Eye Abnormalities

Question 1

Describe Ptosis

Answer 1

-Inability to close the eye may be seen with CN III problem

Question 2

What would Yellow sclera indicate?

Answer 2

• Jaundice
• Described as scleral icterus
• If jaundice is NOT present, sclera are anicteric

Question 3

Abnormalities of conjunctivae for color & exudates

Answer 3

• Bulbar (covers the eyeBall)

- Palpebral (lines the eyelids)

Question 4

How do you look at conjunctivae?

Answer 4

Ask patient to look up while you pull down lower lids to examine

Question 5

Conjunctiva pallor indicates what?

Answer 5

Anemia

Question 6

Red or swollen conjunctiva indicates what?

Answer 6

Injection – caused by dilation of blood vessels secondary to an inflammatory or infectious process

Question 7

Describe Pinguecula

Answer 7

• Yellowish growth on the sclera, adjacent to cornea, may be a precursor to pterygium
• From sun

Question 8

Describe Pterygium

Answer 8

• Wedge or wing-shaped growth may grow into cornea

- From sun

Question 9

Describe Arcus senilis

Answer 9

Ring about the margin of the cornea, common in the elderly, may indicate hyperlipidemia

Question 10

Opacity of the lens indicated what?

Answer 10

Cataract

Question 11

Describe Chalazion

Answer 11

• Meibomian gland lipogranuloma
• Cyst of the inner eyelid due to inflammation of a blocked meibomian gland
• Usu. on upper eyelid
• Chalazion is chronic, usually painless, points to inside of lid

Question 12

Describe Hordeolum

Answer 12

• External stye
• Due to infection of a sebaceous gland at margin of the eyelid
• Acute, painful, external

Question 13

What is the best way to distinguish chalazion from hordeolum?

Answer 13

1) History

2) Chalazion is chronic

Question 14

Describe Xanthelasma

Answer 14

• Sharply demarcated yellowish deposit of cholesterol underneath the skin, usu. around the eyelids
• Hereditary component – more common in people of Asian descent or from Mediterranean region

-May or may not indicate high lipid levels

Question 15

Describe Periorbital cellulitis

Answer 15

• Infection & inflammation of the eyelid & portions of the skin around the eye
• Must differentiate between orbital cellulitis (a medical emergency)

Question 16

Describe Orbital cellulitis

Answer 16

-Assoc. with – proptosis (bulging eye), limited movement (ophthalmoplegia), pain with eye movement, or loss of vision

Question 17

Describe Exopthalmos (proptosis)

Answer 17

• Protrusion of the eyes
• Rim of sclera between upper lid & iris visible
• Produces characteristic stare
• Associated with Graves disease (type of hyperthyroidism)
• Also see lid lag

Question 18

Describe the differences between Episcleritis vs Scleritis vs conjunctivitis

Answer 18

• Episclera – between the conjunctiva & sclera
• Episcleritis has abrupt onset

-Scleritis – gradual onset, more severe, pain, ↓ vision, commonly assoc. with systemic autoimmune / inflammatory disease

• Episcleritis vs conjunctivitis
• Episcleritis more localized

Question 19

Describe Uveitis

Answer 19

• Inflammation of the uveal tract (iris, ciliary body, & choroid)
• If limited to iris = iritis
• Painful (with consensual pupillary light reflex)
• Limbic flush (inflammation around the iris)
• Commonly assoc. with systemic autoimmune / inflammatory disease

Question 20

Describe Subconjunctival hemorrhage

Answer 20

• Painless, small blood vessel breaks

- Can occur with injury, increased pressure (↑BP, cough, sneeze), blood thinning medication

Question 21

Describe Hyphema

Answer 21

• Bleeding in the ant. chamber

- Usu. due to trauma

Question 22

Describe Myopia

Answer 22

Impaired far vision

Question 23

Describe presbyopia

Answer 23

Impaired near vision

Question 24

What does a crescent shadow on the medial aspect of the iris signify?

Answer 24

• Shadow created if the iris bows abnormally forward –> creates a narrow ACUTE angle with the cornea (a shallow ant. chamber) –> then light casts a crescent shadow
• The narrow angle (shallow chamber) increases risk of acute angle-closure glaucoma (sudden increase in intraocular pressure (IOP) that threatens sight)

Question 25

What are the different types of glaucoma and what does it cause?

Answer 25

1) Acute angle closure glaucoma (aka narrow angle or closed angle glaucoma) - Less common form - Results in sudden increase in Intra Ocular Pressure (IOP) & eye pain - Crescent shadow present 2) Open angle glaucoma - Common form - IOP is increased but angle is normal - No crescent shadow present

Question 26

What does an Abnormal, asymmetric corneal light reflection indicate?

Answer 26

- Strabismus (deviation from normal conjugate position) | - Due to imbalance of extraocular eye muscle tone or paralysis of 1 or more extraocular eye muscles

Question 27

Describe the different Strabismus

Answer 27

- Convergent (internal) strabismus, aka esotropia - Eye moves inward - Divergent (external) strabismus, aka exotropia - Eye moves outward

Question 28

Describe Pupil inspection

Answer 28

- Inspect size, shape, equality - Miosis → constriction - Mydriasis → dilation

Question 29

Describe Horner’s Syndrome

Answer 29

1) Ptosis 2) Anhidrosis: absent sweating on the affected side 3) Miosis (or “PAM”): unequal pupil size = Anisocria - Due to dysfunction of the sympathetic nervous system - May be congenital or assoc. with disease [e.g. Pancoast tumor (lung cancer tumor in apex of the lung)]

Question 30

Describe Tonic (Adie’s) Pupil

Answer 30

- Affected pupil is larger - Reduced reaction to light (mydriasis) - Reduced near reaction - Due to dysfunction of parasympathetic nervous system - Most commonly affects young women, cause unknown

Question 31

What cranial nerves innervate the eye muscles?

Answer 31

- LR6 SO4 AO3 - Lateral rectus CN VI (Abducens) - Superior oblique CN IV (Trochlear) - All others CN III

Question 32

If pupils are normal & react normally to light & accommodation, can document what?

Answer 32

PERRLA: Pupils Equal Round & Reactive to Light & Accommodation

Question 33

What if red reflex is absent?

Answer 33

-May be due to opacity of the lens (e.g. cataract), retinal detachment, retinoblastoma, other disease, artificial eye - Retinoblastoma – childhood cancer of the retina - Will see white light – leukocoria

Question 34

What is the cup-to-disc ratio used for?

Answer 34

- To assess the progression of glaucoma. | - As glaucoma advances, the cup enlarges until it occupies most of the disc area.

Question 35

What is Papilledema?

Answer 35

Optic disc swelling assoc. with increased intracrainial pressure

Question 36

Describe Hypertensive retinopathy

Answer 36

- “dry” retina | - Few hemorrhages, few exudates, multiple cotton wool spots

Question 37

Describe Diabetic retinopathy

Answer 37

- “wet” retina | - Multiple hemorrhages, multiple exudates, few cotton wool spots

Question 38

What is the difference between Central retinal vein occlusion vs central retinal artery occlusion

Answer 38

VEIN occlusion: When this fluid collects in the macula | ARTERY occlusion: "Cherry red spot"