Diagnostic Tests for Eye conditions
Eye conditions Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Eye conditions:
- Vision & Eye Health: Home Testing:
Eye conditions Diagnosis: Book Excerpts
Diagnosis of Eye conditions: medical news summaries:
The following medical news items
are relevant to diagnosis of Eye conditions:
Diagnostic Tests for Eye conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Eye conditions.
EYE PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The primary care specialist may want to treat cases of obvious conjunctivitis without a culture and sensitivity. However, a smear and culture is useful especially if
Neisseria
is suspected. A smear may also reveal eosinophils suggesting allergic conjunctivitis. The primary care specialist may also use fluorescein dye to diagnose a foreign body. Most primary care physicians feel competent to use tonometry to diagnose glaucoma and may feel competent to use a slit lamp. However, when there is any doubt about the diagnosis, the most cost-effective approach is to refer the patient to an ophthalmologist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
SCOTOMA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
This should include a careful eye examination with slit lamp, tonometry, and visual field examinations. If the initial findings suggest an ocular disorder, referral to an ophthalmologist should be made. If the neurologic examination is abnormal, the patient should be referred to a neurologist, rather than ordering expensive tests such as a CT scan, MRI scan, VEP studies, angiography, and spinal fluid examinations.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Eye pain:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does he have headaches? If so, find out how often and at what time of day they occur.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Ocular deviation:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn’t in distress, find out how long he has had the ocular deviation. Is it accompanied by double vision, eye pain, or a headache? Also, ask if he’s noticed associated motor or sensory changes or a fever.
Check for a history of hypertension, diabetes, allergies, and thyroid, neurologic, or muscular disorders. Then obtain a thorough ocular history. Has the patient ever had extraocular muscle imbalance, eye or head trauma, or eye surgery?
During the physical examination, observe the patient for partial or complete ptosis. Does he spontaneously tilt his head or turn his face to compensate for ocular deviation? Check for eye redness or periorbital edema. Assess the patient’s visual acuity, and then evaluate extraocular muscle function by testing the six cardinal fields of gaze.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Scotoma:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests — confrontation testing and the Amsler grid — may also help in identifying a scotoma.
Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.
Explore the patient’s medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Raccoon eyes:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After raccoon eyes are detected, check the patient’s vital signs and try to find out when the head injury occurred and the nature of the head injury. (See Recognizing raccoon eyes.) Then evaluate the extent of underlying trauma.
Start by evaluating the patient’s level of consciousness (LOC) using the Glasgow Coma Scale. (See Glasgow Coma Scale, page 374.) Next, evaluate cranial nerve (CN) function, especially CN I (olfactory), III (oculomotor), IV (trochlear), VI (abducens), and VII (facial). If the patient’s condition permits, also test his visual acuity and gross hearing. Note irregularities in the facial or skull bones as well as swelling, localized pain, Battle’s sign, or face or scalp lacerations. Check for ecchymoses over the mastoid bone. Inspect for hemorrhage or cerebrospinal fluid (CSF) leakage from the nose or ears.
Also, test drainage with a sterile 4" x 4" (gauze pad, and note whether you find a halo sign — > a circle of clear fluid that surrounds the drainage, indicating CSF. Also, use a glucose reagent stick to test clear drainage for glucose. An abnormal test result indicates CSF, because mucus doesn’t contain glucose.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Doll's eye sign, absent:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After detecting an absent doll's eye sign, perform a neurologic examination. First, evaluate the patient's level of consciousness, using the Glasgow Coma Scale. Note decerebrate or decorticate posture. Examine the pupils for size, equality, and response to light. Check for signs of increased ICP — increased blood pressure, increasing pulse pressure, and bradycardia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Setting sun sign [Sunset eyes]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you observe the setting-sun sign in an infant, evaluate his neurologic status; then obtain a brief history from his parents. Has the infant experienced a fall or even a minor trauma? When did this sign appear? Ask about early nonspecific signs of increasing ICP: Has the infant’s sucking reflex diminished? Is he irritable, restless, or unusually tired? Does he cry when moved? Is his cry high pitched? Has he vomited recently?
