Sales Training Feb 14 - Medicine

Anatomy and Physiology andTechniques of Examination

examples of abnormalities

Cornea and Lens.  With oblique lighting, inspect the cornea of each eye for opacities and note any opacities in the lens that may be visible through the pupil. Iris.  At the same time, inspect each iris. The markings should be clearly defined. With your light shining directly from the temporal side, look for a crescentic shadow on the medial side of the iris. Because the iris is normally fairly flat and forms a relatively open angle with the cornea, this lighting casts no shadow.

See Table 7-9, Opacities of the Cornea and Lens, p. 268.

Occasionally the iris bows abnor- mally far forward, forming a very narrow angle with the cornea. The light then casts a crescentic shadow. This narrow angle increases the risk for acute narrow-angle glaucoma—a sudden increase in intraocular pres- sure when drainage of the aqueous humor is blocked. In open-angle glaucoma, the com- mon form of glaucoma, the normal spatial relation between iris and cornea is preserved and the iris is fully lit.

Light

Light

Pupils.  Inspect the size, shape, and symmetry of the pupils. If the pupils are large ( > 5 mm), small ( < 3 mm), or unequal, measure them. Use a card with black circles of varying sizes to measure pupillary size.

Miosis refers to constriction of the pupils, mydriasis to dilation.

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6

7 mm

Simple anisocoria, or a difference in pupillary size of 0.04 mm or greater, is visible in approximately 35% of healthy people. If pupillary reactions are normal, anisocoria is considered benign. 41

Compare benign anisocoria with Horner’s syndrome, oculomotor nerve paralysis, and tonic pupil. See Table 7-10, Pupillary Abnormalities, p. 269.

Test the pupillary reaction to light. Ask the patient to look into the distance, and shine a bright light obliquely into each pupil in turn. Both the distant gaze and the oblique lighting help to prevent a near reaction. Look for:

●● The direct reaction (pupillary constriction in the same eye)

●● The consensual reaction (pupillary constriction in the opposite eye)

C h a p t e r 7 |  The Head and Neck

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8/24/12 9:00 PM