Approach to Eye Complaint LECTURE Flashcards
What relevant PMH is associated with eye involvement/changes/problems?
glaucoma diabetes mellitus thyroid disease ASCD (arteriosclerotic coronary disease) Collagen vascular disease HIV IBS
What relevant medications are associated with eye involvement/changes/problems?
steroids plaquenil (preventing or treating malaria) antihistamines antidepressants antipsychotics antiarrhythmics beta blockers
What external eye features should you examine in the periorbital area?
brow: alopecia? scaly?
periorbital area: elasticity changes (from topical meds), allergic shiners (black eyes from allergies) exopthalamos (hyperthyroidism, SCREAMS), rash (herpes, shingles)
What external eye features should you examine in the eyelids/eyelash area?
ptosis
chalazion (nontender, IN THE LID)
hordeolum (tender, along lash line)
blepharitis (inflammation, VERY RED)
What external eye features should you examine in the lacrimal apparatus area?
Punctae (skin lesions, autoimmune disease)
Dacrocystitis (newborn with big cyst-like red dots by eye) will go away on its own
What external eye features should you examine in the conjuctiva area?
lower eyelid look up upper eye look down FINDINGS: erythema (subconj hem) purulence: pink eye pterygium ( pinkish, triangular tissue growth on the cornea of the eye. It typically starts on the cornea near the nose, caused by excessive UV exposure)
Causes of Conjunctivitis? PT presentation?
Viral/bacterial/allergic causes
Gritty, irritated feeling • Swollen eyelids • Discharge • ”Red eyes”
What eye features should you examine in the cornea?
SHOULD BE: Clear
What CNs are you testing with Corneal sensitivity cotton swab
Sensory CN V to feel, CN VII to blink
What does it mean if Cornea is brown?
hyphema (blood from trauma in anterior chamber)
What does it mean if Cornea is white? or has a white line around the outside?
white: abrasion
white line: arcus senilis (common over 60 YO, if under 40 CHECK CHOLESTEROL?
What is the red reflex? What colors should lens be? (what if they are yellow? gray? have brown speckles?)
lens should be clear/transparent
Yellow or gray or speckled- cataract (can be different if person has increased melanin, but should be symmetric?
What eye features should you examine in the sclerae? What color should it be? What if it’s blue? or yellow? Or has brown or gray spots?
Should be white
BLUE: Brittle bone disease
YELLOW: “Icterus”, causes: Neonatal, liver disease, pancreatic cancer, GB disease
spots: INCREASED MELANIN increased risk for glaucoma, rarely melanoma
What is Esotropia? Exotropia?
ES: eye turns in
EX: eye turns out
(your ~ex~ is out the door
When esotropia is identified in kids, what is the treatment?
1) Patching
2) Surgery
- If not treated, brain focuses on unaffected dye, and the loss of vision is called ‘amblyopia’
When you should not dilate a patient?
Never dilate when patient has a shallow anterior chamber – dilation may trigger an acute narrow angle glaucoma.
What is Papilledema?
Increased intracranial pressure causes intraaxonal edema along the optic nerve, leading to swelling and engorgement of the optic dis
What are cotton wool spots? What PTs should you see these in?
White or grayish, ovoid lesions wih irregular “soft” borders. Result from extruded axoplasm from retial ganglion cells caused by microinfarcts of the retinal nerve fiber layer. Seen in hypertension, diabetes, HIV and other conditions.
What are drusen bodies? When do you see them?
Yellowish, round spots, consist of dead pigment epithelial cells, randomly distributed but may concentrate at the posterior pole between the optic disc and the macula
Seen in: normal aging and age-related macular degeneration.
What is Glaucomatous Cupping
Increased intraocular pressure within the eye
leads to increased cupping (backward
depression of he disc) and atrophy.
Base of the enlarged cup is pale. •
Normal cup to disc ratio is 0.4.
Ratios of 0.7 suggest possible glaucoma
How would you document a normal exam?
Visual acuity 20/20. Sclera white, conjunctiva pink. Pupils are 4mm constricting to 2mm, equally round and reactive to light and accommodation. Disc margins sharp, no hemorrhages or exudates, no arteriolar narrowing.
PERRLA = Pupils equally round and reactive to light and accommodation.