Next, perform a physical examination, keeping in mind that neurologic responses are primarily reflexive during early infancy. Assess the infant’s LOC. Is he awake, irritable, or lethargic? Keeping in mind his age and level of development, try to determine his ability to reach for a bright object or turn toward the sound of a music box. Observe his posture for normal flexion and extension or opisthotonos. Examine muscle tone, and observe for seizure automatisms.
Examine the infant’s anterior fontanel for bulging, measure his head circumference and compare it to previous results, and observe his breathing pattern. (Cheyne-Stokes respirations may accompany increased ICP.) Also, check his pupillary response to light: Unilateral or bilateral dilation occurs as ICP rises. Finally, elicit reflexes that are diminished in increased ICP, especially Moro’s reflex. Keep endotracheal (ET) intubation equipment available.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Eye Disorders:
Vision testing
(Professional Guide to Diseases (Eighth Edition))
Several tests assess visual acuity and identify visual defects:
❑ Ishihara’s test determines color blindness by using a series of plates composed of a colored background, with a letter, number, or pattern of a contrasting color located in the center of each plate. The patient with deficient color perception can’t perceive the differences in color or, consequently, the designs formed by the color contrasts.
❑ The Snellen chart or other eye charts evaluate visual acuity. Such charts use progressively smaller letters or symbols to determine central vision on a numerical scale. A person with normal acuity should be able to read the letters or recognize the symbols on the 20/20 line of the eye chart at a distance of 20 feet.
Subjective testing
Several tests accomplish subjective testing of the eyes:
❑ B-mode ultrasonography delineates retinal tumors, detachments, and vitreous hemorrhages — even in the presence of opacities of the cornea and lens. A handheld B-scanner has simplified ultrasonic examination of the eye, making it possible to perform such studies in the ophthalmologist’s office.
❑ The convergence test locates the breaking point of fusion (before double vision occurs). For this test, the examiner holds a small object in front of the patient’s nose and slowly brings it closer to the patient. The point at which the eyes “break” is termed the near point of convergence and is measured in prism diopters.
❑ The cover-uncover test assesses eye muscle misalignment or tendency toward misalignment. In this test, the patient stares at a small, fixed object — first from a distance of 20'(6.1 m) and then from 1' (0.3 m). The examiner covers the patient’s eyes one at a time, noting any movement of the uncovered eye, the direction of any deviation, and the rate at which the eyes recover normal binocular vision when latent heterophoria is present.
❑ Duction test checks eye movement in all directions of gaze. While one eye is covered, the other eye follows a moving light. This test detects weakness of rotation due to muscle paralysis or structural dysfunction.
❑ Fluorescein angiography evaluates the blood vessels in the choroid and retina after I.V. injection of fluorescein dye; images of the dye-enhanced vasculature are recorded by rapid-sequence photographs of the fundus.
❑ Goldmann’s applanation, Tonopen tonometry, and Schiøtz tonometry all measure IOP. After instilling a local anesthetic in the patient’s eye, the examiner places the Schiøtz tonometer lightly on the corneal surface and measures the indentation of the cornea produced by a given weight. The Schiøtz tonometer has been largely replaced by an electronic Tonopen tonometer for bedside use. Applanation tonometry gauges the force required to flatten a small area of central cornea, and is the most accurate method of measuring IOP. For this test, a patient must be seated at a slit lamp and the cornea stained with fluorescein dye before the prism of the applanation tonometer touches the cornea and the examiner adjusts the controls until the two lines form an “S.”
❑ Gonioscopy allows for direct visualization of the anterior chamber angle.
❑ The Maddox rod test assesses muscle dysfunction; it’s especially useful in disclosing and measuring heterophoria (the tendency of the eyes to deviate). It can reveal horizontal, vertical and, especially, torsional deviations.
