Exam 1
Eye abnormalities
Exophthalmos: bulging of eye anteriorly out of orbit
o cause: graves disease (bilateral), retro-orbital tumor (unilateral)
o Subjective: change in eye position
o Objective: eye protrusion, lids do not reach pupils,
Episcleritis: inflammation of superficial layers of sclera anterior to the insertion of rectus
muscles
o Possible causes: autoimmune disease, polyarteritis nodosa, psoriatic arthritis,
gout, foreign body, chemical exposure, infection
2 types
Simple: intermittent episodes of severe inflammation recurring in
1–3-month intervals
nodular: prolonged attacks of inflammation, more painful
o Subjective: acute onset of mild-moderate discomfort or photophobia, watery
discharge without crusting
o Objective: diffuse or localized redness of bulbar conjunctiva, purplish elevation of
a few millimeters, watery discharge
Band Keratopathy: deposition of calcium in the superficial cornea
o causes: patients with chronic disease of the cornea, Hypercalcemia,
hyperparathyroidism, trauma, renal failure, sarcoidosis, syphilis
o Subjective: decreased vision with deposition progress, foreign body
sensation/irritation
o Objective: line just below pupil- passes over the cornea rather than around the
iris as with arcus senilis, horizontal grayish bands interspersed with dark areas
that look like holes
Corneal ulcer: disruption of the corneal epithelium and stroma
o Causes: connective tissue disease (RA, Sjogren syndrome), systemic vasculitic
disorder (polyarteritis nodosa, SLE), virial or bacterial infection, extreme dryness
(incomplete lid closure, poor lacrimal gland function), prolonged use of contacts
o Subjective: pain, photophobia, Hx of wearing contacts, blurry vision, sensation of
foreign body in the eye.
o Objective: visual acuity affected variably (depending on location of ulceration),
inflammation and erythema of lid and conjunctiva, purulent exudate, ulcer is
round or oval with well-defined border, base of ulcer appears ragged and gray
Strabismus: both eyes do not focus on object simultaneously, but able to focus with
either eye
o Cause: possible cranial nerve III damage due to brain swelling
Paralytic: impairment of extraocular muscles
Non-paralytic: no primary muscle weakness
o Subjective: poor vision, sudden onset double vision, report eye deviation
, o Objective: detected by the cover-uncover test, if extra-ocular muscle is impaired
the eye will not move in the direction controlled by that muscle.
Horner syndrome: Interruption of sympathetic nerve innervation to the eye
o Causes: lesion to primary neuron, stroke, trauma to brachial plexus, tumors,
dissecting carotid aneurysm, operative trauma
o Subjective
o Objective: unilateral ptosis, miosis, hemifacial anhidrosis (droopy eyelid,
constricted pupil, half of face does not sweat)
Cataracts: opacity in lens
o Cause: denaturation of protein in lens caused by aging, hyperparathyroidism,
steroids, rubella, fetal insults during first trimester
o Subjective: cloudy/blurry vision, faded colors, light appears too bright/ halo
around light, poor night vision, frequent prescription changes
o Objective: lens cloudiness
Non proliferative Diabetic retinopathy
o Cause:
Hard exudates: lipids traveling through incompetent capillaries
Soft exudates (cotton wool spots): infarction of the nerve layer
o Subjective: asymptomatic in initial stages, visual changes and blurred vision in
advanced stages
o Objective: blood vessels with balloon like sacs (microaneurysm), blots of
hemorrhage on retina, tiny yellow patches of hard exudates
Proliferative diabetic retinopathy
o Cause: vessels grow out of the retina towards the vitreous humor. New vessels
are not supportive and are likely to hemorrhage. Hemorrhage is a common cause
of diabetes related blindness. (treatment is neovascularization)
o Subjective: asymptomatic, floaters, blurred vision in advanced stages
o Objective: must change lens setting in ophthalmoscope to see these vessels.
