EYE ASSESSMENT/TESTS: Snellen Test: A Snellen test uses a chart with different sizes of letters or forms to evaluate

your visual acuity-that is, the sharpness of your vision. The test shows how accurately you can see from a distance. The level of vision is usually measured using a Snellen chart or equivalent. It is viewed at 6 metres (20 feet). A visual acuity of 6/6 indicates that the chart was viewed at 6 metres, and the lowest line that could be read was labelled . What is tonometry? Tonometry is a method of measuring the pressure in the eye. Tonometry is used to determine the pressure in the eye by measuring the tone or firmness of its surface. A tonometry test measures the pressure inside your eye, which is called intraocular pressure (IOP). This test is used to check for glaucoma, an eye disease that can cause blindness by damaging the nerve in the back of the eye (optic nerve). Damage to the optic nerve may be caused by a buildup of fluid that does not drain properly out of the eye.

Ophthalmoscopy: Examination of the interior of the eye, including the lens, retina and optic nerve, by indirect or direct ophthalmoscopy. Indirect ophthalmoscopy employs a head lamp device to shine a very bright light into the eye. This is generally done by an ophthalmologist.

either stationary pinpoint light sources or projected dots within a large white bowl. The examiner uses a device the size of a flashlight to examine the eye. Static perimetry: The most common type of modern visual field testing employs a device with fixed light sources. The operator looks through a single monocular eyepiece into the patient's eye. Gonioscopy. 2.Direct ophthalmoscopy is in more common usage. The ophthalmoscope is equipped with a rotating disc of lenses to permit the eye be examined at different depths and magnifications. Popular devices include the Octopus or the Humphrey-Zeiss field analyzer. thus minimizing the time spent by a technician running the test. The device consists of a concave mirror and a battery-powered light (contained within the handle). These tests are automated and run by the onboard computer. . This may be enhanced by drugs that dilate the pupil and enlarge the opening into the structures within the eye. The mapping of the sensitivity contours of the visual field. Perimetry 1. The determination of the limits of the visual field.Examination of the angle of the anterior chamber of the eye with a gonioscope or with a contact prism lens.

such as the traditional workhorse Goldman perimeter.a test for color vision deficiency that uses a series of pseudoisochromatic plates on which numbers or letters are printed in dots of primary colors surrounded by dots of other colors. choroid. A special dye is injected into a vein in the arm and pictures are taken as the dye passes through the blood vessels in the eye Ishihara test. a disease that is caused by increased pressure inside the eye. COMMON EYE DRUGS. . The most common drugs used for this purpose are demecarium (Humorsol) and echthiophate (Phospholine iodide). Amsler grid: It's an important tool to test macular vision in and around the center of the retina and detect specific conditions such as macular degeneration Fluorescein angiography: A test to examine blood vessels in the retina. and iris of the eye.Kinetic perimetry: The process utilizes moving light sources. Fixation monitoring as well as movement of the light source require a dedicated trained technician throughout the entire test. This test is particularly useful in weeding out malingerers. This test produces an island map of peripheral visual perception intensity. Cholinergic drugs are also used in control of glaucoma. the figures are discernible by patients with normal color vision.

At specific dosages they lower the intraocular pressure (IOP). supposedly by increasing the outflow of aqueous humour via the uveoscleral pathway. such as migraine. the ability of the eye to change its focus from distant to near objects (and vice versa). Some also are used to relieve the type of chest pain called angina or to prevent heart attacks in people who already have had one heart attack. they are used to treat certain kinds of glaucoma. travoprost. .The main use of beta blockers is to treat high blood pressure. TERMS Accommodation: In medicine. If they are not. Drugs used in the treatment of open-angle glaucoma or ocular hypertension. This process is achieved by the lens changing its shape. Bimatoprost reduces IOP by increasing the uveoscleral outflow as well as the trabecular outflow. not + "iso". equal + "kore". Common agents include latanoprost. bimatoprost (a synthetic prostamide structurally related to prostaglandin) and unoprostone isopropyl. These drugs may also be prescribed for other conditions. Anisocoria: Both pupils are usually of equal size. It is the process of adjusting the focal length of a lens. and irregular heartbeat. In eye drop form. pupil = not equal pupils). Accommodation is the adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies. that is termed anisocoria (from "a-". tremors.