❑ Ophthalmodynamometry measures the relative central retinal artery pressures and indirectly assesses carotid artery flow on each side. This test has been largely supplanted by the color Doppler imaging test, which can assess blood flow velocities in ophthalmic vessels.
❑ Ophthalmoscopy — direct ophthalmoscopy or binocular indirect ophthalmoscopy allows examination of the interior of the eye after the pupil has been dilated with a mydriatic.
❑ Refraction tests may be performed with or without cycloplegics. In cycloplegic refraction, eyedrops weaken the accommodative power of the ciliary muscle. Lenses placed in front of the eye direct light rays onto the retina, thus focusing the image so that it can be transmitted along the visual pathway. A retinoscope may be used in the same way by directing a beam of light through the pupil onto the retina; the light’s shadow is neutralized by placing the appropriate lens in front of the eye.
❑ Slit-lamp biomicroscopic examination allows a well-illuminated examination of the eyelids and the anterior segment of the eyeball.
❑ Visual field tests assess the function of the retina, the optic nerve, and the optic pathways when both central and peripheral visual fields are examined.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Eye discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation by finding out when the discharge began. Does it occur at certain times of day or in connection with certain activities? If the patient complains of pain, ask him to show you its exact location and to describe its character. Is the pain dull, continuous, sharp, or stabbing? Do his eyes itch or burn? Do they tear excessively? Are they sensitive to light? Does he feel like something is in them?
After taking vital signs, carefully inspect the eye discharge. Note its amount, color, and consistency. Then test visual acuity, with and without correction. Examine external eye structures, beginning with the unaffected eye to prevent cross-contamination. Observe for eyelid edema, entropion, crusts, lesions, and trichiasis. Next, ask the patient to blink as you watch for impaired eyelid movement. If the eyes seem to bulge, measure them with an exophthalmometer. Test the six cardinal fields of gaze. Examine the eye for conjunctival injection and follicles and for corneal cloudiness or white lesions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Ocular deviation:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in distress, find out how long he has had the ocular deviation. Is it accompanied by double vision, eye pain, or headache? Also, ask if he has noticed any associated motor or sensory changes, or fever.
Check for a history of hypertension, diabetes, allergies, and thyroid, neurologic, or muscular disorders. Then obtain a thorough ocular history. Has the patient ever had extraocular muscle imbalance, eye or head trauma, or eye surgery?
During the physical examination, observe the patient for partial or complete ptosis. Does he spontaneously tilt his head or turn his face to compensate for ocular deviation? Check for eye redness or periorbital edema. Assess visual acuity, then evaluate extraocular muscle function by testing the six cardinal fields of gaze.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Scotoma:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.
Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure (IOP) are necessary.
Explore the patient’s medical history, noting especially any eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Doll's eye sign, absent [Negative oculocephalic reflex]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After detecting an absent doll’s eye sign, perform a neurologic examination. First, evaluate the patient’s level of consciousness (LOC), using the Glasgow Coma Scale. Note decerebrate or decorticate posture. Examine the pupils for size, equality, and response to light. Check for signs of increased ICP—increased systolic blood pressure, widening pulse pressure, and bradycardia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Eye pain [Ophthalmalgia]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s eye pain doesn’t result from a chemical burn or from acute angle-closure glaucoma, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or a discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of severe pain that developed suddenly. Does he have headaches? If so, find out how often and at what time of day they occur.
During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the eyelids and conjunctivae for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye, page 322.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Raccoon eyes:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After raccoon eyes are detected, check the patient’s vital signs and try to find out when the head injury occurred and the nature of the head injury. (See Recognizing raccoon eyes.) Then evaluate the extent of underlying trauma.
Start by evaluating the patient’s level of consciousness (LOC) using the Glasgow Coma Scale. (See Using the Glasgow Coma Scale, page 480.) Next, evaluate function of the cranial nerves, especially the first (olfactory), third (oculomotor), fourth (trochlear), sixth (abducens), and seventh (facial). If the patient’s condition permits, test his visual acuity and gross hearing. Note any irregularities in the facial or skull bones, as well as any swelling, localized pain, a Battle’s sign, or lacerations of the face or scalp. Check for ecchymoses over the mastoid bone. Inspect for hemorrhage or cerebrospinal fluid (CSF) leakage from the nose or ears.
