Approach to Eye Complaint LECTURE

Question 1

What relevant PMH is associated with eye involvement/changes/problems?

Answer 1

glaucoma
diabetes mellitus
thyroid disease
ASCD (arteriosclerotic coronary disease)
Collagen vascular disease
HIV
IBS

Question 2

What relevant medications are associated with eye involvement/changes/problems?

Answer 2

steroids
plaquenil (preventing or treating malaria)
antihistamines
antidepressants
antipsychotics
antiarrhythmics
beta blockers

Question 3

What external eye features should you examine in the periorbital area?

Answer 3

brow: alopecia? scaly?
periorbital area: elasticity changes (from topical meds), allergic shiners (black eyes from allergies) exopthalamos (hyperthyroidism, SCREAMS), rash (herpes, shingles)

Question 4

What external eye features should you examine in the eyelids/eyelash area?

Answer 4

ptosis
chalazion (nontender, IN THE LID)
hordeolum (tender, along lash line)
blepharitis (inflammation, VERY RED)

Question 5

What external eye features should you examine in the lacrimal apparatus area?

Answer 5

Punctae (skin lesions, autoimmune disease)

Dacrocystitis (newborn with big cyst-like red dots by eye) will go away on its own

Question 6

What external eye features should you examine in the conjuctiva area?

Answer 6

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)

Question 7

Causes of Conjunctivitis? PT presentation?

Answer 7

Viral/bacterial/allergic causes

Gritty, irritated feeling • Swollen eyelids • Discharge • ”Red eyes”

Question 8

What eye features should you examine in the cornea?

Answer 8

SHOULD BE: Clear

Question 9

What CNs are you testing with Corneal sensitivity cotton swab

Answer 9

Sensory CN V to feel, CN VII to blink

Question 10

What does it mean if Cornea is brown?

Answer 10

hyphema (blood from trauma in anterior chamber)

Question 11

What does it mean if Cornea is white? or has a white line around the outside?

Answer 11

white: abrasion

white line: arcus senilis (common over 60 YO, if under 40 CHECK CHOLESTEROL?

Question 12

What is the red reflex? What colors should lens be? (what if they are yellow? gray? have brown speckles?)

Answer 12

lens should be clear/transparent

Yellow or gray or speckled- cataract (can be different if person has increased melanin, but should be symmetric?

Question 13

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?

Answer 13

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

Question 14

What is Esotropia? Exotropia?

Answer 14

ES: eye turns in
EX: eye turns out
(your ~ex~ is out the door

Question 15

When esotropia is identified in kids, what is the treatment?

Answer 15

1) Patching
2) Surgery
- If not treated, brain focuses on unaffected dye, and the loss of vision is called ‘amblyopia’

Question 16

When you should not dilate a patient?

Answer 16

Never dilate when patient has a shallow anterior chamber – dilation may trigger an acute narrow angle glaucoma.

Question 17

What is Papilledema?

Answer 17

Increased intracranial pressure causes intraaxonal edema along the optic nerve, leading to swelling and engorgement of the optic dis

Question 18

What are cotton wool spots? What PTs should you see these in?

Answer 18

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.

Question 19

What are drusen bodies? When do you see them?

Answer 19

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.

Question 20

What is Glaucomatous Cupping

Answer 20

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

Question 21

How would you document a normal exam?

Answer 21

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.