Diplopia: A visual symptom in which a single object is perceived by the visual cortex as two objects rather than one. STRABISMUS.The state of refraction of the eye in which parallel rays. . Chemosis: Swelling around the iris (the colored circle that surrounds the pupil) due to edema (swelling) of the bulbar conjunctiva (the clear membrane that coats the outer surface of the eye). the pupil is merely the absence of iris. when the eye is at rest. are focused exactly on the retina. Emmetropia. Aphakia is mainly congenital or as result of LENS DISLOCATION AND SUBLUXATION. and diseases of the BRAIN STEM and OCCIPITAL LOBE. TROCHLEAR NERVE DISEASES.The pupil may appear to open (dilate) and close (constrict) but it is really the iris that is the prime mover. the larger pupil lets more light enter the eye. Disorders associated with this condition include REFRACTIVE ERRORS. Aphakia. The size of the pupil determines how much light is let into the eye.Absence of crystalline lens totally or partially from field of vision. OCULOMOTOR NERVE DISEASES. from any cause except after cataract extraction. With anisocoria. ABDUCENS NERVE DISEASES.

usually through a traumatic disruption of the wall of the cavity. Exenteration. Removal of the contents of the eyeball. or irritation of the CONJUNCTIVA or CORNEA. Contraction of the pupil.the process whereby tissue or organs that usually reside within a body cavity are displaced outside that cavity. Removal or destruction of the nucleus of a cell. . evisceration of bowel. Mydriasis: Dilation of the pupils induced by eyedrops. leaving the sclera and sometimes the cornea. hyphemaBlood in the anterior chamber of the eye. defective sympathetic innervation.Enucleation-Removal of an entire structure (such as an eyeball or tumor).Removal of internal organs and tissues. as one shells the kernel of a nut. usually radical removal of the contents of a body cavity. without rupture. The opposite of miosis. Evisceration. Miosis: Pupillary constriction. This may result from congenital absence of the dilatator pupillary muscle.

the visual axes diverge. either pendular or with a slow and fast component. and other conditions. and other disorders. MIGRAINE. also called the optic disk or papilla. RETINAL DISEASES and GLAUCOMA)..Protrusion of one or both eyeballs. SUBARACHNOID HEMORRHAGE. such as a retroorbital tumor (usually unilateral) or thyroid disease (usually bilateral). is the area where the optic nerve (the nerve that carries messages from the eye to the brain) enters the eyeball. OPTIC NERVE DISEASES. The danger with strabismus is that the brain cones may come to rely more on one eye than the other and . Photophobia: Abnormal sensitivity to light. Exophthalmos. MENINGITIS. Strabismus: A condition in which the visual axes of the eyes are not parallel and the eyes appear to be looking in different directions.Involuntary rhythmic oscillation of the eyeballs.Nystagmus. Photophobia may also occur in association with DEPRESSION and other MENTAL DISORDERS. If the visual axes converge. The optic nerve head.g. a sign of increased intracranial pressure. or due to pathology. or exotropia. This may occur as a manifestation of EYE DISEASES.Papilledema: Swelling of the head of the optic nerve. This occurs with a variety of EYE DISEASES (e. it is called convergent strabismus or esotropia. In divergent strabismus. can be congenital and familial. Scotoma: A localized defect in the visual field bordered by an area of normal vision.

and most commonly in the middle ear and mastoid region. The acoustic nerve (the 8th cranial nerve) is concerned with hearing and the sense of balance and head position. frequently occurring in the meninges.that part of the brain circuitry connected to the less-favored eye fails to develop properly. Sensorineural Hearing Loss: Hearing loss resulting from damage to the sensory mechanism internal from the oval and round windows. central nervous system. leading to amblyopia (blindness) in that eye. EARS Acoustic: Having to do with sound or hearing. bones of the skull. . Conductive Hearing Loss: Hearing loss due to interference with the acoustic transmission of sound to the cochlea. An acoustic neuroma is a tumor on the acoustic nerve. The interference is in the outer or middle ear. Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium.