Test any drainage with a sterile 4” x 4” (gauze pad, and note whether you find a halo sign—a circle of clear fluid that surrounds the drainage, indicating CSF. Use a glucose reagent stick to test any clear drainage for glucose. An abnormal test result indicates CSF, because mucus doesn’t contain glucose.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Setting-sun sign [Sunset eyes]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you observe the setting-sun sign in an infant, evaluate his neurologic status; then obtain a brief history from his parents. Has the infant experienced a fall or even a minor trauma? When did this sign appear? Ask about early nonspecific signs of increasing ICP: Has the infant’s sucking reflex diminished? Is he irritable, restless, or unusually tired? Does he cry when moved? Is his cry high pitched? Has he vomited recently?
Next, perform a physical examination, keeping in mind that neurologic responses are primarily reflexive during early infancy. Assess the infant’s LOC. Is he awake, irritable, or lethargic? Keeping in mind his age and level of development, try to determine his ability to reach for a bright object or turn toward the sound of a music box. Observe his posture for normal flexion and extension or opisthotonos. Examine muscle tone, and observe for seizure automatisms.
Examine the infant’s anterior fontanel for bulging, measure his head circumference and compare it with previous results, and observe his breathing pattern. (Cheyne-Stokes respirations may accompany increased ICP.) Check his pupillary response to light: Unilateral or bilateral dilation occurs as ICP rises. Finally, elicit reflexes that are diminished in increased ICP, especially Moro’s reflex. Keep endotracheal intubation equipment available.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Red Eye:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Vision. Visual acuity should be checked; it is usually normal in episcleritis, scleritis, blepharitis, and conjunctivitis unless associated keratitis, such as in epidemic keratoconjunctivitis, is present. Decreased vision is demonstrable in keratitis and acute angle-closure glaucoma, but only mildly decreased in uveitis.
B. Inspection. The location of conjunctival redness is important. It is usually peripheral or diffuse in conjunctivitis, whereas in keratitis it is central or diffuse. It is localized in episcleritis or scleritis. In uveitis, it is central with a “ciliary flush.” In glaucoma there is a central perilimbal injection. Tenderness of the globe is usually only present in scleritis or uveitis. Pupillary reaction is normal, except in glaucoma where it is often a fixed mid-dilated pupil and in uveitis where a sluggish, miotic pupil is invariably present. Consensual photophobia is present in uveitis also, because of iris response and movement. The corneal appearance is normal except for scarring and ulceration of Chlamydia trachomatis and the haziness or edema of glaucoma.
C. Special tests. Staining of the cornea with fluoroscein is normal, except with corneal ulceration and abrasion, herpes zoster or simplex keratitis, or a bacterial corneal ulcer. Tonometry will demonstrate increased intraocular pressure in glaucoma. If a slit lamp is available, a narrow chamber angle will be seen with glaucoma. The slit lamp is also helpful to confirm the swelling and to inspect scleritis, not present in episcleritis.
Testing
A. Microbiology studies. Immunofluorescent tests on ocular scrapings for
C. trachomatis and culture for Neisseria gonorrhoeae are sometimes required. Bacterial cultures are generally reserved for infections of the neonate, in persistent conjunctivitis, or with keratitis if a break has occurred in the corneal epithelium (5). Viral cultures are rarely performed. Gram’s stain or Giemsa’s stain of epithelial scrapings may also be helpful. Urethral cultures may be indicated. Immunofluorescent detection of the herpes-specific antigen is also possible.
B. Other laboratory studies. Additional testing is primarily indicated for scleritis or uveitis because of a high frequency of associated rheumatologic disorders. Workup should include a complete blood count, sedimentation rate, C-reactive protein, antinuclear antibodies, rheumatoid factor, and a serologic test for syphilis (VDRL). A spine x-ray study can be helpful in diagnosing ankylosing spondylitis.
