CLINICAL PERSPECTIVES STRUCTURES AROUND THE GLOBE Orbit- provides a safe place for the eyeball...
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CLINICAL PERSPECTIVESSTRUCTURES AROUND THE GLOBE
Orbit- provides a safe place for the eyeballeyelids- closes light off of eye, protects, distributes tearstears- lubricates & protectslacrimal system- distributes tearsconjunctiva- covers sclera and inner surface of eyelidsorbital septum- bone covering top of orbiteyebrow- covers orbital septum, protects eye from sweat
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Extraocular Muscles
• Superior & Inferior Recti
• Medial & Lateral Recti
• Superior & Inferior Obliques
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Eyelids & eyelashes
• meibomian glands- oil glands
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Conjunctiva
• sclera- white fibrous covering of eyeball
• limbus- point where sclera and cornea meet
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Lacrimal Apparatus
• puncta- inner margin of the upper & lower lids
• caniliculi- passages to sacs & ducts
• lacrimal sac- contains some tears
• nasolacrimal duct- drains tears into nose
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Eye Divided Into Two Parts
• Anterior Segment– aqueous humor– pupil– Iris– lens
• Posterior Segment– vitreous humor– retina– optic nerve
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Cornea• clear, avascular window of the eye, most
refractive power
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Anterior Segment
• aqueous humor• trabecular meshwork• canal of Schlemm • ciliary process• lens
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Pupil & Iris
• Pupil- adjusts light
• Iris- pigmented muscular ring
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Structures In the Globe
• 3 Main Structures: – protective outer layer– vascular inner layer– sensory retina
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Vascular Inner Layer
• Uveal tract
• Ciliary body
• Choroid
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Sensory Layer
• Central Retina– Macula & fovea contain mostly cones– Optic disk
• Peripheral Retina– Contains mostly rods
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Transmission of Visible Information to the Brain
• Light energy from environment to chemical energy in retina to electrical energy in optic nerve & synapses to chemical energy in nerve cells
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Relationship of Sight to Vision
• Images from eye structures must be interpreted in the visual cortex for sight to occur
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• The eyes and associated structures must be normal in structure & function.
• The neurological pathways from the retina & optic nerve to the visual cortex must be in tact.
• The brain must be capable of interpreting the information received.
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MEDICAL EYE REPORT
• Name• Sex• Age• Family Medical Hx• General Medical Hx• Surgical Hx• Medications• Ophthalmic complaint
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Eye Care Professionals• Optometric technicians, ophthalmic
technicians• Vision Rehabilitation practitioner• Teacher of Visually Impaired• D.O.- doctor of optometry, doctor of
ophthalmology, low vision specialist• M.D.- ophthalmologist• Specialist- did fellowship in specialty,
FACS• optician
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VISUAL ACUITIES
• Autorefractor
• Lensometer
• Snellen chart (distance)
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• Checking distance each eye using an occluder
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• Jaeger near vision chart
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• Ishihara- color vision charts
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• Titmus fly
• Amsler grid
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External Examination
• LLL- Lids, lens, lacrimal system
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CAUSES & FUNCTIONAL IMPLICATIONS OF VISUAL
IMPAIRMENT
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• PERL- Pupils equal & reactive to light
•
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• MM- Muscular motility
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• Eye Muscle Balance
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Cornea & Anterior Segment
• Ophthane- numbs eye
• Midriatic- dilates pupil
• Cycloplegic- relaxes lens
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• Tonometer- measures pressure– FP- finger pressure– Air puff– Contact
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• Keratometer- measurement of corneal thickness
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• Goniometer- measures angle of anterior segment (risk factors for glaucoma)
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• Slit lamp
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• Direct ophthalmoscope
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Undilated versus Dilated Pupil
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• Indirect ophthalmoscope
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Normal Fundus
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• Phoropter
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Functional & Visual Efficiency Testing
• Behavioral
• Electrophysiological
• Subjective
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Behavioral
• OKN (optokinetic nystagmus)- cortical
• PLT (preferential looking test)- Teller acuities
• Chromatic luminance- contrast sensitivity
• Tracking a toy or light
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Electrophysiological
• Fundus photos & OCT
• VER- visual evoked response- visual pathways, cortical function
• ERG- electroretinogram (cone & rod function)
• EOG- electrooculogram (measures charge & potentials of eyes)
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Subjective
• Acuity– Lea charts– Snellen– Tumbling E– Amsler grid
• CSF- contrast sensitivity function• Flicker fusion macular & foveal function• Color- Ishihara & Farnsworth• Visual fields
– Confrontation– Ganzfeld globe– computerized
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Visual Efficiency Testing
• ISAVE
• Program to Improve Visual Efficency (Barraga)
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• Conditions That Result In Low Visual Acuity
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Ocular Muscle Disorders-
• eyes that are not in proper alignment
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Strabismus & Amblyopia
amblyopia- a reduction in visual acuity due to non-use of the eye
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• tropia- marked deviation of an eye• esotropia- turning in of one or both eyes
• exotropia- turning out of one or both eyes
• hypertropia- turning up of one or both eyes• hypotropia- turning down of one or both eyes• phoria- tendency of eye to deviate, particularly when
fatigued or fusion broken
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Nystagmus
• Involuntary, rhythmical repeated movement of one or both eyes in a horizontal, vertical or pendular motion– null point- point of least nystagmus & best
vision– pendular nystagmus- up-and-down
movements of equal speed, amplitude & duration
– jerk nystagmus- slower movement in one direction