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PCM EX 2 > 5a. Approach to Eye Complaint > Flashcards

5a. Approach to Eye Complaint Flashcards

1
Q

What are the associated symptoms for eye complaints?

A
  • Pain
  • Drainage
  • Itching or burning
  • Vision change
  • Blurry vision
  • Flashing lights
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2
Q

Name relevant ROS for eye complaint.

A
  • General: fever, weight change
  • Neuro: headache, motor wkn, speech/swallow, dizziness, poor balance
  • CV: dysrhythmias, chest pain
  • Endocrine: polydipsia, polyuria, hyperglycemia
  • MSK: back pain or joint pain
  • Skin: frequent infxn, dry skin
  • GI: change in bowel function
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3
Q

Name relevant PMH for eye complaint.

A
  • Glaucoma
  • DM
  • Thyroid Disease
  • ASCD
  • Collagen Vascular Disease
  • HIV
  • Inflammatory Bowel Disease
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4
Q

Name somer elevant medications that can have ocular side effects.

A
  • Steroids
  • Plaquenil
  • Anti-histamines
  • Anti-depressants
  • Anti-psychotics
  • Anti-arrhythmics
  • Beta-blockers
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5
Q

What is the first thing you do with an eye exam?

A

Inspection

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6
Q

Name external structures to inspect​.

A
  • Eyebrows
  • Periorbital area
  • Eyelashes
  • Lacrimal apparatus
  • Conjunctiva
  • Cornea
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7
Q

What should you look out for with inspection of the eyebrows?

A
  • Symmetry
  • Plucking (?)
  • Falling out (?)
  • Scaly skin (seborrheic dermatitis)
  • Scars
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8
Q

What should you look for with inspection of the periorbital area?

A
  • Edema
  • Change in elasticity (lipoatrophy or lipohypertrophy from topical meds)
  • Bruising
  • Injur
  • Allergic shiners
  • Xanthelasma (may indicate high cholesterol)
  • Proptosis/exopthalmos (may indicate hyperthyroidism)
  • Dacrocystitis
  • Rash (shingles vs. pustules that indicate acne or bites)
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9
Q

What should you do first when inspecting eyelids/eyelashes?

A

Ask the patient to remove their glasses

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10
Q

What should you check for when inspecting eyelid/eyelashes?

A
  • Do the lids close completely?
  • Is there flakiness or crustiness?
  • Is there erythema?
  • Is there swelling?
  • Are there scabs or new skin lesions?
  • Is there ptosis?
  • Do the eyelids invert/evert?
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11
Q

A patient is at risk for ___ if eyelids do not close completely.

A

Corneal abrasions

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12
Q

What can erythema of the eyelids/eyelashes indicate?

A
  • Contact dermatitis/allergies
  • Blepharitis
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13
Q

Scabs or new skin lesions of the eyelids can indicate ___.

A

basal cell carcinoma or squamous cell carcinoma

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14
Q

Hard sensation or pain with palpation of the eyelid can indicate ___.

A

hyperthyroidism, glaucoma, or retrobulbar tumor

(also sometimes chalazion palpable through eyelid)

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15
Q
A

CHALAZION

  • blocked Meibomian gland
  • exam: nontender, nonpainful unless inflamed
  • within the eyelid
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16
Q
A

HORDEOLUM

  • blocked Meibomian gland (inner margin) OR tear eyelash follicle or tear gland
  • exam: (+) tender, (+) painful
  • along the. lashline
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17
Q
A

BLEPHARITIS

  • inflammation at the base of the hair follicles often from S. aureus
  • can also be caused by allergies
  • difficult but not impossible to treat
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18
Q
A

DACROCYSTITIS

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19
Q

What would you look at when evaluating the lacrimal apparatus?

A

punctate lesions

[can indicate skin lesions/CA or autoimmune disease]

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20
Q

How would you evaluate the conjunctiva?

A
  • lower the lower eyelid and ask pt to look up
  • raise the upper eyelid and ask pt to look down
  • should be “clear”
  • consider inversion of upper eyelid if concern for FB
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21
Q

Erythema of the conjunctiva can inidicate ___.

A

subconjunctival hemorrhage

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22
Q

Purulence of the conjunctiva can indcate ____.

