Term
| Understand the significance of unilateral and bilateral exophthalmos (proptosis) |
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Definition
Unilateral exophthalmos: indicative of retro-orbital tumors, intracranial AV fistula, periorbital bacterial cellulitis (in children)
Bilateral exophthalmos: indicative of Graves' hyperthyroidism, leukemia, lymphoma
in any case, leads to corneal drying and limits movement of the globe |
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Term
| What role(s) does auscultation play in examination of the eyes? |
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Definition
auscultate with bell
1. continuous bruit of an AV fistula - may be located as far back as the carotid siphon
2. bruits assoc. w/ hyperthyroidism, carotid artery occlusive disease, or severe anemia |
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Term
| Describe the eye findings of Graves' disease. |
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Definition
Graves' disease: autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones
Associated eye findings:
(1) dryness and irritation
(2) upper eyelid retraction, redness (erythema), conjunctivitis, and bulging eyes (proptosis)
(3) chemosis (conjunctival edema) <- decreased lymph drainage |
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Term
| Differentiate between chalazia and hordeolums in terms of origin, location and clinical presentation and significance. |
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Definition
Chalazia
Origin: meibomian glands
Location: posterior margin of lid
clinical presentation: painless bead-like nodule; otherwise normal, chronic, non-infection
significance: chronic inflammation of meibomian glands
Hordeolums (sty)
Origin: infection with Staphylococcus aureus
Location: external-> hair follicle of eyelash; internal-> inflammation on the conjunctival surface of lid
clinical presentation: tender red inflammatory process, acute, assocated with pus and infection
significance: acute inflammation of the eyelid |
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Term
| Describe the mechanisms responsible for chemosis. |
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Definition
chemosis - conjunctival edema
1. Increased vascular permeability - hypersensitivity (allergic) reactions and local infections
2. Venous congestion - SVC obstruction or right ventricular heart failure
3. Decreased plasma oncotic pressure - nephrotic syndrome or liver failure.
4. Decreased lymphatic drainage - Graves' disease
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Term
| Differentiate between conjunctival hemorrhages (petechial hemorrhages) and larger bulbar conjunctival hemorrhages in terms of location, size, etiology and significance. |
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Definition
petechial conjunctival hemorrhages
Location - palpebral conjunctiva
size - small
etiology -
significance - infectious endocarditis (Infectious endocarditis or Small vessel vasculitis)
bulbar conjunctival hemorrhages
Location - bulbar conjunctiva
size - large
etiology - local trauma
significance - indicative of local trauma, acute venous hypertension, sustained venous hypertension (SVC obstruction), and in blood clotting disorders |
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Term
| Know the significance of scleral icterus and blue sclerae. |
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Definition
scleral icterus (jaundice) - yellow discoloration of the bulbar conjunctiva, NOT the discoloration of the sclera
indicative of hepatic dysfunction or biliary tract obtruciton whenever serum concentration of bilirubin increases
blue sclerae - indicative of osteogenesis imperfecta > Marfan's or Ehlers-Danlos > severe iron deficiency anemia
normal in newborns and infants |
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Term
| Understand which structures contribute to the refractive power of the eye. What are their relative contributions? |
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Definition
Cornea and the lens contribute to the refractive (focusing) power of the eye.
cornea > lens |
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Term
| Differentiate between a pterygium and a pingueculum in terms of location, composition, clinical presentation and significance. |
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Definition
Pterygium
Location: grows across the cornea, from medial -> lateral (in bulbar conjunctiva)
composition: triangular fibrovascular thickening of the bulbar conjunctiva
clinical presentation: may interfere with vision if it grows across the pupil; history of exposure to UV light
Pingueculum
Location: either side of the iris, in bulbar conjunctiva
composition: yellow, fatty nodule in the bulbar conjunctiva
clinical presentation: asymptomatic, harmless, doesn't affect vision
significance: occurs with aging, chronic sun exposure, and dry and windy conditions |
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Term
| What corneal finding is pathognomonic for herpetic keratitis? |
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Definition
dendrtic ulcer
(esp. for herpes simplex keratitis and less so for herpes zoster keratitis) |
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Term
| Compare corneal arcus, band keratopathy, and Kayser-Fleischer rings in terms of clinical presentation, etiology and their ability to interfere with vision. |
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Definition
corneal arcus
- gray white lipid deposit that parallels the edge of the cornea at the limbus
clinical presentation: middle age, later life, young adults iwth elevated serum lipids
etiology: lipid deposit
interfere vision?: NO EFFECT ON VISION
Band keratopathy
- manifestation of hypercalcemia
clinical presentation: extends across the anterior corneal surface; patients have renal failure, sarcoidosis, and malignancies
etiology: calcium deposition within the corena
interfere vision?: Obscures vision
Kayser-Fleischer ring - golden-brown or green ring at the periphery of the cornea
clinical presentation: Wilson's disease (hepatolenticular degeneration)
etiology: copper deposition
interfere vision?: No
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Term
| A 42 y/o male patient presents with increased appetite, but weight loss, anxiety, weakness, and fatigue. On examination of the eyelid, lid lag is present. Ausculatation with the bell over the eye reveals a non-continuous bruit. What does the patient have? |
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Definition
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Term
| List the causes of corneal drying (KELPS) |
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Definition
- Exophthalmos (proptosis) - also limits movement of the gobe.
- Lagopthalmos - inability to close the eye (CN 7); leads to ulceration too.
- Keratoconjunctivitis sicca - dry eyes resulting from inadequate tear production
- Sjogren's syndrome - autoimmune disease characterized by dry eyes, dry mouth, and arthritis
- Ectropion - outward turning of the eyelid margin
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