Assessment of the Eyes

Techniques Normal Findings Deviation from Normal

1. Inspection even hair distribution, absence of the lateral
External structures even alignment, equal third of the eyebrows
a. Eyebrows movement as facial (e.g., myxedema)
expression changes
uneven alignment

unequal or absent
movement as facial
expression changes

scaliness
b. Eyelashes eyelashes present and eyelashes absent or
evenly distributed along unevenly distributed
the eyelid margins along the eyelid margins
c. Eyelids skin intact, similar in color lid lag - a rim of sclera
to the face, smooth and visible above the corneas
uniform and irides

no sclera visible above

the corneas and irides
when the eyelids are
open

ability to completely close ptosis - drooping of the

the eyelids upper eyelid

upper eyelid margins at

or near the limbus (the
border between the
cornea and sclera) when
the eyelids are open

blinking symmetrical, epicanthus - vertical fold

present, at 15 - 20 blinks of skin that lies over the
per minute inner canthus

ectropion - margin of the

lower eyelid is turned
outward
entropion - margin of the
lower eyelid is turned
inward

periorbital edema -
swelling and puffiness
around the eyelid

blepharitis -
inflammation of the
eyelids

sty (acute hordeolum) -

redness, tenderness, and
swelling around a hair
follicle on the eyelid
margin
 chalazion - beady,
nontender nodule on the
skin around the eyelid
(chronic inflammation of
the meibomian gland)

xanthelasma - slightly
raised, yellowish, well-
circumscribed plaques on
the skin around the eyelid
herniated fat - bulging of
the lower eyelids, bulging
of the inner third of the
upper eyelids, or both

retracted eyelid -
retraction of the upper
eyelid which results in a
rim of sclera between the
upper eyelid and corneas
and irides and a wide-
eyed stare

blinking asymmetrical,
absent, less than 15 or
greater than 20 blinks per
minute
d. Lacrimal gland absence of a bulge in the dacryoadenitis -
and nasolacrimal outer third of the upper inflammation of the
gland eyelids lacrimal gland
characterized by pain,
redness, and swelling in
the outer third of the
 upper eyelid

e. Lacrimal sac and puncta mucosa pink, dacryocystitis -

nasolacrimal sac nonedematous inflammation of the
absence of discharge lacrimal sac and
absence of tearing nasolacrimal duct
absence of swelling characterized by pain,
between the nose and redness, and swelling
lower eyelids between the nose and
lower eyelid

f. Conjunctiva and bulbar conjunctiva is Jaundice - sclera yellow-

sclera transparent with tiny orange
vessels visible

sclera is blue-white,
shiny, smooth, moist

palpebral conjunctiva is
pink, shiny, smooth,
moist conjunctivitis - diffuse,
dilated, reddened bulbar
conjunctival vessels that
tend to be maximal in the
periphery
 subconjunctival
hemorrhage - sharpy
demarcated, bright red
area that fades over days
to yellow then
disappears.

pterygium - triangular
thickening of the bulbar
conjunctiva, usually on
the nasal side, that grows
across the cornea

pinguecula - yellowish-
white, triangular nodule
on the bulbar conjunctiva
on either side of the iris

g. Cornea, lens and cornea transparent arcus senilis - thin,

pupil grayish-white arc or circle
lens, visible through the in the cornea, not quite at
pupil, transparent the edge of the cornea
anterior chamber, visible
through the cornea,
transparent

corneal scar - superficial

grayish-white opacity in
the cornea

nuclear cataract -
central grayish-white
opacity in the lens

peripheral cortical
cataract - peripheral
grayish-white opacity in
the lens that produces
spokelike shadows that
point inward

hyphema - accumulation
of blood in the aqueous
fluid of the anterior
chamber
hypopyon -
accumulation of purulent
material in the aqueous
fluid of the anterior

chamber

monocular blindness -
shining a penlight into a
blind eye produces no
pupillary response in the
blind or good eye,
whereas shining a
penlight into the normal
eye produces normal
pupillary responses in
both the blind and good
eye

mydriasis - dilated, fixed

pupils (greater than 7
millimeters)
miosis - constricted,
fixed pupils (less than 3
millimeters)

anisocoria - slightly
unequal pupil size

oculomotor nerve
damage - unilateral,
dilated pupil that reacts
neither to light or
accommodation
accompanied by
deviation of the affected
eye downward and ptosis
of the eyelid of the
affected eye

Argyll-Robertson pupil
- small, irregular pupils
that do not react to light,
but react to
accommodation

Tonic (Adie's) pupil -

unilateral, large pupil that
has a sluggish or absent
reaction to light, and a
sluggish reaction to
accommodation

Horner's syndrome -
unilateral, small, regular
pupil that reacts to light
and accommodation
accompanied by ptosis of
the eyelid of the affected
eye and lack of tearing
iritis -ciliary injection of
the iris accompanied by
moderate, aching, deep
pain; decreased vision;
absent ocular discharge,
and a clear or cloudy
cornea

irides inconsistent color