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
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
3
Q
Name relevant PMH for eye complaint.
A
- Glaucoma
- DM
- Thyroid Disease
- ASCD
- Collagen Vascular Disease
- HIV
- Inflammatory Bowel Disease
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
5
Q
What is the first thing you do with an eye exam?
A
Inspection
6
Q
Name external structures to inspect.
A
- Eyebrows
- Periorbital area
- Eyelashes
- Lacrimal apparatus
- Conjunctiva
- Cornea
7
Q
What should you look out for with inspection of the eyebrows?
A
- Symmetry
- Plucking (?)
- Falling out (?)
- Scaly skin (seborrheic dermatitis)
- Scars
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)
9
Q
What should you do first when inspecting eyelids/eyelashes?
A
Ask the patient to remove their glasses
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?
11
Q
A patient is at risk for ___ if eyelids do not close completely.
A
Corneal abrasions
12
Q
What can erythema of the eyelids/eyelashes indicate?
A
- Contact dermatitis/allergies
- Blepharitis
13
Q
Scabs or new skin lesions of the eyelids can indicate ___.
A
basal cell carcinoma or squamous cell carcinoma
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)
15
Q
A
CHALAZION
- blocked Meibomian gland
- exam: nontender, nonpainful unless inflamed
- within the eyelid
16
Q
A
HORDEOLUM
- blocked Meibomian gland (inner margin) OR tear eyelash follicle or tear gland
- exam: (+) tender, (+) painful
- along the. lashline
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
18
Q
A
DACROCYSTITIS
19
Q
What would you look at when evaluating the lacrimal apparatus?
A
punctate lesions
[can indicate skin lesions/CA or autoimmune disease]
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
21
Q
Erythema of the conjunctiva can inidicate ___.
A
subconjunctival hemorrhage
22
Q
Purulence of the conjunctiva can indcate ____.
A
pink eye/conjunctivitis
23
Q
A
pterygium
24
Q
A
subconjunctival hemorrhage
25
conjunctivitis
26
What are causes of conjunctivitis?
* virus
* bacteria
* allergy
27
What are complaints related to conjunctivitis?
* gritty, irritated feeling
* swollen eyelids
* discharge
* "red eyes"
28
Brown tint in cornea occurs from **hyphema**.
What is a hyphema?
blood from trauma found within the anterior chamber
29
White scar in the cornea can indicate \_\_\_\_.
previous abrasion or ulcer
30
Describe the test for corneal sensitivity.
* Perform the exam superficial (not too deep or else possible abrasion)
* Tests **CN V** (corneal sensation) and **CN VII** (blink reflex)
31
How can you test for corneal abrasion?
Fluoroscein stain and blue light
32
whitish linear (lipid deposition) encircling the colored iris
**ARCUS SENILI****S**
* common in \>60 y/o
* if \<40 y/o - check cholesterol level
33
What reflex is tested with the lens?
"Red" reflex
34
Normal "red" reflex should be clear or transparent.
**Yellow** or **gray** can indicate \_\_\_.
cataracts
## Footnote
[\*in person w/ high melanin, this can also be the color, but should be symmetric]
35
Normal lens should be clear or transparent.
**Brown speckles** can indicate \_\_\_.
cataracts
36
cataracts
37
Normal sclera color should be **white**.
**Brown or gray spots** can be \_\_\_\_.
* can be a birthmark
* increased melanin in sclera
* can be associated with increased risk for glaucoma, rarely melanoma
38
Normal sclera color should be **white**.
**Blue** can be \_\_\_\_.
inherited *and* seen frequently in **brittle bone disease**
39
Normal sclera color should be **white**.
**Yellow** can indicate \_\_\_\_.
"scleral icterus"
causes: neonatal, liver disease, pancreatic CA, GB disease
40
**Blue sclerae:** inherited, seen frequently in brittle bone disease
41
**Nevus of Ota**
* excessive melanocytes in the tissue causing hyperpigmentation of the eye
42
oculodermal melanocytosis
43
Test the **extraocular muscles**.
44
Esotropia and exotropia are forms of \_\_\_\_\_\_, referring to weak extraocular muscles.
strabismus (commonly called "lazy eye")
45
When "lazy eye" is identified in young, what would help?
1. Patching.
2. If patching fails, then surgery indicated.
46
What happens if the "lazy eye" is not treated?
Brain will choose to focus with unaffected eye and the other eye will lose vision (**amblyopia**).
47
What is **amblyopia**?
weak vision (also referred to as "lazy eye")
48
What is **mydriasis**?
dilated pupils with prescription drops
49
When should you never **dilate** the pupils?
when the patient has a _shallow anterior chamber_
can trigger an _acute narrow angle glaucoma_
50
Name the proper way to use ophthalmoscope.
51
Identify structures that arrow is pointing to.
52
What is **papilledema**?
increased ICP causes intra-axonal edema along optic nerve causing swelling and engorgment of the optic disc
53
Compare **arterioles** and **venules**.
* Arterioles are **smaller**.
* Arterioles are **brighter** (b/c oxygenated blood).
54
What are **cotton wool spots**?
* 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
What are **drusen bodies**?
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
What is **glaucomatous cupping**?
* 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
How do you document an eye exam?