Diagnostic assessment
The red eye most commonly results from conjunctivitis, which is benign. Other causes can threaten sight, so a thorough evaluation must be done to prevent permanent visual impairment. Chlamydial conjunctivitis of a chronic nature causes trachoma, which is the leading cause of blindness in humans. The history and physical for both are very important. The history should include trauma, infectious exposure, and the length of symptoms. The examination should be thorough and methodical as stressed in the introductions. An immediate referral to an ophthalmologist should be made with severe deep pain, proptosis, perilimbal injection, tenderness, photophobia, and decreased vision.
References
1. Bertolini J, Pelucio M. The red eye. Emerg Med Clin North Am 1995;13(3):561–579.
2. Davey CC. The red eye. Br J Hosp Med 1996;55(3):89–94.
3. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician 1998;57(4):735–746.
4. Hara JH. The red eye: diagnosis and treatment. Am Fam Physician 1996;54(8):
2423–2430.
5. Ruppert SD. Differential diagnosis of pediatric conjunctivitis (red eye). Nurse Practitioner 1996;21(7):12–26.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Scotoma:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Visual acuity. The vision of each eye should be assessed with spectacles or contact lenses in each eye independently. Central scotomas are seen with optic nerve, macular disease, or (rarely) an occipital tip lesion; and Snellen visual acuity will be decreased.
B. Visual fields. Confrontation field test is performed with each eye independently. Briefly flash several fingers in each of the four quadrants. Bilateral field loss in the same field of vision in each eye indicates injury posterior to the chiasm. Bitemporal field defects are seen with chiasmal lesions (pituitary masses, craniopharyngiomas, and others). Monocular field defects are seen in retina and optic nerve disease.
C. Pupil examination. The presence of a prominent APD, which implies optic nerve injury, will help to differentiate central scotomas caused by macular disease. An APD is commonly seen with optic neuritis, optic neuropathy (ischemic and traumatic), asymmetric glaucomatous damage, optic nerve tumors, and central retinal artery or vein occlusion. An APD is not seen in early papilledema and minimally with macular degeneration, macular holes, or choroidopathy.
D. Fundus examination. Direct ophthalmoscopy can give a quick assessment of the red reflex (i.e., a dim red reflex in a diabetic with vitreous hemorrhage). Vitreous floaters can occasionally be seen as shadows in the red reflex. Examine the nerve for edema, pallor, or glaucomatous cupping. Macular scarring or pigmentary change is most commonly seen with macular degeneration.
E. Other examinations. A neurologic assessment is needed for a patient with bilateral field loss, screening for contralateral paresis and other focal deficits, palpation of the temporal artery for tenderness or diminished pulse if the history suggests giant cell arteritis, as is auscultation of the carotids for bruits and the heart for a murmur in a patient with amaurosis fugax or stroke. Glaucoma can be screened with tonometry. Check arms and legs for signs of intravenous drug abuse.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Eye Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A foreign body sensation occurs with a foreign body, corneal abrasion, or keratoconjunctivitis sicca. Itching is associated with allergic and vernal conjunctivitis. Photophobia occurs with iritis and herpes simplex keratitis. Deep pain suggests acute glaucoma or posterior scleritis. Pain on eye movement is found with optic neuritis, sinusitis, and influenza.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Red Eye:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Decreased vision, pain, photophobia, and a history of trauma are important indicators of serious pathology.
In conjunctivitis, the anterior chamber is clear and the pupil active. There is great overlap in the clinical spectrum of bacterial and viral conjunctivitis. Ciliary flush (dilation of the fine capillaries around the iris border producing a violet-red halo) is a differentiating sign indicating anterior uveal inflammation caused by iritis/uveitis, infectious keratitis, or acute angle closure glaucoma, rather than conjunctivitis.
