Eye ExamEye Exam

You will be presented with clinical You will be presented with clinical images or illustrations. Answers images or illustrations. Answers will be provided in the following will be provided in the following

slide.slide.

Describe the conjunctiva.Describe the conjunctiva.

The conjunctiva is The conjunctiva is translucent and clear. translucent and clear. The pink color of The pink color of palpebral conjunctiva is palpebral conjunctiva is due to underlying due to underlying vascular bed. White vascular bed. White Sclera is seen through Sclera is seen through bulbar conjunctiva.bulbar conjunctiva.

Note conjunctival reflection.Note conjunctival reflection.

• Note the anterior and Note the anterior and posterior chamberposterior chamber

• Note ciliary body and Note ciliary body and lens connectionlens connection

Diagnosis?Diagnosis?

• Sub conjunctival Sub conjunctival hemorrhagehemorrhage

• Sharply demarcatedSharply demarcated

Afferent pathway for visual acuity?Afferent pathway for visual acuity?

Retina-optic nerve-Optic Retina-optic nerve-Optic chiasma-Optic chiasma-Optic radiation-Occiptal lobe radiation-Occiptal lobe visual cortexvisual cortex

Note fovea as center for visual Note fovea as center for visual field. Locate site for blind spot in field. Locate site for blind spot in

retina.retina.

Center of optic disc has Center of optic disc has no retinal receptors and no retinal receptors and leads to blind spot.leads to blind spot.

Pathway for light reflex?Pathway for light reflex?

• Afferent: Retina-optic Afferent: Retina-optic nerve-mid brainnerve-mid brain

• Efferent: Both oculo Efferent: Both oculo motor nervesmotor nerves

Note direct and consensual light Note direct and consensual light reflex.reflex.

Sorry the pupillary Sorry the pupillary contraction on right is contraction on right is not visible.not visible.

Note the pathway for pupillary Note the pathway for pupillary contraction.contraction.

• Direct reflex on rightDirect reflex on right• Consensual reflex on Consensual reflex on

leftleft

Note the pathway for light reflex.Note the pathway for light reflex.

Is this light reflex normal?Is this light reflex normal?

Yes. Note direct and Yes. Note direct and consensual light reflexconsensual light reflex

Is this light reflex normal?Is this light reflex normal?

Afferent path on left eye is Afferent path on left eye is abnormal.abnormal.

Which muscles are in action?Which muscles are in action?

The right lateral rectus The right lateral rectus and left medial rectus. and left medial rectus. Gaze is conjugate.Gaze is conjugate.

Which nerves are in action?Which nerves are in action?

The right abducens The right abducens (right lateral rectus) (right lateral rectus) and left oculomotor and left oculomotor nerve (left medial nerve (left medial rectus).rectus).Gaze is conjugate.Gaze is conjugate.

Which nerves are in action?Which nerves are in action?

The oculomotor nerves. The oculomotor nerves. Superior rectus in action. Superior rectus in action. Gaze is conjugate.Gaze is conjugate.

Which cranial nerves are in action?Which cranial nerves are in action?

Both oculomotor nervesBoth oculomotor nerves

Inferior recti in actionInferior recti in action

Identify the ocular muscles.Identify the ocular muscles.

• Levator palpabrae supreiorisLevator palpabrae supreioris• Superior rectusSuperior rectus• Inferior recrtusInferior recrtus

Appreciate position of the ocular Appreciate position of the ocular muscles.muscles.

• Superior oblique: Superior oblique: Trochlear nerveTrochlear nerve

• Lateral rectus: Abducens Lateral rectus: Abducens nervenerve

• Oculomotor supplies the Oculomotor supplies the restrest

What ocular muscles are influenced What ocular muscles are influenced by sympathetic system?by sympathetic system?

• Levator palpabrae superiorisLevator palpabrae superioris• Iris muscleIris muscle• Muscle in floor of orbitMuscle in floor of orbit

Is the technique appropriate?Is the technique appropriate?

No. You should look at No. You should look at patient’s left fundus patient’s left fundus with your left eye.with your left eye.

Identify the artery and vein.Identify the artery and vein.

• The artery is narrow The artery is narrow with light reflex.with light reflex.

• The vein is read and The vein is read and thicker than the thicker than the artery.artery.

Diagnosis?Diagnosis?

Leukemic infiltrationLeukemic infiltration

Diagnosis?Diagnosis?

MacroglobulinemiaMacroglobulinemia

Source for tears?Source for tears?

• Lacrimal glandLacrimal gland• Meibonian glandsMeibonian glands• Conjunctival glandsConjunctival glands• Drained by puncta Drained by puncta

into lacrimal sac and into lacrimal sac and on to nasolacrimal on to nasolacrimal duct into nose.duct into nose.

Note pathway for the aqueous Note pathway for the aqueous humor.humor.

Your right eye compared to the Your right eye compared to the subject’s left eye.subject’s left eye.

Note normal mono-ocular field Note normal mono-ocular field of vision.of vision.

• 80-90 degrees temporal80-90 degrees temporal• 45 degrees medial, 45 degrees medial,

limited by noselimited by nose• Eye brows limit upward Eye brows limit upward

fieldfield

Anticipate the visual field Anticipate the visual field defects with lesions marked.defects with lesions marked.

• Blind right eyeBlind right eye• Bitempral hemianopsiaBitempral hemianopsia• Homonymous hemianopsiaHomonymous hemianopsia

Describe and locate the lesion Describe and locate the lesion for each visual field defect.for each visual field defect.

• Left upper retnaLeft upper retna• Left optic nerveLeft optic nerve• ChiasmaChiasma• Right optic tractRight optic tract• Right optic radiationRight optic radiation• Right optic radiationRight optic radiation