Review of Eyes and Ears -3043

• Concerning the papillary light reflex, describe and contrast a direct light reflex with a
consensual light reflex.

Direct light reflex of the pupil occurs when one eye is exposed to bright light
and its pupil constricts. Consensual light reflex of the pupil occurs when one
eye is exposed to light and the other eye’s pupil constricts simultaneously.
See Fig. 14-8, p. 304.

• Discuss the most common causes of decreased visual function in the older adult.

Cataract formation, glaucoma, and macular degeneration

See text discussion on “The Aging Adult,” p. 30-305.

• Explain the statement that normal visual acuity is 20/20.

Normal visual acuity of 20/20: the top number indicates the distance the
person is standing from the chart, and the bottom number gives the distance
at which a normal eye could have read a particular line on a chart. “20/20”
means that one can read at 20 feet what the normal eye could have read at
20 feet.

• To test for accommodation, the person focuses on a distant object, then shifts the gaze to a
near object about 6 inches away. Describe the normal findings.

Constrict, converge (see Fig. 14-19, p. 316)

• Describe the purpose of the cover and uncover test.

To detect small degrees of deviated alignment, perform the cover test (see
Fig. 14-13, p. 311). This test interrupts the fusion reflex that normally keeps
the two eyes parallel. A normal response is a steady, fixed gaze.

Phoria: a mild weakness noted when fusion is blocked.

Tropia: more severe than phoria—a constant malalignment of the eyes.
See Table 14-1, Abnormal Findings: Extraocular Muscle Dysfunction, p. 332-
333.

• Describe papillary light reflex, fixation and accommodation.

Pupillary light reflex: the normal constriction of the pupils when bright light
shines on the retina. Can be direct or consensual. See Fig. 14-8, p. 304.
Fixation: a reflex direction of the eye toward an object attracting a person’s
attention. The image is fixed in the center of the visual field, the fovea
centralis.

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 Accommodation: the adaptation of the eye for near vision. Movement of the
ciliary muscles increases the curvature of the lens. Accommodation is
observed through convergence (motion toward) of the axes of the eyeballs
and constriction of the pupils.

• Describe the method of assessing the six cardinal fields of vision.

See Figs. 14-16 and 14-17, p. 314, and text discussion under “Eversion of the
Upper Lid,” p. 313-314.

• Differentiate among the types of hearing loss and give examples

A conductive hearing loss involves a mechanical dysfunction of the external

or middle ear, and is considered a partial loss because the person is able to
hear if the sound amplitude is increased enough to reach the nerve elements
in the inner ear. Common causes are impacted cerumen, foreign bodies in
the ear canal, perforated tympanic membrane, and otosclerosis.
A sensorineural (or perceptive) hearing loss indicates pathology of the inner
ear, cranial nerve VIII, or the auditory areas of the brain. A simple increase in
amplitude may not enable the person to hear. Common causes are ototoxic
drugs and presbycusis, a gradual nerve degeneration that occurs with aging.
A mixed loss is a combination of both types of hearing loss in the same ear.

• Why are infants at greater risk for middle ear infections?

The infant’s eustachian tube is shorter and wider than an adult’s, and its
position is more horizontal; therefore it is easier for pathogens from the
nasopharynx to move through the eustachian tube to the middle ear. See Fig.
15-5, p. 347.

• Describe these tests of hearing acuity: whispered voice test: Weber test: Rinne test.

For descriptions of the tests of hearing acuity, see the text and Figs. 15-9 to
15-12 in the section “Test Hearing Acuity” on pp. 354-355.

• Define otosclerosis and prebycusis.

Otosclerosis is a common cause of conductive hearing loss in young adults

between ages 20 and 40. It is a gradual hardening that causes the foot plate
of the stapes to become fixed in the oval window, thus impeding the
transmission of sound. The result is progressive deafness.

Presbycusis is a type of hearing loss that occurs with aging, and is a gradual
sensorineural loss caused by nerve degeneration in the inner ear or auditory
nerve. Its onset usually occurs around age 50, and then slowly progresses.
Early on, the person notices loss of high-frequency tone; it is harder to hear

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 consonants than vowels. The presence of background noise makes the ability
to localize sounds more difficult.

• Contrast the motions used to straighten the ear canal when using the otoscope with an infant
versus an adult.

When using an otoscope for examination of an infant or child younger than

age 3, pull the pinna straight down in order to match the slope of the ear
canal. For an adult, pull the pinna up and back. See Fig. 15-17, p. 358.

• Describe normal and abnormal appearance of the ear drum.

A pearly gray color of the eardrum is a normal finding. For the other
descriptions, refer to Table 15-4, Abnormal Findings: Abnormal Findings Seen
on Otoscopy, p. 368.

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