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
What are cataracts?
How can you detect catarcts?
- Clouding of the lens in your eye
- Detected via red reflex test
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
In what patients can there be a lighter red reflex that appears yellow, orange or pink?
- Patients with a lighter colored eyes
- African Americans
People with blue sclera have an increased risk of what?
What should it not be confused with?
- Bone disease
- Nevus of Ota: birthmark blue sclera and periorbital tissues
What is the cover.uncover test
- Used to identify weakness of EOM
- Eyes should remain synchronous regardless of being covered
- Watch for drift as eye is uncovered
What is esotropia and exotropia?
Esotropia: eyes turne in
Exotropia: eyes turned out
Both are forms of strabismus (aka lazy eye)
If a patient has a shallow anterior chamber, should you dilate the eyes with eye drops?
No!!
Dilation can tigger an acute narrow angle glaucoma
What techniques should utlize for an opthalmoscopic exam?
- Right eye with opthalmoscope in right hand to examine patient’s right eye and vice versa
- Patient should focus on distant point in front of them
- Start 10-15 inches laterally from eye and move in 1-3 inches from the eye
- Follow lateral blood vessel
- Then optic disc
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
- What is icterus and what causes it
- Yellow sclera
- Causes
- Neonatal liver disease
- Pancreatic cancer
- GB disease
- What’s worse, horizontal or vertical nystagmus?
- Vertical
- Arterioles and venules of the eye
- Arterioles are smaller and brighter
- Papilledema
- Indicative of increased intracranial pressure
- Retinal proliferation is commonly seen (along with cotton wool spots) in patients with _ and _
- HTN and DM