An active corneal process is indicated by a foreign body sensation with the patient unable to spontaneously open the eye or keep it open. These patients will also have photophobia. The eye is tender in patients with
scleritis, iritis, and glaucoma, but not in conjunctivitis. A pinpoint pupil is seen in cases of corneal abrasion, iritis, or infectious keratitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Eye discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After taking vital signs, carefully inspect the eye discharge. Note its amount, color, and consistency. Then test visual acuity, with and without correction. Examine external eye structures, beginning with the unaffected eye to prevent cross-contamination. Observe for eyelid edema, entropion, crusts, lesions, and trichiasis. Next, ask the patient to blink as you watch for impaired lid movement. If the eyes seem to bulge, measure them with an exophthalmometer. Test the six cardinal fields of gaze. Examine for conjunctival injection and follicles and for corneal cloudiness or white lesions.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Eye pain:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctivae for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye, page 272.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Ocular deviation:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete neurologic assessment, including a complete eye assessment. During the physical assessment, observe the patient for partial or complete ptosis. Does he spontaneously tilt his head or turn his face to compensate for ocular deviation? Check for eye redness or periorbital edema. Assess visual acuity; then evaluate extraocular muscle function by testing the six cardinal fields of gaze. (See Testing the six cardinal positions of gaze.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Scotoma:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure (IOP) are necessary. Then identify and characterize the scotoma using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests — confrontation testing and the Amsler grid — may also help in identifying a scotoma.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Red Eye:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Historyand physical exam can distinguish many causes of red eye, includingconjunctivitis, trauma, lid disorders, nasolacrimal duct obstruction,allergic reaction, preseptal cellulitis, orbital cellulitis, keratitis,and uveitis.Age of child and presence of purulenteye discharge help narrow causes of conjunctivitis.If purulentdischarge occurs in neonates up to 3 wks of age, Gram stain andappropriate bacterial and chlamydial cultures should be performed.In this age group, it is especially important to determine whetherinfection is caused by N. gonorrhoeae.When infant presents with mucopurulentor purulent eye discharge between 3 wks and 3 mos of age, chlamydialeye culture should be performed.Because chlamydial infection is unusualafter 3 mos of age, infants with eye discharge may be presumed tohave bacterial infection, and broad-spectrum antimicrobial eye dropsmay be given as therapeutic trial without culture. If infectiondoes not resolve or is recurrent, bacterial culture should be performed.Presence of eosinophils on Wright stain from conjunctival scrapingsuggests allergic conjunctivitis. Fluorescein staining should be performedwith suspected corneal abrasion. Slit-lamp exam should be performedwith suspected keratitis or uveitis. Visual acuity should alwaysbe measured in anyone with significant eye pathology (e.g., trauma,keratitis, or uveitis).Ophthalmologic consultation is necessarywhenever significant eye pathology or injury occurs or is suspectedwith or without loss of vision.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Eye discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by finding out when the discharge began. Does it occur
at certain times of the day or in connection with certain activities? If the patient complains of pain, ask him to show you its exact location and to describe its character. Is the pain dull, continuous, sharp, or stabbing? Do his eyes itch or burn? Do they tear excessively? Are they sensitive to light? Does he feel like something is in them?
After taking the patient's vital signs, carefully inspect the eye discharge. Note its amount, color, and consistency. Then test visual acuity, with and without correction. Examine external eye structures, beginning with the unaffected eye to prevent cross-contamination. Observe for eyelid edema, entropion, crusts, lesions, and trichiasis. Next, ask the patient to blink as you watch for impaired lid movement. If the eyes seem to bulge, measure them with an exophthalmometer. Test the six cardinal fields of gaze. Examine for conjunctival injection and follicles and for corneal cloudiness or white lesions.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Ocular deviation:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in distress, find out how long he has had the ocular deviation. Is it accompanied by double vision, eye pain, or headache? Also, ask if he has noticed associated motor or sensory changes or fever.
Check for a history of hypertension, diabetes, allergies, and thyroid, neurologic, or muscular disorders. Then obtain a thorough ocular history. Has the patient ever had extraocular muscle imbalance, eye or head trauma, or eye surgery?
