EENT

• EXTRAOCULAR STRUCTURES

  • EYELIDS
  • EYE LASHES
  • CONJUCNTIVA
  • LACRIMAL APPARATUS
• EXTRAOCULAR MUSCLES

  • OCULOMOTOR: superior rectus, inferior oblique, inferior rectus, medial rectus
  • TROCHLEAR: superior oblique
  • ABDUCENS: lateral rectus
• EYE LASHES

  NORMAL: present and curving, outward, no crusting

  DEVIATION: inverted lashes (entropion), everted lashes (ectropion)
• EYE LIDS

  NORMAL:

  • Upper eyelid normally covers one-half of upper Iris
  • Palpebral Fissures Symmetrical
  • Eyelids in Contact With Eyeball
  • Surface Characteristics, Position in Relation toThe Cornea

  DEVIATION:

  • Asymmetry of lids: CN III
  • Damage, stroke
  • Ptosis of both eyelids (drooping of eyelids)
  • Myasthemia gravis (drooping of eyelids/ eye weakness)
  • Basal cell carcinoma (skin cancer/ bump)
  • Squamous cell carcinoma (bump in eye)
  • Xanthelasma – lipidosis (soft, semisolid, yellow papules or plaques)
  • Chalazion (developing lump due to blockage and swelling of an oil gland in the eyelid)
  • Hordeoulum/stye
• SNELLEN CHART


  used to test distance vision and measure visual acuity.

  • 20/20 In adults and children age 6 and older,
  • 20/50 For children age 3 and younger
  • 20/40 For children age 4
  • 20/30 For children age 5
• ROSENBAUM CARD

  • is used to evaluate near-vision. This small, handheld card has a series of numbers, E’s, X’s, and O’s in graduated sizes.
  • 14 inches (35.6cm)
  • It was developed by Dr. J. George Rosenbaum for testing vision at the bedside of patients after cataract surgery.
• (EREN) JAEGERS CARD

  • an eye chart used in testing near vision acuity. it is a card on which paragraphs of text are printed, with the text sizes increasing from 0.37 mm to 2.5 mm.
  • 12 – 14 inches
• ISIHARA TEST

  • a color perception test for red-green color deficiencies
  • It was named after its designer, Shinobu Ishihara, a professor at the University of Tokyo, who first published his tests in 1917.
• ALLEN CARD TEST

  • Done at a distance of 3 meters /15 feet
  • Consist of a set of seven card with each card containing a single picture
  • Usually used for 2 years old child and older
  • The child is first shown cards at close range with both eyes open and is asked to name each picture
• Snellen Chart

  • 20/20 Normal Acuity
  • 20/15 Better Vision
  • 20/200 Legally Blind (Smaller Fraction 20/40)

  Rosenbaum Card

  • NORMAL: 14/14
  • DEVIATION: Smaller Fraction, Myopia, Hyperopia, Presbyopia

  Jaeger’s Card

  • NORAML: 14/14
  • DEV: Smaller Fraction

  Ishihara Test

  • NORMAL: Correctly Identify Embedded Figures/Identify colored Bars On Snellen Chart
  • DEV: Inability To Detect The Embedded Number Or Letter, Color Blindness

  ALLEN CARD TEST

  • NORMAL: Can Identify 3 Of The Seven Objects At A Distance Of 15ft
  • DEV: Macular Degeneration disease That Affect The Cones That Mediate Color Vision
• BULBAR CONJUNCTIVA

  NORMAL:

  • Transparent, capillaries sometimes evident
  • Sclera appear white
  • Darker or yellowish and with a small brown macules in the dark skinned clients are normal

  DEV:

  • Jaundice
  • Conjunctivitis
  • Pale
  • Lesions
  • Nodules
• PALPEBRAL CONJUNCTIVA

  NORMAL:

  • Smooth, shiny, pinkish-peach color, with minimal blood vessels

  DEV:

  • Extremely pale
  • Extremely red
  • Nodules/lesions
• LACRIMAL APPARATUS

  NORMAL:

  • No edema or tenderness or tearing
  • Puncta is visible w/o swelling or redness

  DEV:

  • Swelling of lacrimal gland
  • Redness/swelling
  • Excessive tearing
• CLARITY AND TEXTURE

  NORMAL:

  • Transparent, shiny and smooth
  • Details of iris are visible

  DEV:

  • Opaque, surface not smooth
  • Arcus senilis under age 40
• PALPATE: EYEBALL

  NORMAL:

  • Globe firm
  • Non tender

  DEV:

