Approach to Neuro Complaint Flashcards by Natalie Tupper

History if a pt has an eye complaint

age
pregnant
glasses?
injuries/trauma
surgeries
eye infections
recent travel
current eye issues

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Associated symptoms for eye complaints

pain
drainage
itching/burning
vision change
blurry vision
flashing lights

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relevant ROS for eye complaints

general (fever)
neuro
CV (chest pain)
endocrine (HYPERGLYCEMIA)
MSK
Skin (dry skin, dry eyes)
GI (autoimmne disease)

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diabetic retinopathy

high blood sugar levels for extended period of time

vision changes, urinary changes, arthritis

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relevant past medical history

glaucoma
diabetes
thyroid disease
ASCD
collagen vascular disease
HIV

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relevant meds

some can have ocular side effects

steroids 
antihistamines
antidepressants
antipsychotics
beta blockers

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PE for eye

inspect first

brow area
perioribital area
lashes
lacrimal apparatus
conjuctiva &amp; cornea

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external inspection of eyebrows

symmetry
plucking?
falling out?
scaly skin
scars

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external inspection of periorbital area

edema
change in elasticity 
bruising
injury
allergic shiners
xanthelasma 
proptosis
dacrocystitis
rash

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if pt has evidence of xanthelasma, what should you check?

check cholesterol level

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what could proptosis & exophthalmos be associated with?

hyperthryoidism

consistent with Graves Disease

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if you find a rash in the periorbital area…

to hairline (herpes)

pastules (acne, insect bites)

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exam of external eye (eyelids & eyelashes)

remove glasses

do the lids close completely?

flakiness

erythema

swelling

scabs/new lesions

ptosis

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what are you looking for when you palpate eyelid over globe?

chalazion

hard sensation or pain may represent hyperthryroidism, glaucoma, retrobulbar tumor

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Chalazion

blocked meibomian gland

generally non-tender & non-painful unless becomes inflammed

in the LID

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Hordeolum (sty)

blocked Meibomian gland or tear eyelash follicle or tar gland

tender/painful

along the lashline

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Blepharitis

inflammation @ base of hair follicles (caused by S aureus or allergies)

collarettes near lash line & scales are on the lashes

difficult but not impossible to treat

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Lacrimal apparatus

infected tear duct

skin lesions/cancer

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Dacrocystitis

infected tear duct

in newborns v older folks (in babies, massage it to open it up)

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Conjunctiva

lower the eyelid & have pt look up

raise upper eyelid & pt look down

should be “clear”

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what does erythema of conjunctiva indicate?

subconjunctival hemorrhage (usually assoc w/ trauma, not painful & do not affect vision)

what does purulence of conjunctive indicate?

pink eye, conjunctivitis

what can foreign body in upper eyelid cause?

erythema
purulence
pterygium

pterygium

excessive sun exposure or UV light (start from middle & grow towards pupil)

conjunctivitis

viral/bacterial/allergic causes ``` pts might complain of: gritty, irritated feeling swollen eyes disharge red eyes ```

eval of cornea

should be clear check corneal sensitivity

hyphema (cornea)

can cause brown tint of cornea (blood from trauma in anterior chamber)

whitish scar on cornea

previous abrasion or ulcer

Corneal abrasions

common in ER, urgent care, primary care painful use blue light to visualize important to look for & remove foreign body

Arcus senilis

whitish linear encircling the colored iris (lipid deposition) common over 60 years (if under 40 yo, consider checking cholesterol level)

yellow or gray lens

cataract can be normal in persons w/ increased melanin but should be symmetric

what color is the red reflex?

can look white or yellow based on person's ethnicity

brown speckles on lens

cataract

what color should the sclerae be?

should be white

brown sclerae

increased melanin can be assoc w/ increased risk for glaucoma (rarely melanoma)

blue sclerae

inherited seen frequently in brittle bone disease

yellow sclerae

"Icterus" caused by neonatal jaundice, liver disease, pancreatic cancer, GB disease

melanosis oculi

little gray/light brown freckles in sclera (normal in pigmented individual) not a problem but worth noting b/c can lead to glaucoma or malignant melanoma

nevus of ota

birthmark in eye that goes up into skin

extraocular muscles

cover/uncover test

esotropia

eye turns in

exotropia

eye turns out

amblyopia

non-corrected lazy eye loss of vision

what can cause a lazy eye?

strabismus (weak extraocular muscles)

mydriasis

dilating pupils w/ Rx drops NEVER dilate w/ shallow ant chamber

papilladema

increased intracranial pressure causes intra-axonal edema along optic N dulling of sharp disc margins

cottwon wool spots

common finding in diabetic retinopathy looks like sprinkled cotton (ABnormal)

drusen bodies

yellowish, round spots sign of macular degeneration (can't focus vision)

glaucomatous cupping

increased intraocular pressure w/ in eye leads to increased cupping (backward depression of disc)

PERRLA

pupils equally round & reactive to light & acommodation