><ul><li>- loss of sharp focus of light on the retina </li></ul><ul><li>- may be due to opacities in the cornea, lens or vitreous </li></ul><ul><li>- Pinhole test is used to determine if blurred vision is optical in origin </li></ul>
  123. 146. <ul><li>Visual loss </li></ul><ul><li>- injury or impairment to any portion of the visual pathway </li></ul><ul><li>Acute loss of vision is medical emergency </li></ul><ul><li>Chronic progressive loss of vision is common with disease of the cornea, lens or retina </li></ul>
  124. 147. <ul><li>Pain in the eye </li></ul><ul><li>Careful examination of the cornea, anterior chamber, iris, retina are mandatory in patients complaining of eye pain </li></ul><ul><li>Always assess visual acuity of each eye </li></ul>
  125. 148. <ul><li>Causes: </li></ul><ul><li>endocrine – thyrotoxicosis </li></ul><ul><li>idiopathic – cluster headache </li></ul><ul><li>inflammatory- sty, optic neuritis, chalazion </li></ul><ul><li>infection- herpes zoster </li></ul><ul><li>sinusitis – ethmoid, frontal, sphenoid </li></ul><ul><li>trauma/mechanical - foreign body, corneal abrasion, glaucoma </li></ul>
  126. 149. Thank You
  127. 154. <ul><li>Corneal ulcer </li></ul>
  128. 155. <ul><li>Cataract </li></ul>
  129. 156. <ul><li>Eye Hemorrhage </li></ul>
  130. 157. Grades of Retinal Hypertension <ul><li>1 Narrowing in terminal branches of vessels </li></ul><ul><li>2 General narrowing of vessels with severe local constriction </li></ul><ul><li>3 To the preceding signs are added striate hemorrhages and soft exudates </li></ul><ul><li>4 Papilledema is added to the preceding signs </li></ul>
  131. 158. Grades of Retinal Sclerosis <ul><li>1 Thickening of vessels with slight depresion of veins at arteriolar- venular crossings </li></ul><ul><li>2 Define AV crossing changes and moderate local sclerosis </li></ul><ul><li>3 Venule beneath the arteriole is invisible; </li></ul><ul><li>severe local sclerosis and segmentation </li></ul><ul><li>4 To the preceding signs are added venous obstruction and arteriolar obliterations </li></ul>
  132. 161. <ul><li>(Lower) Homonymous Hemianopsia (Upper) </li></ul>
  133. 162. <ul><li>Diabetic Retinopathy </li></ul>
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