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Visual acuity test

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Screening test to detect deficiencies in vision

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Color visions assessment

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uses colored plates color blindness is the inability to distinguish certain colors red and green is most common

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Irrigation

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washing a body canal with a flowing solution

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Instillation

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Dropping a liquid into a body cavity

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Visual acuity

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acuteness or sharpness of vision

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Normal visual acuity

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can see clearly able to distinguish fine details-close up and at a distance

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Errors of refraction

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most common cause of defects in visual acuity Refraction- Bending of the parallel light rays coming into the eye so they can be focused on the retina

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Error of refraction

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Light rays are not being bent properly Are not focused on retina adequately Cause-defect in the shape of eyeball can be improved with corrective lenses

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Myopia

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Nearsightedness- eyeball is too long from front to back causes light rays to be brought to a focus in front of retina difficulty see objects at a distance may squint and have headache from eye strain

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Hyperopia

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Farsightedness-Eyeball too short from front to back Causes light rays to focus behind the retina Difficulty viewing objects at a reading or working distance May have blurring, headache and eye strain while performing close-up tasks

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Astigmatism

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Causes distorted and blurred vision for both near and far objects Normal cornea- round or spherical shape;smooth astigmatism-cornea is curved into oval shape-causes light rays to focus on two different points the retina (instead of one point); results in distorted and blurred vision often occurs with myopia or hyperopia

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Presbyopia

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Decrease in elasticity of lens usually begins after age 40 results in a decreased ability to focus clearly on close objects can be corrected with corrective lens

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Ophthalmologist

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Physician specializing in the diagnosis and treatment of diseases and disorders of the eye prescribes ophthalmic and systemic medications performs eye surgery

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Optometrist

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Licensed primary healthcare provider who has expertise in measuring visual acuity and prescribing corrective lenses Can diagnose and treat disorders and diseases of the eye prescribes ophthalmic medications Not a physician, cannot prescribe systemic meds or preform eye surgery

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Optician

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Professional who interprets and fills prescription for eyeglasses and contact lenses

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Assessment of distance visual acuity (DVA)

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Used to diagnose myopia (along with other tests) Snellen eye chart most often used

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Types of charts

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Letter in decreasing sizes-used for school aged children and adults Capital letter E in decreasing sizes (arranged in different directions)- used for preschool children, non English speaking people or nonreaders Pictures of familiar objects- for preschoolers, less accurate because some children are unable to identify objects

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Snellen Big E Chart

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Perform in a well-lit room free from distractions Performed at a distance of 20 feet mark off with paint or tape on floor

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Two numbers next to each row of letters.....

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Number above the line: distance at which the test is conducted (20 feet) Number below the line: distance from which a person with normal visual acuity can read the row of letters

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Normal DVA

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20/20= person can read what he or she is supposed to read at 20 feet

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DVA 20/30

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smallest line the individual could read at 20 feet people with normal acuity can read this line at 30 feet

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DVA 20/15

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smallest line the individual could read at 20 feet people with normal acuity can read this line at 15 feet indicates above average DVA

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Conducting a Snellen Test

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Acuity of each eye is measured separately (usually starting with the right eye) If patient wears eyeglasses or contacts- keep them on during test and record in chart that they were worn

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The eye occluder.....

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held over eye not being tested-should not use patients hand because of peaking through the fingers Instruct patient to leave eye not being tested open (closing eye can cause squinting)

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Assessment of near visual acuity (NVA)

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assesses patients ability to read objects close up (reading) used to detect hyperopia and presbyopia NVA card contains different sizes of type: ranging from size of newspaper headline down to very small print

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NVA

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available in variety of forms: printed paragraphs, printed words or pictures

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To preform NVA testing.....

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perform test in well lit room free of distractions, patient holds card at a distance of 14-16 inches, reading glasses should be worn (if patient uses them) and each eye should be tested separately

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cont....

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observe for squinting, watering of eye, etc. patient continues until reaching smallest line that can be read record results as smallest type patient could read- recording based on the type of test card used Also record- date and time, if corrective lenses were worn and unusual symptoms exhibited by patient (squinting)

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Congenital defect (color vision)

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most common-inherited (present at birth), most often affects males

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Acquired defect

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acquired after birth-eye or brain injury, disease or certain drugs

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Color vision tests

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detect congenital color vision defects, performed in med office Basic color vision screening test- ask patient to identify red and green lines of snellen chart

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Ishihara Test

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Detects: total congenital color blindness, red-green Ishihara book: series of plates consisting of colored dots- forms a numeral against a background of dots of contrasting colors Patients with normal color vision can read the number

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Plates with winding colored lines

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used for preschool children and non English speaking people-patient is asked to trace line formed by colored dots using a cotton swab or eraser, not fingers (fingers degrade the plates)

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Conduct Ishihara Test

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in quiet room, illuminated by natural daylight (bright lights can change the shades of color

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Ishihara Test consists of.....

