- abnormal protusion of the eye

- caused by periorbital bacterial cellulitis in children

- Graves' hyperthyroidism, lymphoma, leukemia, retro-orbital tumors or intracranial AV fistulas in adults

Exophthalmos (proptosis)

- with positive proptosis exam, the distance frm orbital angle to anterior edge of the cornea exceeds this many mm for WF/WM/BF/BM

19/21/23/24 mm

- the oily superficial layer of the tear coat that helps prevent evaporation is made by these

Meibomian glands

- the major component of watery middle layer of the tear coat is made by these

Lacrimal glands

- the innermost mucoid layer of the tear coat that disperses the water evenly across the orbital surface is made by these

Goblet cells (in conjunctiva)

- excessive tearing that is commonly caused by chronic inflammation is called

Epiphora

- keratoconjunctivitis sicca (dry eyes) often occurs as an isolated finding in this group of people

Postmenopausal women

- this autoimmune disorder causes dry eyes, dry mouth, and arthritis

Sjogren's syndrome

- ausculatation of the eye with the bell can reveal these

AV fistula, bruits w/ hyperthyroidism, carotid artery occlusive disease, or severe anemia

- upper eyelid lies between these two anatomical structures

upper corneoscleral junction (limbus) and upper border of the pupil

- opening between the two eyelids

palpebral fissure

- muscle that shuts the upper eyelid during voluntary closure and involuntary blinking

- innervated by the CN VII

Orbicularis

- inability to completely close the eyelids

- occurs in comatose patients or in patients with CN VII palsy

- leads to corneal drying and ulceration

Lagophthalmos

- raises upper eyelid

- innervated by CN III

Levator Palpebral Superioris

- innervated by sympathetics

- aids in raising upper eyelid

Muller's muscle

- this palsy causes a more severe ptosis than its upper eyelid innervating counterpart

CN III (more than) Sympathetic

Lig Lag

- when sclera is visible above corneoscleral junction

while looking down

- hyperthyroidism (Graves' disease)

Chalazion

- chronic inflammation of meibomian glands near posterior margin of lid

- painless bead-like nodule

Hordeolum

- acute inflammation of eyelid usually due to Staphylococcus aureus

- can be external (hair follicle) or internal (conjunctiva)

Hordeolum

- acute inflammation of eyelid usually due to Staphylococcus aureus

- can be external (hair follicle) or internal (conjunctiva)

Ectropion

- outward turning of the eyelid margin

- commonly from aging

- leads to irritation, burning, excessive tearing (epiphora), or corneal drying

Entropion

- inward turning of the eyelid margin

- commonly from aging

- leads to irritation, burning, excessive tearing (epiphora), or corneal drying

- lies on the surface of the sclera

Bulbar conjunctiva

- lies on the undersurface of the eyelids

Palpebral conjunctiva

Pterygium

- triangular fibrovascular thickening of the bulbar conjunctiva

- grows slowly across the cornea (from nasal side)

- may interfere with vision in later stages

- associated with UV light exposure

Pingueculum

- yellow, fatty nodule in the bulbar conjunctiva on either side of the iris

- occurs w/ again, chronic sun exposure, dry and windy conditions

- usually asymptomatic, harmless (no effect on vision)

- may become inflamed --> interfere w/ contact lenses

Chemosis

- conjunctival edema

Results from

-increased vascular permeability

(allergic reactions and local infections)

- venous congestion (SVC or RV failure)

- decreased plasma oncotic pressure

(nephrotic syndrome or liver failure)

- decreased lymphatic drainage (Graves' disease)

Petechial conjunctival hemorrhage

- palpebral conjunctiva bleed

(infectious endocarditis --> heart valves or endothelial lining of the heart)

Bulbar conjunctival hemorrhage

- from local trauma, acute venous hypertension (severe coughing), sustained venous hypertension (SVC obstruction), clotting disorders

- often no cause is identified

Scleral icterus (jaundice)

- yellow discoloration of the bulbar conjunctiva (not sclera)

- manifests w/ hepatic dysfunction or biliary tract obstruction

- whenever (un)conjugated bilirubin increases

- should be visible with increase of 2.5-3 mg/dl of serum bilirubin

Osteogenesis Imperfecta (Blue Sclerae)

- can be found also in patients w/ Marfan's syndrome or Ehlers-Danlos syndrome

- rarely in pt's with severe iron deficiency anemia

- normal finding in newborns or infants

- avascular tissue innervated by CN V

- extracts oxygen from air anteriorly, glucose from aqueous humor posteriorly

- pumps water from stroma to humor to maintain clarity

- site of most of the refractive power of the eye

Cornea

- transitional zone from cornea to sclera (edge of iris)

- ciliary flush is located in this area

- 1-2 mm wide

Limbus

- Laser-assisted In Situ Keratomileusis

- microkeratome (knife) cuts flap in cornea, laser modifies corneal shape, flap is folded back

- corrects hyperopia, hypoopia, and astigmatism

LASIK

- this is used to identify corneal epithelium trauma or infection

- only reliable way to detect a corneal lesion

- corneal surface fluoresces blue-green at damaged site

- contact lenses should be removed prior to test

Fluorescein dye and cobalt-blue light

- looks like a neuronal dendrite involving the cornea

- characteristic of herpes simplex keratitis

- can also occur with herpes zoster (shingle)

Dendritic Ulcer

- most common ulcer with herpes zoster corneal outbreak

Diffuse punctate ulcer

- gray-white lipid deposit that parallels the edge of the cornea (pre-limbus)

- no effect on vision

- common in elderly

- potentially pathologic with younger people (hyperlipidemia)

Corneal arcus (arcus senilis)

- band keratopathy manifests from this condition

- calcium deposition within the cornea may extend across surface and obscure vision

- the condition can result from renal failure, sarcoidosis, and certain malignancies (tumors)

Hypercalcemia

- golden-brown or green ring (Kayser-Fleisher) at the periphery of the cornea

- results from copper deposition

- another symptom can include behavior problems

- characteristic of this disease

- also effects the liver and basal ganglia

Wilson disease (hepatolenticular degeneration)

Dendritic Ulcer

herpes simplex

Diffuse Punctate Ulcer

herpes zoster (shingles)

Band Keratopathy

hypercalcemia

- within cornea

- caused by renal failure, sarcoidosis, and certain malignancies (tumors)

Keyser-Fleisher Ring

- golden-brown or green ring at periphery of cornea

Wilson's disease (hepatolenticular degeneration)

- also affects liver and basal ganglia