Docstoc

External

Document Sample
External Powered By Docstoc
					Session 3. External Eye




EXTERNAL EXAMINATION
     Essential Equipment
• Good light.
• Fluorescein strips.
• Magnification of some
  kind.(remember the ophthalmoscope
  can be a magnifier).
• Mydriacyl.
• Va chart!!!!!
• Ophthalmoscope
             External.
• Lids and position,lashes,shape,globe
  contact,puncta.
• Conjunctiva..
• Inferior fornix
• Superior fornix
• Cornea and A.C.,limbus.
• Staining.
                    LIDS
•   Close apposition to the globe.
•   Puncta not visible.
•   Lower lid has a “square” edge.
•   Lashes point forward.
•   Lid closure covers the globe.
•   Deposits ,scurf,redness,dilated vessels.
•   Meibomian gland orifices.
    LID Eversion Technique
• Pull the lid forward by holding the lashes.
• Place a swab stick or similar 10 mms from
  the lid margin edge.
• Evert the lid by rotating the lashes over
  swab stick.
• Pay particular attention to the tarsal
  groove,a common place for FB’s.to lodge.
                       Grasp the lashes and pull forwar
                       to place the lid at a mechanical
                       disadvantage




Rotate and use
either a cotton
tipped applicator or
little finger
as a fulcrum.
A.C. DEPTH
Ophthalmoscope on + 1
              PUPILS
• PUPIL response.
• Direct and consensual.
• Swinging light test.
          Ocular Motility.
•   Muscle movements and types
•   Innervations.
•   Convergence.
•   Cover test.
             Ocular Motility
 @23 degrees abduction    @ 49degrees
                          adduction
Superior       Superior   Inferior
Rectus.        Rectus     Oblique.
Intorts.                  Elevates.
Elevates.      Inferior   Extorts.
Adducts        Oblique    Abducts.
Inferior       Inferior   Superior
Rectus.        Rectus.    Oblique.
Extorts.       Superior   Depresses.
Adducts.       Oblique    Abducts.
Depresses.                Intorts.
 3rd   nerve                                  3rd nerve




 later
Lateral rectus




                                             4th nerve
 3d nerve
            Lateral rectus   Medial rectus
         COVER TESTS
• The cover test basically establishes
  that both eyes are looking at the
  same thing.
• Cover and uncover.
• Cover and look behind.
• Rapid alternate cover.
• With children use an accommodative
  target eg a toy that moves.
SIMPLE COVER TEST
       Confrontation fields.

•   Technique.(red target and hands)
•   Demo.
•   Group work.
•   Limitations.
•   Threshold machines and kinetic.
                 Technique
•   Same level as patient.
•   Cover other eye yourself!!!
•   Compare left to right and right to left.
•   You are comparing yourself to patient.
•   Take age and awareness into account.
•   Use a RED object.
•   Finger or hand test for the confused.
             Demonstration
•   External Exam.
•   Lids.
•   Eversion.
•   Pupils.
•   Ophthalmoscope +1.
•   Ocular mts.
•   Cover test
•   Confrontation fields
Q55
•This lesion has been present for
many years .
•The patient is worried if this
represents a potentially malignant
condition.
•How would you advice them?
•What is the scientific basis for the
advice?
Q54
•Describe the
slide.
•D.D.?
•Rx?

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:8/25/2011
language:English
pages:23