Approach to Neuro Complaint

Question 1

History if a pt has an eye complaint

Answer 1

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

Question 2

Associated symptoms for eye complaints

Answer 2

pain
drainage
itching/burning
vision change
blurry vision
flashing lights

Question 3

relevant ROS for eye complaints

Answer 3

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

Question 4

diabetic retinopathy

Answer 4

high blood sugar levels for extended period of time

vision changes, urinary changes, arthritis

Question 5

relevant past medical history

Answer 5

glaucoma
diabetes
thyroid disease
ASCD
collagen vascular disease
HIV

Question 6

relevant meds

Answer 6

some can have ocular side effects

steroids 
antihistamines
antidepressants
antipsychotics
beta blockers

Question 7

PE for eye

Answer 7

inspect first

brow area
perioribital area
lashes
lacrimal apparatus
conjuctiva & cornea

Question 8

external inspection of eyebrows

Answer 8

symmetry
plucking?
falling out?
scaly skin
scars

Question 9

external inspection of periorbital area

Answer 9

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

Question 10

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

Answer 10

check cholesterol level

Question 11

what could proptosis & exophthalmos be associated with?

Answer 11

hyperthryoidism

consistent with Graves Disease

Question 12

if you find a rash in the periorbital area…

Answer 12

to hairline (herpes)

pastules (acne, insect bites)

Question 13

exam of external eye (eyelids & eyelashes)

Answer 13

remove glasses

do the lids close completely?

flakiness

erythema

swelling

scabs/new lesions

ptosis

Question 14

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

Answer 14

chalazion

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

Question 15

Chalazion

Answer 15

blocked meibomian gland

generally non-tender & non-painful unless becomes inflammed

in the LID

Question 16

Hordeolum (sty)

Answer 16

blocked Meibomian gland or tear eyelash follicle or tar gland

tender/painful

along the lashline

Question 17

Blepharitis

Answer 17

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

Question 18

Lacrimal apparatus

Answer 18

infected tear duct

skin lesions/cancer

Question 19

Dacrocystitis

Answer 19

infected tear duct

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

Question 20

Conjunctiva

Answer 20

lower the eyelid & have pt look up

raise upper eyelid & pt look down

should be “clear”

Question 21

what does erythema of conjunctiva indicate?

Answer 21

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

Question 22

what does purulence of conjunctive indicate?

Answer 22

pink eye, conjunctivitis

Question 23

what can foreign body in upper eyelid cause?

Answer 23

erythema
purulence
pterygium

Question 24

pterygium

Answer 24

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

Question 25

conjunctivitis

Answer 25

viral/bacterial/allergic causes

pts might complain of:
gritty, irritated feeling
swollen eyes
disharge
red eyes

Question 26

eval of cornea

Answer 26

should be clear

check corneal sensitivity

Question 27

hyphema (cornea)

Answer 27

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

Question 28

whitish scar on cornea

Answer 28

previous abrasion or ulcer

Question 29

Corneal abrasions

Answer 29

common in ER, urgent care, primary care

painful
use blue light to visualize
important to look for & remove foreign body

Question 30

Arcus senilis

Answer 30

whitish linear encircling the colored iris (lipid deposition)

common over 60 years (if under 40 yo, consider checking cholesterol level)

Question 31

yellow or gray lens

Answer 31

cataract

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

Question 32

what color is the red reflex?

Answer 32

can look white or yellow based on person’s ethnicity

Question 33

brown speckles on lens

Answer 33

cataract

Question 34

what color should the sclerae be?

Answer 34

should be white

Question 35

brown sclerae

Answer 35

increased melanin

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

Question 36

blue sclerae

Answer 36

inherited

seen frequently in brittle bone disease

Question 37

yellow sclerae

Answer 37

“Icterus”

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

Question 38

melanosis oculi

Answer 38

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

Question 39

nevus of ota

Answer 39

birthmark in eye that goes up into skin

Question 40

extraocular muscles

Answer 40

cover/uncover test

Question 41

esotropia

Answer 41

eye turns in

Question 42

exotropia

Answer 42

eye turns out

Question 43

amblyopia

Answer 43

non-corrected lazy eye

loss of vision

Question 44

what can cause a lazy eye?

Answer 44

strabismus (weak extraocular muscles)

Question 45

mydriasis

Answer 45

dilating pupils w/ Rx drops

NEVER dilate w/ shallow ant chamber

Question 46

papilladema

Answer 46

increased intracranial pressure causes intra-axonal edema along optic N

dulling of sharp disc margins

Question 47

cottwon wool spots

Answer 47

common finding in diabetic retinopathy

looks like sprinkled cotton (ABnormal)

Question 48

drusen bodies

Answer 48

yellowish, round spots

sign of macular degeneration (can’t focus vision)

Question 49

glaucomatous cupping

Answer 49

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

Question 50

PERRLA

Answer 50

pupils equally round & reactive to light & acommodation