Transcript No Slide Title

Eye Exam
You will be presented with clinical
images or illustrations. Answers
will be provided in the following
slide.
Describe the conjunctiva.
The conjunctiva is
translucent and clear.
The pink color of
palpebral conjunctiva is
due to underlying
vascular bed. White
Sclera is seen through
bulbar conjunctiva.
Note conjunctival reflection.
• Note the anterior and
posterior chamber
• Note ciliary body and
lens connection
Diagnosis?
• Sub conjunctival
hemorrhage
• Sharply demarcated
Afferent pathway for visual acuity?
Retina-optic nerve-Optic
chiasma-Optic
radiation-Occiptal lobe
visual cortex
Note fovea as center for visual
field. Locate site for blind spot in
retina.
Center of optic disc has
no retinal receptors and
leads to blind spot.
Pathway for light reflex?
• Afferent: Retina-optic
nerve-mid brain
• Efferent: Both oculo
motor nerves
Note direct and consensual light
reflex.
Sorry the pupillary
contraction on right is
not visible.
Note the pathway for pupillary
contraction.
• Direct reflex on right
• Consensual reflex on
left
Note the pathway for light reflex.
Is this light reflex normal?
Yes. Note direct and
consensual light reflex
Is this light reflex normal?
Afferent path on left eye is
abnormal.
Which muscles are in action?
The right lateral rectus
and left medial rectus.
Gaze is conjugate.
Which nerves are in action?
The right abducens
(right lateral rectus)
and left oculomotor
nerve (left medial
rectus).
Gaze is conjugate.
Which nerves are in action?
The oculomotor nerves.
Superior rectus in action.
Gaze is conjugate.
Which cranial nerves are in action?
Both oculomotor nerves
Inferior recti in action
Identify the ocular muscles.
• Levator palpabrae supreioris
• Superior rectus
• Inferior recrtus
Appreciate position of the ocular
muscles.
• Superior oblique:
Trochlear nerve
• Lateral rectus: Abducens
nerve
• Oculomotor supplies the
rest
What ocular muscles are
influenced by sympathetic system?
• Levator palpabrae superioris
• Iris muscle
• Muscle in floor of orbit
Is the technique appropriate?
No. You should look at
patient’s left fundus
with your left eye.
Identify the artery and vein.
• The artery is narrow
with light reflex.
• The vein is read and
thicker than the
artery.
Diagnosis?
Leukemic infiltration
Diagnosis?
Macroglobulinemia
Source for tears?
• Lacrimal gland
• Meibonian glands
• Conjunctival glands
• Drained by puncta
into lacrimal sac and
on to nasolacrimal
duct into nose.
Note pathway for the aqueous
humor.
Your right eye compared to the
subject’s left eye.
Note normal mono-ocular field
of vision.
• 80-90 degrees temporal
• 45 degrees medial,
limited by nose
• Eye brows limit upward
field
Anticipate the visual field
defects with lesions marked.
• Blind right eye
• Bitempral hemianopsia
• Homonymous hemianopsia
Describe and locate the lesion
for each visual field defect.
• Left upper retna
• Left optic nerve
• Chiasma
• Right optic tract
• Right optic radiation
• Right optic radiation