Deafness." A discharge from the nose. pulsations. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The distinction between acquired and congenital deafness specifies only the time that the deafness.Pain in the ear. Tinnitus may occur as a manifestation of COCHLEAR DISEASES. . From the Greek words "rhinos" meaning "of the nose" and "rhoia" meaning "a flowing. Otalgia.General term for inability to hear. Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing. and other conditions. CRANIOCEREBRAL TRAUMA. clicking. and other noises. VESTIBULOCOCHLEAR NERVE DISEASES. INTRACRANIAL HYPERTENSION. The term subjective tinnitus is used when the sound is audible only to the affected individual. ringing.A discharge from the ear. Rhinorrhea: Medical term for a runny nose.discharge of cerebrospinal fluid through the external auditory canal or through the eustachian tube into the nasopharynx. cerebrospinal fluid otorrhea. Otorrhea. Hearing loss can be present at birth (congenital) or become evident later in life (acquired deafness).

Lesions in the temporal and parietal lobes may be associated with FOCAL SEIZURES that may feature vertigo as an ictal manifestation.Vertigo: Vertigo is an abnormal sensation that is described by the person as a feeling they are spinning or that the world is spinning around them.S. . and cerebral cortex. Almost all children have one or more bouts of otitis media before age 6. or a perforated eardrum. 6th ed. often with drainage of purulent material (pus). Vertigo may be associated with disorders of the inner ear. An illusion of movement.. pp300-1) DISORDERS: Acute otitis media: Inflammation of the middle ear in which there is fluid in the middle ear accompanied by signs or symptoms of ear infection: a bulging eardrum usually accompanied by pain. vestibular nerve.. brainstem. either of the external world revolving around the individual or of the individual revolving in space. Acute otitis media is the most frequent diagnosis in sick children in the U. (From Adams et al. Principles of Neurology. especially affecting infants and preschoolers. It is most often associated with an inner ear problem.

especially high frequency sounds. It is a common disorder. Presbycusis: Age-related hearing loss with gradually progressive inability to hear. staphylococcus. Pregnancy may trigger it. They may have trouble distinguishing and understanding conversation in a noisy setting. or pseudomonas types of bacteria. Presbycusis is common. Cuts or abrasions in the lining of the ear canal (for example. industrial machinery. What causes Meniere's disease? Although the cause of Meniere's disease is unknown. The swimmer's ear infection is usually caused by excessive water exposure. Acute external otitis is commonly a bacterial infection caused by streptococcus. causing progressive loss of hearing. Presbycusis most often occurs in both ears. Because the loss of hearing is so gradual. from cotton swab injury) can also predispose to bacterial infection of the ear canal. especially among young women. When water collects in the ear canal (frequently trapped by wax). but up to half of presbycusis is genetically determined. it probably results from an abnormality in the way fluid of the inner ear is regulated.What is "swimmer's ear" or acute external otitis? External otitis or "swimmer's ear" is an infection of the skin covering the outer ear and ear canal. people with presbycusis may not realize that their hearing is diminishing. thereby causing deafness. but both ears may be affected in about 10% to 20% of patients. Men . Meniere's disease typically starts between the ages of 20 and 50 years of age (although it has been reported in nearly all age groups). Otosclerosis-The formation of spongy bone in the labyrinth capsule. the skin will become soggy and serve as an inviting culture media for bacteria. Otosclerosis usually affects both ears. The ossicles can become fixed and unable to transmit sound vibrations. The hearing loss can usually be corrected with a hearing aid. power tools. or very loud music) contribute significantly to presbycusis. affecting a third of people between 65 and 75 years and up to a half of people 75 and over. In most cases only one ear is involved. Environmental exposures (such as to guns. The abnormal formation of new bone in the middle ear that gradually immobilizes the stapes (stirrup bone) and prevents it from vibrating in response to sound.