  • Excessively firm
  • Tender globe
  • Glaucoma
• Conjunctivitis

  the inflammation or infection of the transparent membrane that lines your eyelid and eyeball
• Conjunctival pallor

  reason enough to perform a hemoglobin determination
• Pterygium or pinguecula


  Growth or thickening of conjunctiva from inner canthal area toward iris
• Subconjunctival Hemorrhage


  occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva)
• Nevus


  a birthmark or a mole on the skin, especially a birthmark in the form of a raised red patch.
• Papilloma


  one of the most common eyelid tumors and usually occurs in middle-aged or elderly. It is benign, painless, and carries little to no risk for growth into cancer. It looks like a skin tag and can be solitary or multiple, smooth or rough and is similar in color to adjacent skin
• LACRIMAL APPARATUS


  LACRIMAL GLANDS (ins)

  NORMAL: no edema, no tenderness, no tearing, puncta is visible without swelling

  DEV PATEL: Swelling of lacrimal glands, redness/swelling around the puncta, excessive tearing

  LACRIMAL GLANDS (pal)

  NORMAL: no drainage
• CORNEA

  • clear outer layer at the front of the eye.
  • helps eye to focus light so you can see clearly
• CLARITY AND TEXTURE

  NORMAL:

  • transparent, shiny and smooth, details of iris are visible

  CORNEAL LIGHT REFLEX

  DEV:

  • asymmetrical corneal light reflex, weak extraocular muscles, strabismus, congenital exoptropia

  CORNEA AND LENS

  N:

  • lens clear, smooth, shiny
• TYPES OF STRABISMUS

  ESOTROPIA: misalignment of eyes, in which one eye deviates towards the nose (>)(|)

  EXOTROPIA: one or both eyes turn outward toward the ears (<)(|)

  HYPERTROPIA: one of your eyes drift or look up uncontrollably. (^)(|)

  HYPOTROPIA: downward turn of the eye (V)(|)
• RED REFLEX TEST


  used to screen for abnormalities of the back of the eye (posterior

  segment) and opacities in the visual axis, such as a cataract or corneal opacity
• Cloudy cornea


  vit A deficiency; infection which may be accompanied by HYPOPION (pus in anterior chamber)
• Kayser - Fleischer ring o yellow ring in outer margin


  WILSON’s disease, increased copper absorption
• Corneal scar 


  appears grayish white, usually due to an old injury or inflammation
• Early Pterygium 


  thickening of the bulbar conjunctiva that extends across the nasal side
• Negative corneal reflex

  • indicates neurological problem, CN V and VII
  • may also be absent or diminished in people who wear contact lenses
• SCLERA

  • the white outer layer of the eyeball

  NORMAL

  • smooth, white, shiny
• COMMON ABNORMALITIES OF SCLERA

  Diffuse Episcleritis - inflammation of the episclera

  Bluish Sclera - osteogenesis imperfecta

  Icteric sclera - at the limbus; due to elevated bilirubin (jaundice)
• PUPIL

  • the dark-colored openings at the center of your eyes that let light in 2 to 4 mm in diameter in bright light and 4 to 8 mm in the dark

  NORMAL:

  • size and equality: round, equal bilaterally,
  • reaction to light: constriction

  DEV: no reaction (anisocoria)
• COMMON ABNORMALITIES OF PUPIL

  ANISOCRIA

  • difference in pupil sizes

  MIOSIS

  • also known as pinpoint pupils, characterized by constricted and fixed pupils —possibly a result of narcotic drugs or brain damage.

  MYDIASIS

  • pupils become dilated typically resulting from central nervous system injury, circulatory collapse, or deep anesthesia

  TONIC PUPIL O UNILATERAL LARGE PUPIL

  • reacts to light slowly (benign)

  HORNER'S SYNDROME O ENEQUAL PUPILS

  • affected pupil small but reacts to light and has ptosis on affected eye related to sympathetic nerve lesion
• Argyll Robertson Pupils


  Small and irregular with no reaction to light or accommodation, associated with neurosyphilis
• Oval Pupils


  Irregularly shaped pupils may be caused by certain eye surgeries or may indicate a transtentorial herniation with third nerve compression
• Sluggish or Fixed Pupil


  Lack of oxygen to optic nerve or brain or topical or systemic drug effects
• Absence of Consensual Response


  Seen in conditions that compress or deprive those areas of oxygen
• Absent Light Reflex

  No change in power of contraction during accommodation (Argyll Robertson pupil); Paralysis and locomotor ataxia caused by syphilis