Vitreous hemorrhage may be present (this will obstruct view of retina)
Lipemia retinalis
o Cause: serum triglyceride above 2000 mg/dl
o Subjective: elevated serum triglyceride, no visual changes
o Objective:
Grade I: white and cream aspect of peripheral retina vessels
Grade II: creamy color of the vessels extends toward the optic disk
Grade III: retina appears salmon color and all vessels have a milky
appearance
Retinal abnormalities resolve as triglyceride levels normalize
Retinitis pigmentosa: autosomal recessive disorder with genetic defects cause cell death,
predominantly in rod photoreceptors
o Cause: associated with Usher Syndrome (deafness) and Kearns-Sayre syndrome
(paralysis of extraocular muscles, dysphasia, ataxia, cardiac conduction defects)
Eye abnormalities
Exophthalmos: bulging of eye anteriorly out of orbit
o cause: graves disease (bilateral), retro-orbital tumor (unilateral)
o Subjective: change in eye position
o Objective: eye protrusion, lids do not reach pupils,
Episcleritis: inflammation of superficial layers of sclera anterior to the insertion of rectus
muscles
o Possible causes: autoimmune disease, polyarteritis nodosa, psoriatic arthritis,
gout, foreign body, chemical exposure, infection
2 types
Simple: intermittent episodes of severe inflammation recurring in
1–3-month intervals
nodular: prolonged attacks of inflammation, more painful
o Subjective: acute onset of mild-moderate discomfort or photophobia, watery
discharge without crusting
o Objective: diffuse or localized redness of bulbar conjunctiva, purplish elevation of
a few millimeters, watery discharge
Band Keratopathy: deposition of calcium in the superficial cornea
o causes: patients with chronic disease of the cornea, Hypercalcemia,
hyperparathyroidism, trauma, renal failure, sarcoidosis, syphilis
o Subjective: decreased vision with deposition progress, foreign body
sensation/irritation
o Objective: line just below pupil- passes over the cornea rather than around the
iris as with arcus senilis, horizontal grayish bands interspersed with dark areas
that look like holes
Corneal ulcer: disruption of the corneal epithelium and stroma
o Causes: connective tissue disease (RA, Sjogren syndrome), systemic vasculitic
disorder (polyarteritis nodosa, SLE), virial or bacterial infection, extreme dryness
(incomplete lid closure, poor lacrimal gland function), prolonged use of contacts
o Subjective: pain, photophobia, Hx of wearing contacts, blurry vision, sensation of
foreign body in the eye.
o Objective: visual acuity affected variably (depending on location of ulceration),
inflammation and erythema of lid and conjunctiva, purulent exudate, ulcer is
round or oval with well-defined border, base of ulcer appears ragged and gray
Strabismus: both eyes do not focus on object simultaneously, but able to focus with
either eye
o Cause: possible cranial nerve III damage due to brain swelling
Paralytic: impairment of extraocular muscles
Non-paralytic: no primary muscle weakness
o Subjective: poor vision, sudden onset double vision, report eye deviation
, o Objective: detected by the cover-uncover test, if extra-ocular muscle is impaired
the eye will not move in the direction controlled by that muscle.
Horner syndrome: Interruption of sympathetic nerve innervation to the eye
o Causes: lesion to primary neuron, stroke, trauma to brachial plexus, tumors,
dissecting carotid aneurysm, operative trauma
o Subjective
o Objective: unilateral ptosis, miosis, hemifacial anhidrosis (droopy eyelid,
constricted pupil, half of face does not sweat)
Cataracts: opacity in lens
o Cause: denaturation of protein in lens caused by aging, hyperparathyroidism,
steroids, rubella, fetal insults during first trimester
o Subjective: cloudy/blurry vision, faded colors, light appears too bright/ halo
around light, poor night vision, frequent prescription changes
o Objective: lens cloudiness
Non proliferative Diabetic retinopathy
o Cause:
Hard exudates: lipids traveling through incompetent capillaries
Soft exudates (cotton wool spots): infarction of the nerve layer
o Subjective: asymptomatic in initial stages, visual changes and blurred vision in
advanced stages
o Objective: blood vessels with balloon like sacs (microaneurysm), blots of
hemorrhage on retina, tiny yellow patches of hard exudates
Proliferative diabetic retinopathy
o Cause: vessels grow out of the retina towards the vitreous humor. New vessels
are not supportive and are likely to hemorrhage. Hemorrhage is a common cause
of diabetes related blindness. (treatment is neovascularization)
o Subjective: asymptomatic, floaters, blurred vision in advanced stages
o Objective: must change lens setting in ophthalmoscope to see these vessels.
Vitreous hemorrhage may be present (this will obstruct view of retina)
Lipemia retinalis
o Cause: serum triglyceride above 2000 mg/dl
o Subjective: elevated serum triglyceride, no visual changes
o Objective:
Grade I: white and cream aspect of peripheral retina vessels
Grade II: creamy color of the vessels extends toward the optic disk
Grade III: retina appears salmon color and all vessels have a milky
appearance
Retinal abnormalities resolve as triglyceride levels normalize
Retinitis pigmentosa: autosomal recessive disorder with genetic defects cause cell death,
predominantly in rod photoreceptors
o Cause: associated with Usher Syndrome (deafness) and Kearns-Sayre syndrome
(paralysis of extraocular muscles, dysphasia, ataxia, cardiac conduction defects)
