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Conjunctival injection (redness): this can be diffuse, sectorial or limbal.Pupils: abnormal size, shape, colour and symmetry (see above).Eyelashes: loss of eyelashes (can be associated with malignant lesions), trichiasis ( eye lashes rubbing on the cornea) and blepharitis collarettes.
![pupil misshapen pupil misshapen](https://image.slidesharecdn.com/pupil-120302214229-phpapp01/95/pupil-3-1024.jpg)
Eyelids: lumps (benign or malignant), oedema, ptosis and entropion/ectropion.Periorbital erythema and swelling: a feature of preseptal cellulitis (anterior to the orbital septum) or orbital cellulitis (posterior to the orbital septum).Pathology which may be noted during general inspectionĮxamples of pathology you may note during general inspection of the eye include:
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In rare cases, asymmetry of colour can suggest Horner’s syndrome, with the paler washed-out iris being pathological. Pupil colourĪsymmetry in pupillary colour is most commonly due to congenital disease. Peaked pupils in the context of trauma are suggestive of globe rupture (the peaked appearance is caused by the iris plugging the leak). posterior synechiae associated with uveitis) or previous trauma and surgery. Abnormal shapes can be congenital or due to pathology (e.g. If the difference is more pronounced in dim lighting, this would imply the smaller pupil is abnormal as the larger pupil would then dilate while the pathologically small pupil remains the same size.Įxamples of asymmetry include a larger pupil in oculomotor nerve palsy and a smaller one in Horner’s syndrome. This is because the normal pupil will constrict in brighter light accentuating the difference in size. If the difference in pupil size becomes greater in bright light such as when facing a window in daylight, this would suggest that the larger pupil is the pathological one. This may be longstanding and physiological or be due to acquired pathology. Note any asymmetry in pupil size ( anisocoria). Pupils can be smaller in infancy and larger in adolescence, then often smaller again in the elderly. smaller in bright light, larger in the dark). Normal pupil size varies between individuals and depends on lighting conditions (i.e. Inspect the patient’s pupils for abnormalities. The pupil is the hole in the centre of the iris that allows light to enter the eye and reach the retina.
Pupil misshapen pdf#
life.Download the anterior segment eye examination PDF OSCE checklist, or use our interactive OSCE checklist. Damage to the drainage angle of the eye (which cannot be seen without a mirror contact lens and a slit lamp microscope) increases the chances of glaucoma developing in later life. The lens may be damaged or dislocated and a cataract may develop. This is particularly important in a patient with an associated head injury, as this may be interpreted as (or mask) the dilated pupil that is suggestive of an acute extradural haematoma. The iris may also be damaged and the pupil may react poorly to light. All patients with visual impairment after blunt injury should be seen in an ophthalmic department. Haemorrhage may also occur into the vitreous or in the retina, and this can be accompanied by a retinal detachment. Patients who sustain such injuries need to be reviewed at an eye unit as the pressure in the eye may rise, and further haemorrhages may require surgical intervention. Haemorrhage may occur and a collection of blood may be visible in the anterior chamber of the eye (hyphaema). However, if a smaller object (such as a squash ball) hits the area, the eye itself may take most of the impact. When a large object (such as a football) hits the eye, most of the impact is usually taken by the orbital margin.