ABNORMAL EYES

SIGNS
Exophthalmos

- increase in the volume of the orbital content

causing a protrusion of the globes forward
- Due to Grave’s disease if bilateral and
retroorbital tumor or inlammation of the orbit
if unilateral
Retracted Lid
- Wide –eyed stare
- Rim of sclera between the lid and the iris is
noted
- often due to hyperthyroidism
 Eyelids
Ptosis
- drooping of the upper lid
- causes:
1. indicates a congenital or acquired weakness
of the levator muscle or paresis
of the 3rd CN
2. Myasthenia Gravis
- Superior eyelids covers more than the iris
Lid inversion ( Entropion )

- Inward turning of the lid margin

- More common in the elderly
- Lower lashes when turned inward irritate the
conjunctiva and lower cornea
Lid eversion ( Ectropion)
- Lower Lid margin turns outward, exposing the
palpebral conjuctiva
- When the punctum of the lower lid turns
outward, tearing occurs
- Common among elderly
• Herniated Fat
- causes puffy eyelids
- Common in elderly but
may affect the younger ones
• Swollen eyelids
Xanthelasma
- yellow lid plaques
- painless, non pruritic near the inner canthus
- ass. with hypercholesterolemia
Chalazion
- a subcutaneous nontender nodule involving
a meibomian gland
- Unlike sty, usually points
inside the lid rather than
on the lid margin
Sty
- lid pustule/external hordeolum
- acute suppurative inflammation of the follicle
of an eyelash
• Icteric sclerae
Conjunctiva
• Pale Palpebral Conjunctiva
Pterygium
- An abnormal growth of conjunctiva that
extends over the cornea from the limbus.
- More common to people
heavily exposed to ultraviolet
light
- May interfere vision if
it advances over the pupil
 Subconjunctival Hemorrhage
- Bright red blood in a sharply defined are
surrounded by a normal appearing conjunctiva
- No pain , no discharge
- Vision not affected
- Cornea clear
- Bleeding maybe due
to coughing, sneezing,
weight lifting, trauma
 Conjunctivitis
- conjunctival injection:
diffuse dilatation of
conjunctival vessels
with redness that tends
to be maximally
peripherally, mild discomfort, watery, mucoid or
mucopurulent discharge, vision not affected,
cornea clear
Acute Iritis
- eye is diffusely red,
painful, decreased
vision, small pupils,
no ocular discharge,
clear or sl. Clouded
cornea
Glaucoma
- eye may be diffusely red
- severe aching pain
- decreased vision
- ocular discharge absent
- pupils dilated, fixed
- Cornea steamy, cloudy
- Due to acute increase in intraocular pressure
Pupils
• Mydriasis
- pupillary dilation caused by
contraction of the dilator of
the iris
- It is a normal response to
decreased light, strong
emotional stimuli, topical application of mydriatic
and cyclopleic drugs like atropine and
phenylephrine
• Medical causes:
1. adie’s syndrome
2. Aortic arch syndrome
3. Botulism
4. Brain stem infarction
5. Carotid artery aneurysm
6. Glaucoma
7. Oculomotor nerve palsy
8. Drugs
- anticholinergics
- antihistamines
- sympathomimetics
- barbiturates ( overdose)
- estrogens
- tricyclic antidepressants
Miosis
- pupillary constriction caused
by contraction of the sphincter
muscle in the iris
- occurs normally as a response
to fatigue, increased light,
as part of the eye’s accommodation reflex, as
part of the aging process
• Medical causes:
1. Cerebrovascular arteriosclerosis
2. Cluster headache
3. Corneal foreign body
4. Corneal ulcer
5. Horner’s syndrome
6. Acute iritis
7. Hyphema
8. Pontine hemmorhage
9.Neuropathy
10. Tabes dorsalis
11. Uveitis
12. Drugs
- acetylcholine - clonidine hydrochloride
- carbachol - opiates
- Pilocarpine - reserpine
 Unequal pupils (anisocoria)
- when anisocoria is greater in bright light than in
dim light, the larger pupil can not constrict
properly
- causes :
1. blunt trauma
2. open angle glaucoma
3. impaired parasympathetic nerve supply to the
iris
4. oculomotor nerve paralysis
- When anisocoria is greater in dim light, the
smaller pupil can not dilate properly
- Seen in Horner’s syndrome due to
interruption of the sympathetic nerve supply
Argyll Robertson Pupil
- small, irregular pupils that do not react to light
but do react to near effort
- Usually but not always due to CNS syphilis
Tonic Pupil (Adie’s Pupil)
- pupil is large, regular and usually unilateral
- reaction to light is severely reduced and
slowed or even absent
- Near reaction, though slow, is present
- Slow accommodation causes blurred vision
Cornea
Arcus senilis
- gray band of opacity in the periphery of the
cornea which is composed of lipid deposits
- If seen before 40 yrs old, it may indicate type 2
hyperlipidemia
- It may in time form
complete circle
(circus senilis)
> Corneal ulcer
- disruption of the corneal
epithelium and stroma
- causes:
a) viral/bacterial infection
b) incomplete lid closure
c) poor lacrimal gland function
d) frequent use of contact lenses
 Lens
Cataract
- opacity occuring in
the lens due to denaturation
of lens caused often by aging
- It may cause vision to
become impaired and
hazy eventually cause
blindness in the affected eye.
• 2 kinds of cataract
1. Nuclear cataract
- looks as gray opacity surrounded by a black
rim when seen by a flashlight
- thru an ophthalmoscope , the cataract looks
black against the red reflex
2. Peripheral cataract
- produces spokelike shadows that point inward
gray against black as seen with a flashlight
- black against red with an ophthalmoscope
EOM muscles
Strabismus ( Squint)
- a condition in which both
eyes do not focus on an
object simultaneously
• 2 groups:
1. Paralytic strabismus
- caused by weakness or
paralysis of 1 or more EOM or CN 3 PARALYSIS

their nerve supply

2. Nonparalytic strabismus
- has no primary muscle weakness
- patient can focus with either eye but not with
both simultaneously
- deviation is constant in all direction of gaze
- caused by imbalance in ocular muscle tone.
- maybe hereditary
Retina
Diabetic retinopathy
(proliferative)
- Development of new vessels
due to anoxic stimulation
( neovascularization)
- bleeding from these vessels
is a major cause of
blindness
Diabetic retinopathy
(background or
nonproliferative)
- Marked by dot hemorrhages
microaneurysms, presence of
hard & soft exudates
 Grades of Retinal Hypertension
1 Narrowing in terminal branches of vessels

2 General narrowing of vessels with severe local

constriction

3 To the preceding signs are added striate hemorrhages

and soft exudates

4 Papilledema is added to the preceding signs

 Grades of Retinal Sclerosis
1 Thickening of vessels with slight depresion of veins at
arteriolar- venular crossings

2 Define AV crossing changes and moderate local

sclerosis

3 Venule beneath the arteriole is invisible;

severe local sclerosis and segmentation

4 To the preceding signs are added venous obstruction

and arteriolar obliterations
Thank You