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14 color plates- 1-11 basic test plates further assessment of patients with red-green deficiency- plates 12-14

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Normal color vision

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10 or more plates read correctly

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Color vision deficiency

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7 or fewer plates read correctly If there is a defect in color vision the patient is referred to ophthalmologist or optometrist

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eye irrigation

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washing the eye with a flowing solution purpose= cleanse the eye washing away: foreign particles, ocular discharges and harmful chemicals remove inflammation though application of heat

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eye instillation

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Dropping of a liquid into the lower conjunctival sac Purpose- teat eye infections, soothe an irritated eye, dilate pupil, anesthetize the eye during eye exam Medications instilled in eye= liquid (eye drops) and ointment

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Hearing Test

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use of tuning fork or audiometer

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Audiometer

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instrument that emits sound waves at various frequencies

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Assessment of hearing

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part of complete physical exam, can have hearing loss and not even know about it

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Person with normal hearing

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can her frequencies of normal speech- ranges from 300-4000 Hz (hertz or cycles per second

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Patients that have hearing loss.....

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referred to otolaryngologist or audiologist

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Conductive hearing loss

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results when there is a physical interference with normal conduction of sound waves through the external and middle ear- amount of sound reaching inner ear is less than normal

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Conductive loss in external ear

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caused by an obstruction of external ear canal: impacted cerumen, external otitis (swimmers ear), foreign bodies, and benign growths

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Conductive loss in middle ear

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caused by an obstruction in middle ear: serous otitis media (fluid in middle ear), acute otitis media (infection in middle ear), perfrated tympanic membrane, otosclerosis

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Sensorineural hearing loss (SNHL)

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results from damage to inner ear or auditory nerve: Sound is conducted normally through outer and middle ear structures, Problem with perception of sound waves: results n a hearing deficit- causes= hereditary factors, degenerative changes from the normal aging process, intense noise exposure over period of time, ototoxicity caused by certain medications, infectious diseases (measles, mumps, etc)

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Mixed hearing loss

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combination of both conductive and sensorineural loss

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Hearing acuity tests

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test one ear at a time, deficit may exist in only one ear ear not being tested blocked by an earplug or masked masking: presentation of sound to ear not being tested (so patients response is based only on hearing in ear being tested)

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Gross Screening Test

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simple and quick test used to identify a very large hearing impairment whisper test: patient asked to repeat simple word or series of numbers: whispered from a distance of 1-2 feet If hearing loss is detected, more precise test is performed (tuning fork, audiometry)

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Tuning for tests

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provide a general assessment of hearing acuity use of tuning fork with frequency of 512 or 1024 Hz- These frequencies fall within the range of normal speech

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Weber test

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useful when one ear hears better than the other: fork set in vibration, base of fork placed on center of patients head, patient indicates where sound is heard best Results-Normal- hears sounds equally in both ears Conductive hearing loss- hears sound better in problem ear Sensorineural hearing loss- patient does not hear the sound as well in problem ear

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Rinne test

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compares the duration of sound perception by air conduction with that of bone conduction: fork is set in vibration, base of fork is placed against bone of mastoid process, patient indicates when sound is no longer heard, prongs of fork (still vibrating) placed in the air: 1 inch from opening of ear, patient indicates when sound is no longer heard

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results of rinne test

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Normal- hears sound twice as long through air conduction as through bone conduction Conductive- hears the sound longer by bone conduction than by air conduction Sensorineural- sound is reduced; also hears sound longer through air conduction than through bone conduction but not twice as long

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Audiometry

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measurement of hearing acuity using an audiometer Audiometer: an instrument that quantitatively measures the various frequencies of sound waves provides info on: how extensive hearing loss is and which frequencies are involved conduct in quiet room, headphones placed snugly over ears, delivers a single frequency at time, patient signals when sound is heard, results are plotted on a graph (audiogram)

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Tympanometry

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helps determine cause of hearing loss Not a hearing test tympanometer: earpiece attached to an electronic device Normal ear: eardrum exhibits mobility in response to pressure Fluid present in middle ear: eardrum will not move (remains stiff);used to diagnose serous otitis media (common cause of temporary hearing loss in children)

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Ear irrigation

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performed to cleanse external ear canal to remove cerumen, discharge or foreign body relieve inflammation by applying antiseptic solution apply heat to ear

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cont.....

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impacted cerumen must be softened before removal by instilling warm mineral oil or hydrogen peroxide do not perform if tympanic membrane is perforated, could result in severe irritation or infection

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Ear instillation

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dropping of a liquid into the external auditory canal performed to: soften cerumen, combat infection with antibiotic eardrops, relieve pain

Chapter 21- eye and ear – Flashcards

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