A

pink eye/conjunctivitis

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23
Q
A

pterygium

24
Q
A

subconjunctival hemorrhage

25
Q
A

conjunctivitis

26
Q

What are causes of conjunctivitis?

A
  • virus
  • bacteria
  • allergy
27
Q

What are complaints related to conjunctivitis?

A
  • gritty, irritated feeling
  • swollen eyelids
  • discharge
  • “red eyes”
28
Q

Brown tint in cornea occurs from hyphema.

What is a hyphema?

A

blood from trauma found within the anterior chamber

29
Q

White scar in the cornea can indicate ____.

A

previous abrasion or ulcer

30
Q

Describe the test for corneal sensitivity.

A
  • Perform the exam superficial (not too deep or else possible abrasion)
  • Tests CN V (corneal sensation) and CN VII (blink reflex)
31
Q

How can you test for corneal abrasion?

A

Fluoroscein stain and blue light

32
Q

whitish linear (lipid deposition) encircling the colored iris

A

ARCUS SENILIS

  • common in >60 y/o
  • if <40 y/o - check cholesterol level
33
Q

What reflex is tested with the lens?

A

“Red” reflex

34
Q

Normal “red” reflex should be clear or transparent.

Yellow or gray can indicate ___.

A

cataracts

[*in person w/ high melanin, this can also be the color, but should be symmetric]

35
Q

Normal lens should be clear or transparent.

Brown speckles can indicate ___.

A

cataracts

36
Q
A

cataracts

37
Q

Normal sclera color should be white.

Brown or gray spots can be ____.

A
  • can be a birthmark
  • increased melanin in sclera
  • can be associated with increased risk for glaucoma, rarely melanoma
38
Q

Normal sclera color should be white.

Blue can be ____.

A

inherited and seen frequently in brittle bone disease

39
Q

Normal sclera color should be white.

Yellow can indicate ____.

A

“scleral icterus”

causes: neonatal, liver disease, pancreatic CA, GB disease

40
Q
A

Blue sclerae: inherited, seen frequently in brittle bone disease

41
Q
A

Nevus of Ota

  • excessive melanocytes in the tissue causing hyperpigmentation of the eye
42
Q
A

oculodermal melanocytosis

43
Q

Test the extraocular muscles.

A
44
Q

Esotropia and exotropia are forms of ______, referring to weak extraocular muscles.

A

strabismus (commonly called “lazy eye”)

45
Q

When “lazy eye” is identified in young, what would help?

A
  1. Patching.
  2. If patching fails, then surgery indicated.
46
Q

What happens if the “lazy eye” is not treated?

A

Brain will choose to focus with unaffected eye and the other eye will lose vision (amblyopia).

47
Q

What is amblyopia?

A

weak vision (also referred to as “lazy eye”)

48
Q

What is mydriasis?

A

dilated pupils with prescription drops

49
Q

When should you never dilate the pupils?

A

when the patient has a shallow anterior chamber

can trigger an acute narrow angle glaucoma

50
Q

Name the proper way to use ophthalmoscope.

A
51
Q

Identify structures that arrow is pointing to.

A
52
Q

What is papilledema?

A

increased ICP causes intra-axonal edema along optic nerve causing swelling and engorgment of the optic disc

53
Q

Compare arterioles and venules.

A
  • Arterioles are smaller.
  • Arterioles are brighter (b/c oxygenated blood).
54
Q

What are cotton wool spots?

A
  • white or grayish ovoid lesions w/ irregular “soft” borders
  • result from extruded axopolasm from retinal ganglion cells caused by microinfarcts of the retinal nerve fiber layer
  • seen in HTN, DM, HIV, etc.
55
Q

What are drusen bodies?

A

yellow, round spots that vary from tiny to small with soft or hard edges

haphazardly distributed but may concentrate at posterior pole b/w optic disc and macula

consist of dead pigment epithelial cells

seen in normal aging and age-related macular degeneration

56
Q

What is glaucomatous cupping?

A
  • increased IOP w/in the eye leads to increased cupping (backward depression of the disc and atropy)
  • base of enlarged cup is pale
  • normal = 0.4, glaucoma = 0.7
57
Q

How do you document an eye exam?

A

PCM EX 2 (11 decks)

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