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Extra info for 2007-2008 Basic and Clinical Science Course Section 12: Retina and Vitreous
In younger children, a transilluminator light can be directed into the eye by gently pressing it on the lower eyelid (Figure 1–27). Visual Fields The peripheral visual ﬁelds are usually assessed using the evoked saccade and confrontation tests described in the earlier section on more detailed tests in the pediatric ofﬁce. The central visual ﬁeld may be affected in some optic nerve and retinal diseases. Optic nerve disorders often cause a localized defect in the visual ﬁeld (a scotoma). Some retinal disorders cause an abnormality in which objects appear wavy or distorted CHAPTER 1 The Eye Examination ■ A 19 B FIGURE 1–29 ■ Color plates to assess for defects in color vision.
Mirrors are present in the casings (arrow), which reﬂect an image of the eye when the instrument is held in place. (B) A millimeter gauge is used to measure the location of the anterior cornea. (C) Exophthalmometer in place. The reﬂection of the eye and the ruler are visible (arrow). CHAPTER 1 The Eye Examination ■ A B 23 C FIGURE 1–39 ■ Measurement of eyelid levator muscle function. The ruler is placed next to the patient’s eye and is used to measure movement of the eyelid. (A) When looking straight ahead, the space between the edges of the upper and lower eyelids is 8 mm (normal) (arrows).
After 1 to 2 minutes a blue light is shined into the eyes. In normal patients, there will only be a thin layer of ﬂuoresceinstained ﬂuid remaining in the lower tear lake (between the eyelid and the eyeball). In patients with lacrimal obstruction, a thicker layer is present in the obstructed eye, reﬂecting the delayed drainage of tears (Figure 1–40). This test is also useful in children who present with decreased tearing. Most such children have normal basal tear formation, which can be veriﬁed by noting a normal tear layer.