Lecture 6: Eye Exam Flashcards
What is relevant history to ask about if a patient has an eye complaint?
- Age
- Prengnant
- Glassess/contacts
- Injuries/trauma
- Eye infections
- Recent travel
What are some symptoms you can inspect when people come in with an eye complaint?
- Pain
- Drainage
- Itching/burning
- Vision changes or bluriness
- Flashing lights
What is relevant PMH related to eye complaints?
- Glaucoma
- DM
- Thyroid disease
- ASCD (atherosclerotic coronary disease)
- Collagen Vascular disease
- HIV
- IBD
What are relevant medications related to eye complaints?
- Steroids
- Plaquenil
- Antihistamines
- Antidepressants
- Antipsychotics
- Antiarryhtmics
- Beta Blockers
When inspecting the external structures of the eye, what features are you looking at?
- Eyebrow area
- Periorbital area
- Lashes
- Lacrimal apparatus
- Conjuctiva
- Cornea
What are important features to look for when inspecting eyebrows?
- Scaly skin (seborrheic dermatitis)
- Scars
- Symmetry
- Plucking or falling out
What are important features to look for when inspecting eyelids and lashes?
- Ptosis
- Lids invert/evert
- Erythema/swelling
- Scabs
What are important features to look for when inspecting periorbital area?
- Edema
- Changes in elasticity
- Bruising
- Injury
- Allergic shiners
- Xanthelasma
- Cholesterol issues
- Expothalamos
- Dracocystitis
- Rashes
What is xanthelasma?
- Benign soft yellow plaques filled with cholesterol
- Most often on medial aspects of eyelids
- Dyslipidemia in 50% of patients but also classic for primary biliary cholangitis associated with hypercholesterolemia
What is a chalazion?
- Blocked Meibomian gland in the lid
- Painless unless inflammed
- More common on upper eyelid
What is a hordeolum (stye)?
- Blocked meibomian gland, tear eyelash follicle, or tear gland
- Painful inflammation
- Along lash line
What is blepharitis?
What causes it?
- Inflammation at the base of hair follicles
- Often due to S. aureus
What can affect the lacrimal apparatus?
- Punctae:
- Skin lesions
- Auto immune diseases
- Dacrocystitis: infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac
When looking at conjunctiva, what is normal and what is abnormal
- Normal: clear
- Abnormal
- Erythema: subconjunctival hemorrhage
- Purulence: Pink eye or conjunctivitis
- Pterygium: pinkish, triangular tissue growth on the cornea of the eye
What are symptoms of conjunctivitis?
- Gritty/irritated feelign
- Swollen eyelids
- Discharge
- Red eyes
What are fluorescein stain use for?
- Used to identify epithelial defect (ex: corneal abrasion)
- Perform after complete screening exam
How do you test for red reflex?
What are you looking for?
- Have patient look directly at light at arm length away
- Reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope
What are cotton wool spots?
Who are more suspectible to develop this?
- White or grayish ovoid lesions w/ irregular soft borders
- Results from extruded axoplasm from retinal ganglion cells caused by micoinfarcts of retinal nerve fiber layer
- Seen in patients w/ hypertension, HIV, or diabetes
What are drusen bodies?
- Yellowish, round spots that concentrate at posterior pole b/t optic disc and macula
- Precursors to macular degeneration
What is glaucomatous cupping?
- Increased intraocular pressure within eye that leads to increased cupping (backwards depression of the disc) and atrophy
- Higher ratios can suggest glaucoma
- Arcus senilis
- Lipid deposition encircling iris
- Common in people over 60
- If < 40 years, check cholesterol
- Papilledema
- Indicative of increased intracranial pressure
- Retinal proliferation is commonly seen (along with cotton wool spots) in patients with _ and _
- HTN and DM