causing partial paralysis. . tinnitus (ringing in the ears).and women are equally affected. it can interfere with the facial nerve. Meniere's disease is also called idiopathic endolymphatic hydrops. Schwann cells bunch together. The tumor results from an overproduction of Schwann cells -. pressing against the hearing and balance nerves. especially if the attacks of vertigo are severe. and eventually press against nearby brain structures. The symptoms may be only a minor nuisance. the system of intercommunicating canals and cavities within the inner ear responsible for sensing balance. becoming lifethreatening Mastoiditis: Inflammation of the mastoid. often secondary to ear infection. Acoustic neuroma: A benign tumor that may develop on the hearing and balance nerves near the inner ear. Due to diverse causes including viral and bacterial infections. Labyrinthitis may be accompanied by the sudden onset of a feeling of vertigo triggered by head or body movement together with feelings of nausea and malaise.small sheet-like cells that normally wrap around nerve fibers like onion skin and help support the nerves. or can become disabling. When growth is abnormally excessive.An otoscopic examination is the visual examination of the auditory canal and tympanic membrane using an otoscope. often causing gradual hearing loss. EAR TESTS: Otoscopic examination:. and dizziness. Inflammation of the cavity and air cells in the mastoid part of the temporal bone. If the tumor becomes large. and occur without warning. Labyrinthitis: Inflammation of the labyrinth. frequent.

WHISPER TEST 1. It can detect unilateral (one-sided) conductive hearing loss and unilateral sensorineural hearing loss. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds.6 m) behind the patient (to prevent lip reading) . Some otoscopes can deliver a small puff of air to the eardrum to determine if the eardrum will vibrate (which is normal).[1] It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. and the canal for any variations from normal. or hearing loss. The Weber test is a quick screening test for hearing. one can quickly screen for the presence of conductive hearing loss. The examiner stands at arm's length (~0. puncture.Purpose: An otoscopic examination is a procedure that examines the auditory canal and tympanic membrane for infection or blockage due to the presence of a foreign object or build up of wax. The test is named after Ernst Heinrich Weber (1795±1878). Thus.The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. Audiometry . The Rinne test is a hearing test. An otoscopic examinations is also part of a normal physical examination. the tympanic membrane for signs of rupture.

. This level of hearing loss has a significant affect on communication.2. This impairment is the third most chronic impairment among older people. The opposite auditory canal is occluded by the patient or examiner and the tragus is rubbed in a circular motion (goal. then repeat using a different number-letter combination. Whispering at the end of exhalation is to ensure as quiet and as standardized voice as possible. 6. to describe any changes and if they have had any prior treatment. hearing is considered normal and no further screening is necessary on that ear. the patient fails in that ear. 2003 October 25. 5. Patients with no wax occlusion of their ear canal and who failed this test have a hearing loss that correlates with 30 dB loss. If on repeated testing. 4. the patient can answer three out of a possible six numbers-letters correctly. 3. BMJ. 7. If the patient responds correctly.327(7421):967. Significance Hearing loss prohibits patients from understanding conversations. If they cannot answer three out of six or more. contributes to cognitive decline. Whispered voice test for screening for hearing impairment in adults and children: systematic review. (Note: patients with memory problems may need a simplified letter/number combination to compensate for their inability to remember) *Pirozzo S. to block hearing from that ear) The examiner exhales and whispers a combination of numbers and letters (example 4-K-2). Repeat the sequence in the opposite ear using different combinations of numbers and letters. It is also useful to ask the patient and family if they have noticed any changes in hearing. and leads to social isolation. the patient passes. If the patient responds incorrectly.

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