eye care basics and optical options rick smith & sam powdrill
TRANSCRIPT
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Eye care basicsand optical options
Rick Smith &
Sam Powdrill
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Eye Anatomy
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Visual Image
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Components of Vision
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The External Eye
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The Skull
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Bones of the Orbit
• Frontal• Zygoma• Ethmoid• Maxilla• Sphenoid
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The Lacrimal System
The tear film
• Lipid layer• Aqueous layer• Mucus layer
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The Eyelids
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Vessels and
Musclesof the Eyelids
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Extrinsic Eye Muscles
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Extrinsic muscles with innervation
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The Globe
• Anterior chamber aqueous
• Iris
• Lens
• Posterior chamber vitreous
• Optic nerve
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Layers of the eye
• Protective
• Vascular
• Visual
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Protective Layer
• Sclera
• Cornea
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Vascular layer
• Iris
• Ciliary body
• Choroid
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Angle of the Eye
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Visual Layer
• The retina
• Optic nerve
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Central Retina
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Optic Nerve (II) Visual pathway
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Optic Nerve (II) – Visual pathway
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Refraction
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Prism
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Converging
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diverging
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Lens Power
• Measured in diopters• One diopter lens focuses at 1 meter Lens power = 100 cm focal length focal length = 100 cm Lens power
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Refractive errors
• Nearsighted – myopia
• Farsighted – hyperopia
• Astigmatism
• Presbyopia
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Refraction
• Convex lens
• Concave lens
• Accommodation
• Refractive error
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Correction of Refractive Errors
• Pinhole
• Myopia
• Hypermetropia
• Astigmatism
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Exam of the Eye
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Pathways of Blindness
• Corneal• Anterior chamber• Lens• Vitreous• Retina • Optic nerve• Occipital• Functional
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Instruments needed to examine the eye
1. Visual acuity chart2. Flashlight3. Ophthalmoscope4. Tonometer5. Simple loupe
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Measure Visual acuity
The vital sign of the eye• Distance vision
• Near vision
• Peripheral vision
• Central vision
• Color vision
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Snellen charts
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Pinhole
eliminates the
refractive error
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Visual acuity
• Cover the eye with the palm of the hand
• Test the eyes separately then together
• Point to the letters clearly
• Use a random sequence
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Recording Visual acuity
20/20Upper number = distance in feet from the
patient to the chart
Lower number = distance in feet at which a person with excellent visionwould see the same letter
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Examples
• 20/40• 20 /400• 20/15• 10/50• CF 10ft• HM• LP• NLP
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Central vision
• Test for loss of central vision - macula
• Amsler grid
• Abnormal in macular degeneration
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Amsler grid
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Color vision
• Check for red / green color blindness• Ishihara chart
• Color comparison method with a red object
• Color blindness is an X linked genetic disorder that most often affects males.
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Ishihara chart
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Tonometry
• Schiotz• Applanation • Air puff• tonopen
Normal is
10 to 20 mmHg
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Extraocular Muscles
• Six Cardinal eye movements• Corneal light reflex position• Nystagmus• Cover - uncover test• Convergence
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Peripheral vision
Testing the visual field• Confrontation method – compares the
examiner’s visual field with the patient’s
• Automated – done in optometrist’s or ophthalmologist’s office
• Abnormal in glaucoma
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Visual fields by confrontation
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Eyelids
Inspect • Symmetry – skin creases• Opening and closing completely• Eyelash position• Ptosis• Tremor or fasciculations • Swelling or infection• Flakiness
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cataract
• Ophthlmoscope set on +4
• Shadows against Red reflex
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Direct light vs Coaxial light on the lens
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Eyelids
Palpate • Eyelids for nodules• Intraocular pressure
Evert upper and lower lids and inspect • Color • Discharge• Lacrimal system
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Conjunctiva and Sclera
Inspect • Redness• Vessels• Growths or lesions, foreign bodies• Proptosis• enophthalmos
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Cornea
Inspect• Clarity – scars obscure part of the iris.• Light reflex – reflex is scattered in edema• Corneal sensitivity• Arcus• Depth of anterior chamber – iris shadow• Abrasions or foreign bodies – use fluorescein stain
with blue light to examine the cornea for defects
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Iris and pupilInspect Iris
• Color• Angle• lesions
Inspect Pupil • Size• Shape • Reaction to light• Reaction to near • Consensual response• PERRLA
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Ophthalmoscope examLens clarity – lens opacity is a cataractRed reflex – ophthlmoscope set on + 4Vitreous clarity – floaters, sclerotic bandsRetinal color and backgroundRetinal vessels – hemhorrage, cotton wool spots,
AV nicking, neovascularization, Optic disc – cup/disc ratioOptic nerve head – papilledema, cupping or
atrophyMacula for drusen or changes
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Retina
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Retina
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