External Eye Physical Exam

Question 1

hyperopia

Answer 1

means they eye has far sight but poor near sight

Question 2

myopia

Answer 2

eye has near sight but poor far sight

Question 3

presbyopia

Answer 3

with age (>40y/o) the lens loses its elasticity and causes diminished near sight but continued far sight

Question 4

vitreous floaters

Answer 4

another common complaint in people >50 y/o and some young people. Patients describe them as moving cobwebs, spots, smudges

Question 5

near vision

Answer 5

tested with Rosenbaum chart/newsprint at 14”, one eye at a time then both together
-indirectly: a screening test of the anterior segment of the eye, central vision, the optic nerve and the visual centers in the brain

Question 6

peripheral vision

Answer 6

roughly assessed by the or by moving wiggling finger slowly into the field of vision from the top, bottom, and both sides of each eye

Question 7

visual field deficits

Answer 7

abnormalities of the anterior segments of the eye, chronic glaucoma, retinal detachments and neural lesions along the visual pathway

Question 8

CN III, IV, AND VI

Answer 8

cardinal planes of gaze: giant asterick or capital “H” drawn in the air

Question 9

corneal light reflection and the cover-uncover test

Answer 9

ways to check symmetrical alignment of the eyes and therefore binocular fixation. If there is strabismus/refractive difference bw eyes the brain will suppress the poorer image => amblyopia & monocular vision

Question 10

corneal light reflection

Answer 10

light shone at the eyes from a central position should cast a corneal reflection on the same point in each eyes
-asymmetrical=>acquired or congenital muscle imbalance=>strabismus

Question 11

cover-uncover test

Answer 11

instruct the patient to fix their gaze on an object; the doctor then covers one eye with their hand looking for movement of the other eye, the doctor then uncovers the eye and checks for movement of that eye.

• movement: acquired/congenital muscle imbalance=>strabismus
• when eyes fail to work in a conjugate fashion monocular vision will occur, which effects depth perception

Question 12

lid (lag) retraction

Answer 12

upper lid is slow to react as the eye looks down exposing the sclera bw the lid margin and iris
-suggests hyperthyroidism, 7th CN damage/tumor behind the eye if unilateral

Question 13

lid (sag) ptosis

Answer 13

congenital/acquired weakness of the levator muscle or paresis of a branch of the 3rd CN causes the upper lid to droop compared to the opposite eye

Question 14

blephaitis

Answer 14

inflammation of the eyelash follicles & Meibomian glands resulting in red, swollen, crusty lid margins; associated with allergies, seborrheic dermatitis & psoriasis

Question 15

sty(e) (hordeolum)

Answer 15

bacterial infection of a gland in an eyelash follicle causing a well circumscribed red, swollen tender pustule

Question 16

chalazion

Answer 16

hard, painless papule on the eyelid due to an obstruction of a meibowmian (oil) gland

Question 17

ectropion

Answer 17

loss of orbicularis oculi muscle tone with ageing causing the lower lid to turn outward interfering with proper tear drainage; => 7th CN palsy

Question 18

entropion

Answer 18

inversion of the lower lid due to scar tissue formation on the inner surface of the lid; eyelashes then irritate the conjunctiva and cornea

Question 19

dacryocystitis/dacryostenosis

Answer 19

inflammation of the tear sac secondary to chronic obstruction or narrowing of the nasolacrimal duct. A painful swollen nodule develops bw the nose and eye with accompanying tearing & discharge; usually in infants

Question 20

contagious conjunctivitis (pink eye)

Answer 20

• self-limiting bacterial/viral infection causing red, burning, itchy eyes with a discharge that tends to stick the eyelids together overnight
• pain is minimal, vision is not affected and BV dilate from the periphery toward the center of the eye sparing the area surrounding the cornea (limbus)

Question 21

allergic/chemical conjunctivitis (environmental irritants)

Answer 21

have the same signs and symptoms but perhaps less thick discharge

Question 22

pinguecula

Answer 22

yellow elastic fibers form a plaque on either side of the cornea resulting from chronic irritation to teh bulbar conjunctiva

Question 23

pterygium

Answer 23

sunny, dusty, windy conditions may stimulate growth of the pinguecula forming a vascular membrane that may extend over the cornea

Question 24

aubconjunctival hemorrhage

Answer 24

microtraumas like coughing, sneezing or straining may cause a conjunctiva vessel to break trapping blood bw the clear mucous membrane and the sclera

Question 25

yellow sclera

Answer 25

as people age the sclera thins and fatty deposits may show through; jaundice causes uniform yellowing of the sclera where it often appears before other tissues turn yellow (natural light reveals it best)
-antimalarial drugs

Question 26

blu sclera

Answer 26

osteogenesis imperfecta may thin the sclera allowing the choroid to show through giving the sclera a blue color

Question 27

brown sclera

Answer 27

patches of melanin are common in people with dark complexions

Question 28

corneal abrasions

Answer 28

once surface is broken, it is extremely painful, visual acuity is disrupted commensurate with the injury and conjunctival vessels radiate out from the limbus

Question 29

corneal arcus/ring

Answer 29

grayish band along part of the edge of the limbus initially, eventually encircling the entire cornea; not considered clinically significant in people over 60 y/o; under 40 y/o=> hyperlipidemia

Question 30

kayser-Fleischer ring

Answer 30

golden-brown band around the limbus of the cornea associated with Wilson’s disease