During the physical examination, observe the patient for partial or complete ptosis. Does he spontaneously tilt his head or turn his face to compensate for ocular deviation? Check for eye redness or periorbital edema. Assess the patient's visual acuity, and then evaluate extraocular muscle function by testing the six cardinal fields of gaze.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Scotoma:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Explore the patient's medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
Identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.
Next, test the patient's visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Doll's eye sign, absent [Negative oculocephalic reflex]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After detecting an absent doll's eye sign, perform a neurologic examination. First, evaluate the patient's level of consciousness, using the Glasgow Coma Scale. Note decerebrate or decorticate posture. Examine the pupils for size, equality, and response to light. Check for signs of increased ICP—increased blood pressure, increasing pulse pressure, and bradycardia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Eye pain [Ophthalmalgia]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does the patient wear contact lenses? How often are they removed or replaced if they're disposable? Does he have headaches? If so, find out how often and at what time of day they occur.
During the physical examination, don'tmanipulate the eye if you suspect trauma. Carefully assess the lids and conjunctiva for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Raccoon eyes:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After raccoon eyes are detected, check the patient's vital signs and try to find out when the head injury occurred and the nature of the head injury. (See Recognizing raccoon eyes.) Then evaluate the extent of underlying trauma.
Start by evaluating the patient's level of consciousness (LOC) using the Glasgow Coma Scale. Next, evaluate cranial nerve (CN) function, especially CN I (olfactory), III (oculomotor), IV (trochlear), VI (abducens), and VII (facial). If the patient's condition permits, also test his visual acuity and gross hearing. Note irregularities in the facial or skull bones as well as swelling, localized pain, Battle's sign, or face or scalp lacerations. Check for ecchymoses over the mastoid bone. Inspect for hemorrhage or cerebrospinal fluid (CSF) leakage from the nose or ears.
Also, test drainage with a sterile 4" x 4" gauze pad, and note whether you find a halo sign—a circle of clear fluid that surrounds the drainage, indicating CSF. Also, use a glucose reagent stick to test clear drainage for glucose. An abnormal test result indicates CSF because mucus doesn't contain glucose.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Setting-sun sign [Sunset eyes]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you observe setting-sun sign in an infant, evaluate his neurologic status; then obtain a brief history from his parents. Has the infant experienced a fall or even a minor trauma? When did this sign appear? Ask about early nonspecific signs of increasing ICP: Has the infant's sucking reflex diminished? Is he irritable, restless, or unusually tired? Does he cry when moved? Is his cry high-pitched? Has he vomited recently?
Next, perform a physical examination, keeping in mind that neurologic responses are primarily reflexive during early infancy. Assess the infant's LOC. Is he awake, irritable, or lethargic? Keeping in mind his age and level of development, try to determine his ability to reach for a bright object or turn toward the sound of a music box. Observe his posture for normal flexion and extension or opisthotonos. Examine muscle tone, and observe for seizure automatisms.
Examine the infant's anterior fontanel for bulging, measure his head circumference and compare it with previous results, and observe his breathing pattern. (Cheyne-Stokes respirations may accompany increased ICP.) Also, check his pupillary response to light: Unilateral or bilateral dilation occurs as ICP rises. Finally, elicit reflexes that are diminished in increased ICP, especially Moro reflex. Keep endotracheal (ET) intubation equipment available.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
The number of people seeking LASIK and PRK, the two most common laser eye surgeries, has increased dramatically. In the year 2000, an estimated 1.5...
If you have poor vision you should know about laser eye surgery as a treatment option. There are two common techniques: LASIK and PRK. How do these...
People living with Parkinson's disease face many hurdles, but they don't do it alone. Listen to how one couple is coping with the ups and...
An estimated 60 million Americans are in need of vision correction. So it's no surprise that LASIK surgery-- a laser treatment touted as a...
See full list of 7 related videos
» Next page: Diagnosis of Eye conditions
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
